Lupus is a chronic autoimmune disease where the body’s immune system attacks the individual’s internal organs and tissues. A person with a lupus diagnosis experiences symptoms related to his or her heart, skin, joints, kidneys, and lungs. Our Social Security disability lawyers in New Jersey and Pennsylvania see clients in systemic pain and fatigue daily.
People who have lupus experience a wide range of symptoms depending upon their biology and genetic make-up. For some people, symptoms are mild and controlled with prescription drugs. For others, severe organ damage has occurred, making it nearly impossible to return to their standard quality of life.
In this article, we are going to answer your most frequently asked questions about getting approval for SSDI benefits.
Social Security Disability Insurance (SSDI) Benefits Are Available for Qualifying Claims
The good news is that there are options available to disabled adults with lupus in paying for necessary expenses, medical treatment, and other accommodations. Patients with lupus often apply for Social Security disability insurance benefits (SSDI). This action is reasonable, given the impact of chronic symptoms.
In short, symptoms associated with the disease are devastating enough to force a person into disability. The Social Security Administration (SSA) provides SSDI insurance after recipients have paid into the program over a mandated period. The claims administrator assigned to your claim determines if you qualify for SSDI benefits.
Does Lupus Qualify for SSDI Benefits?
Adults with lupus are eligible for SSDI benefits as long as you paid Social Security taxes and earned enough credits. You must also be able to demonstrate that your condition meets the SSA’s guidelines that define disability. If you meet both of those elements, you have a strong chance of being approved for SSDI payments.
The SSA maintains a “listing of impairments” for disabilities that are eligible for SSDI benefits. At this time, the only form of lupus that is on this list is systemic lupus erythematosus (SLE). However, eligibility for SSDI benefits is not limited to the listing of impairments. A skilled attorney can — and should — advocate for individuals with other forms of lupus to receive benefits. For example, a person who has discoid lupus may have disabling pain from raw, painful lesions that are not healed with treatment. In this situation, an applicant may qualify for SSDI benefits because of their lupus diagnosis, even though they do not have SLE.
Specific Criteria to Qualify for SSDI
While the listing of impairments has SLE as a type of lupus that qualifies for SSDI benefits, individuals with other types of lupus may also be eligible for benefits based on another listed condition. Each listing further explains the specific criteria for which the condition must meet.
For individuals with a SLE diagnosis, qualifying for benefits requires submitting evidence of your disability. In addition to a verifiable SLE diagnosis, your condition must also meet at least one of the following two requirements:
Requirement A: Have at least two organs be moderately affected while experiencing at least two of the following symptoms: fatigue, malaise, and weight loss.
OR
Requirement B: Experience SLE flare-ups with at least two of the following symptoms: fatigue, malaise, and weight loss. Limitation of activities must occur in the following areas: daily life, social function, or inability to complete tasks on time.
SSDI Qualifications for Lupus with Diminished Functional Capacity
The SSA considers the total impact of your SLE diagnosis regarding your daily life and ability to earn a living. However, they also want to ensure the SSA pays benefits to people who need it. Therefore, the claims administrator assigned to your case attempts to assess your level of disability based upon your residual functional capacity (RFC).
An RFC is a rating assigned to your physical and mental abilities by the SSA agent in charge of your claim. The rating places restrictions on your physical capacity for certain activities. For this reason, it is important to understand how a diagnosis of lupus may affect all areas of your life — particularly when it comes to your ability to work.
How Lupus Impacts An Individual’s Ability to Work
Lupus is a chronic autoimmune disease that can cause damage to any part of the body, including the skin, joints, and/or organs. The symptoms of lupus tend to last for longer than six weeks, and may last for many years — or even a lifetime.
One of the most challenging aspects of lupus is that individuals with lupus may experience periods of relatively good health, and then experience episodes (known as flares) where their symptoms are markedly worse, and then improve — only to reappear again. Lupus affects each person differently, so the signs and symptoms of the disease will vary depending on which body systems are impacted.
Common signs and symptoms of lupus include:
- Fatigue
- Joint pain, stiffness, and swelling
- Fever
- Skin lesions that appear or worsen with exposure to the sun
- Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose, or rashes that may appear in other places on the body
- Fingers and toes that turn white or blue when exposed to the cold or during periods of heightened stress
- Dry eyes
- Shortness of breath
- Chest pain
- Headaches, confusion, and memory loss
Because lupus can impact a person’s organs, there are a number of serious related conditions that may occur as a result of a lupus diagnosis. For example, a person with lupus may develop an inflammation of the chest cavity lining, known as pleurisy, which can make it painful to breathe. If lupus affects a person’s brain or central nervous system, they may experience behavior changes, vision problems, strokes or seizures.
There is no cure for lupus. However, medication can help to control the signs and symptoms of lupus. However, many of the medications used to treat lupus — such as antimalarial drugs, immunosuppressants, and biologics — have severe side effects that can also be disabling. These side effects may include an increased risk of infection, nausea, diarrhea, and liver damage.
What to Do If the SSA Denies Your Claim
There are many moving parts towards receiving a successful SSDI claim for your medical condition. After reviewing the above information, it’s easy to see how and why the SSA denies lupus disability claims. This outcome can be frustrating for someone who is clearly suffering and needs benefits as soon as possible.
You do have the opportunity to appeal the SSA’s decision on your claim. However, time limits and other restrictions apply. It’s imperative to act fast to give yourself the best fighting chance at winning your appeal.
If the SSA denied your claim, you don’t have to fight them alone. At Bross & Frankel, P.A., our team of disability lawyers in New Jersey and Pennsylvania are working to help you prove your case and prevail during your appeals hearing. Schedule your free claims review by calling our office at (856) 795-8880.