Lupus and Social Security Disability Claims
By Pitt Dickey

This column will exam how the Social Security Administration evaluates Disability Insurance Benefits claims for people who suffer from Systemic Lupus Erythematosus. The Social Security Administration (SSA) has a set of criteria that it uses called Listings to determine whether a person is eligible for monthly disability insurance payments.

To see how the SSA reviews claims that involve persons who suffer from lupus it is useful to take a brief look at the medical terms that describe these conditions. Systemic Lupus Erythematosus (Lupus) is a chronic inflammatory disease that can affect a person's joints, skin, kidneys, nervous system, heart and lungs.

The disease is an autoimmune disorder in which the immune system in effect mistakes parts of the body as an infection and develops antibodies to fight the perceived infection. These antibodies are called Antinuclear Antibodies (ANA) and can be measured in the patients blood as a aid to diagnosis. The antibodies react with the body and form immune complexes. These complexes grow in the body and cause inflammation, pain and injury to the surrounding body tissues. Lupus is not generally life threatening and can be mild in many people. In serious cases it can prevent the patient from being able to work and in very severe cases it can lead to death from complications related to the Lupus. A person with Lupus should continue to be followed by a physician for this condition.

There are three types of Lupus; systemic, discoid and drug-induced lupus. Systemic Lupus can effect almost any system of the body and is more serious than Discoid Lupus. Discoid Lupus which effects the skin only and typically appears as a rash on the face, scalp and neck. Drug Induced Lupus can result from complications from certain prescription medications which may be prescribed to treat high blood pressure or an irregular heart beat.

Lupus strikes women more often than men. It tends to affect Black, Indian and Asian women more often than Caucasian women. Lupus is frequently difficult to diagnose because its symptoms mimic a number of other health problems. Patients with Lupus tend to have "flares" of this disease when their symptoms are more pronounced and then the symptoms will recede. I have had clients who have encountered delays in their final diagnosis of Lupus because it can be very difficult to determine that the client has Lupus.

The SSA in reviewing the diagnosis of Lupus uses a standard to determine if the patient has clinical characteristics such as fever, fatigue, malaise ( lack of energy ), and weight loss. The SSA also looks to see if the patient has multi system involvement including anemia (low red blood cell or hemoglobin count), leukopenia (low white blood cell count) or thrombocytopenia (low clotting blood cell count). The SSA also examines the clinical records of the patient to determine the amount of ANA in the patient's blood.
 
To meet the SSA listing the patient with Lupus must meet the systemic standard described in the prior paragraph and have serious impairments resulting from Lupus in at least one of the following areas:

Joint involvement, muscle involvement, ocular (eye) involvement, respiratory involvement, cardiovascular involvement, digestive involvement, renal (kidney) involvement, skin involvement, neurological involvement or serious mental involvement.

The Lupus patient would also meet the Listing for the award of disability with a lesser involvement of two of the systems named above coupled with documented constitutional symptoms and signs of severe fatigue, fever, malaise, and weight loss. At least one of the body systems listed above much have moderately severe impairment.

It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. The Judge has the discretion to decide if a person's health problems are serious enough to warrant an award of disability benefits despite not meeting the specific technical requirements of one of the SSA listings for disability.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over nineteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 555 Executive Place, Fayetteville, N.C. He can be reached at 485-8020.