Can You Get Disability Benefits (SSDI or SSI) for Lupus?

Lupus, formally known as systemic lupus erythematosus (SLE), is a chronic auto-immune disease—specifically, a connective tissue disorder. Lupus affects multiple organs or body systems, such as the joints, kidneys, brain, intestines, or eyes. While some people with lupus have mild symptoms that are successfully managed with medication, others experience more significant impairments, such as cognitive problems or organ damage.

Is Lupus a Disability?

The Social Security Administration (SSA) awards disability benefits to adults who can't work full-time for at least one year due to a severe medical condition. Under the SSA's five-step disability determination process, this means needing to show either that you meet the requirements of a listed impairment or that you're unable to perform any jobs due to limitations from lupus symptoms.

Children can also qualify for disability for lupus, although the process is slightly different since the SSA isn't concerned about a child's ability to work. Instead, children can get benefits if they meet the medical requirements of the childhood lupus listing (which are similar to the adult requirements) or if they "functionally equal" the listing by having very significant limitations in multiple developmental areas relative to their peers.

Getting Disability for Lupus Under the SLE Listing

Listed impairments are conditions that the SSA considers especially serious. The agency can award you disability benefits "automatically," without having to determine whether or not you can work, if your medical records contain certain evidence required under a listing.

The criteria for listing 14.02, Systemic lupus erythematosus, are fairly complicated. You can satisfy the listing in one of two ways: provide documentation of multiple organ or body systems affected by lupus, or demonstrate significant limitations in several functional areas. Either way, you should have a diagnosis of lupus made according to the current "Criteria for the Classification of SLE" found in the most recent edition of the Primer on the Rheumatic Diseases.

Disability for Lupus that Affects Multiple Body Systems or Organs

One way you can qualify for disability under listing 14.02 is by showing that your lupus affects two or more body systems or organs, and one of the areas involved is affected to at least a "moderate" degree of severity. Examples of affected organs or body systems can include:

• kidneys and the renal system (lupus nephritis or glomerulonephritis)
• lungs and the respiratory system (pleuritis or pneumonitis)
• the heart and cardiovascular system (endocarditis, myocarditis, pericarditis, or vasculitis)
• the nervous system (neurologic disorders such as seizures)
• blood and the hematologic system (anemia, leukopenia, or thrombocytopenia)
• mental and cognitive systems (anxiety, "lupus fog," mood disorders, or organic brain syndrome)
• skin disorders (photosensitivity), and
• other immune disorders, such as inflammatory arthritis.

Social Security doesn't clearly define what a "moderate" degree of severity is for purposes of listing 14.02, but it's greater than "mild." It's smart to get the judgment of a medical provider who can clarify how severe your lupus is, so consider asking your treating doctor for a medical source statement. Additionally, your medical record will need to document at least two of the "constitutional symptoms or signs," meaning severe fatigue, fever, malaise (a general feeling of discomfort), or involuntary weight loss.

Disability for Lupus that Significantly Compromises Your Daily Life

If your lupus is confined to one body system or organ, you can still meet the listing if you have "repeated manifestations" of SLE with at least two constitutional symptoms, and your symptoms cause a "marked limitation" in either your activities of daily living, social functioning, or ability to concentrate.

Activities of daily living include taking care of basic chores such as grocery shopping, doing the laundry, and paying bills. Social functioning includes interacting appropriately with others and communicating effectively. The ability to concentrate includes being able to complete tasks in a timely manner, without distractions or interference from pain or mental fog.

Just like with a "moderate" level of severity, what constitutes a "marked" limitation in the above areas isn't well defined. Generally, you can consider a marked limitation to be something that you struggle to do independently, but that you can eventually complete given enough time—such as needing to take frequent rest breaks when cleaning the bathroom due to joint pain.

Qualifying for Disability With a Reduced Functional Capacity

Not all disability applicants with lupus will be able to meet the strict criteria of the SLE listing. For example, your lupus may affect only one organ severely, or you might not have much difficulty taking care of yourself and maintaining social relationships. But you can still qualify for benefits if your residual functional capacity rules out all full-time work.

Your residual functional capacity (RFC) is a set of limitations on the activities you can perform at work. These limitations can be physical—such as a restriction against lifting more than ten pounds or standing for more than two hours—or mental, like a prohibition against skilled work or jobs involving constant public contact.

Social Security compares your current RFC with the demands of your past jobs to see if you could do those jobs today. If not, the agency then considers factors such as your age, education, and work experience to determine whether any other jobs exist that you could perform despite the limitations in your RFC. For most disability applicants under the age of 50, this means showing that you can't do even the simplest, sit-down jobs. Applicants 50 and older may use the medical-vocational grid to eliminate jobs they don't already know how to do.

Childhood Lupus Disability Listing Requirements

The SSA evaluates lupus in children under listing 114.02. Similar to the adult listing, you'll need to establish that your child's lupus affects multiple organs, with at least a moderate degree of severity in one organ, and at least two constitutional symptoms and signs (severe fatigue, fever, malaise, or involuntary weight loss. But unlike the adult listing, the childhood listing doesn't allow a way for "repeated manifestations" of lupus to automatically qualify for benefits.

However, your child may still qualify for disability if their lupus symptoms are "functionally equivalent" to listing 114.02. Under Social Security Ruling 09-1p, the SSA can find functional equivalence when a child has a "marked" limitation in two, or an "extreme" limitation in one, of the following areas:

• acquiring and using information (following instructions and remembering facts)
• attending and completing tasks (finishing schoolwork and completing chores)
• interacting and relating with others (making friends and speaking politely)
• moving about and manipulating objects (tying shoes and boarding a school bus)
• caring for yourself (dressing appropriately and avoiding danger), and
• health and physical well-being (experiencing lupus flare-ups and getting treatment).

Again, the SSA doesn't provide much guidance about what limitations are considered "marked" and which are considered "extreme." Extreme is the most restrictive degree of functional limitations, however. If your child has an extreme limitation in an area, that means they cannot (or very rarely) complete activities in that area independently.

The SSA compares how well your child functions with certain developmental milestones for other children their age without medical impairments. In addition to medical evidence, the agency will look at records from your child's teachers or school counselors to see whether your child is in the expected range of functioning for their age.

What Medical Evidence Do You Need to Get Disability for Lupus?

On your application for disability benefits, you're asked to provide the contact information for all medical providers you've seen regarding your lupus diagnosis and any complications. When you submit your application, the SSA will use the information you've given to request your medical records. Your file will be assigned to a claims examiner who will review your records for the following:

• clinical notes from your doctors' ongoing medical treatment
• lab results, blood work, or biopsies
• objective imaging, such as an X-ray, MRI, or CT scan
• a list of medications you've been taking and any side effects you've had, and
• physical examinations showing any abnormalities, such as reduced range of motion.

Because lupus is a disease that often has fluctuations in symptom severity, you should make sure to visit your doctor every time you have a "flare-up." Documentation of these flare-ups can be used to establish that you meet the SLE listing criteria or that you'd miss too much work to be competitively employable.

What Kinds of Benefits Can I Claim for Having Lupus?

Adults with lupus may be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. SSDI eligibility is based on your work history and how much you've contributed to Social Security in payroll taxes. SSI is a needs-based benefit available to people who have limited income and assets.

Minor children can get SSI for lupus provided their parents have earnings and resources below the SSI eligibility threshold. Once they reach the age of 18, they may be able to receive SSDI benefits as a "disabled adult child," provided they have at least one parent who is collecting SSDI.

How Much Disability Can You Get for Lupus?

Social Security doesn't award benefits based on the type of disorder that's causing your disability. Instead, the agency calculates your payments based on your earnings record (for SSDI) or the federal benefit rate (for SSI). In 2024, the monthly federal benefit rate is $943 for individuals and $1,415 for couples.

The maximum you can receive in SSDI for 2024 is $3,822 per month, although the average payment is much smaller, at $1,537. That's because SSDI payments depend on how much you've made in past wages, which varies significantly between beneficiaries.

How Long Does it Take to Get Disability for Lupus?

While the application process itself is fairly simple, figuring out whether you qualify for disability can take some time. You can expect to wait between three to five months for an initial decision on your application. If you're denied at this first step, you can appeal by requesting reconsideration of your claim, which can take another three to five months. If you're denied again, you'll need to ask for a hearing with an administrative law judge.

Wait times for a disability hearing vary significantly across the country, ranging from six months to almost two years depending on the hearing office workload. For more information about the disability determination timeline, see our article on how long it takes to get a decision from Social Security.

Getting a Lawyer to Help With Your Disability Claim

You don't need an attorney to apply for benefits or even appeal a denial, but it makes sense to hire one. An experienced disability lawyer will know what medical evidence is most persuasive to the SSA, when to shore up any weaknesses in your claim (and draw attention to your strengths), and how to cross-examine witnesses at your hearing. Most disability attorneys offer free consultations, so you can ask around until you find out who is a good fit for you.