Lupus and Social Security Disability

Applying For Social Security Disability Benefits with Lupus

According the Lupus Foundation of America, lupus affects 1.5 million Americans, and 90 percent of those diagnosed are women. Though there are a few different types of lupus, the most common by far is systemic lupus, which has the potential to damage major body organs.

If you or a loved one has been diagnosed with lupus and can no longer work, the Social Security Administration (SSA) may be able to help. It has two benefit programs available to help those with disabilities who are in need.

The Financial Costs of Lupus

On average, individuals with lupus had to pay an extra $12,643 per year in health care costs and were subject to an estimated $8,659 in lost productivity costs. In total, the Lupus Foundation found that the disease costs individuals over $20,000 annually.

Because lupus is most commonly diagnosed young, between 15 and 44, many patients have lupus for most of their lives. However, the symptoms of lupus often greatly affect an individual's ability to work, as one-third of patients reported being unable to work full time or at all, the Lupus Foundation of America explained.

The road to a lupus diagnosis can be a long one. On average, it takes about six years for doctors to narrow down symptoms and figure out that the cause is lupus. This could raise expenses even more, as more than half of patients are misdiagnosed at least once and sent to four or more different doctors.

Lupus is much more likely to affect women, with 90 percent of patients being female. Additionally, it is diagnosed two to three times more often in women of color and those who have another family member with the disease.

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Medically Qualifying for Benefits with the Blue Book

All applications for Social Security disability benefits are evaluated both medically and financially by SSA staff. In order to determine whether or not you qualify medically, the SSA uses their Blue Book. The Blue Book is the official list of all disabilities that are eligible for benefits.

Lupus can be found in section 14.02—Immune System Disorders under Systemic Lupus Erythematosus.

The SSA defines systemic lupus erythematosus (SLE) as a chronic inflammatory disease that can affect any organ or body system. It's often accompanied by constitutional symptoms such as severe fatigue, fever, malaise, and involuntary weight loss, as well as major organ or other damage in the respiratory, cardiovascular, renal, hematologic, skin, neurologic mental, or immune systems. To qualify with the Blue Book, you need medical evidence of either:

  • Involvement of two or more organs/body systems, with at least one with a moderate level of severity and two more more constitutional symptoms, such as weight loss, chills, fevers and fatigue.
  • Repeated symptoms of SLE, with at least two constitutional symptoms and limitations in daily living activities, maintaining social functioning, and/or completing tasks in a timely manner due to problems in concentration, persistence, or pace.

If you are experiencing any severe SLE symptoms that are keeping you out of work, talk to your doctor to see if you qualify for social security disability.

Qualifying Without Meeting a Medical Listing

If your symptoms aren't severe enough to meet the Blue Book listing, but if your lupus is causing you to earn less than $1,030 each month, which is the SSA's minimum for substantial gainful employment (SGA) or what the SSA considers a living wage, you may still be eligible for benefits under a medical-vocational allowance.

For individuals who don't meet specific medical listings, but still need benefits., the SSA evaluates claims using a medical-vocational allowance. Instead of looking at your symptoms, the SSA determine your Residual Functioning Capacity (RFC) by looking at the physical and mental limitations caused by your disorder.

Once the SSA decides what kind of work you can do, (sedentary, light, medium, heavy, and very heavy), they will look at your education and work history to determine if there is work you can do. Keep in mind, if they find your lupus isn't severe enough, and you're put in the latter two categories, your chances of approval are rare.

There are many symptoms of lupus that make it hard to work. In addition to the constitutional symptoms of constant fever, fatigue, and malaise, the illness can cause damage throughout your entire body and dozens of resulting conditions and additional limitations. Lupus is the leading cause of kidney disease, stroke, and premature cardiovascular disease in young women, the SLE Lupus Foundation reported, which further debilitate patients.

Because lupus affects so much of the body, approval is likely in moderate to severe cases. However, adults with college degrees and a work history of sedentary and light jobs are less likely to be approved for disability than those in labor-intensive careers.

How to Apply for Social Security Disability Benefits

Before applying for disability, talk to your doctor(s) about your chances of SSA approval. Because almost two-thirds of claims are denied in the initial stage and require various appeals, the entire approval process can take two years more to complete. If your doctor isn't confident in a positive decision by the SSA, then it may not be worth the time and effort.

If you do meet an SSA listing, you can be approved in the initial claim stage if you include all of the medical evidence the SSA needs. Leaving out this information will delay your approval or cause the SSA to deny the application.

Important medical evidence for SLE will include:

  • Anti-nuclear antibody test (ANA) to determine if autoantibodies of cell nuclei are present in the blood.
  • Anti-DNA antibody test to determine if there are antibodies from the genetic material in the cell.
  • Anti-Sm antibody test to determine if there are antibodies of Sm, a protein found in the cell nucleus.
  • anti-SR protein antibody assay, which is a screening process that identifies 50-70 percent of lupus patients who react positively to the SR proteins.
  • Skin and/or kidney biopsy to check for immune diseases.
  • History, length, and outcomes of all prescribed treatments.
  • Summaries of hospitalizations, operative reports, and any other related documents.
  • Detailed reports from any relevant doctor(s) you've seen describing the symptoms s/he found in a thorough physical examination.

When you have everything you need to apply, you can use either the SSA's online application tool or apply at your local SSA office. If you are applying for Supplementary Security Income, you must apply in person at an SSA office. Make sure to look over the application before you submit it, because any unanswered questions or mistakes can also delay your answer as the SSA will have to take the time to find it themselves.

If your lupus worsens, you develop another disorder due to your lupus, or there are any other changes in your condition, don't hesitate to send any new supporting evidence to the SSA. The more evidence you provide of your illness and its limitations, the higher your chance of approval.

If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance.