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Social Security Disability SSI and Filing based on Lupus


How to prove you are disabled
and win disability benefits


 
About the disorder

SLE or lupus is an inflammatory immune disorder that can affect any body part. For example, SLE may harm joints, heart, kidneys, lungs, skin, blood vessels or even the nervous system. While lupus is incurable and can be fatal it can most often be treatable. Unfortunately the disease course is often unpredictable because of alternating periods of exacerbation and remission. The symptoms of lupus are severe fatigue, joint pain, fever, myalgias, involuntary weight loss, skin rashes, anemia, headaches, and multitude of other potential symptoms dependant upon the body system or organ affected.

Significant organ or body system involvement might include the following conditions: cardiovascular (pericarditis, vasculitis, endocarditis, myocarditis), respiratory (pneumonitis, pleuritis), neurological (seizures), renal (glomerulonephritis) hematologic (leukopenia, thrombocytopenia, anemia), mental (mood disorders, anxiety, fluctuating cognition or lupus fog, psychosis, organic brain syndrome), skin (ulcers, rashes, photo sensitivity), or even other immune disorders (inflammatory arthritis).

How the social security administration evaluates Lupus cases

Social Security has a specific impairment listing in their disability guidebook or blue book, as it is more commonly known. Impairment listing 14.02 lists the criteria needed to meet or medically equal the severity requirements of the Social Security disability program if a person has SLE or lupus.

The disability applicant must have a diagnosis of SLE or lupus with: A. involvement of two or more body systems or organs. Additionally, one of the organs or body systems must involve at least a moderate level of severity; and two or more constitutional signs or symptoms (i.e. fever, severe fatigue, malaise, or involuntary weight loss). OR B. Recurring manifestations of SLE, with two or more of the constitutional symptoms or signs and one of the following at a severe or marked level:

1. Limitation in maintaining social functioning.

2. Limitation in completing tasks timely because of deficiencies in persistence, pace, or concentration.

3. Limitation of activities of daily living.

Social Security considers the affects of lupus as it does any other medical or mental impairment. Lupus is a severe impairment if it prevents a person from working at a self-supportive level (Social Security has a monthly earnings amount that it considers self supporting – SGA) for twelve continuous months or more.

If a person does not specifically meet or equal the listing severity criteria of the lupus impairment listing, they may still be approved for disability benefits. Social Security has another method of approving individuals for disability. If a person is unable to work because of the limitations of lupus, they may be approved for disability through a medical vocational allowance.

Social Security disability examiners are able to consider a person’s residual functional capacity (what they are able to do in spite of limitations of their lupus), age, education, past work activity and their ability to perform other types of work when their limitations are considered. If the disability examiner finds that their residual functional capacity is so restrictive it precludes their past work or jobs or any other work, they may be approved for disability benefits.


Can you qualify for disability benefits with this condition?

Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records. This includes whatever statements may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis).

It will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).

Why are so many disability cases lost at the disability application and reconsideration appeal levels?

Speaking as a former Disability Claims Examiner, I can state that there are several reasons:

1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant and his or her disability attorney will generally obtain and present this type of statement to a judge;

2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. At the hearing level, of course, this is exactly what happens. And a number of disability representatives will also take such steps even earlier, at the reconsideration appeal level;

3) Disability judges, unlike disability examiners who decides cases at the first two levels of the system, can make independent decisions without being overturned by immediate supervisors--which happens frequently.















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Information on the following topics can be found here: Social Security Disability Questions

Social Security Disability SSI decisions | The Disability Decision Process and What gets taken into Consideration | Getting Denied for Disability Benefits | Questions about Social Security Disability Approvals and Being Approved | Social Security Disability Hearings | Social Security Medical Examinations | Social Security SSI Doctors | Social Security Disability Representation | Social Security Disability SSI Reviews