Autoimmune diseases affect millions of Americans, causing the body’s immune system to mistakenly attack its own tissues. Conditions such as lupus, rheumatoid arthritis, multiple sclerosis, and Crohn’s disease can be debilitating, robbing individuals of their ability to work and maintain a normal quality of life. However, does the Social Security Administration recognize autoimmune diseases as disabilities that qualify for benefits?

The short answer is yes. People with autoimmune conditions may be eligible for disability benefits, depending on the specific circumstances. It is important to understand how the Social Security Administration evaluates these conditions in order to make a successful claim for benefits. At Tabak Law in Milwaukee, experienced Social Security Disability Insurance attorneys can help clients navigate the process and ensure that they meet the required requirements.

How the SSA Defines Disability

To qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you need to meet the strict definition of disability set by the Social Security Administration (SSA). The agency does not provide benefits based on a single diagnosis. Instead, they evaluate whether your condition prevents you from performing Substantial Gainful Activity (SGA), which means you cannot earn enough to support yourself due to your impairment.

To be approved, your autoimmune condition must meet three key requirements:

First, your condition must significantly interfere with your ability to perform daily activities and work. Second, the Social Security Administration requires that the disabling condition has lasted for at least 12 months or is expected to result in death. Third, the condition must prevent you from performing any type of work that matches your age, education, and experience.

Autoimmune Diseases and the SSA Blue Book

The SSA maintains a medical reference guide known as the Listing of Impairments, commonly referred to as the “Blue Book”. This document outlines specific medical conditions that, if a person meets the criteria, may automatically qualify them for benefits.

Several autoimmune diseases are listed directly in the Blue Book. These include conditions such as systemic lupus erythematosus (SLE), inflammatory arthritis, Sjogren’s syndrome and polymyositis/dermatomyositis. All of these are included under Section 14.00 – Immune System Disorders. Multiple sclerosis falls under Section 11.00 (Neurological Disorders) and inflammatory bowel diseases like Crohn’s disease fall under Section 5.00 (Digestive System).

Meeting the criteria for a Blue Book listing requires your medical records to demonstrate specific clinical findings, laboratory results, and functional limitations associated with the condition. If your records meet these criteria, the Social Security Administration (SSA) may approve your claim without the need for further evaluation. However, even if your autoimmune condition does not exactly match a Blue Book entry, you may still be eligible for benefits through what is called a medical-vocational allowance. This allowance takes into account the impact of your condition on your ability to work and earn income.

Qualifying Through a Medical-Vocational Allowance

Many people with autoimmune diseases are approved for benefits, not because they exactly meet the criteria in the Blue Book, but because the Social Security Administration (SSA) determines that they lack Residual Functional Capacity (RFC). The RFC is a detailed assessment of an individual’s maximum ability to perform work-related tasks despite impairment.

For example, a person with severe rheumatoid arthritis may receive a sedentary rating, which limits them to desk-based work with minimal physical activity. If the Social Security Administration (SSA) determines that there are no jobs available in the national economy that meet this rating, along with your age, education, and previous work history, you may be eligible for benefits based on medical-vocational guidelines.

Autoimmune conditions can cause a range of physical and mental symptoms, including chronic pain, fatigue, cognitive difficulties, and depression or anxiety. These symptoms can be evaluated individually and together to get a better understanding of your overall functional capacity.

The Importance of Medical Evidence

One of the most crucial factors in a successful autoimmune disability claim is the quality and quantity of medical evidence provided. The Social Security Administration will review your entire medical history, including physician notes, laboratory results, imaging tests, treatment records, and any functional assessments conducted by your doctor.

Autoimmune diseases are notorious for being difficult to document, as symptoms often fluctuate and patients may experience periods of remission followed by painful flare-ups. This unpredictability makes it harder for the Social Security Administration (SSA) to understand the severity of a person’s condition, which can make it more challenging to prove permanent disability status. That’s why having detailed, up-to-date medical records and strong support from a treating physician are essential in order to convince the SSA of the severity and consistency of a person’s disability.

A written statement from your doctor confirming the severity of your condition and its impact on your ability to work can greatly strengthen your claim. The Social Security Administration gives significant weight to the opinion of your doctor, as they have the best understanding of your condition and limitations.

Non-Medical Requirements for SSI and SSDI

In addition to medical criteria, your eligibility for certain programs depends on the specific program you are applying for. For SSDI (Social Security Disability Insurance), you must have sufficient work history and paid Social Security taxes – typically five years of full-time work in the last ten years. SSI (Supplemental Security Income) eligibility is based on need, meaning that your income and financial resources must be below certain thresholds set by the Social Security Administration.

Both programs require you to provide proof of citizenship or legal status as a non-citizen, as well as personal identification documents and a detailed work history over the last 15 years.

How Tabak Law Can Help

Navigating the Social Security Administration’s (SSA) rules for autoimmune conditions can be complex and challenging. At Tabak Law, our SSDI and SSI attorneys in Milwaukee understand the intricate requirements of the disability process, from Blue Book listings to RFC assessments, medical-vocational evaluations, and ALJ (Administrative Law Judge) hearings. 

We work closely with your medical providers to gather the necessary evidence to support your case and fight vigorously if your benefits are rejected. Our team is dedicated to helping you navigate the complexities of the system and ensuring that you receive the benefits you deserve.

If you or a loved one have an autoimmune disease that makes it difficult to work, don’t go through this process alone. Contact Tabak Law for a free consultation today. We are here to help Wisconsin residents get the disability benefits they deserve.