Lupus Claims

Lupus (formally known as Systemic Lupus Erythmatosus, or SLE) is a chronic disease that involves symptoms which may vary in intensity over time. A skin rash is often one of the most recognizable symptoms of lupus, but the rash alone is not enough to qualify you for Social Security disability benefits. Lupus is a chronic disease, and it can be extremely painful and disabling for many people. The attorneys at Ankerholz and Smith are prepared to prove how lupus affects you, and your ability to work.

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys.

The Social Security Administration has strict rules and regulations as to the documentation that must be provided before an individual can be granted disability because of lupus. The attorneys at Ankerholz and Smith will work with the person seeking Social Security disability benefits to properly document their medical condition. The presentation of this type of claim can be rather complex, and most people who apply for Social Security disability without a lawyer are unfamiliar with the procedural details needed to be successful with the claim.

Specific documentation is needed to establish the existence of a connective tissue disorder like lupus. At Ankerholz and Smith, we will seek medical records documenting your medical history, physical examination, selected laboratory studies, appropriate medically acceptable imaging and, in some instances, tissue biopsy. Medically acceptable imaging includes, but is not limited to, x-ray imaging, computerized axial tomography (CAT scan) or magnetic resonance imaging (MRI), with or without contrast material, myelography, and radio nuclear bone scans.

Most people who have mild to moderate disease will be treated by a rheumatologist, who specializes in the diseases of joints and muscles.

Lupus can affect multiple bodily systems. The Social Security Administration refers to lupus in its impairment listing manual. The impairment listing manual contains rules and regulations that are used by Social Security disability examiners and administrative law judges to render decisions on Disability and SSI claims that involve specific medical issues. These are sometimes referred to as "listed impairments." For Social Security purposes, lupus is found under the category of immune system impairments. However, the lupus listing differs from most other listings because the regulation refers mainly to other body parts and systems which may be affected by the lupus disease.

The Social Security Administration Impairment Listing requires the following:

14.02 Systemic Lupus Erythematosus must be documented as described in 14.00B1, with:

A. One of the following:

1. Joint involvement, as described under the criteria in 1.00
2. Muscle involvement, as described under the criteria in 14.05
3. Ocular involvement, as described under the criteria in 2.00ff
4. Respiratory involvement, as described under the criteria in 3.00ff
5. Cardiovascular involvement, as described under the criteria in 4.00ff or 14.04D
6. Digestive involvement, as described under the criteria in 5.00ff
7. Renal involvement, as described under the criteria in 6.00ff
8. Hematologic involvement, as described under the criteria in 7.00ff
9. Skin involvement, as described under the criteria in 8.00ff
10. Neurological involvement, as described under the criteria in I 1.00ff
11. Mental involvement, as described under the criteria in 12.00ff

OR

B. Lesser involvement of two or more organs/body systems listed in paragraph A, with significant, documented, constitutional symptoms and signs of severe fatigue, fever, malaise, and weight loss. At least one of the organs/body systems must be involved to at least a moderate level of severity.

The lupus listing for Social Security disability or SSI allows disability examiners and judges to consider all body parts affected by the disease. In general terms, an applicant must prove one major problem associated with the disease, or two lesser problems, at least one of which is of moderate severity.

Our clients who have lupus often suffer the fatigue, fever, malaise, and weight loss described in the Social Security regulation, but symptoms must be "moderately severe" to qualify as meeting a listed impairment. Social Security requires a clinical record of at least three months of active lupus disease despite prescribed treatment to qualify for the assessment of severity and duration of impairment.

If an applicant cannot provide documentation to meet or equal a listed impairment , there is still hope! At Ankerholz and Smith, we have successfully pursued disability and SSI benefits on the basis of a "medical vocational allowance." A medical-vocational allowance requires more evidence to be presented. The claim will be successful if a disability applicant cannot meet the requirements of a listed impairment but is disabled nonetheless due to his or her age, education, work skills, and level of functional limitation.

This last step in the disability evaluation procedure means that if an applicant has an impairment that has lasted (or can be expected to last) for twelve months, and the impairment is severe enough to prevent the applicant from engaging in one of his or her past jobs and the impairment prevents them from engaging in certain other specific types of work (as determined by age, education, transferable work skills, and functional restrictions), then the applicant will be approved for disability benefits, even if they do not meet the requirements for the listing of lupus disease.

Our years of experience in conducting Social Security hearings shows that disability benefit approvals occur more often on the basis of a medical-vocational allowance rather than on the basis of meeting a listing. Your attorney from Ankerholz and Smith will present the evidence that is relevant to a medical vocational allowance case. In any case, a lupus patient's treating doctor must make specific references in medical records as to the physical limitations a patient suffers as a result of having lupus.

When properly documented, lupus disease cases can be successfully presented to the Social Security Administration. At Ankerholz and Smith, we believe pre-hearing preparation of our client and proper presentation of the medical and vocational evidence is critical to a successful award of disability benefits based on lupus disease. Lupus sufferers deserve all possible assistance in dealing with the medical, legal and financial ramifications of this serious disease. Just like the Lupus Foundation of America, the attorneys at Ankerholz and Smith take this disease very seriously!