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Immune Disorders and Social Security Disability Insurance

Immune Disorders Disability Guidelines
 
Here is an explanation of Social Security's five-step process to determine if a patient with an immune disorder qualifies for SSDI:
 
  1. Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $1,040 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
  2.  
  3. Conclude the immune disorder disability must be severe enough to significantly limit one's ability to perform basic work activities needed to do most jobs. For example:
  • Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
  • Seeing, hearing and speaking
  • Understanding/carrying out and remembering simple instructions
  • Responding appropriately to supervision, co-workers and usual work situations
  • Dealing with changes in a routine work setting
 
  1. Immune disorders are listed under the category of impairments known as the Immune System - Medical Listing 14.01. The following criteria have been established indicative of the inability to engage in any substantial gainful activity, i.e., if one has a diagnosis of an immune disorder and one of the following, a finding of disabled under the Social Security Act is warranted:
  • Systemic lupus erythematosus at a moderate level of severity with involvement of a single organ/body system or lesser involvement of two or more organs/body systems with significant, documented constitutional symptoms and signs of severe fatigue, fever, malaise and weight loss.
  • Systemic vasculitis disease is more often idiopathic and chronic. There are several clinical patterns, and must be documented at a moderate level of severity by angiography or tissue biopsy with involvement of a single organ/body system, or lesser involvement of two or more organs/body systems with significant, documented constitutional symptoms and signs of severe fatigue, fever, malaise and weight loss.
  • Systemic sclerosis and scleroderma disorders constitute a spectrum of disease in which thickening of the skin is the clinical hallmark. In addition to skin and blood vessels, the major organ/body system involvement includes the gastrointestinal tract, lungs, heart, kidneys and muscle. There also may be lesser involvement of two or more organs/body systems with significant, documented constitutional symptoms and signs of severe fatigue, fever, malaise and weight loss, or generalized scleroderma with digital contractures, or severe Raynaud's phenomena, characterized by digital ulcerations, ischemia or gangrene.
  • Polymyositis or dermatomyositis is primarily an inflammatory process in striated muscle, with severe proximal limb-girdle muscle weakness, pain and tenderness. Moderately severe limb-girdle muscle weakness, associated with cervical muscle weakness must be documented with either impaired swallowing with dysphagia and episodes of aspiration due to cricopharyngeal weakness, or impaired respiration due to intercoastal and diaphragmatic muscle weakness or associated with a malignant tumor. Individuals may experience significant difficulty climbing stairs or rising from a chair without use of the arms. Proximal limb weakness in the upper extremities may result in inability to lift objects, and interference with dressing and combing hair. Weakness of anterior neck flexors may impair the ability to lift the head from the pillow in bed. The diagnosis is supported by elevated serum muscle enzymes (creatine phosphokinase (CPK), aminotransferases, aldolase), characteristic abnormalities on electromyography and myositis on muscle biopsy.
  • Undifferentiated connective tissue disorder includes syndromes with clinical and immunologic features of several connective tissue disorders, but that do not satisfy the criteria for any of the disorders described; for instance, the individual may have clinical features of systemic lupus erythematosus and systemic vasculitis and the serologic findings of rheumatoid arthritis. It also includes overlap syndromes with clinical features of more than one established connective tissue disorder, and is demonstrated with involvement of a single organ/body system or lesser involvement of two or more organs/body systems with significant, and documented constitutional symptoms and signs of severe fatigue, fever, malaise and weight loss.
  • Inflammatory arthritis is evaluated by history of joint pain, swelling, and tenderness, and signs on current physical examination of joint inflammation or deformity in two or more major joints (hip, knee, shoulder, elbow, wrist-hand, ankle-foot) resulting in inability to ambulate effectively or inability to perform fine and gross movements effectively. Inflammatory arthritis of peripheral joints (hand, foot) or axial joints (joints of the spine) occurring with less restriction of ambulation or other movements but complicated by extra-articular features at a moderately severe level that cumulatively result in serious functional deficit.
 
  1. Explore the ability of an individual to perform work they have done in the past despite their immune disorder. If the SSA finds that a person can do his or her past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.
  2.  
  3. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine an immune disorder disability, the SSA enlists medical-vocational rules, which vary according to age.
 
For example, if a person is:
 
Under age 50 and, as a result of the symptoms of an immune disorder, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.
 
Age 50 or older and, due to an immune disorder, limited to performing sedentary work, but has no work-related skills that allow the person to do so, the SSA will reach a determination of disabled.
 
Age 55 or older and, due to the disability, limited to performing light work, but has no work-related skills that allow the person to do so, the SSA will reach a determination of disabled.
 
Over age 60 and, due to an immune disorder, unable to perform any of the jobs he or she performed in the last 15 years, the SSA likely will reach a determination of disabled.
 
Any age and, because of an immune disorder, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of disabled.
 

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