Autoimmune Disease and SSDI Eligibility

You can qualify for Social Security Disability Insurance (SSDI) with an autoimmune disease or disorder when medical evidence shows that the condition severely limits your ability to work. A diagnosis by itself does not establish disability; you must meet all of the Social Security Administration’s (SSA) disability rules.

For systemic autoimmune disorders, the SSA looks at how the condition affects your body and what you can do. Reviewers consider which organs or body systems are affected, how severe your symptoms are, and how combined limitations affect you. They also look at treatments you’ve tried and how often symptoms and problems return.

This article explains how to use medical evidence to show the effects of an autoimmune disease on your daily life and ability to work when you apply for Social Security disability benefits. 

How the SSA Evaluates Autoimmune Disease for SSDI 

An autoimmune disorder can be evaluated in three different ways.

First, your condition could “meet” a listing in the SSA’s Blue Book, a list of medical problems severe enough to prevent you from working. Meeting a listing means your condition and records match all of the required criteria. 

If your autoimmune disorder doesn’t meet a listing, it may “equal” a listed impairment, meaning your evidence proves it’s as severe and long-lasting.

If your condition doesn’t meet or equal a listing, reviewers assess your residual functional capacity (RFC), which is the most you can do in a work setting despite your documented limitations. They’re deciding if you can do your past work or adjust to new types of work. RFC is discussed more below.

Documenting Systemic Autoimmune Disease

Autoimmune disorders like scleroderma, Sjögren’s syndrome, and vasculitis can affect several parts of the body, and how they affect you may change over time. Therefore, reviewers look at your full medical picture, treatment history, and documented limitations.

To document an autoimmune disease or disorder, your records need to answer these questions:

• Do you have medical evidence establishing an immune system disorder?
• What manifestations are documented (signs, symptoms, and problems affecting an organ or body system)?
• Which organs or body systems are affected?
• How severe are those manifestations?

The medical evidence needed to answer these questions depends on the disorder and the parts of the body it affects. Reviewers look at your medical history, exam findings, lab results, imaging, and biopsy reports for answers.

For example, two people with systemic lupus erythematosus (lupus) may have records documenting different problems. One person’s records may show joint inflammation and abnormal blood tests while another’s show kidney or nerve problems.

Repeated Manifestations (Flare-Ups) and Systemic Symptoms 

Repeated manifestations, often called flare-ups, are one way to meet several autoimmune listings. For this route, reviewers evaluate how often they happen and how long they last.

Under SSA rules, “repeated” means the manifestations happen an average of three times a year, or once every four months, and last at least two weeks. If they last less than two weeks, they must happen substantially more often. If they happen less often, they must last substantially longer than two weeks. 

Your problems don’t have to be the same each time. Your records could show joint swelling at one appointment, severe fatigue at another, and kidney problems later. Reviewers consider all of those symptoms and problems together.

Severe Fatigue and Malaise

Several immune system listings require documentation of at least two “constitutional symptoms or signs.” These are severe fatigue, fever, malaise, or involuntary weight loss.

Severe fatigue means you feel exhausted so often that it significantly limits your physical activity or mental function. Malaise means you often feel sick, uncomfortable, or unwell enough to interfere with your usual activities.

How Treatment Response and Side Effects Affect Your Claim 

In an SSDI claim for an autoimmune disease, your treatment history helps reviewers understand the treatments you’ve tried and their effects, including if treatment controlled the disorder, how long the benefits lasted, and if you had side effects. 

A treatment may work well at first and then become less effective. Side effects can also hinder your ability to work. For example, steroids or immunosuppressants may reduce joint inflammation but cause mental fog or frequent infections. 

How Your Limitations Affect Work

If your disorder does not meet or equal a listing, reviewers use your RFC to determine if you can do your past work or adjust to other types of work.

Since autoimmune diseases often cause several limitations at the same time, reviewers consider those limitations together, such as problems caused by the disease, symptoms, and treatment side effects.