February 7, 2018 | Andrew Mathis, Mathis & Mathis Disability Advocates
Most people don’t understand what it’s like to have lupus. It’s a debilitating disease with complicated symptoms that can change and worsen over time.
If you — or someone close to you — experiences lupus effects severe enough to make working impossible, there is an avenue for financial relief: Social Security Disability benefits.
Social Security is famous for providing retirement benefits. But in the event that health problems force you out of work before you reach retirement age, Social Security also has disability programs that act as a form of insurance.
These programs provide monthly checks and qualify you for government-run medical insurance through Medicare or Medicaid.
Winning those benefits, however, is hard.
As a professional disability advocate, I see the challenges people face with lupus — and with being denied disability benefits — all the time.
But with a serious condition like lupus, a carefully built application can secure your benefits and help you maintain your financial independence.
In this post, I’ll explain how Social Security approaches lupus as a qualifying disability.
What is Chronic Lupus?
The Lupus Foundation of America defines lupus as a chronic autoimmune disease that can damage any part of your body –– skin, joints, and organs –– affecting 5 million people worldwide, with more than 16,000 new cases reported each year.
“Chronic” means the signs and symptoms last longer than six weeks and often for years.
With the right medical care, the Lupus Foundation says, most people with lupus can lead a full life.
But severe cases of lupus can become a disability. Lupus can even be fatal.
Common symptoms, according to the Lupus Foundation, include:
- Extreme fatigue
- Painful or swollen joints
- Pain in chest on deep breathing (pleurisy)
- Sensitivity to sun or light
- Hair loss
- Abnormal blood clotting
How Lupus Qualifies for Social Security Disability
Social Security maintains a list of official qualifying diseases, called its “Blue Book,” and lupus is included on the list.
For Social Security’s purposes, lupus qualifies as a disability when it meets these conditions:
- It involves two or more organs or body systems.
- It includes at least two major signs or symptoms, such as severe fatigue, fever, malaise, and involuntary weight loss.
If lupus symptoms occur repeatedly, the disease qualifies as a disability when it causes these limitations:
- Limitation of daily living activities
- Limitation of social functioning
- Limitation in completing tasks in a timely manner because of problems with concentration, persistence, or pace
Social Security also has rules that apply to every kind of disability:
- You must be unable to continue in past work.
- You must be unable to adjust to other work.
- Your condition must be expected to last at least a year.
Why is it Hard to Win Social Security Disability Benefits?
The Social Security Administration is grappling with years of cuts to the resources it needs to run its programs. It also faces political pressure to avoid granting benefits to anyone who doesn’t deserve them.
So applying for disability benefits is complicated and confusing, filled with long forms and thousands of rules, regulations, and procedures.
In recent years, Social Security and other observers — including me — have reported that most people get denied when they first apply. As many as two-thirds of initial applications for disability benefits get turned down.
When you’re denied, your next step is to appeal. A key step in appealing is going to a hearing with a Social Security administrative law judge. But, as many news reports have shown, Social Security has a backlog of more than 1 million people waiting for hearings. The wait can last more than a year.
A condition like lupus comes with particular challenges in convincing your claims examiner that your health problems are severe enough to warrant benefits.
Lupus has a wide variety of symptoms. Many of them— like fatigue — are difficult for someone else to observe. The symptoms change over time.
But if you have lupus and Social Security denies your application for benefits, you should appeal. Appeals are often when people succeed at winning benefits.
You can get help with your appeal from a professional Social Security Disability advocate. This is what we do at my firm in the Washington, D.C. area.
Most professional advocates will provide a free initial consultation on your case. And most only charge a fee when you win benefits.
Experienced advocates deals with the Social Security system every day. They know how to build your appeal to give you the best chance of winning benefits, including gathering all-important medical evidence.
What Medical Evidence Do You Need?
Social Security calls medical evidence the “cornerstone” for proving a disability application.
The most important evidence you can provide comes from medical professionals who treated you for your impairment.
Hold on to all of your medical records from treatment for lupus. You’ll need these records for your application or appeal. A professional advocate can also help you gather all the evidence you need.
Social Security looks for evidence of these main points:
- Existence of impairment, including the “objective medical evidence” that you have an impairment
- Severity of impairment, establishing how your impairment affects your ability to work
- Non-medical sources, including statements from coworkers, family members, and others who know you
What Forms Do I Need?
Applying or appealing for Social Security Disability benefits means filling out a lot of forms.
Here are a few key ones:
- The Disability Report, Adult, FORM SSA-3368-BK
- The Work History Report, FORM SSA-3359-BK
- The Recent Medical Treatment Report, FORM HA-4631
- The Medications Report, FORM HA-4632
- The Hearing Request, FORM HA-4632
My firm’s website includes descriptions of these and other forms you might encounter in the process of applying for disability benefits.
Do I Have a Disability Case for Lupus?
If your lupus is keeping you from working, you may qualify for Social Security Disability benefits.
Don’t be afraid to apply — or appeal if you’re denied. And don’t hesitate to reach out and get help. Too much is at stake.
When health problems have changed everything, those monthly checks can help you move forward with your life.
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Andrew Mathis is an Accredited Disability Representative (A.D.R.) serving the Washington, D.C. area. He leads Mathis & Mathis Disability Advocates and has spent more than 25 years helping people secure the disability benefits they need.