Social Security Disability & SSI Benefits for Lupus

Lupus is an auto-immune disease that takes a few different forms, some more debilitating than others:

• Systematic lupus erythematosus (SLE), the most common type, causes the body's immune system to attack itself.
• Cutaneous lupus (skin lupus) attacks the skin, causing rashes and lesions.
• Drug-induced lupus has similar symptoms to SLE but generally disappears once exposure to the triggering medication ends.

For this article, we'll focus on the SLE form of lupus, which can be severe enough to qualify for disability benefits from the Social Security Administration (SSA).

Symptoms and Complications of Lupus

Lupus has symptoms that can range from mild to life-threatening and can affect many parts of the body. Some common lupus symptoms include:

• prolonged or extreme fatigue
• pain or joint swelling
• chest pains (commonly caused by inflammation in the lining of the lungs)
• fevers (above 100 degrees)
• skin rashes (often a red, butterfly-shaped rash across the nose and cheeks)
• headaches
• sun or light sensitivity (photosensitivity)
• mouth sores
• anemia
• blood clots
• dry eyes or eyelid rashes, and
• memory problems (forgetfulness and confusion).

Half of people with lupus also have kidney problems (lupus nephritis). Kidney complications can cause additional symptoms, like weight gain, high blood pressure, and decreased kidney function.

Lupus symptoms vary from person to person. For instance, you might suffer from extreme fatigue and swollen knees, while someone else has headaches and kidney problems.

For many adults with lupus, the symptoms come and go (called "flares" and "remissions"). You might experience remissions that last a few months or even years. Or you might have few remissions and near-constant symptoms.

Both the symptoms of lupus and the damage it causes to your organs and body systems can keep you from working regularly.

Can You Get Disability Benefits for Lupus?

If you can't work because of lupus, you might qualify for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits. You must meet both the non-medical and medical requirements to qualify for disability. (Learn more about the non-medical requirements for SSDI and SSI.)

You can meet Social Security's medical requirements in one of two ways:

• by meeting the requirements of a listing in Social Security's blue book (which automatically qualifies you for benefits), or
• by proving that your lupus symptoms prevent you from doing any kind of work.

Meeting the Listing Requirements for Lupus

Lupus (SLE) is one of the diseases included in Social Security's listing of impairments (listing 14.02).

To meet the criteria, your lupus must cause at least two of the following "constitutional" symptoms:

• frequent exhaustion resulting in low physical or mental activity
• fever
• malaise (feelings of physical discomfort or illness resulting in low physical or mental activity), or
• involuntary weight loss.

In addition, your lupus must affect at least two body systems or organs, such as your kidneys and lungs or your skin and brain (with one body system affected at least moderately). If lupus only affects one body system, and you're an adult, you can still qualify under the listing if:

• you have repeated flares of lupus, and
• you have severe limitations in at least one of the following:
• your activities of daily living (like basic hygiene and grocery shopping)
• your ability to maintain social functioning, or
• your ability to complete tasks in a timely manner (because of trouble focusing or working quickly).

Medical Evidence Required to Meet the Lupus Listing

To meet the listing requirements, your lupus diagnosis must be documented, and you'll generally (but not always) have medical evidence that shows you meet the current "Criteria for the Classification of Systemic Lupus Erythematosus" by the American College of Rheumatology. You must have four of the following conditions to meet the guideline criteria:

• malar rash
• discoid rash
• photosensitivity
• oral ulcers
• arthritis
• renal disorder
• neurologic disorder
• hematologic disorder
• immunologic disorder
• antinuclear antibody, or
• serositis (such as pleuritis or pericarditis).

The type of evidence you'll need to prove you meet this criteria will depend on your symptoms. But generally, you'll need medical evidence like:

• doctors' observations
• electrocardiogram (EKG)
• urinalysis
• blood tests.

Your evidence must be recent enough to be relevant (dated in the last few months). But it should include tests and doctor's notes dating back far enough to paint an accurate picture of the progression of the disease. Your doctor's statements should include information about how lupus affects your daily functioning.

Learn more about the medical evidence Social Security requires.

Proving You Can't Work Due to Lupus

If you can't meet the requirements of the listing, you can still qualify for disability if you can prove that you can't work due to your health problems caused by lupus. Social Security uses a residual functional capacity (RFC) assessment to record the physical, mental, and sensory limitations that affect your ability to work.

Physical limitations: Social Security will consider how your physical limitations affect your ability to function in a work environment. For instance, you might have:

• fatigue
• chest pain
• shortness of breath
• headaches, and
• abnormal heart rhythms.

These limitations can make it difficult to stand or walk for a lengthy time, which rules out many jobs.

Mental limitations: Social Security evaluates your mental ability to do the following:

• understand, remember, and carry out instructions, and
• respond well to supervision, co-workers, and the pressures in a work setting.

Those with lupus can suffer personality changes, including anxiety and depression. Lupus might also cause you to have difficulty concentrating or be more forgetful. Social Security will consider these limitations when deciding if you can do even simple work that doesn't require skill.

Sensory limitations: Social Security evaluates impairments of the five senses and those that impose environmental restrictions. For example, let's say you have vision problems or skin issues, including photosensitivity. Social Security will look at what types of jobs these limitations rule out (such as outdoor jobs or jobs requiring excellent vision).

If Social Security finds there's no type of work you can still be expected to do (given your limitations, age, and job skills), you'll win disability benefits through a "medical-vocational allowance."

How to Apply for Disability Benefits for Lupus

If you're applying for SSDI, you can file your application online. For SSI, you can start your application online, and then Social Security will contact you with an appointment to finish your application.

You can also make an appointment to apply for SSI or SSDI by phone by contacting your local Social Security office or calling Social Security's national office at 800-772-1213 (TTY 800-325-0778).

Once you apply, you can expect to wait at least a few months for an initial decision (generally three to six months, according to Social Security). But it might take longer—depending on where you live, as backlogs vary nationwide.

Your disability application might initially be denied (as most are). But you can and should appeal. As lupus is a chronic disease that can cause increasing harm to your body over time, you might find that by the time you get a hearing with a judge, your limitations qualify for Social Security disability benefits.

Learn more about what to do if Social Security denies your disability claim.