Systematic lupus erthymatosus, commonly referred to as lupus, is an autoimmune disease that causes the body’s immune system to attack itself. Depending on the severity of the disease, it can cause varying amounts of damage to joints, skin, kidneys, blood, the heart, and lungs.
There are two ways an individual can qualify for Social Security Disability benefits for lupus. An individual can meet the requirements of a listing set out in Social Security's list of qualifying impairments or show that he or she is unable to work. (There are different rules for children with lupus; see our article on getting disability for a child's lupus).
Meeting the Listing Requirements for Lupus
Lupus is one of the diseases specifically listed in Social Security's listing of impairments. To qualify as disabled under this listing, you must meet the following requirements:
- The lupus must affect at least two body systems or organs, such as the kidneys and the lungs, or the heart and the brain, and
- The lupus must cause at least two of the following symptoms.
- frequent exhaustion resulting in low physical or mental activity
- malaise (feelings of physical discomfort or illness resulting in low physical or mental activity), and/or
- involuntary weight loss.
- Repeated symptoms of lupus, with at least two of the symptoms above resulting in one of the following limitations:
- Limitations of activities of daily living
- Limitation in maintaining social functioning
- Limitation in completing tasks in a timely manner due to lack of focus or ability to work quickly.
- The limitation must seriously interfere with your ability to function independently, appropriately, and effectively.
Medical Evidence Required for Lupus Listing
To determine if an individual has been correctly diagnosed with lupus and that the listing has been "met," Social Security follows the guidelines set out in the current Criteria for the Classification of Systemic Lupus Erythematosus, by the American College of Rheumatology. This sets out eleven criteria to determine if an individual has lupus. Of the eleven criteria, an individual must meet four criteria to be diagnosed with lupus. The criteria include:
- malar rash
- discoid rash
- oral ulcers
- renal disorder
- neurologic disorder
- hematologic disorder
- immunologic disorder, and/or
- antinuclear antibody
Medical evidence proving these symptoms may include doctor observations, electrocardiography, and blood tests, but is also dependent on the type of maladies suffered.
Inability to Work Due to Lupus
Individuals can also qualify for Social Security Disability for lupus if they can prove that they are unable to work due to the health problems caused by lupus. Social Security uses a residual functional capacity (RFC) assessment to record the physical, mental, and sensory limitations that can affect an individual's ability to work.
An individual with lupus might have the following physical limitations: fatigue, chest pain, shortness of breath, headaches, and abnormal heart rhythms. These limitations can make it difficult to stand or walk for a lengthy period of time, which rules out many jobs.
The mental abilities that Social Security evaluates include the ability to understand, remember, and carry out instructions, and respond well to supervision, co-workers, and work pressures in a work setting. Those with lupus may suffer personality changes, including anxiety and depression, and may have difficulty concentrating or have increased forgetfulness. Social Security will take these limitations into account when deciding if the applicant can do even simple, routine tasks that don't require skill.
The sensory limitations that Social Security evaluates include impairments of the five senses and impairments that impose environmental restrictions. Those with lupus often have vision problems and skin issues, including photosensitivity, and they may suffer seizures. All of these limitations caused by lupus are looked at all together to determine if an individual is able to work.
As lupus is a chronic disease that may cause increasing harm to the body over time, it may happen that you are initially denied benefits, but by the time you appeal and get a hearing with a judge, your limitations have become so great that you now qualify for Social Security Disability benefits. For more information, see our series of articles on how Social Security decides when your limitations are so bad that you deserve disability benefits.