Meet the SSA’s Definition of Disability

To qualify for Social Security Disability benefits, you must meet the SSA’s definition of disability, which requires that:

• Your condition is severe enough to significantly impair your ability to work.
• Your condition is expected to last at least 12 months or result in death.

Since lupus can vary in severity, whether or not you qualify will depend on the extent to which your symptoms affect your ability to perform daily activities and work tasks.

Understanding the SSA’s Listing of Impairments

The SSA maintains a Listing of Impairments (also known as the “blue book”), which outlines the medical conditions that qualify for disability benefits. While lupus is not listed explicitly as a disability in the SSA’s blue book, Systemic Lupus Erythematosus (SLE), a more severe form of lupus, can qualify under certain conditions.

Lupus may qualify under the following listings in the blue book:

• Listing 14.02 – Systemic Lupus Erythematosus (SLE): This listing applies if you have severe lupus with certain complications or organ involvement. If you meet the criteria for SLE, such as significant involvement of at least two major organs or systems (like the heart, kidneys, or lungs), you may be approved for benefits.
• Listing 14.04 – Inflammatory Arthritis: If lupus has caused severe arthritis or joint involvement, it may qualify under this listing.

If your lupus does not meet the specific criteria outlined in the SSA’s Listing of Impairments, you may still be eligible for SSD benefits by showing that your condition is functionally equivalent to one of the listed impairments.

Medical Evidence to Support Your Claim

The SSA requires strong medical evidence to support your SSD application for lupus. Without sufficient documentation from your treating physicians, your application may be denied. Here’s what you need:

• Medical Records: Your doctor must provide detailed medical records showing the diagnosis of lupus and how it impacts your ability to work. This includes laboratory test results, imaging studies, doctor’s notes, and treatment plans.
• Functional Limitations: The SSA needs to understand how lupus limits your ability to perform daily activities. Your doctor should provide evidence of the severity of your symptoms, such as fatigue, joint pain, rashes, or organ dysfunction, and how these limitations prevent you from working.
• Hospitalizations and Treatments: If you’ve had hospitalizations or frequent doctor visits due to lupus flare-ups, this information will be crucial. The SSA will want to know the frequency of flare-ups, the treatment prescribed, and how your symptoms change over time.

Residual Functional Capacity (RFC) Assessment

Even if lupus doesn’t meet the exact criteria for a listed impairment, you may still qualify for disability if you can show that you cannot perform any significant work. One of the key factors in this assessment is your Residual Functional Capacity (RFC). This is an evaluation of your ability to perform certain work-related activities despite your limitations.

The SSA will assess how lupus affects your:

• Physical Function: Can you lift, stand, walk, or carry things for an extended period?
• Mental Function: Does lupus affect your cognitive abilities, such as your memory, concentration, or ability to stay organized?
• Social Functioning: Does your condition limit your ability to interact with others in a work environment?

If your RFC assessment shows that you are unable to perform your past job or any other type of work, you may qualify for SSD benefits.

Meeting the Work History Requirements

To qualify for Social Security Disability Insurance (SSDI), you must have worked and paid Social Security taxes for a sufficient number of years. The number of work credits you need depends on your age at the time of diagnosis. Generally:

• You need 40 work credits to qualify for SSDI, with 20 of those credits earned in the last 10 years.
• Younger workers may need fewer credits to qualify for SSDI.

If you do not have enough work credits to qualify for SSDI, you may still be eligible for Supplemental Security Income (SSI) if you have limited income and resources. SSI does not require a work history, but it is based on your financial need.

How the SSA Evaluates Your Claim

Once you submit your SSD application, the SSA will evaluate your claim based on the following steps:

• Step 1: Are You Working? If you are currently working and earning above the substantial gainful activity (SGA) threshold (for 2025, that’s $1,470 per month for non-blind individuals), you will not qualify for benefits.
• Step 2: Severe Condition: The SSA will determine if your lupus is severe enough to limit your ability to work. The more detailed medical evidence you provide, the better your chances.
• Step 3: Meet a Listed Impairment or Functional Equivalent: If your lupus meets the criteria outlined in the Listing of Impairments, you will be approved for benefits. If not, the SSA will determine whether your lupus is severe enough to keep you from doing any type of work.
• Step 4: Can You Do Your Past Work? The SSA will evaluate whether your lupus allows you to perform your past work. If you cannot, they will move on to the next step.
• Step 5: Can You Do Other Work? The SSA will consider whether you can perform any other type of work, taking into account your age, education, skills, and physical and mental limitations.

If you cannot do any type of work, you may qualify for SSD benefits.