Every year, Social Security Disability Insurance (SSDI) helps millions of Americans suffering from incapacitating immune diseases with financial aid. To qualify, you need to meet the Social Security Administration (SSA) eligibility criteria.
What Criteria Does the Social Security Administration Use to Evaluate Immune Conditions?
Immune disorders are covered under Section 14 of the Blue Book. You are eligible for SSDI benefits if you meet the following conditions:
- You have not been able to engage in substantial gainful activity for at least 12 months.
- You have a recurrent immune disorder with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).
- You have difficulty in completing activities related to daily living and social functioning. You also have limited ability to perform tasks due to deficiencies in concentration, persistence or pace.
Other factors are also taken into consideration. The SSA will review your symptoms, regularity, period of outbreaks, the number of times your condition has taken a downturn and for how long, as well as monitoring your health stages. The SSA also takes into consideration the effects of your medication, including side effects.
What Kind of Documentation Is Required for Immune Disorders?
Medical documentation for immune disorders includes, but is not limited to:
- Physical examination reports
- Laboratory findings
- Imaging / biopsy or tissue reports like:
- X-ray imaging
- Computerized axial tomography (CAT scan) or magnetic resonance imaging (MRI)
- Radionuclear bone scans
What Happens When Your Immune Problem Does Not Meet a Blue Book Listing?
If your immune problem is not listed under Section 14 of the Blue Book, the SSA will determine if it meets the conditions of a listing in another body system. If it doesn’t, the next step is to determine whether the severity of your immune problem medically equals an existing listing. If these steps do not prove conclusive, the SSA checks for Residual Functional Capacity (RFC) which means they will determine whether you are fit enough to engage in substantial gainful activity. If you aren’t, then you can be approved for SSDI benefits through a medical vocational allowance.
What Kind of Immune Disorders Are Listed in the Blue Book?
- The SSA classifies immune disorders into three categories: Autoimmune Disorders occur when the body’s immune system attacks healthy cells, resulting in a range of disorders.
Systemic Lupus Erythematosus: Lupus is a connective tissue disorder that affects multiple organs in the body like joints, kidneys, eyes, intestines, or the brain. To qualify:
- Two or more body systems or organs must be affected with at least one of them being moderate to severe accompanied by two or more of the constitutional symptoms.
- You must have experienced recurring episodes of lupus with functional limitations.
Discoid lupus, which only affects the skin, is not listed in the Blue Book.
Systemic Sclerosis (scleroderma): Scleroderma is a disease caused due to an overproduction of collagen. To qualify under this listing, you must fall into one of the following categories:
- One or more body organs must be affected with at least two constitutional symptoms.
- Atrophy with irreversible damage, deformity.
- Raynaud’s phenomenon, gangrene in two extremities or ischemia.
- Repeated occurrences with constitutional symptoms and limitations in function.
Sjögren’s Syndrome: An immune system disorder that is first recognized by dry eyes and a dry mouth. It can accompany other immune disorders such as rheumatoid arthritis and lupus. The SSDI qualifying criteria are the same as those for lupus.
Systemic vasculitis: Vasculitis refers to an assorted group of disorders characterized by inflammation and damage in blood vessel walls, resulting in tissue necrosis. The criteria for qualifying are:
- One or more body systems / organs affected with constitutional symptoms.
- Repeated manifestations with constitutional symptoms and functional limitations.
Rheumatoid Arthritis: Severe cases of rheumatoid arthritis can qualify for disability benefits. To qualify, you need to have one of the following:
- Inflammation or deformity of one or more peripheral joints which prevent you from performing fine and gross movements.
- Inflammation or deformity in one or more major peripheral joints with at least two constitutional symptoms or two body organs being affected.
- Ankylosing spondylitis or other spondyloarthropathies with fixation of the cervical spine at certain degrees.
- Repeated occurrences of inflammatory arthritis with at least two constitutional symptoms accompanied by functional limitations.
In addition to the above, polymyositis, dermatomyositis, and other undifferentiated and mixed connective tissue disease also fall under the autoimmune disease category in the Blue Book, each with their own criteria.
- Immune Deficiency Disorders (excluding human immunodeficiency virus (HIV) infection) are recurring or uncommon infections that are caused due to a poor or absent immune response. They can be primary (congenital) or acquired. To meet the listing, you must fall under one of these categories:
One or more of the following infections: Sepsis, meningitis, pneumonia, septic arthritis, endocarditis, or sinusitis documented by appropriate medically appropriate imaging.
Stem Cell Transplant qualifies as a disability for 12 months from the date of transplantation.
Repeated Occurrences of an immune deficiency disorder with two or more constitutional symptoms and functional limitations.
- HIV Infection or Human Immunodeficiency Virus (HIV) infection is characterized by an increased vulnerability to infections or other conditions. To qualify under this listing, you need to have HIV with documentation and one of the following:
- Bacterial infections
- Fungal infections
- Protozoan or helminthic infections
- Viral infections
- Malignant neoplasms
- Conditions of the skin or mucous membranes
- HIV encephalopathy
- HIV wasting syndrome
- Diarrhea for 1 month or longer, resistant to treatment, and requiring intravenous hydration, intravenous alimentation, or tube feeding
- One or more of the following infections: Sepsis, meningitis, pneumonia, septic arthritis, endocarditis or sinusitis with appropriate medical reports
- Repeated manifestations of HIV infection that cause limitations in daily living
Multiple Sclerosis, a chronic autoimmune disease of the central nervous system, has a separate listing under neurological disorders.
Is There a Faster Way to Process SSDI Benefits?
The SSA will automatically fast-track your application if your conditions meets a medical condition listed on the Compassionate Allowance (CAL) program. This program has been initiated to provide financial aid as quickly as possible to those who suffer from a severe or terminal medical condition.
Apply for SSDI Benefits Today
SSDI benefits for immune system disorders can be difficult to win because of the complicated procedure and documentation required. This is especially true if you have been denied benefits and are applying a second time. Advocates who specialize in SSDI matters can help you gather all the relevant facts to demonstrate you clearly meet the SSDI criteria.
Our advocates at Disability United are experienced, and can provide you expert guidance throughout the claims process. Moreover, they understand your situation and are ready to answer any questions you might have at any stage.
We can help you get the benefits you deserve. Start by filling out our form and get a free disability evaluation.