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Lupus and Social Security Disability

Applying for Social Security Disability Benefits with Lupus

The Lupus Foundation of America estimates that there are about 1.5 million people in the U.S. living with Lupus. It is an autoimmune disease, which means that in addition to the fatigue, inflammation, and joint pain and stiffness often seen with the condition, your immune system is also compromised, making you more at risk for developing infections and other complications.

For many people, lupus develops slowly and can respond well to treatments that keep symptoms under control. These people are often able to continue working for many years and may even be able to hold a full-time job through to retirement. For those patients for whom lupus is more aggressive or unresponsive to treatment however, the disease can quickly limit employability or put an end to working entirely.

Painful and stiff joints, organ damage, osteoporosis, kidney and heart disease, and fatigue and weakness are just a few of the symptoms and complications that may prevent you from performing everyday job functions. If your lupus has made work impossible or has significantly limited your ability to maintain full-time, gainful employment, then you may be able to get approved for disability benefits through the Social Security Administration (SSA). These benefits can be the financial relief you need to ensure your bills are paid and that your medical care and everyday living expenses are covered.

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The Costs of Lupus

Lupus is a chronic condition that must be closely monitored to ensure systemic affects are minimized. In other words, you regularly see your doctor and have tests performed to find and prevent or limit damage caused by the disease. Monitoring costs therefore add up quickly, though the exact expenses are different for each patient, due to the varying nature of the disease itself.

The Lupus Foundation of America reports that the average annual direct medical costs are $12,643 per patient. The type and severity of your symptoms significantly affect your direct medical expenses though. For instance, a person for whom lupus affects multiple body systems (joints, heart, kidneys, and skin) will have higher treatment costs than a patient for whom the disease primarily affects only one body system.

Doctors must often prescribe multiple medications to control symptoms, and frequent prescription adjustments may be necessary, especially while trying to discover the right cocktail of drugs to effectively control your lupus. Common prescriptions include corticosteroids, antimalarial drugs, and other autoimmune suppression medications, like Acthar and Benlysta.

If you have severe complications from lupus, then you may need additional prescriptions, including high blood pressure drugs, diuretics to reduce fluid retention, anti-seizure medications for seizures, or antibiotics to treat frequent infections. With all of these medications combined, your monthly prescription costs may run several hundred, or even several thousand dollars, dependent upon your prescription drug insurance coverage.

Lost work time cannot be overlooked when considering the costs of living with lupus, and the Lupus Foundation of America reports the average annual loss of income at $8,659 per person. This is, of course, when employment is still an option. When lupus prevents work entirely, then you’re faced with the challenge of surviving without employment income. Whether you work reduced hours or cannot work at all, Social Security disability benefits can be the answer to your financial concerns.

Medically Qualifying for Benefits for Lupus

The lupus disability listing appears in the Immune System Disorders section of the SSA’s Blue Book. The Blue Book is a complicated resource for most people to use though, as it is written for medical professionals and therefore contains lots of technical language and complex medical information.

Work with your doctor to understand the evidence necessary to support your disability claim. Your doctor can also assist with compiling and providing to the SSA the appropriate records for you to prove your lupus qualifies for benefits.

To meet the lupus listing, you must have at least two body systems or organs that are affected by the disease and you must additionally experience other signs and symptoms on a consistent basis, like fatigue, fever, or weight loss.

Alternately, you can meet this listing my proving that your daily functioning is significantly compromised due to your lupus symptoms and complications. To qualify in this manner, you must have persistent fever, fatigue, weight loss, or other “constitutional” symptoms. These symptoms must additionally make it difficult or impossible to function socially, complete tasks in a reasonable time frame, or to keep up with “activities of daily living,” which include things like bathing, cooking, cleaning your home, or running errands, to name just a few.

Qualifying for Benefits without Meeting a Disability Listing

Most people with severe or advanced systemic lupus are able to satisfy the Blue Book listing requirements. If you are not however, then you may still be able to prove your disability through a “residual functional capacity” (RFC) analysis.

This process is standard for the SSA for any applicant that doesn’t meet or closely match a disability listing. You’ll receive notification in the mail that more information is needed to evaluate your claim. Along with this notification, you’ll receive questionnaires about your physical and/or mental limitations.

When you fill out these questionnaires, be honest and detailed. Tell the SSA about all of the affects that your symptoms, treatment side effects, and lupus complications have on your everyday life. For example, fatigue, fever, and a general feeling of “illness” may prevent you from getting out of bed or leaving your home and therefore mean frequent absences from work. Pain, inflammation, and weakness may stop you from doing everyday tasks, like laundry, sweeping the floor, or mowing the lawn.

This kind of information may at first seem silly for the SSA to ask for, but they use these details about your everyday life to better understand how your lupus may limit your ability to perform common job functions. For example, if you can’t mow the lawn or clean your house, then you can’t perform physical job duties, like those required in retail jobs, manufacturing positions, or similar employment situations.

It’s important to understand though that in order to be approved through an RFC, you must also show that your lupus would prevent you from working in an office or other primarily sedentary job. To support this argument, the SSA must see that you experience problems with completing tasks in a timely manner, processing thoughts or other information, or that you have other cognitive or physical symptoms that would keep you from working at all, in any job whatsoever.

How to Apply for Disability Benefits with Lupus

Whether you meet the disability listing or must go through an RFC evaluation for your lupus disability claim, the SSA usually requires the same medical evidence:

  • Results of diagnostic tests used to rule out other medical conditions that cause similar symptoms as lupus
  • Longitudinal reports from your doctor, reporting symptoms, complications, treatments, and treatment affects over a period of three or more months (12 months is even better)
  • Prescription medications used and their affects on your specific symptoms and complications
  • Hospitalization and other treatment records, if appropriate
  • Test results or lab work reports, showing diagnosis of common complications, like kidney or heart disease, bone loss, seizures, anemia, etc.

You’ll need your financial details, work history, and education information before applying for benefits. Gathering contact information for all your medical care providers is recommended too, as the SSA will need these details to request copies of your medical records. When you’re ready to start your application, you can visit the SSA’s website to apply for SSDI, or you can go to the local SSA office to apply for SSI and/or SSDI benefits.