Can You Get Disability for Lupus?
The Lupus Foundation estimates that about 1.5 million Americans are affected by systemic lupus erythematosus (SLE). It is a chronic autoimmune disease in which the body’s immune system attacks and damages healthy cells and tissue. Lupus often prevents individuals from performing activities of daily living due to symptoms such as fatigue, joint pain, and frequent fevers. These symptoms often flare up unexpectedly, leading to frequent work absences and difficulty maintaining a consistent schedule.
Written by:
Linda Cosme-Vice President of DIsability Policy & Strategy, Citizen’s Disability
If your lupus prevents you from earning a stable income, you may qualify for financial assistance through the Social Security Administration. To qualify for Social Security Disability Insurance benefits, or SSDI, you must have paid a sufficient amount into Social Security through payroll taxes and have a severe medical condition that has lasted at least 12 months to meet the definition of disability. Supplemental Security Income benefits, or SSI, may be available regardless of your work history if your condition qualifies as a disability and you have limited income or resources.
Does Lupus Qualify for Disability Benefits?
Yes, lupus often qualifies for disability benefits through the SSA. However, not everyone with the condition is eligible for Social Security benefits. The SSA evaluates eligibility on a case-by-case basis.
You must meet the SSA’s definition of disability and have accumulated sufficient work credits to qualify for SSDI benefits. To qualify for SSI benefits, you must have a disabling condition that meets the SSA’s requirements, and your income and resources must not exceed certain limits.
You must have earned sufficient work credit to qualify for SSDI. You can earn up to four work credits per year. When evaluating your eligibility, the SSA will look at the work credits you earned recently and the number of years you have worked in your lifetime. To earn work credits, you must pay Social Security taxes from your earnings. Typically, these are deducted from your paycheck. The work credits you need to qualify vary by age.
The SSA’s Listing of Impairments outlines the medical criteria for specific conditions to be considered disabling. The SSA determines eligibility by following a sequential evaluation process that examines five steps. v For the steps, see https://www.citizensdisability.com/applying-for-ssdi/evaluation-process/
Social Security Listing 14.02 describes the lupus-specific eligibility criteria. If an applicant meets or equals the Listing 14.02 requirements, the DDS can issue a favorable disability determination at step three of the process.
Eligibility Criteria for Lupus
To qualify under the Listings of Impairments, an applicant must have SLE, or systemic lupus erythematosus. There is a form of lupus that is not systemic. It is called discoid (or cutaneous) lupus erythematosus. The terms “discoid” and “cutaneous” mean that it involves only the skin. It rarely progresses beyond that and is typically not disabling because it does not affect the basic functions of the body. However, even the non-systemic lupus may limit a person’s residual functional capacity when combined with other conditions, and this can result in a favorable determination. In this case, having a strong and knowledgeable SSDI disability advocate can help applicants navigate the five-step sequential evaluation process for a successful outcome.
Under Section 14.02 – Immune System Disorders, there are two ways to qualify for lupus disability benefits under this listing. You only need to meet one of these two options to qualify.
Listing 14.02(A)
The SSA may consider you disabled if your lupus involves two or more organs or body systems. At least one of these organs or body systems must be moderate or severe. You must also have at least two of lupus’s constitutional signs or symptoms, which are those related to the entire body or its general health. Thus, qualifying symptoms may include malaise, severe fatigue, involuntary weight loss, or fever.
According to Social Security, major organ or body system involvement can include: respiratory (pleuritis, pneumonitis), cardiovascular (endocarditis, myocarditis, pericarditis, vasculitis), renal (glomerulonephritis), hematologic (anemia, leukopenia, thrombocytopenia), skin (photosensitivity), neurologic (seizures), mental (anxiety, fluctuating cognition (“lupus fog”), mood disorders, organic brain syndrome, psychosis), or immune system disorders (inflammatory arthritis).
Listing 14.02(B)
The second set of lupus disability criteria requires you to have repeated manifestations of systemic lupus erythematosus, meaning you experience frequent flare-ups. These flare-ups must involve at least two whole-body symptoms, such as severe fatigue or fever. Additionally, you must have at least one of the following:
- A significant limitation of activities of daily living, such as walking, bathing, getting dressed, or eating meals
- A significant limitation in maintaining social functioning, meaning you have difficulty interacting with others or participating in activities
- A significant limitation in completing tasks on time due to impaired concentration, persistence, or pace
RFC for Lupus
The SSA assesses your residual functional capacity, or RFC, when determining an applicant’s eligibility for lupus disability benefits. This measure helps the SSA determine what types of work you can still do on a regular basis despite your lupus. It considers limitations on strength-based, non-exertional physical, and mental work.
Social Security disability examiners and the state agency medical consultant are responsible for assigning RFC based on your medical records and daily activities, but your doctor may also provide a medical opinion that is supported with your laboratory and testing results. Lupus patients may have varying levels of function depending on the severity and type of symptoms they experience, but many have limited functional capacity. If your lupus symptoms significantly affect your ability to perform all or most types of work, your RFC may be limited, and you may qualify for disability benefits.
Living With Lupus and Receiving Disability Benefits
Some lupus patients qualify for both SSDI and SSI. You may be eligible to receive both types of benefits if you meet the lupus disability criteria for both programs. For example, you have worked in jobs covered by Social Security, have limited income and resources, and meet the Social Security definition of disability.
Social Security Disability Insurance
If you are eligible for SSDI benefits for lupus, your exact compensation will depend on your specific circumstances, including your work history. The average disabled worker receives around $1,537.70 per month from SSDI of June 2024. You may also qualify for Medicare benefits after 24 months on SSDI.
Supplemental Security Income
In 2024, SSI pays up to $943 per month to disabled individuals with limited income and resources. The SSA will determine your exact benefits based on your income and other factors.
Contact Us for Help Applying for Disability Benefits
Social Security benefits can be a lifeline for people living with lupus. If you or a loved one is unable to earn a stable living due to lupus, we can help. Our team is here to guide you through your options and navigate the application process to increase the likelihood of approval.
If the SSA has denied your initial application or request for reconsideration, Disability Advice can help you appeal the reconsideration determination with a Request for a Hearing by an Administrative Law Judge. You have 60 days to file an appeal, so now is the time to act. Contact us today to schedule a free consultation and see how we can assist you in getting the disability benefits you deserve.
- Free case evaluation
- Assist with denied claims
- Ensure you have all documents
- Make the process easy for you
Written by:
Linda Cosme-Vice President of DIsability Policy & Strategy, Citizen’s Disability
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“Professionalism at its best. From intake to getting my claim started, they are the ones you need. 100% recommend to everyone.”
Pablo P.
“Having never gone through this process before, it was very easy and straightforward. VERY professional and polite.”
Alan A.
“I had a great experience with my representative. She was very friendly and she made the process very easy. I’m glad I had the pleasure to work with her in filing my claim. She provided great customer service.”
Dana C.
“I was very nervous about reaching out for help with disability benefits. This experience was so much easier than what I thought it would be. They were understanding and supportive, and answered all of my questions. I would highly recommend them.”
Alice P.
“One of the best customer service experiences I have ever had. Patient and kind and couldn’t of made my experience better. Thank you for all the help.”
Jama M.
“The person I spoke with was very knowledgeable and very thorough with answering all of my questions and making sure all my information was correct. He was very patient, kind, and was very helpful. I wasn’t sure if I would qualify, and he checked and took all of my information. The process was made very easy, thank you so much for your help.”
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