I’ve Been Diagnosed with Lupus. Can I get Social Security Disability Benefits?

January 4, 2016 in

Did you know that approximately 1.5 million Americans have Lupus? Systematic lupus erythematosus, 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. Your immune system is the part of the body that fights off bacteria, viruses and germs. When suffering from an autoimmune condition your body cannot tell the difference between the body’s healthy tissues and unhealthy germs. Because the body cannot tell the difference the body will attack and destroy healthy tissue.

Lupus is typically a difficult condition to diagnosis as it often mimics other conditions.

The most common signs and symptoms of this condition include:

  • fatigue
  • fever
  • joint pain
  • rash
  • shortness of breath
  • chest pain
  • 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 a month of fatigue and joint pain. This condition is most commonly treated by medications which may include NSAIDs, antimalarial drugs, corticosteroids, or immunosuppressants.

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. The Social Security Disability program is a type of “working” insurance that is meant to provide you with an income while you are prevented from working. It is not unemployment. And frankly, whether you are able to find a job or not is not a consideration in your disability. Social Security simply wants to know why you are unable to work and for how long you will be out. Social Security Disability is defined as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. If you believe you will only be out of work for a short period of time, less than 12 months, then there is no point applying for the program. Social Security is very strict on the 12-month durational requirement. 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 that are 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 by showing repeated manifestations of SLE with at least two of the previously discussed symptoms and marked limitations in performing ADLs, maintaining the social function, or completing tasks in a timely manner.

If SSA determines you do not meet or equal a listing, you may still be considered disabled based on your residual functional capacity. Your RFC describes the most you can do in spite of your functional limitations. When assessing an individual’s functional capacity, Social Security 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.

It is more common for SSA to find an individual disabled based upon their RFC versus a Listing. Your RFC is determined based upon your symptoms, medical records, any opinions from your treating doctors, and also your testimony – whether it be through questionnaires or at a hearing. Lupus can affect you both physically and psychologically.

Medical evidence is key to proving you meet the medical requirements of disability. Medical evidence can include:

  • physician examinations and treatment notes
  • mental health records
  • laboratory testing
  • imagining studies (including MRIs, CT scans, Xrays, etc)

There is a long list of what counts as medical evidence. The bottom line is to win the SSD case you need to have some sort of medical treatment documenting your condition and/or limitations. Both to try to meet a Listing or to qualify based on your residual functional capacity.

If you find any of this confusing you are not alone. What you should take away from this discussion is that if your Lupus diagnosis is affecting your ability to work you should seek an experienced disability attorney for guidance as to how to proceed with a disability claim. A claim based on Lupus is more complex than most claims. Hiring an experienced attorney will ensure your claim is properly argued. And the best part is any attorney fee is contingent upon the attorney winning your claim. There are no out-of-pocket costs for you and social security will handle paying the attorney. What do you have to lose?

At the LaBovick Law Group, we work with many individuals suffering from Lupus. We know the struggles you are going through and 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.