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What Social Security considers disabling
Medical Evidence and Disability
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SSD SSI Definitions
SSDRC authored by Tim Moore
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Can you get approved for disability based on Lupus?
Systemic lupus erythematosus (SLE) or simply lupus is evaluated in the immune system section of the Disability Evaluation Under Social Security disability handbook, more commonly known as the blue book. Although there is a specific listing for lupus (SLE) in the Social Security disability handbook (listing 14.02), in a real sense no specific disability criteria has been established for lupus.
Unfortunately, lupus is an exacerbating and remissing autoimmune disorder that attacks different body systems or multiple body systems simultaneously with each exacerbation. Lupus causes a wide range of functional limitations that are dependent upon the body system or organs that have been affected. Consequently, Social Security evaluates the functional limitations imposed by lupus under a variety of other impairments depending upon which body system or systems are affected.
Functional limitations caused by lupus are evaluated under other impairment listing sections that address impairments of the following body systems: joints, muscles, ocular, respiratory, cardiovascular, digestive, renal, hematological, skin, neurological, or brain (mental). This simply means that to be approved for Social Security disability benefits for lupus an individual must meet the criteria established for the body system affected by lupus. For example, an individual with neurological involvement must meet the criteria contained within the neurological listing.
If an individual does not meet the criteria established for their particular manifestation of lupus symptoms, they still may be able to receive Social Security disability if the following is true:
A) Their lupus condition involves two body systems or organs to a lesser extent, and at least one of the body systems or organs is affected by an impairment that is at least moderately severe.
B) The individual is experiencing severe documented constitutional symptoms and signs such as weight loss, joint pain and stiffness, fever, extreme tiredness, or malaise.
Immune system disorders are covered in section 14.00, which has two parts, A and B, that elaborate on just how Social Security evaluates various immune system disorders.
Part A of the immune system section states that the impairment listed in Section 14.00 must involve some sort of deficiency of one or more parts of the immune system, and the listing goes on to list various cell types and antibodies that may be involved.
Part B of the immune system section states that irregularities in the immune system may cause the development of connective tissue disorders. Generally, connective tissue disorders are chronic multiple body system disorders, which vary in manifestation, course, and prognosis. Connective tissue disorders generally cause a loss in body function and often require long term care that involves frequent medical evaluation and treatment.
Since we know what a connective tissue disorder is, we can take a look at what type of documentation Social Security requires for a medical determination.
Social Security uses medical history, lab studies, medical imaging (x-ray, MRI, CT scans, etc.), and even biopsies to establish the existence, duration, and severity of an individualís lupus condition. If an individual does not have enough medical information, Social Security may purchase non-invasive tests such as imaging or blood work to evaluate an individualís condition (however they never purchase test that are considered risky or invasive i.e. angiograms or biopsies).
In addition to this type of medical documentation, Social Security requires a longitudinal treatment record of at least three months in order to establish that an active impairment exists in spite of prescribed treatment and that the condition is expected to last twelve months or more.
Why a twelve month period? If possible, Social Security uses a twelve month period to establish the severity and duration of an individualís lupus. Social Security must also establish that the limitations imposed by lupus prevent an individual from performing substantial gainful work activity.
Individuals with lupus most often do not meet the requirements of a listing; however many may be awarded benefits based upon a medical vocational allowance.
Due to the nature of autoimmune disorders such as lupus, many claimants benefit from medical vocational allowances simply because Social Security considers an individualís age, education, functional limitations, and work skills when making a medical disability determination on a claim.
Return to: Social Security Disability Resource Center, or read answers to Questions
Related Body System Impairments:
Filing for Social Security Disability or SSI with Crohn's Disease
Facts about Crohn's Disease and Filing for Disability
Social Security Disability SSI and Filing based on Lupus
Polychondritis and Filing for Disability
Bursitis and Filing for Disability
Undifferentiated Connective Tissue Disease and Filing for Disability
Costochondritis and Filing for Disability
Ankylosing Spondylitis and Filing for Disability
Polymyositis and Filing for Disability
Hidradenitis Suppurativa and Filing for Disability
Behcet's disease and Filing for Disability
Lupus, Social Security Disability, and Applying for Benefits
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria