Appealing SSA Decision With Lupus

If you have lupus, which is an autoimmune disease, you may not be able to work and earn a living. Lupus causes fatigue, joint pain and stiffness, and inflammation. If you are not able to work, you may qualify for disability benefits. However, if your initial claim is denied you are not alone. About 70 percent of disability claims are denied during the first review. You should not be discouraged, because as your claim advances your odds of approval increase. You need to know how to properly appeal the denial.

How To Appeal The Decision

When your disability claim for lupus is denied, you will receive a denial notice from the Social Security Administration (SSA). This letter will explain why your claim was denied, and how long you have to file an appeal. The appeal is referred to as a request for reconsideration at this point. You will want to gather the additional information your claim needs to succeed when it is reviewed again. You will want to enlist the help of a disability attorney who will know what details are needed and who will ensure your claim is filed in a timely manner.

Make sure that you have all the medical documentation needed to meet the criteria of the Blue Book, which is the medical guide used by the SSA to determine disability eligibility. If you miss the deadline to appeal your claim, you will have to start the process all over from the beginning, which could cost you valuable time and delay the claims process even longer.

Blue Book Criteria

The Blue Book is used to determine medically eligible. Lupus claims are reviewed using the Immune System Disorders section of the Blue Book. To meet the criteria of the lupus listing, you will need to have at least two body systems or organs that are affected by the condition. You must also experience other signs and symptoms consistently, such as weight loss, fever, or fatigue.

You must provide supporting medical records, such as test results like bloodwork and medical notes. Details about your treatment and the side effects from the treatment, which sometimes includes anti-inflammatory drugs, corticosteroids, and chemotherapy drugs such as methotextrate should be included in those records.

Consider An RFC

If your lupus doesn’t meet the exact criteria of the Blue Book listing, you could still qualify for disability benefits. You can use a medical vocational allowance with a residual functional capacity (RFC) form. Your physician, such as your rheumatologist, will complete the RFC and detail what you can and cannot do. As an example, your RFC may explain because of joint pain and inflammation you cannot walk without a cane, or you may not be able to stand longer than an hour.

The RFC is part of the medical vocational allowance, which takes your age, work history, skills, and educational background into consideration. The disability examiner will determine what kind of work – if you can work at all – you can do.

Appealing SSA Decision With Lupus

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