Lupus is a chronic autoimmune disease that can affect any part of the body, including skin, joints, and organs. Some cases of lupus are manageable with treatment, while other cases are quite debilitating. If a Lupus diagnosis prevents you from working, you may be entitled to Social Security Benefits. Applying for Social Security Benefits requires presenting evidence of a long-term disability. If you have Lupus, Jon Sipes, Attorney at Law, may be able to assist you in obtaining Social Security Disability benefits. Attorney Sipes has decades of experience helping South Texans with disabling conditions get Social Security Disability benefits.
What Are Social Security Benefits?
There are two types of Social Security benefits under the Social Security system: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). For the most part, the two kinds of Social Security benefits require a person to experience the ill effects of a drawn-out condition that keeps that person from working.
Whether you qualify for SSDI or SSI depends on whether you worked and paid into the Social Security System. Eligibility for SSDI considers an applicant’s age, the number of years worked, and the amount paid into the system. You must have worked some portion of the last ten years to be eligible for SSDI.
SSDI payments are based on the amount of Social Security payroll taxes you paid during your employment history. The amount of SSI payments are based on an amount set by Congress. As a result, monthly SSDI payments are usually higher than SSI payments.
If you are ineligible for SSDI, you may still qualify for SSI. SSI is a need-based program that benefits the elderly, the blind, and those with other disabilities.
Am I Eligible for Social Security Benefits?
The Social Security Administration, a government agency responsible for administering Social Security benefits, is tasked with reviewing applications for benefits and determining applicants’ eligibility. In approving an application for benefits, the Social Security Administration must find that an applicant has a long-term disability.
The Social Security Administration defines a long-term disability as a long-term medical condition expected to continue for at least 1 year or result in death. Disabilities can result from several situations, including physical injuries, chronic medical conditions, or mental illness. The Social Security Administration applies several tests to determine whether a disability prevents an applicant from performing any type of work when considering an application.
In addition to being long-term and severe, an applicant’s medical condition must also prevent him or her from performing any substantial gainful activity (SGA). SGA is an activity that results in earning income over an established amount. As of 2020, Congress set the amount recognized as SGA at $1,260 per month or more. This amount is subject to yearly revision.
What is Lupus?
Lupus, or systematic lupus erythematosus, is an autoimmune disease that causes the body to attack its own systems, such as the skin, joints, and organs like the heart, lungs, and kidneys. In some cases, a person diagnosed with lupus can manage the condition with drugs and other therapies. In other cases, lupus impacts a patient’s daily routine, causing pain and preventing the body from functioning correctly.
Is Lupus a Disability?
Lupus may qualify as a disability for Social Security purposes. Lupus is one of the conditions listed explicitly as a disability in the Social Security’s listing of impairments. For lupus to qualify as a disability, lupus must:
- affect two bodily systems or organs, such as the heart and the lungs, or the brain and the kidneys; or
- cause at least two of the following symptoms:
- frequent exhaustion causing low physical or mental activity;
- fever;
- Malaise (discomfort or illness resulting in low physical or mental activity); and/or
- involuntary weight loss.
In adults, the Social Security Administration may also consider the repeated symptoms, including at least two of the above, that limit daily activity, social functioning, or the ability to complete tasks on time, and interfere with the ability to function independently, appropriately, and effectively.
How Is Lupus Diagnosed?
The Social Security Administration requires a diagnosis of lupus is based on criteria set out by the American College of Rheumatology. A patient must meet four of the following eleven criteria to be diagnosed with lupus, including:
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Sersitis
- Renal disorder
- Neurologic disorder
- Hematologic disorder
- Immunologic disorder, and/or
- Antinuclear antibody.
To approve an application for disability based on lupus, the Social Security Administration will require the application to include medical evidence proving these symptoms, such as a doctor’s observations and medical and lab testing records.
Can I Still Qualify for Disability Benefits if I Don’t Meet the Social Security Administration’s Criteria for Someone with Lupus?
The short answer to this question is yes. If you do not meet the Social Security Administration’s definition of someone with disabling lupus, you may still qualify for disability benefits if you can show that your condition prevents you from working.
In this case, the Social Security Administration evaluates an applicant’s ability to work through a tool called a Residual Functional Capacity (RFC) assessment. The RFC measures the most an applicant can do despite physical or mental impairments. To assess RFC, the Social Security Administration considers evidence, including medical records, a medical exam, and your statements regarding your pain or other limitations caused by CTS.
The RFC examines an applicant’s physical abilities, mental abilities, and other abilities such as senses affected by impairment. Lupus often causes physical limitations, such as fatigue, pain, shortness of breath, headaches, and abnormal heart rhythms. These limitations may make it challenging to perform physically or mentally demanding jobs.
Any application for disability benefits should include a thorough explanation of symptoms and medical evidence to substantiate those symptoms. The application must also explain how the symptoms prevent the applicant from performing work and indicate that they are likely to continue for more than one year.
What Happens if a Disability Claim is Denied?
If the Social Security Administration denies a claim of disability based on lupus, you have the option to appeal that decision to an Administrative Law Judge. You will then need to make a case on appeal that explains why your lupus should be considered a disability.
Even if your initial application and appeal are denied, because lupus is a degenerative disease that gets progressively worse, you should consider re-filing an application for disability benefits should your condition worsen.
Discuss Your Claim for Benefits Based on Lupus with an El Paso Social Security Disability Attorney
Lupus is a particularly frustrating disease in that it can manifest itself in many forms. If you have been diagnosed with lupus or experience symptoms associated with lupus that prevent you from working, contact Jon Sipes, Attorney at Law, to discuss applying for Social Security Benefits. Attorney Sipes has helped hundreds of El Paso area clients apply for and appeal denials of disability benefits and understands how to present your case. If you are considering applying for Social Security disability benefits, Attorney Jon Sipes can help you through the process.