Lupus Disability Claims

Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that can affect the skin, joints, kidneys, brain, and other organs. Symptoms can vary in severity, but SLE may be severely disabling. If SLE causes disability, then it is essential for the proper documentation to be gathered in order to support a disability claim.

SLE almost always causes joint pain and swelling. Other symptoms may include chest pain, fatigue, fever, malaise, hair loss, mouth sores, sensitivity to sunlight, skin rash, swollen lymph nodes, headaches, numbness, tingling, seizures, vision problems, personality changes, abdominal pain, nausea, vomiting, abnormal heart rhythms, coughing up blood and difficulty breathing, Raynaud’s phenomenon, swelling in the legs, and weight gain. If a patient only has skin symptoms, then this is called discoid lupus; not systemic lupus erythematosus.

Because of the wide range of symptoms, autoimmune disorders can be very challenging to diagnose. For a clinical diagnosis of SLE, a patient must have 4 out of 11 common signs of the disease. 11 of the common signs of the disease are malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuritis or pericarditis, kidney disorder, neurological disorder, blood disorder, immunologic disorder, and positive antinuclear antibody (ANA) testing. Objective testing is available to diagnose lupus, although no single test can diagnose lupus. Testing includes antibody tests (such as ANA panel), complete blood count, chest x-ray, echocardiogram, kidney biopsy, and urinalysis. About 95% of patients with lupus test positive for ANA, although ANA testing is not conclusive to diagnose lupus.

If SLE is causing a disability, a claimant needs to see the appropriate specialist and undergo all relevant testing. Rheumatologists are the appropriate specialists to diagnose and treat lupus. If a claimant suffering from SLE applies for disability and has not treated with a rheumatologist, then it will be challenging for them to prove a disability. Even though there is no cure for SLE, regular treatment is necessary to control symptoms. If a claimant does not maintain regular treatment, then their claim may fail to show the severity of their symptoms. Therefore, it is critical for a claimant with SLE to regularly see their doctors, including a rheumatologist.

Long Term Disability Claims and Social Security Disability Claims

For a claimant who is suffering from SLE and insured under a long term disability policy, then they must prove that they are disabled under the definition of disability found in their insurance policy. Moreover, they must meet all other requirements of their long term disability policy in order to be approved. Typically, long term disability policies do not specifically address lupus.

Unlike long term disability policies, the Social Security Administration specifically addresses cases involving SLE. A listing at 14.02 sets out the criteria to prove that SLE is disabling:

1. Systemic lupus erythematosus (14.02).
a. General. Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect any organ or body system. It is frequently, but not always, accompanied by constitutional symptoms or signs (severe fatigue, fever, malaise, involuntary weight loss). Major organ or body system involvement can include: Respiratory (pleuritis, pneumonitis), cardiovascular (endocarditis, myocarditis, pericarditis, vasculitis), renal (glomerulonephritis), hematologic (anemia, leukopenia, thrombocytopenia), skin (photosensitivity), neurologic (seizures), mental (anxiety, fluctuating cognition (“lupus fog”), mood disorders, organic brain syndrome, psychosis), or immune system disorders (inflammatory arthritis). Immunologically, there is an array of circulating serum auto-antibodies and pro- and anti-coagulant proteins that may occur in a highly variable pattern.
b. Documentation of SLE. Generally, but not always, the medical evidence will show that your SLE satisfies the criteria in the current “Criteria for the Classification of Systemic Lupus Erythematosus” by the American College of Rheumatology found in the most recent edition of the Primer on the Rheumatic Diseases published by the Arthritis Foundation.

Proving that a claimant meets the above criteria can also be beneficial for proof of disability in long term disability claims.

Contact O’Ryan Law Firm

If you have applied for disability benefits and your claim has been denied, contact O’Ryan Law Firm immediately. O’Ryan Law Firm represents individuals who have been denied long term disability benefits and Social Security disability benefits. Please call 317-255-1000 (local) or 1-855-778-5055 (toll free) for a free consultation.