How to Apply for Disability Benefits with Lupus

Systemic lupus erythematosus (SLE), more commonly called lupus, is an autoimmune disease that affects the body’s connective tissue but can impact multiple areas of the body, including the intestines, kidneys, brain or eyes. The severity of your illness will determine whether you qualify for lupus disability benefits. In mild cases, people have joint pain that can be fairly easily controlled with medication. Severe cases, however, can involve kidney damage or damage to other organs.

Lupus Disability Benefits

Severe cases of lupus are sometimes accompanied by cognitive or memory issues as well as lack of concentration (called “lupus fog”). Sufferers are sometimes severely fatigued and can suffer from anxiety and depression.

How do you determine whether you qualify for lupus disability benefits?

There are two types of benefits you may qualify for. The first is Supplemental Security Income (SSI) designed for low-income people. The other is lupus social security disability administered by the Social Security disability income (SSDI) program; you’re eligible for SSDI if you worked and therefore paid taxes into the Social Security system.

For both programs, SSA outlines the functional impairment limitations that qualify you for lupus disability benefits. SSA publishes a disability listing called the Blue Book. SLE is the only form of lupus that qualifies you for disability benefits. Other forms of lupus, like discoid lupus which attacks the skin, do not qualify.

The Blue Book listing for SLE is fairly complex. You will need to have either need to meet the medical criteria or you’ll have to have significant functional limitations. You’ll have to provide an official diagnosis for SLE. You’ll also have to meet two of these four medical problems:

• fever of unknown origin

• severe fatigue

• malaise (feeling that you’re frequently ill, and discomfort)

• massive weight loss

Your lupus must affect two or more organs, such as your heart, lungs, brain or kidneys. Some of the organ complications that accompany lupus are as follows:

• decreased kidney function or inflammatory kidney conditions like nephritis

• lung inflammation or other respiratory conditions

• inflammation of the heart or blood vessels

• headaches, seizures and other neurologic problems

• blood cell issues like decreased red or white cells or platelets

• Mental or cognitive issues like lupus fog, mood disorders, anxiety, depression or organic brain syndrome

• Joint issues like inflammatory arthritis. It usually starts in the fingers, hands, wrists, or knees.

If your lupus has caused a serious medical problem, such as arthritis or kidney disease, you may qualify for disability under that disease’s Blue Book listing.

If you don’t meet the medical requirements, you still might be able to apply for lupus disability benefits in a couple of different ways. Perhaps your medical treatments prevent you from effectively fulfilling a full-time job. One example would be if you had to go for dialysis two to three times per week.

If your lupus is severe enough to limit your ability to function at work, you may qualify, but you must be able to demonstrate the following severe limitations:

• Impaired activities of daily living (ADLs)

• Inability to maintain social functioning

• Inability to complete tasks based on concentration issues

In these cases, SSA will do a reduced functional capacity (RFC) assessment. The RFC will classify your ability into one of several categories: sedentary work, light work, medium work, heavy work or very heavy work. The RFC is also used to assess cognitive ability as well. The SSA will consider things like your ability to remember work instructions or rules. Your report will include both a physical and mental RFC combined, and both will be taken into account regarding your ability for regular work. SSA will compare your RFC to your 15-year work history to look for a decline in your ability to perform your job. They’ll also factor in your education level, work experience and current age.

If you are deemed unable to perform even a sedentary job, you will most likely qualify under the SSA medical-vocational allowance for lupus disability. People over age 55 with limited education have a better chance of qualifying.

When you apply for lupus disability, SSA requires extensive medical records. The agency will need a diagnosis of lupus, medical history, and medical test records showing regular doctor exams, lab work, medical imaging and other tests performed in relation to your lupus condition. You’ll need to show records for as long a period as you can to show the history of your illness. If your doctor has prescribed medication or other regimens like physical therapy, you need to demonstrate that you’ve been following doctors’ orders by taking your meds or going to sessions.

SLE is a fluctuating disease; you can be in remission at times and have full-blown symptoms at other times. This is why it’s even more important to show continual medical records.

Disability for some illnesses is straightforward, but this isn’t the case for lupus. The process can be difficult, complicated and frustrating, so you might consider hiring an attorney with lupus case experience.