Today we have a guest blog from an expert! Tim Moore, a former medicaid-disability caseworker, sent in this article for the blog on filing for disability when you have lupus (SLE):
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 individual’s 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 individual’s 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 individual’s 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 individual’s age, education, functional limitations, and work skills when making a medical disability determination on a claim.
The author of this article is Tim Moore, a former medicaid-disability caseworker and a former disability claims examiner for the social security administration's DDS, or disability determination services. Tim Moore is the publisher of The Social Security and Disability Resource Center.