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Lupus - Social Security Disability and SSI Benefits

  • Date: 2010/05/25 (Rev: 2014/01/01) Jonathan Ginsberg
  • Synopsis : Information regarding applying for Social Security Disability Benefits when suffering from Lupus.

Main Document

Lupus erythematosus, or as it is more commonly referred to, lupus, is a devastating disease that affects nearly 1.5 million Americans and five million people worldwide. While there are four different types of lupus, the most commonly diagnosed form of lupus is systemic lupus erythematosus. Here, the dynamics of the common disease will be discussed in relation to applying for Social Security Disability benefits.

About Lupus

Lupus is classified in the medical community as an autoimmune disease. Those who suffer with lupus have an immune system that attacks healthy tissue as opposed to foreign substances that may be harmful to the body. The inflammation response attacks joints as well as organs such as skin, kidneys, heart, lungs, blood vessels, and the brain. Experts are unsure about what causes autoimmune diseases; however, there is a correlation between genetics and environment in autoimmune disease cases.

No two lupus cases look exactly alike. While some cases are more severe than others, there are a wide range of symptoms as well as severities.

Some of these symptoms include the following:

  • Fatigue
  • Fever
  • Weight loss or gain
  • Joint pain, stiffness and swelling
  • Butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose
  • Skin lesions that appear or worsen with sun exposure
  • Mouth sores
  • Hair loss (alopecia)
  • Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon)
  • Shortness of breath
  • Chest pain
  • Dry eyes
  • Easy bruising
  • Anxiety
  • Depression
  • Memory loss

Treating Lupus

Treatment for lupus depends on the signs and symptoms. Determining whether the signs and symptoms should be treated and what medications to use requires a careful discussion of the benefits and risks of each treatment with a physician. As the signs and symptoms flare and subside, the patient and the physician may find that medications or dosages will need to be changed. Some of the medications used to treat lupus include non-steroidal anti-inflammatory drugs, antimalarial drugs, and corticosteroids. Side effects of these medications may include stomach bleeding, kidney problems, increased risk for heart problems, vision problems, muscle weakness, weight gain, easy bruising, thinning bones (osteoporosis), high blood pressure, diabetes and increased risk of infection. Applying for Social Security Disability Benefits

Social Security Disability Insurance (SSDI) is a federal program designed to pay monetary benefits to qualified applicants who have worked long enough and paid their social security taxes. Based on medical evidence, work history, and education history, the Social Security Administration determines whether or not applicants qualify for benefits and how much each applicant can receive. The Social Security Administration (SSA) sets forth specific criteria when qualifying applicants for benefits. With regard to lupus specifically, the medical evidence must be consistent with SSA's classification of an immune system disorder as well as the following criteria:

A. Involvement of two or more organs/body systems, with:

1. One of the organs/body systems involved to at least a moderate level of severity; and

2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).

OR

B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:

1. Limitation of activities of daily living.

2. Limitation in maintaining social functioning.

3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

These criteria are addressed in much more detail by the Social Security Administration (SSA). However, keep in mind that the lupus symptoms which meet the criteria for receipt of benefits may develop as a result of the disease process and/or the medications prescribed and used to treat the disease. The medical evidence supporting one's argument that he or she may meet these criteria, and therefore qualify for disability benefits, is crucial to obtaining a favorable finding. Physicians are considered experts in their field of practice, and their diagnosis, treatment and prognosis concerning a person's condition are key to determining if someone who suffers with lupus qualifies for Social Security Disability benefits.

Jonathan Ginsberg has been practicing Social Security Disability law in the Atlanta, Georgia area for over 20 years. His website can be found at www.atlantasocialsecuritydisabilityattorney.net

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