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Qualifying for Social Security Disability Benefits With Lupus

Lupus — a chronic inflammatory disease that weakens the immune system — can develop slowly or come on suddenly. While not everyone with lupus qualifies for Social Security Disability Insurance (SSDI) or SSI benefits, you may qualify if the disease affects multiple organ systems, leading to recurring symptoms that limit your ability to perform activities of daily living.

Educating yourself about this chronic and unpredictable disease and its disabling physical and mental effects can help you better prepare for the disability claims process.

Effects of Lupus on the Body

If you have lupus, depending on the severity of the disease, the symptoms you experience may affect your ability to work. Systemic lupus erythematosus (SLE) can lead to major organ damage. It may affect the heart, lungs, kidneys, skin, joints, blood, and nervous system.

Lupus can also cause digestive problems due to inflammation in the esophagus, lining of the abdomen and large intestine. Some people have inflammation of the pancreas or suffer liver complications. Although many of these health issues are caused by the disease itself, certain medications you take to manage the symptoms of lupus can cause serious side effects on the body. The Administrative Law Judge is required to consider side effects of medication.

Financial Impact of Lupus

While symptoms of lupus vary among individuals and range from mild to severe, the disease may affect both your productivity and quality of life.

Along with the cost of medical services associated with the diagnosis and treatment of lupus, the disease can affect your ability to work. Some people can only work part-time due to pain, persistent fatigue, kidney disease, heart disease, or the concentration and memory problems the disease can cause.

The many health problems that lupus can bring prevents some people from working any job, impacting their ability to support themselves and their families. The inability to perform substantial gainful employment is a key factor the Social Security Administration (SSA) considers when you file a claim.

survey conducted by the Lupus Foundation of America found that every two of three members reported losing part or all of their income because they were no longer able to work full time as the result of complications caused by the disease. One in four survey participants also reported receiving disability benefits and enrollment in Medicare or Medicaid to pay for health care costs.

Medical Evidence of Lupus

When you apply for Social Security Disability Insurance (SSDI) or SSI benefits, you must submit have evidence of your condition. Without supporting medical evidence, the Social Security Administration isn’t likely to approve you for disability benefits.  

If you are applying for SSDI benefits based on a diagnosis of SLE, there must be medical records, including reports from any doctors or other health professionals who have physically examined you or treated your symptoms. Additional medical documentation you need includes results of anti-nuclear, anti-DNA, and anti-Sm antibody tests that detect the presence of certain antibodies and autoantibodies. There may be skin biopsies as well.

Other laboratory tests that can be helpful include a complete blood count (CBC) to test for a low white blood cell and platelet counts and low hemoglobin — all of which are blood abnormalities that can occur with lupus. An erythrocyte sedimentation rate may also indicate the presence of an inflammatory condition such as lupus.

You increase your chance of approval by providing as much evidence as possible of your illness and the limitations the disease causes that impact your ability to work. Otherwise, there may be a delay in the resolution of your disability claim.

Documentation of Treatment

Include the dates and effectiveness of medical treatments — including a full list of medications and their side effects — doctors have prescribed. Note all hospitalizations for any reason. 

Along with the objective medical evidence you submit, opinion statements from your treating physicians indicating why they believe the evidence shows you are disabled may help your case. Social Security assesses whether you comply with your doctors’ recommendations for treatment. SSA also will look to see that you keep scheduled doctors’ appointments and take your medications as prescribed.

Social Security may consider a long history of trying different treatment options and seeing different specialists as evidence of the severity of your condition. Because the approval process can take time, submit new medical evidence of changes in your condition that occur during the period of time while you wait for Social Security’s decision.

If your lupus symptoms are so debilitating that you can no longer work, contact Glen Cook Social Security Attorney to assist you in applying for Social Security disability benefits. The assistance of an attorney can help increase the odds of winning your Social Security disability claim.