Qualifying for SSD Benefits After Your Lupus Diagnosis

Approximately 1.5 million Americans suffer from lupus. And while it generally strikes women between the ages of 15-44, men, children, and teens can develop it too. Because these are prime working and career-building years, lupus can economically devastate families. Many are unable to work with the disease because of the extreme symptoms. These can include pain, fatigue, hair loss, cognitive issues, and physical impairments. The added risks of cardiovascular disease, rashes, strokes, and pain in the joints can also be debilitating. Can you get disability for lupus? Fortunately, the SSA offers disability benefits for individuals afflicted with this condition.

What is Lupus?

Lupus is a chronic autoimmune condition characterized by attacks by your immune system against healthy cells in your body. It causes widespread inflammation and cell damage and can impact many parts of the body, such as your skin, joints, kidneys, and heart. Common symptoms of lupus include:

• Fatigue
• Skin rashes
• Joint pain
• Chest pain
• Shortness of breath & difficulty breathing
• Kidney problems
• Cognitive decline
• Photosensitivity

While the severity of the different symptoms varies widely from person to person, lupus tends to go through periods of remission and flare-ups where the impact on the body varies. Individuals with lupus manage their symptoms with medication to prevent organ damage, but those medications are also likely to have side effects. Common medications include NSAIDs, corticosteroids, hydroxychloroquine, and immunosuppressants. Side effects of such medications can include rashes, stomach upset, eye damage, mood disorders, high blood pressure, osteoporosis, increased risk of infections, and other difficult symptoms.

Is Lupus a Disability According to the SSA?

The SSA has a list of conditions and diagnostic criteria they require for disabled individuals to receive SSI or SSDI. This information is listed in the Blue Book, as is a list of Compassionate Allowances, or conditions that merit automatic approval for Social Security disability benefits. Lupus is listed in the Blue Book under Section 14.02 for systemic lupus erythematosus (SLE). Because the SSA only awards disability benefits to conditions that prevent you from performing Substantial Gainful Activity (SGA) and earning a living, you need one of the following to qualify for lupus disability benefits:

• Involvement of 2 or More Organs: Lupus needs to damage at least two organs or bodily systems to be eligible, such as your kidneys, eyes, heart, or brain. At least one of these organs must be moderately to severely affected.
• Severe Symptoms: You need to have at least two severe systemic symptoms, such as chronic fever, extreme chronic fatigue, unintended weight loss, or other similar issues. These symptoms must be persistent and recurring to be eligible.

However, even if you don’t qualify under the above requirements, you can still qualify if lupus causes the following:

• Significant Functional Limitations: As an alternative to the above, your lupus must severely impact your ability to perform daily activities, manage social obligations, or complete tasks in a timely manner (this can be due to deficiencies in concentration, persistence, or pace). This may involve issues with performing daily tasks such as bathing or dressing, an inability to focus, or severe issues with interacting socially.

Common Lupus Comorbidities to Bolster Your SSD Claim

If your lupus symptoms alone aren’t severe enough to qualify you for Social Security disability, you may be able to bolster your odds of approval by including any other conditions you suffer from. Lupus has a number of commonly comorbid conditions, many of which can further impact your quality of life, ability to work, and daily function. Common comorbidities include:

• Cardiovascular issues
• Thin skin & easy bruising
• Kidney disease
• Chronic infections
• Metabolic syndrome
• Diabetes
• Cancer
• Thyroid disorders
• Fibromyalgia
• Mental health issues

Many of these conditions on their own could qualify you for disability benefits, but together, you significantly bolster your odds of being approved.

Required Medical Evidence to Support Your Lupus Disability Claim

You must also have medical evidence to obtain benefits. A medical history, a report of a physical examination, a report of laboratory findings and sometimes imaging is required. For SLE specifically, the SSA uses the American College of Rheumatology’s Criteria for the Classification of Systemic Lupus Erythematosus. This gives eleven criteria that help determine if the patient has lupus. The patient must have four of the eleven to be diagnosed. They include:

• Serositis
• Oral ulcers
• Arthritis
• Photosensitivity
• Blood disorders (for example: sickle cell, anemia)
• Renal involvement
• Antinuclear antibodies
• Immunologic phenomena (eg, dsDNA; anti-Smith [Sm] antibodies)
• Neurologic disorder
• Malar rash
• Discoid rash

You must also meet the SSA’s requirements for qualifying for SSD benefits. And you must be able to prove that you are unable to work due to your condition.

How to Apply for Lupus Disability Benefits

Applying for disability benefits for lupus is an involved process that can take months. Knowing the steps required will make it easier to navigate the process, whether you plan to apply for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).

Applying for Social Security Disability Insurance (SSDI) With Lupus

SSDI benefits are designed to provide financial support to disabled individuals who have participated in the workforce but can no longer work due to disability. Eligibility is based on the acquisition of work credits, which are credits earned for every 3-month work period in which you earned at least 1,730 and paid into Social Security. To qualify, you’re required to have earned 40 work credits, and half of them need to have been earned in the last 10 years. Younger applicants have more flexible requirements for the number of work credits earned and the timeline in which they’re earned.

In addition to having the required number of work credits, you must also earn less than $1,550 per month (or $2,590 if you’re blind) and be unable to work due to the severity of your condition. This is in addition to your lupus being severe enough to meet the requirements described above. SSDI pays an average of $1,537 per month, but it can pay as little as $100 or as much as $3,822p>

Applying for Supplemental Security Income (SSI) With Lupus

Unlike SSDI, SSI benefits are provided regardless of work history. This means people who have been disabled since before they could enter the workforce, or those who haven’t been able to work long enough to accrue disability benefits, can all still receive disability benefits. SSI is typically provided to impoverished seniors, but it’s also available for disabled individuals of any age.

The income limits for SSI are $1,550 per month, but with the additional requirement that you cannot have more than $2,000 in assets (or $3,000 if you’re married). Unlike SSDI, which pays based on your average income while you worked, SSI pays a flat amount of $943 per month, with the amount reducing based on the number of alternative income sources you have.

Individuals with lupus may even be able to apply for both SSI and SSDI, maximizing the benefits you can receive to help support you if you meet the eligibility requirements for both.

You May Qualify for Legal Assistance

Learn more about qualifying for SSD benefits after your lupus diagnosis and to connect with a qualified disability advocate near you. They will help you with your application and can expedite the process, getting you the maximum benefits you’re owed. In fact, a Social Security attorney can nearly triple your approval odds for benefits!

Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now:

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