The Social Security Administration recognizes that lupus (Systemic lupus erythematosus) can support a finding of “disabled” under Social Security’s definition. As those who suffer with this condition know very well, lupus falls within the category of autoimmune diseases. 1 Normally, the body creates antibodies to defend itself against viruses and bacteria. In an autoimmune disease like lupus, the body does not “recognize” its own cells and tissues and creates antibodies to attack those cells and tissues.
According to the Lupus Foundation of America web site, inflammation is the primary feature of lupus. In mild cases, lupus may cause achy or swollen joints, rashes, fatigue and sensitivity to sunlight. In more severe cases, lupus patients may experience problems with kidney function, anemia, blood clotting problems, Raynaud’s syndrome (cold fingers and toes) or seizures.
Because lupus patients experience a wide range of symptoms and the disease is a progressive condition that can create activity limitations that range from mild to severe, it is not enough to appear before the Social Security Administration with a diagnosis of lupus and expect to win. It is certainly helpful to have a clear diagnosis of lupus and on-going treatment records, but in my experience you will need to show that your symptoms create more than mild discomfort and inconvenience.
Objective Criteria for a Lupus Diagnosis
There are generally accepted medical criteria that support a diagnosis of lupus. These criteria include clinical observation of symptoms by your doctor and positive lab tests for lupus. Not surprisingly, Social Security judges prefer to see lab test results that document your lupus (such as elevated SED rate, abnormal kidney enzymes, positive ANA test).
In my experience, some of the factors that judges look for when evaluating lupus cases include:
- positive lab tests clearly demonstrating lupus diagnosis
- medical records that document the clinical symptoms of the disease
- long and on-going treatment history
- evidence that you have been compliant with treatment, and that your symtoms remain despite your best efforts to treat them
- evidence (which can be your testimony) of extreme fatigue associated with your diagnosis
Approaches to Winning a Lupus Case
There are basically two ways to win a lupus case:
- meet a listing at 14.02 (Systemic Lupus Erythematosus)
- residual functional capacity – prove that even if you do not meet a listing, your functional capacity for work has been so reduced by the symptoms associated with your lupus that you would not be a reliable employee. This strategy can work if you have a mild to moderate case of lupus in addition to other medical or mental health conditions.
My experience has generally been positive in convincing judges that my lupus clients are disabled. Lupus is a recognized autoimmune disease that lends itself to a more objective diagnosis than other autoimmune conditions like fibromyalgia and chronic fatigue syndrome. Judges also recognize that lupus is a progressive and chronic condition without a “cure.”
Lupus Cases that can be Difficult
The cases that have been more challenging are those where a family doctor makes a diagnosis of lupus but does not refer to the published diagnostic criteria accepted by the medical community. You may also have difficulty if you do not seek on-going medical treatment with a rheumatologist for your lupus – judges expect you to be compliant with your medical regimen and to see your doctor several times a year. A judge may also question whether a non-specialist has sufficient training to diagnose and treat lupus. In other words, a diagnosis of lupus by your family doctor four years ago with minimal follow-up and a record that contain multiple other diagnoses for your fatigue and rashes will probably not be enough.
Finally, I occasionally see clients with non-systemic forms of lupus. There is a family of lupus that affects the skin, which is called subacute cutaneous lupus. Arguably a claimant subacute with cutaneous lupus can “equal” the listing since the skin is an “organ” and the listing calls for involvement of an organ or body system, but these cases can be more challenging.
Lupus Disability Case Study #1: 46 year old high school teacher claiming disability based on lupus joint pain, rib cage pain, fatigue and medication side effects
- SLE or Systemic Lupus Erythematosus is the most common form of lupus. However, other forms of lupus such as Discoid Lupus can also support a finding of disabled. ↩