Applying for Social Security Disability When You Have Lupus

When is the Right Time?

By Emily E. Warren, Esq.

The Social Security Administration recognizes Lupus as a medical condition that may prevent a person from working, resulting in an approval of disability benefits. To know when the right time to apply is, you should: understand the basic rules for each of the two Social Security disability benefit programs, review the medical and non-medical requirements of each program considering your own personal situation, and discuss with your medical provider whether he or she will support you in the disability process.

Social Security Disability Insurance and Supplemental Security Income Benefits

The two Social Security administered disability programs are called Social Security Disability Insurance (also known as SSDI) and Supplemental Security Income (also known as SSI). To be eligible to file for disability, you must meet the requirements of one of these two programs.

The SSDI program will look to your ten most recent years of work history to determine if you are eligible to participate. Each year you have the opportunity to earn up to four work credits by working and paying into the Social Security program. The dollar amount you must earn to gain one credit varies by year, but for 2024 you would need to earn $1,730 to earn one credit or $6,920 to earn all four credits for the year. Looking backwards, you must have earned 20 of the last 40 credits (preceding the date you became disabled) to participate in the SSDI program. In short, if you have worked (full-time) for five of the past ten years, you will be covered. The monthly benefit amount you would be entitled to will depend upon how much you have worked, earned, and paid in to the Social Security system over the life of your work history. Nonwork income will not impact your monthly benefit rate, but income from work activity might. If approved, you would also be entitled to Medicare benefits approximately 29 months after the first day that Social Security determines your disability began. These benefits may be paid up to one year prior to the date on which you filed your application.

The SSI program is based on financial and medical need. It looks at your family’s total resources to determine whether you are eligible to participate. As a family, you are not allowed to have more than one vehicle, one home (that you must also reside in), or resources of greater than $2,000 (as a single individual) or $3,000 (as a married person). The monthly benefit rate fluctuates by year, but currently the maximum monthly benefit rate is $943/month for an individual or $1,415 for a couple. If your resources exceed these limits, even after disability is approved, your benefit may be reduced or eliminated. The earliest date benefits could be paid under this program is the date of application. If your claim is ap - proved, you will also be awarded Medicaid coverage.

What Does It Mean To Be “Disabled”

The medical definition of disability under both the SSDI and the SSI programs is the same. You must be unable to work and engage in substantial gainful activity (SGA). This means you must not be able to earn more than the SGA amount each month. For 2024, SGA is $1,550. Therefore, you must be unable to work and earn $1,550 or more, as a result of your medical impairment(s). Also, it must be expected that your medical impairment(s) will keep you from working and earning this month for at least a period of twelve months. But, to be clear, you do not have to wait twelve months to file your application, you simply must have a reasonable belief that your condition will last that long at a level that would prevent you from earning SGA.

Not every medical diagnosis entitles you to an award of Social Security disability benefits. The condition must, first, be a medically determinable impairment,” which is a term of art defined by Social Security as:

A physical or mental impairment must result from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. The impairment must be established by objective medical evidence (signs, laboratory findings, or both) from an acceptable medical source, not on an individual’s statement of symptoms. 1

This condition must then meet additional criteria. It must either meet all of the requirements of a specific “listing” published by Social Security or your impairment or combination of impairments must prevent you from performing your past work or any other work that exists in the national economy in significant numbers.

For individuals seeking to receive disability benefits as a result of their Lupus diagnosis, the specific “listing” that must be met is Listing 14.02 – Systemic Lupus Erythematosus (SLE)2. Your Lupus diagnosis can meet the requirements of this listing in one of two ways. The first way to establish that it meets the listing is to show that two or more of your organs/body systems are involved, with one of the organs/ body systems being involved to at least a moderate level of severity, and, you must have at least two of the constitutional symptoms or signs of lupus (Severe Fatigue, Fever, Malaise, or Involuntary Weight Loss). The second way you can establish that your Lupus diagnosis meets the criteria for this “listing” is to show that you have had repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following limitations at a marked level: Limitation of activities of daily living; or Limitation in maintaining social functioning; or Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace. For clarity, Severe Fatigue means frequent exhaustion resulting in low activity. In order for Fever to be considered, it must not be caused by anything other than your SLE. Finally, Malaise means frequent feelings of illness or bodily discomfort (pain).

Emily Warren heads up the ERISA litigation section of Margolius, Margolius and Associates and has over 15 years of litigation experience in this area. She has worked extensively on ERISA / Long Term Disability, SERS, OPERS, STRS, and Social Security disability cases since joining the firm. Emily is a highly proficient writer and has enjoyed significant success at the Federal Court level in appealing Social Security disability cases. Emily also enjoys litigation in the civil rights areas of housing and employment discrimination. She handles these matters before the Ohio Civil Rights Commission (OCRC) and the Equal Employment Opportunity Commission (EEOC) and litigates these cases in Ohio state courts and the U.S. Northern and Southern Districts of Ohio. In addition, Emily champions the rights of the disabled working on ERISA disability claims (short and long term disability) in both the U.S. Northern and Southern Districts of Ohio and the U.S. Sixth Circuit Court of Appeals, advocating for an expansion of employee rights under ERISA. She has made this area of the law, which notoriously favors large insurance companies, one of her primary focuses. She is a past Chair and the current Treasurer of the Cleveland Employment Lawyers Association.

Even if your SLE does not meet each of the requirements of this Listing, you may still be entitled to disability. An alternative to meeting a Listing is to show that you have an impairment or combination of impairments that, when considered singly or in combination, renders you unable to sustain work activity.

You Are Ready To File For Disability, Now What?

If, after discussing your condition(s) with your doctor, you believe that you are ready to file for disability, you may do so in several ways. If you will be applying for both SSDI and SSI or just SSDI, you can file online at www.ssa.gov. You may also apply for either or both programs by going to your local social security office and doing so in person, or by calling the national Social Security hotline (1-(800) 772-1213), following the prompts for disability (until you get a live person on the phone) and asking them to make you a phone appointment to file for disability benefits.

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Set up a free appointment at 440-638-5224 or email lupuslegacy@interventionpoint.com