Lupus can be severe enough to force you out of work. When it does, you may qualify for disability benefits from the Social Security Administration, or as service-connected compensation from the Veterans Administration, or if you are covered under a disability insurance policy.
Unfortunately, winning a lupus disability claim isn’t easy. Claims based on this debilitating disease are frequently denied on the initial filing and at the appeal level. If this has happened to you, do not lose hope. Specific obstacles must be overcome in lupus disability cases.
As disability attorneys, we see the difficulties faced by people living with lupus and the ensuing hardship when benefits are denied. With a complex condition like lupus, it takes a carefully constructed initial claim or the well-founded appeal of a denied claim to secure your deserved benefits and help you sustain financial independence.
Chronic Lupus Attacks in the Prime of Your Working Life
Lupus is a disease where a person’s immune system attacks and destroys the good, healthy tissue of the body. People develop lupus in the prime of life, usually between the ages of 15-44. Of the 1.5 million Americans diagnosed with lupus, ninety percent are women. The disease is two to three times more common among people of color.
Lupus can attack any part of your body: skin, joints, or internal organs such as kidneys, lungs, heart, mucous membranes, and the nervous system. Symptoms vary widely, and many are hard to pin down.
Symptoms include fever, rashes, painful and swollen joints, excessive fatigue, headaches, and weight loss. Both cognitive and physical impairments can affect every facet of life, from “lupus fog” and memory problems, to pleurisy, heart attack, or stroke.
The most common form of lupus is systemic lupus erythematosus (SLE). No single test can diagnose SLE. With such a variety of symptoms, getting a true diagnosis can take several years of targeted medical testing, careful review of your signs and symptoms, and medical and family histories.
Lupus and Social Security Disability Benefits
Social Security acknowledges that lupus can cause a person to become affected to the point they can no longer work and earn a gainful living. But a diagnosis of lupus is not enough to qualify for and receive Social Security Disability Insurance benefits, or SSDI.
Social Security offers two ways to qualify for SSDI:
- The first way is by proving you meet or equal the medical listing for lupus in SSA’s Listing of Impairments. Systemic lupus erythematosus (SLE) appears in the Immune System Disorders section 14.00.
SSA’s medical listing gives you two paths:
- You have to show that lupus affects two or more organs or body systems, and you have at least two of these constitutional symptoms: fatigue, fever, malaise, or involuntary weight loss.
– or –
- You must show repeated evidence of SLE with at least two of the constitutional symptoms (severe fatigue, fever, malaise, or involuntary weight loss) plus marked limitation of one of the following:
- Activities of daily living
- Ability to function socially
- Ability to timely complete tasks due to deficits in concentration, stamina, or keeping pace.
- If you do not meet or equal the above medical listings, Social Security also has rules that apply to every kind of disability. You may still be able to prove you are disabled through a “residual functional capacity” (RFC) evaluation. This is known as a medical-vocational allowance. SSA needs to find that your condition causes enough functional problems that you cannot do your past work or any other work.
This final condition – proving you are unable to work – is perhaps the most important piece of the Social Security disability puzzle. Most SSDI cases are ultimately resolved in this way.
Insurance Companies Will Challenge Your Lupus Disability Claim
Generally speaking, insurance carriers do not make it easy for those who have lupus to get the benefits that they deserve. Lupus is a prime example of disability denials based on the grounds that you are not “disabled enough” and should be able to work.
Some insurers even earmark legitimate claims based on lupus as targets of denial, to minimize the payout. By its very nature, the disease is unpredictable, with periods of flare-ups and remissions. Lupus does not follow a typical course of development. Many insurers will pounce on these and other features of lupus to manipulate them into grounds for denial.
You must be prepared for these and other tactics by insurers who would rather not pay. With reinforced proof and testimony of how lupus affects your everyday activities, and a strong narrative showing the lack of functional capacity to work, the better your claim will stand up to an insurer’s wrongful denial.
We urge that you consult with us as soon as possible to maximize your chances for a successful initial claim, to appeal a denied claim, or if a lawsuit becomes necessary.
Our attorneys understand the complicated medical facts surrounding lupus. We work in close collaboration with treating doctors and experts. We will develop the evidence necessary to support your claim and challenge insurance companies’ physicians and other experts who would attempt to deny your rightful benefits.
Obtaining VA Benefits for Lupus
Getting fair veterans’ disability compensation for lupus can be a tough fight. This is often due to the difficulty in diagnosis and insufficient presentation of the claim, only made worse by a VA system still grinding out thousands of unpaid and overdue disability claims.
But even with its complicated nature as an autoimmune disease, the VA recognizes that military service connection creates a higher risk for veterans to develop lupus. Many times, the VA rates lupus disability claims too low. The amount of service-connected compensation awarded for lupus is based on how severely you are disabled by lupus. The ratings vary widely, from 10% to 100%. In VA’s Schedule for Rating Disabilities, lupus is bundled together with Infectious diseases, immune disorders, and nutritional deficiencies.
The rating schedule lists both Systemic Lupus and Cutaneous Lupus. Both forms cannot be used in a claim; but if both internal tissues and the skin are affected, VA assigns the code for the type of lupus that gives the higher rating.
Likewise, if lupus harms tissues that have created other impairments, such as arthritis affecting mobility in your knee, disability may be rated under a single symptom when that rating is higher.
Establishing your rights as a veteran to service-connected disability benefits tied to lupus – while securing a satisfactory rating – can be a complicated and frustrating endeavor on your own. Our veterans’ attorneys can assist through all phases of the VA disability claim and appeal process.
Your Best Option for Success
A condition like lupus comes with particular challenges in convincing a claims examiner that your health problems are severe enough to warrant benefits. For help with your initial lupus disability claim application, or if you have recently been denied disability benefits for lupus, please contact us today for a free legal consultation. We can assist you wherever you live in the United States.