Can You Get Disability For Lupus?
You can get disability for Lupus if you have least two body systems or organs that are affected by the disease. You must additionally experience other signs and symptoms on a consistent basis, like fatigue, fever, or weight loss. If you meet this Blue Book listing and are unable to work for at least 12 months, you can get disability for lupus.
What is 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). By meeting the Blue Book listing for lupus, those with lupus can qualify for disability benefits.
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.
Is Lupus a Disability?
Yes, according to the Social Security Administration (SSA), lupus is considered to be a disability, meaning that people can get disability for lupus. This is because the SSA has a Blue Book listing for lupus.
Since lupus is a disease in which the body’s immune system attacks organs and tissue can produce a wide variety of symptoms that include fever, fatigue, and joint pain, people can get disability for lupus by meeting the requirements of the SSA's Blue Book listing for lupus. It is important to note that a lupus disability applicant not only has to prove the existence of lupus, but also must prove that the symptoms of the disease make it impossible for them to work their current job.
Blue Book Listing For Lupus
Figuring out whether a condition is a disability in the SSA’s eyes boils down to whether or not the condition is listed in their Blue Book. The Blue Book is the SSA’s manual of medical conditions that they see as being severe enough to qualify someone for disability.
Since there is a Blue Book listing for lupus, people can get disability for lupus. The specific Blue Book listing for lupus is in Section 14.02 – Systemic Lupus Erythematosus.
The SSA’s Blue Books defines the severity of symptom standards applicants have to meet to qualify lupus as a disability. If you suffer from lupus, you must show the disease has negatively impacted two or more organs and/or body systems. You also have to suffer from at last two serious symptoms that have forced you out of work.
The SSA also names the limitations that can make a disability claim valid under the guidelines established by the Blue Book. If lupus limits your daily activities, social functioning skills, and the ability to complete tasks on time, then you might be eligible for disability benefits. The SSA applies rules to every disability, including being unable to work and transition to another occupation, as well as the symptoms of the disease are expected to remain for at least one year.
To prove you suffer from severe lupus symptoms, you must submit convincing medical evidence, such as the results of diagnostic tests and detailed descriptions of treatments and physical therapy sessions alongside your lupus disability claim.
You should submit copies of every healthcare receipt, including the cost of prescription medications and the use of an assistive device. Ask your healthcare provider to submit a statement that describes your prognosis of making a full or partial recovery.
Can You Get Disability for Lupus?
Meeting the Blue Book listing for lupus under Section 14.02 is just one criterion that determines whether you qualify for Social Security disability benefits. This is because the SSA has other criteria that disability applicants must meet in order to get approved for benefits. For example, the SSA requires applicants to have worked long enough prior to their development of their disabling medical condition. The SSA measures work history based on applicants' accumulation of work credits. This is because, for every year that an individual works, they earn a certain amount of work credits.
Calculating Social Security work credits involves referring to your annual wages and/or self-employment income. You can earn as many as four work credits each year.
The amount of wages and/or self-employment income you need to earn for a work credit also changes each year. For example, you will earn one work credit for every $1,640 you generate in wages and/or self-employment income throughout 2023.
When you earn $6,560 in wages and/or self-employment income, you reach the maximum number of work credits allowed by the SSA. Regardless of your age, you must earn the minimum number of work credits within a period designated by federal law.
You also have to demonstrate you have missed work for 12 consecutive months in order to get disability for lupus. The timekeeping records maintained by your employer, as well as the copies of bank statements, act as evidence of missed time from work.
It is also critical to note that you cannot work nine months, go back to work for six months, and then miss work another 10 months to qualify for Social Security disability benefits. The SSA requires documentation that shows you missed work for 12 consecutive months.
How Much Can You Receive on Disability Benefits For Lupus?
The amount you will receive in disability benefits after you have been diagnosed with lupus will depend on your situation. Since Lupus is a chronic condition that needs to be closely monitored in order to minimize its effects, you will likely regularly need to see your doctor and undergo tests.
These costs eventually accumulate and will be much higher if the lupus affects multiple body systems such as the joints, heart, kidneys, and skin.
Your doctor may need to prescribe multiple medications which help to control the symptoms. Common prescriptions include corticosteroids, anti malarial drugs, as well as other autoimmune suppression medications, like Acthar and Benlysta.
You should ensure you submit copies of every receipt for your costs of medical care, including the cost of prescription medications and if necessary the cost of the use of an assistive device. When you add up the your monthly prescription costs the number could reach several thousands of dollars.
Some lupus victims may be able to work. But if working is not possible for you, Social Security Disability Insurance (SSDI) benefits can help you pay your medical bills. The Maximum SSDI benefit amount per month is $3,627 in 2023.
If you are approved for SSDI, then you may be eligible for federal Medicare benefits. However, the Medicare does not start until 2 years and 5 months after the date you were found disabled.
If you are not eligible for SSDI because you have insufficient work credits you should qualify for Supplemental Security Income (SSI), which means you should be able to claim Medicaid benefits instead which includes the cost of all your medical treatment for lupus.
How Much Can Having Lupus Cost You? Determining If Lupus Is Disabling Enough
Lupus is a chronic condition that must be closely monitored to ensure systemic effects are minimized. In other words, you regularly see your doctor in order to 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 for lupus can be the answer to your financial concerns.
Medically Qualifying for Benefits for Lupus - Is Lupus A Qualifying Disability?
Lupus is considered a disability by the SSA and, thereby, qualifies for disability benefits. The Blue Book listing for lupus appears in the Immune System Disorders section, in listing 14.02. 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.
You should 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 disability 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.
Functional Limitations of Lupus
It's possible that your lupus is affecting only one organ or bodily system significantly, such as your kidneys, but not another organ even marginally, so you don't meet the medical requirements.
You might not meet the functional restrictions criterion if you can still take care of yourself (feed yourself, clean your house, shop for your household necessities, etc.) and maintain a social life, and you don't have any mental difficulties that prevent you from accomplishing chores.
However, if you are unable to work full-time (for example, because you need kidney dialysis twice a week), you are still entitled to disability benefits. Because of limitations, you may be eligible for benefits in this case.
Qualifying for Benefits without Meeting a Disability Listing For Lupus
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 avoid denied disability, 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 - Will The SSA Consider Lupus A Disability?
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.
Consult with a Social Security Attorney To Determine If Lupus Is A Disability
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.
Considering applying for Social Security disability benefits but not sure how much you’ll earn per month? Our SSDI Calculator can help you determine how much you’ll receive from the SSA before you file for disability
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 Social Security office to apply for SSI and/or SSDI benefits.
But even before that, you can fill out this free evaluation form to learn more about your case and take the first steps towards finding legal representation.
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