SSDI Benefits Could Help Those With Lupus

Does Your Lupus Qualify You For Social Security Disability Benefits?

If you have lupus, you may qualify for Social Security Disability Insurance (SSDI).

To find out if you qualify, review your condition under the Social Security Administration’s (SSA) five-step sequential evaluation process:

1. Are you working? The SSA defines work as the ability to engage in substantial gainful activity (SGA). If you are working and earning more than SGA, your benefits will be denied. To qualify, your condition must prevent you from working for at least 12 continuous months.

2. Your condition must be severe enough to limit significantly your ability to perform basic work activities like:

• Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling.
• Seeing, hearing and speaking.
• Understanding/carrying out and remembering simple instructions.
• Responding appropriately to supervision, co-workers and work situations.
• Dealing with changes in a routine work setting.

A recent study tracked more than 2,000 people with lupus and found the average cost for treatment in the year after diagnosis is: 1. $13,415 for mild lupus. 2. $29,512 for moderate lupus. 3. $68,260 for severe lupus. Hospitalizations and outpatient visits were the leading cost drivers.*

*Source: Disease and economic burden increase with systemic lupus erythematosus severity 1 year before and after diagnosis: a real-world cohort study, United States, 2004–2015 | Lupus Science & Medicine (bmj.com).

3. Does your lupus meet or equal a medical listing? Lupus is listed under Immune System Disorders (Listing 14.0), and has several specific medical listings or categories. To satisfy the listing criteria, your lupus must have:

14.02 Systemic lupus erythematosus (SLE). As described in listing 14.00D1. With:
A. Involvement of two or more organs/body systems, with:

1. One of the organs/body systems involved to at least a moderate level of severity; and
2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).

OR B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise or involuntary weight loss) and one of the following at the marked level:

1. Limitation of activities of daily living.
2. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

If your lupus doesn’t satisfy a medical listing, the SSA continues to the next two steps to review how your limitations and symptoms affect your ability to work.

4. Can you perform work you’ve done in the past? If you can, benefits are denied. If you cannot, the process proceeds to the last step.

5. Are you capable of performing other work? SSA will review vocational factors (age, education, work experience), to determine what other work, if any, you can do. At this step, the SSA enlists medical-vocational rules. If SSA finds there is other work you can perform, benefits are denied. If SSA finds you do not have transferable skills to do any other work, benefits are awarded.