Steps to Qualify for SSDI with Lupus

Understand the SSDI Eligibility Requirements

To qualify for SSDI, you must meet certain requirements, including:

• Work History: You need to have worked and paid Social Security taxes for a sufficient number of years. SSDI is a program for people who have a disability that prevents them from working for at least 12 months or is expected to result in death.
• Medical Evidence: You must have medical evidence showing that your lupus is severe enough to prevent you from working. This includes detailed records from your doctor, hospital visits, and any specialists involved in your treatment.

Gather Comprehensive Medical Documentation

Lupus is a complex condition that varies in severity from person to person. To qualify for SSDI, you must prove that lupus is significantly limiting your ability to work.

Key documentation includes:

• Complete Medical Records: Ensure you have up-to-date and complete records from your doctor, including lab results, tests, and notes about your symptoms and treatments.
• Specialist Reports: Lupus often requires care from specialists such as rheumatologists. Include any records from specialists that demonstrate how your condition affects your ability to function.
• Doctor’s Opinion: A statement from your treating physician explaining how lupus limits your daily activities and work ability will strengthen your case. The more specific and detailed, the better.
• Test Results: Documenting lab work, biopsies, or imaging studies that show the progression or severity of your lupus is critical to your claim.

Meet the SSA’s Listing for Lupus

The SSA evaluates lupus under its Listing of Impairments, which includes the criteria that must be met for SSDI eligibility. To qualify for SSDI with lupus, you must show that your condition meets one of the following:

• Systemic Lupus Erythematosus (SLE) Under the SSA’s Criteria: If you have a diagnosis of systemic lupus erythematosus and it results in severe limitations, such as repeated flare-ups or organ damage, you may meet the SSA’s criteria for disability.
• Functional Limitations: Your lupus must cause extreme limitations in at least two of the following areas:
• Physical functioning (e.g., difficulty walking, lifting, or carrying objects)
• Mental functioning (e.g., cognitive impairments or difficulty concentrating)
• Social functioning (e.g., difficulty interacting with others)
• Maintaining a routine or adapting to daily life.

Complete the SSDI Application Carefully

To apply for SSDI, you must fill out the SSA’s disability application accurately and thoroughly. Errors or missing information can result in delays or denials.

Follow these tips:

• Apply Online or In Person: You can apply online at www.ssa.gov or schedule an appointment at your local SSA office to apply in person.
• Provide Complete Information: Be honest about your medical condition, work history, and financial situation. Failure to disclose accurate information may result in a denial.
• Submit All Required Documents: Be sure to include your medical records, work history, and any other documentation the SSA requests. Missing paperwork can delay the process.

Understand the SSA’s Five-Step Evaluation Process

The SSA evaluates every disability claim through a five-step process. Understanding this process can help you strengthen your application:

• Step 1: Substantial Gainful Activity (SGA): If you are working and earning above a certain threshold, the SSA may decide you are not disabled.
• Step 2: Severe Condition: Your lupus must be severe enough to prevent you from performing basic work tasks.
• Step 3: Meet a Listed Impairment: If your lupus meets the SSA’s listing criteria (as discussed above), you may automatically qualify for SSDI.
• Step 4: Past Work: The SSA will assess if you can perform any of your previous work.
• Step 5: Other Work: If you cannot perform past work, the SSA will look at whether you can perform other types of work based on your age, skills, and education.

Be Prepared for a Possible Denial

It is common for SSDI claims to be denied initially, even if you have a valid case. If your claim is denied, don’t be discouraged—there are steps you can take to appeal the decision.

Here’s what you can do:

• Request Reconsideration: If your claim is denied, you can request that the SSA review your case again.
• Request a Hearing: If the reconsideration is denied, you can request a hearing with an Administrative Law Judge (ALJ), where you’ll present your case in person.
• Submit New Evidence: If you have new medical records or other supporting documents, submit them as part of your appeal to improve your chances.

Consider Getting Legal Help

While it’s possible to apply for SSDI on your own, working with an attorney can increase your chances of success—especially if your case is complex or you need to go through the appeals process.

An attorney can help you:

• Gather and organize medical records.
• Ensure your application is accurate and complete.
• Represent you during the appeals process.