If you have an autoimmune disorder that prevents you from working, you need to know what the Social Security Administration (SSA) looks for in autoimmune disorder disability claims. Primarily, they are looking for medical evidence that shows you have a specific condition and are so ill that you cannot work and are disabled.
The SSA recognizes three broad groups of autoimmune disorders: autoimmune disorders, immune deficiency disorders, and human immunodeficiency virus (HIV). In each instance, it lists the requirements for disorders to be considered disabling.
An Overview of What the SSA Looks For When You File an Autoimmune Disorder Disability Claim
The SSA’s Blue Book lists specific characteristics the SSA looks for when you file an autoimmune disorder disability claim. Beginning with a broad overview, they will want:
- Your medical history.
- Physical exam reports.
- Laboratory findings
- Medical imaging or biopsy reports.
Autoimmune Disorders
Leaving aside immune deficiency disorders and HIV, the requirements for a claim related to autoimmune disorders include:
- Systemic lupus erythematosus (SLE): Usually requires evidence that your condition meets the requirements for SLE developed by the American College of Rheumatology and published by the Arthritis Foundation.
- Systemic vasculitis: Angiography or biopsy confirming a diagnosis.
- Systemic sclerosis: Documentation showing that your clinical findings differentiate your condition from other autoimmune disorders.
- Polymyositis and dermatomyositis: Electromyography and muscle biopsy results show that you have this condition. For dermatomyositis, additional skin findings are required. An additional list of evaluation criteria applies.
- Undifferentiated and mixed tissue disease: Clinical features and blood tests indicate conditions matching two or more autoimmune diseases.
- Inflammatory arthritis: Medical findings match the conditions for Rheumatic Diseases published by the Arthritis Foundation. Listing-level conditions apply.
- Sjögren’s syndrome: Medical evidence aligns with the criteria for Sjögren’s syndrome published by the Arthritis Foundation.
Please note that the above is a highly summarized list. We can sum it up even further by saying the SSA is looking for concrete medical evidence of a disorder as well as evidence that it renders you disabled and unable to work.
Immune Deficiency Disorders
This category refers to genetic immune deficiency disorders as well as those acquired because of medication use. The evidence must show what type of immune deficiency you suffer from. Laboratory evidence is generally required.
In most instances, the SSA will look at how long your immune system deficiency might mean you are unable to work and whether it should be re-evaluated periodically. In medication-induced immune deficiency, they will also consider factors like the frequency and severity of infections and whether there is organ deterioration.
Besides this, the SSA may look for things like infections that resist treatment or whether you need to be hospitalized or be placed on a drip more than twice a year because of your condition.
HIV-AIDS
Many people with these conditions are able to lead comparatively normal lives, so the SSA will thoroughly scrutinize applications. They will look for a lot of information, and what they want from you may differ depending on your situation. However, things the SSA looks for include:
- Accepted medical tests confirming HIV infection.
- Records showing how it affects you.
- Evidence of HIV-related disorders.
- Your CD4 measurement.
- Other information, e.g., BMI and haemoglobin.
- Your record of HIV-related hospitalizations.
- Evidence of gynecological complications.
- Evidence of HIV-related dementia.
Although this is an extremely complex area, you are likely to qualify for a disability claim if your medical records confirm that you are unable to work.
Doctors Provide The Evidence, But You May Need A Lawyer to Navigate the Claims Process
In general, doctors will carry out all the tests and examinations you need to produce evidence to support an autoimmune disorder disability claim, but they do not handle the claims process. As you can see, there are many requirements, and an omission can mean your claim is rejected. To navigate the SSA’s autoimmune disorder disability claims process effectively, consult a lawyer with extensive experience in this area.