Lupus and Social Security Disability Benefits

Lupus and Social Security Disability Benefits in Sacramento, CA

Lupus, an enduring autoimmune illness, has the potential to impact various areas of the body such as the skin, joints, and organs. While some individuals with lupus can manage their symptoms through treatment, others experience significant limitations.

“In situations where a lupus diagnosis hinders your ability to work, you might be eligible for Social Security Benefits. “

To apply for these benefits, it is necessary to provide substantial evidence of a long-term disability. If you are living with lupus and require assistance, Jon Sipes, an experienced attorney specializing in disability law, can offer guidance in obtaining Social Security Disability benefits. With decades of experience, Attorney Sipes has helped numerous individuals in California with disabling conditions secure the benefits they deserve.

What Are Social Security Benefits?

Under the Social Security system, there are two main types of benefits available: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both forms of benefits generally require individuals to have a prolonged condition that prevents them from working.

The eligibility for SSDI or SSI depends on whether the person has worked and made contributions to the Social Security System. For SSDI, eligibility factors include the applicant’s age, the number of years worked, and the amount contributed to the system. To be eligible for SSDI, one must have worked for a portion of the past ten years.

SSDI payments are calculated based on the amount of Social Security payroll taxes paid during the individual’s employment history. On the other hand, SSI payments are determined by a set amount established by Congress. Consequently, monthly SSDI payments tend to be higher compared to SSI payments.

If someone is not eligible for SSDI, they may still qualify for SSI. SSI is a need-based program designed to support the elderly, individuals who are blind, and those with other disabilities.

Am I Eligible for Social Security Benefits?

The Social Security Administration (SSA), a government agency responsible for managing Social Security benefits, carries out the task of assessing benefit applications and evaluating applicants’ eligibility. To approve a benefits application, the SSA must determine that the applicant has a long-term disability.

According to the SSA, a long-term disability is defined as a medical condition that is expected to last for at least one year or result in death. Disabilities can arise from various circumstances, including physical injuries, chronic medical conditions, or mental illnesses. When evaluating an application, the SSA employs multiple tests to ascertain whether a disability prevents the applicant from engaging in any form of work.

In addition to being long-term and significant, the applicant’s medical condition must also hinder them from participating in substantial gainful activity (SGA). SGA refers to activities that generate income surpassing a specified threshold. As of 2021, Congress has established the SGA threshold at $1,310 per month or higher. It’s important to note that this amount is subject to annual adjustment.

What is Lupus?

Lupus, scientifically referred to as systemic lupus erythematosus (SLE), is a complex and chronic autoimmune disease. It manifests when the body’s immune system, which is designed to protect against harmful invaders, mistakenly starts attacking its own healthy tissues and organs. This relentless immune response can target various systems within the body, including the skin, joints, and crucial organs like the heart, lungs, and kidneys.

The unpredictable nature of lupus further adds to the complexity of the disease. Flare-ups, periods of increased disease activity, can occur unpredictably, causing a sudden worsening of symptoms and requiring additional medical attention and support. Moreover, the symptoms and severity of lupus can vary significantly from person to person, making it a highly individualized condition that necessitates personalized treatment approaches.

For those individuals whose lupus symptoms significantly impair their daily functioning and quality of life, the road can be particularly challenging. Basic tasks that many take for granted, such as working, exercising, or engaging in social activities, may become daunting or even impossible. The physical and emotional toll of lupus can be overwhelming, impacting not only the individual diagnosed but also their loved ones who provide support and care.

Is Lupus A Disability?

Lupus can potentially meet the criteria for disability according to the Social Security Administration (SSA). The SSA has a specific listing of impairments, and lupus is explicitly mentioned as one of the conditions that may qualify as a disability.

To qualify as a disability, lupus must meet certain criteria. Firstly, it should affect at least two bodily systems or organs, such as the heart and lungs, or the brain and kidneys. Alternatively, lupus must cause a combination of at least two specific symptoms. These symptoms include frequent exhaustion resulting in low physical or mental activity, recurring fever, malaise (a general feeling of discomfort or illness leading to reduced physical or mental activity), and involuntary weight loss.

In the case of adults, the SSA also considers the impact of recurring symptoms on daily functioning. To meet the criteria, an individual must experience at least two of the above symptoms, which in turn significantly limit their ability to engage in daily activities, impair social functioning, or hinder their capacity to complete tasks on time. Furthermore, these symptoms should interfere with the ability to function independently, appropriately, and effectively.

It’s important to note that meeting these criteria is just one aspect of the evaluation process for disability benefits. The SSA assesses an individual’s medical records, treatment history, and overall functional limitations to determine eligibility for Social Security Disability benefits related to lupus.

How Is Lupus Diagnosed?

In order to establish a diagnosis of lupus for Social Security Administration (SSA) purposes, the criteria defined by the American College of Rheumatology (ACR) must be met. The ACR has established eleven criteria for lupus, and a patient must fulfill at least four of these criteria to receive a lupus diagnosis. The criteria include:

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Renal disorder
Neurologic disorder
Hematologic disorder
Immunologic disorder
Antinuclear antibody

When applying for disability benefits based on lupus, the SSA requires the inclusion of medical evidence that demonstrates these symptoms. This evidence may consist of a doctor’s observations, medical records, and laboratory test results. By providing comprehensive medical documentation, the applicant can support their claim for disability benefits related to lupus.

Is it possible to qualify for disability benefits even if I do not meet the specific criteria outlined by the Social Security Administration for individuals with lupus?

Yes, it is possible to still qualify for disability benefits even if you do not meet the exact criteria set by the Social Security Administration (SSA) for individuals with lupus. The SSA considers the overall impact of your medical condition and its effect on your ability to work and perform daily activities. While meeting the specific criteria can provide strong evidence for your case, it is not the only factor considered.

The SSA evaluates each disability claim on an individual basis, taking into account your medical records, treatment history, functional limitations, and the severity of your symptoms. Even if you do not meet the exact criteria, if your lupus condition significantly impairs your ability to work and perform substantial gainful activity, you may still be eligible for disability benefits.

It is crucial to provide comprehensive medical evidence, including doctor’s reports, laboratory test results, and any other relevant documentation, to support your claim. This evidence should demonstrate the impact of lupus on your daily life, limitations in functioning, and your inability to sustain employment. Consulting with a knowledgeable disability attorney or representative can help you navigate the application process and increase your chances of receiving the benefits you deserve.

What Happens if a Disability Claim is Denied?

In the event of a denial of a disability claim based on lupus by the Social Security Administration (SSA), you have the opportunity to appeal the decision to an Administrative Law Judge. During the appeal process, you will need to present a compelling case explaining why your lupus should be recognized as a disability.

It is important to note that if your initial application and subsequent appeal are still denied, you should not lose hope. Lupus is a degenerative disease that tends to worsen over time. Therefore, if your condition deteriorates and significantly impacts your ability to work and perform daily activities, it is advisable to refile an application for disability benefits. It is crucial to provide updated medical documentation and evidence of the progression of your lupus to support your claim.

By reapplying and emphasizing the worsening of your condition, you increase the chances of a successful claim for disability benefits. Consulting with a disability attorney or representative can provide valuable guidance and assistance throughout the process, improving your chances of receiving the benefits you are entitled to.

Securing excellent representation is essential for a successful disability hearing and ultimately obtaining the benefits you deserve. Jon Sipes offers exceptional advocacy to ensure your rights are protected throughout the process. As his client, he will thoroughly explain your rights and tailor the best strategy for your disability hearing.

With a deep understanding of the medical and financial hurdles you are encountering, Jon Sipes is committed to your case. He operates on a contingency fee basis, meaning you will not be responsible for attorneys’ fees unless he successfully secures benefits on your behalf. Your best interests are his priority.

To take the first step towards a consultation and to discuss your situation further, please reach out to our office today. We are here to assist you in navigating the complexities of the disability claims process.

This information included on these pages does not constitute legal advice and should be used as such. They are for informational purposes only.