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I Have Lupus. Does That Qualify Me for Disability?

The Lupus Foundation of America estimates that approximately 1.5 million Americans have lupus. That is approximately 1 in every 20 Americans. Systematic lupus erythematosus (SLE), more commonly known as lupus, is an autoimmune disorder that causes your immune system to attack your own tissue and organs. This is a chronic inflammatory condition that may affect multiple body systems including joints, skin, kidneys, blood cells, heart and lungs. When suffering from an autoimmune condition, your body cannot tell the difference between the body’s healthy tissues and unhealthy germs. Meaning, your body will attack and destroy healthy tissue unknowingly.

Some people are more prone to suffering from lupus than others. For example, women – especially women of color – are more likely to be diagnosed with lupus than men. Symptoms of lupus typically begin between the ages of 15 and 44.

Lupus is a difficult condition to diagnose, as it often mimics other conditions. The most common signs and symptoms of this condition include fatigue and fever, joint pain, rash, shortness of breath, chest pain or headaches. However, a blood test, imaging or urinalysis may be used to diagnose the condition. There are varying levels of severity with lupus. Similar to gout, lupus has periods of flares and remissions. Meaning, you may experience a few days of feeling perfectly healthy, but then experience a month of fatigue and joint pain. This condition is most commonly treated by medications that may include NSAIDs, antimalarial drugs, corticosteroids or immunosuppressants. People suffering from lupus will generally seek treatment from a rheumatologist. Because this condition is so hard to diagnose, your rheumatologist will generally diagnose by exclusion. Meaning, he or she will test for other potential conditions first before settling on a lupus diagnosis.

If you suffer from lupus, and it is having a major impact on your ability to work, you should consider applying for Social Security Disability benefits. Social Security Disability (SSD) is a federally mandated insurance program meant to provide assistance to individuals unable to work due to a physical and/or mental condition. This program is often confused with unemployment benefits. However, it is completely the opposite of unemployment benefits. SSD is not concerned with the job market. SSD is simply concerned with whether, in spite of your limitations, there are jobs available.

SSD is defined as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) that can be expected to result in death or that has lasted or can be expected to last for a continuous period of no fewer than 12 months. If you believe you will only be out of work for a short period of time, fewer than 12 months, then there is no point applying for the program. SSD is very strict on the required 12-month duration. The 12-month rule is built right into the exact definition of the program.

There are two ways to prove you are disabled based on your lupus condition. The first way is by meeting the requirements of the Social Security Listing for lupus. Social Security’s Listing is a list of impairments for each major body system – impairments considered severe enough to prevent an individual from working full time. Most of the listed impairments are permanent or expected to result in death. Social Security’s Listing for lupus can be found at 14.02. This listing requires a showing that two or more body systems are involved with one organ having at least a moderate level of severity and at least two signs or symptoms including severe fatigue, fever, malaise or weight loss. Or, you could meet the listing requirements by showing repeated manifestations of SLE with at least two of the previously discussed symptoms and marked limitations in performing activities of daily living, maintaining social function or completing tasks in a timely manner.

If the Social Security Administration (SSA) determines that you do not meet or equal a listing, you may still be considered disabled based on your residual functional capacity (RFC). Your RFC describes the most you can do in spite of your functional limitations. When assessing an individual’s functional capacity, the SSA considers the individual’s ability to do sustained work-related physical and mental activities in a work setting on a regular and continuing basis. Meaning, 8 hours a day for 5 days a week (see SSR 96-8p). If you require a significant amount of breaks during a regular working period, that may make you unemployable.

Medical evidence is key to proving you meet the medical requirements of disability. Medical evidence can include physical examinations and treatment notes, mental health records, laboratory testing, imaging studies including MRIs, CT scans, X-rays, etc. There is a long list of what counts as medical evidence. The bottom line is – to win your SSD case, you need to have some sort of medical treatment documenting your condition and/or limitations – both to try to meet a listing and to qualify based on your RFC.

Applying for SSD benefits can be a complicated affair. Most people think that by submitting an application for disability benefits, the SSA will review and approve them for benefits, and then they will start receiving a monthly check. In a perfect world, that is exactly how the process will play out. However, we do not live in a perfect world. There are a lot of factors that go into determining if you meet the SSA’s definition of disability. The analysis process is long and cumbersome. At the LaBovick Law Group, we work with many individuals suffering from lupus. We know the struggles you are going through, and we know how to properly develop your claim. If you are considering applying for SSD, let us handle the stress of applying for you – so you can focus on healing.

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