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Disability Benefits for Lupus (SLE)

Lupus 1 orig

Rheumatoid Arthritis (“RA”) and Systemic Lupus Erythematosus (“lupus”) are examples of Autoimmune Disorders (which are sometimes called “Connective Tissue Disorders”). These are potentially serious illnesses where a person's own immune system goes “rogue” and attacks the body, rather than protecting the body from infection. In effect, the immune system becomes hyperactive and uncontrolled, causing inflammation and damage to many parts of the body, including the joints, muscles, skin, and, in some cases, the internal organs.

Systemic Lupus Erythematosus (SLE)

In lupus, the immune system can attack not only the joints (as in RA), but it frequently attacks the skin (“butterfly” rash), the lungs (“interstitial lung disease”), kidneys (“glomerulonephritis”), central nervous system (brain and spinal cord), and the liver (“autoimmune hepatitis/cirrhosis”).


Other Autoimmune Disorders


Although RA and lupus are some of the more common disorders, there are many others. In all of them, it's the immune system that is at fault, causing persistent inflammation and damage to various parts of the body.
In Polymyositis (PM) and Dermatomyositis (DM), the muscles (PM) and the skin (DM) are inflamed, which causes debilitating muscle weakness (“myopathy”) and skin rashes.


In Vasculitis, the blood vessels become inflamed, causing rashes and tissue damage.
In Psoriasis and Psoriatic Arthritis, the skin and the joints become inflamed, causing plaques on skin and damage to the joints.


In Ankylosing Spondylitis, the spine and sacroiliac joints become inflamed, causing back pain and stiffness, and loss of motion as the disease progresses.

In Ulcerative Colitis and Crohn's Disease, the inflammation is in the intestinal tract and colon, with abdominal pain, diarrhea, gastrointestinal bleeding, and other problems.


In Scleroderma, the disease can affect the skin, lungs, gastrointestinal tract, and kidneys. Wegener's Granulomatosis (now called “Granulomatosis with Polyangiitis”) affects the sinuses, lungs, and kidneys. Sjogren's Syndrome causes dryness of the eyes and mouth (“sicca syndrome”), and it can cause swelling of the parotid glands, salivary glands, and peripheral neuropathy. All these disorders can cause disabling symptoms, such as severe musculoskeletal pain, decreased stamina, chronic fatigue, and exertional limitations that include impaired ability to sit, stand, lift, and carry.


You Need “More Than a Diagnosis”


The “diagnosis” of an autoimmune disorder is just the starting point for your disability application. Having a bad or a serious illness, like lupus, doesn't automatically get you a disability award. Neither does being on serious medications, such as corticosteroids (prednisone), immunosuppressive drugs (methotrexate), or “biologics” (Enbrel or Humira), that may be required to treat an autoimmune disorder.


Even cancer patients, who are being treated with chemotherapy, do not automatically qualify for disability benefits.
That's because Social Security looks at not only what diagnosis and symptoms you have, but, more importantly, how your symptoms impair your ability to function and perform work-related activities.


We like to think of this as a three-step process. (1) What is your diagnosis? (2) What are your symptoms? (3) What is your impairment (i.e., specific work-related activities that you cannot do)? Doctors are generally pretty good at documenting, in the medical record, a patient's diagnosis and symptoms. That comes “naturally” to them, because that's the information they need to keep track of, after each office visit, as part of your treatment program. However, doctors typically don't do a good job at documenting a patient's impairments, because they are not used to doing that, and it's usually not “necessary” for treatment purposes.

However, your functional impairment is precisely the information that your doctor must enter into your medical records, if you want a good chance at getting disability benefits. However, for your doctor to do that, you must do your part and tell your doctor, at each office visit, not only what your symptoms are, but how they impair what you can and cannot do.

For example, if you have rheumatoid arthritis (“diagnosis”), and your RA causes you to have severe pain and swelling in your hands, knees, and feet (“symptoms”), your doctor will typically document your diagnosis and symptoms as a matter of course, but he must also document how your symptoms prevent you from performing certain activities (“impairment”).

The way Social Security likes to do that, is to have your doctor document how much you can do in an 8-hour workday in terms of sitting, standing/walking, and lifting/carrying. In other words, you have certain limitations that are specified as a result of your symptoms - that the most you can sit is ____ hours, stand or walk for ____ hours, and lift or carry ____ pounds - these are your physical limitations that result in a Residual Functional Capacity (RFC) determination.

In addition, if your doctor documents (if applicable) how many hours, during an 8-hour day, your symptoms (pain, fatigue) require you to lie down and rest, These are examples of how the doctors can specify the connection between the medical condition and the resulting limitations. The devil is in the details so to speak.

Many Doctors Don't Understand How to Prepare a Disability Report


A common issue and pet peeve of judges is that sometimes the doctor documents his opinion that the patient "is disabled" and "cannot work" - the reason judges are annoyed by this (and lawyers) is that it is not the role of the doctor to determine that (in the context of a disability application) but rather that is the jurisdiction and power of the Social Security and the Administrative Law Judge (“ALJ”), at your Disability Hearing. In other words, there is the SSA's definition of disability that you must prove up to the Judge with the support of your medical documentation and testimony.

Get a Good Doctor


With that in mind, you must get a good doctor. With RA, lupus, and other autoimmune or connective tissue disorders, your doctor should be an expert (e.g., in this case a rheumatologist) in diagnosing and treating your condition. In addition, for purposes of Social Security disability, he must also understand how to document your impairment as well as your diagnosis and symptoms. 

SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).

SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work. 

SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.


Conclusion

A diagnosis of RA or lupus, by itself, is usually not enough to successfully get Social Security disability benefits. It's also not enough for your doctor just to document your symptoms (e.g., joint pain, fatigue, etc.), without specifying what work-related activities (sit, stand/walk, carry/lift) you are unable to perform. A doctor who, in good faith, issues a disability report that is conclusory (e.g., “My patient is permanently disabled from performing any work”) may hurt your chances of getting a disability award. He needs to do more. 

 SSA "Listing" or "Blue Book" description for SLE can be found here (See 14.02)

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