As a life-long, autoimmune condition that can have wide-reaching implications for your overall health, wellbeing, stamina, and employability, lupus is an illness for which you can receive disability benefits. In order to meet Social Security Administration (SSA) medical eligibility rules however, your lupus must be severe and significantly decrease your ability to work or stop you from working entirely.

Medically Qualifying for Benefits with Lupus

Every applicant for disability benefits is compared to the SSA’s medical guide known as the Blue Book. Many people who are diagnosed with lupus, or Systemic lupus erythematosus (SLE), are able to meet the SSA’s disability listing for the disease. Medically qualifying under this listing requires your lupus affects two or more organs or body systems and that it causes you to experience at least two “constitutional symptoms,” like fatigue, fever, weight loss, or malaise, which is a persistent, generalized feeling of being ill or unwell.

You can also qualify under the SLE listing if you experience pronounced constitutional symptoms that severely decrease your daily functioning. Specifically, the SSA must see from your medical records and disability application that you have major struggles with:

• maintaining personal connections or participating in social events,

OR

• “activities of daily living” (ALDs), which include things like cooking, cleaning, bathing, running errands, caring for children or pets, and other everyday tasks and activities,

OR

• the timely completion of tasks due to difficulties with stamina, pace, or concentration.

Medical Documentation and Proving Disability with SLE

The specific medical evidence necessary for approval depends on how your lupus affects you. For example, if your kidneys are profoundly affected, then the SSA will need test results, showing impaired kidney function.

SLE also presents differently in blood tests for different patients. Various markers may be present in your blood stream, validating the diagnosis of lupus and potentially ruling out other similar autoimmune disorders.  

In the Blue Book, you and your doctor will also find information on how the SSA evaluates the medical records of applicants with SLE. These details appear in 14.00D1, with some other references to the disease found throughout the introductory information in the Autoimmune section.

Your rheumatologist or primary care doctor can help you understand the medical documentation required for approval. He or she can also assist by ordering additional tests, if necessary, and by providing your records in a timely manner to the disability examiner that reviews your claim.

Disability Benefit Programs and Technical Qualification

The SSA offers benefits through Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) to qualified applicants.

• For SSDI, you must have worked and paid Social Security taxes.
• For SSI, no work history is necessary, but you must meet financial-need criteria.

Some applicants receive benefits through both programs, and your spouse or children may additionally qualify for auxiliary benefits, once you’re approved for disability.

Applying for Benefits

You can apply for SSDI online or stop in at your local SSA office to submit your application. SSI applications however, require a trip to the local branch, because a personal interview is a standard part of the process.

Most applications are initially denied, but do not give up if your claim is denied! There is a long appeals process available. In fact, nearly 50% of applicants are awarded benefits if they appeal the claim.

This article was provided by Social Security Disability Help, an independent organization dedicated to helping people of all ages receive disability benefits. If you need any additional assistance or have any questions, their staff can be reached at help@disability-benefits-help.org.