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How to Get SSDI Benefits for Lupus

How to Get SSDI Benefits for Lupus

People with lupus having limitations affecting daily functioning levels, social networking, inability to focus or meeting any other impairment related disability listed in SSA's Blue Book may qualify for SSDI benefits.

Systematic lupus erthymatosus, a.k.a. Lupus is an autoimmune disorder that causes the body to attack its own organs, tissues and cells. This may lead to one or multiple organ failures over time. Depending on the severity of the condition it could also cause varying amounts of damage to the liver, kidneys, skin, blood, heart and lungs, intestines, brain or eyes. While symptoms for some people may improve or even go away with prescription medications, others may suffer acute joint problems or even complete organ failure. Moreover, in rare but not impossible cases, some patients may face problems that make it difficult to work, such as decreased memory, cognition and concentration (also known as lupus fog), malaise (general discomfort and uneasiness), anxiety, depression or severe fatigue.

There are two basic ways you could qualify for disability with lupus. First, you must be able to prove to the SSA that your 'disability' due to lupus is acutely disabling. On the other hand, you could qualify for disability benefits if you meet the impairments listed in the Social Security's Blue Book of SSA.

Qualifying for Symptoms for SSDI for people with Lupus

A compromised immune system due to lupus means the person is prone to possibly all kinds of disease and organ failure. For some patients, symptoms appear slowly and develop only rarely to cause disability. On the other hand, some people face fast evolving conditions due to lupus. The SSA understands this and would go into detail to look into the medical implications caused by your condition. Take for instance, discoid lupus is a type of lupus affecting only skin conditions and may only cause a rash, which is not 'disabling' enough as per SSA's Blue Book listing of impairments. While a person with SLE with decreased kidney function would be able to qualify since the condition is 'disabling' enough and prevents the person from performing substantial gainful activity, SGA. In other cases, often enough patients with lupus develop rheumatoid arthritis which completely affects their daily functioning levels making it unable to go to work. Hence, the SSA would look into all medical and non-medical requirements to analyze if you qualify for disability benefits.

How to Get SSDI Benefits for Lupus

Once you apply for SSDI benefits for Lupus, the SSA will assign you a disability examiner (DE) at the Disability Determination Services (DDS) that will look into your symptoms if you are able to take up old work or new, less demanding work. This process is called determining your residual functional capacity (RFC) which is used by the SSA to analyze the severity of your disability. So, your DE will look at the skill levels of your past work to analyze and determine whether you are able to take up other similarly skilled jobs, despite your physical or mental limitations including any skilled, semi-skilled or unskilled work that you could take up after taking into consideration your lupus related symptoms.

Medical Evidence: It is important that you have updated documented medical evidence for each symptom caused due to lupus from the date of diagnosis. This also included the treatments you have seeked, the doctor's you have consulted, their prescriptions, whether you followed those prescription treatments and if they improved or worsened your conditions. Remember, the more medical evidence you could show to your DE, the more your chances for qualifying for SSDI benefits.

Non-Medical Evidence (RFC Limitations): Also, it is important to get your doctor's and employer's testimonies stating how your condition affects your daily functioning capacity. This is because even if you do not qualify for SSDI benefits by not meeting the SSA's listings in the Blue Book, you may qualify through the non-medical evidence, such as inability to take up previous or new work and/or an inability to perform daily tasks.

SSA's Blue Book Listing for Lupus: The SSA's official listing for lupus, listing 14.02, is fairly complicated. It not only requires a formal diagnosis of lupus but also that a patient meet two out of four of the following:

  • - fever with no other cause
  • - severe fatigue (frequent exhaustion resulting in low activity)
  • - malaise (frequent feelings of illness or bodily discomfort), or
  • - involuntary weight loss.

Medical Criteria for Lupus Diagnosis: According to the SSA, a patient must meet two of the following in order to be considered as having lupus. Additionally, of these two, atleast one of the two organs must be affected to a moderate degree of severity or more. Of these organ problems are:

  • - hematologic (anemia, decrease in red blood cells; leukopenia, decrease in white blood cells; or thrombocytopenia, decrease in platelets)
  • - cardiovascular (inflammation of heart tissue or blood vessels)
  • - neurologic (headache, seizures)
  • - renal (decreased kidney function, lupus nephritis, or glomerulonephritis)
  • - inflammatory arthritis (often occurs in fingers, hands, wrists, or knees).
  • - respiratory (chest pain, inflammation of lung tissues, or pulmonary embolism)
  • - mental (anxiety, lupus fog, mood disorders, or organic brain syndrome).

How to Apply for Disability Benefits for Lupus

You submit an application for SSI or SSDI through your local SSA office, call the SSA at 800-772-1213. In your application, include how your lupus is affecting your ability to work, including how may sick days you needed to take for flare-ups or for medical treatment. It would take six months for the SSA to determine your SSDI application to analyze whether you meet the qualification. Moreover, if you get denied and seek for reconsideration appeal, it will take another 3 months for reanalysis of your SSDI denial. For double denial, you would need to apply for a disability hearing by the administrative law judge (ALJ) which in turn would take another 9 to 18 months.

If you have a child with disability due to lupus, you may also apply for benefits from Supplemental Security Income (SSI) or disability benefits, SSDI for dependants.

Get Help from a Professional

Getting a diagnosis for lupus is fairly complicated due to limitations in analyzing whether the symptoms and organ dysfunctioning is due to any other underlying disease. However, we suggest you seek help from a professional disability attorney who knows their way in the whole process and the requirements needed for a medical or RFC qualification for SSDI qualification for Lupus. Especially if you have been denied and do not seem to waste more time in denials due to not meeting the medical qualifications. In that case, a disability attorney would better be able to guide you into questions your DE may ask to analyze you for an RFC qualification for disability benefits. You can contact a professional disability attorney here.

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Tuesday, 05 July 2022