Can You Qualify for Social Security Disability Benefits with an Autoimmune Condition?

Autoimmune conditions, where the body's immune system mistakenly attacks its own tissues, affect millions of Americans. Disorders like lupus, rheumatoid arthritis, and scleroderma can cause chronic pain, fatigue, and organ damage, often making it impossible to maintain employment. If you're dealing with an autoimmune disorder, you may be wondering: Can I get Social Security Disability Insurance (SSDI) benefits? The short answer is yes, but qualification depends on meeting specific criteria set by the Social Security Administration (SSA). In this post, we'll explore the basics of SSDI, how autoimmune conditions fit into the eligibility framework, and steps you can take if you're considering applying.

Understanding SSDI Basics

SSDI is a federal program that provides monthly benefits to individuals who have worked and paid Social Security taxes but are now unable to engage in substantial gainful activity due to a severe disability. To qualify, you must meet these general requirements:

• Work Credits: You need a sufficient work history, typically based on your age and how long you've paid into Social Security. For most adults, this means at least 40 credits, with 20 earned in the last 10 years.

• Definition of Disability: Your condition must be severe enough to prevent you from performing any substantial work (earning above a certain threshold, around $1,550 per month in 2025 for non-blind individuals). It must also be expected to last at least 12 months or result in death.

• Medical Evidence: You'll need documentation from healthcare providers showing the diagnosis, symptoms, treatments, and how the condition limits your daily activities.

Autoimmune conditions can certainly meet this definition if they cause significant functional limitations, but the SSA evaluates them under a specific framework.

How Autoimmune Conditions Qualify Under SSA Guidelines

The SSA maintains a "Blue Book" of impairments, which lists medical conditions that may qualify for disability benefits. Autoimmune disorders fall under Section 14.00: Immune System Disorders.

This section covers a range of conditions caused by dysfunctional immune responses, including rheumatic diseases and connective tissue disorders. Common autoimmune conditions that may qualify include:

• Systemic Lupus Erythematosus (SLE or Lupus)

• Rheumatoid Arthritis (under Inflammatory Arthritis)

• Systemic Sclerosis (Scleroderma)

• Sjögren's Syndrome

• Polymyositis and Dermatomyositis

• Systemic Vasculitis

• Undifferentiated and Mixed Connective Tissue Disease

• Inflammatory Arthritis (e.g., Psoriatic Arthritis, Ankylosing Spondylitis)

To meet the listing for these conditions, your medical evidence must typically show:

• Organ or Body System Involvement: Often, involvement of two or more organs or systems (e.g., joints, skin, lungs, kidneys) with at least one affected to a moderate level of severity.

• Constitutional Symptoms: At least two symptoms like severe fatigue, fever, malaise, or involuntary weight loss that significantly impact your functioning.

• Repeated Manifestations: Flare-ups occurring on average three times a year (each lasting two weeks or more), combined with marked limitations in areas such as daily activities (e.g., grooming, cooking), social functioning (e.g., interacting with others), or completing tasks (e.g., due to concentration issues from pain or fatigue).

For example, with Lupus (Listing 14.02), you might qualify if you have organ involvement plus constitutional symptoms, or repeated flares leading to marked functional limitations. Similarly, for Inflammatory Arthritis (14.09), persistent joint inflammation or deformity that requires assistive devices (like a cane or walker) could meet the criteria.

If your condition doesn't exactly match a listing, the SSA may still approve benefits if it's "medically equivalent" in severity or if a residual functional capacity (RFC) assessment shows you can't perform any past or other work. Factors like treatment side effects (e.g., from steroids or immunosuppressants) and fluctuating symptoms are considered.

Challenges in Proving Disability for Autoimmune Conditions

Autoimmune disorders can be tricky to document because symptoms often wax and wane, and diagnoses rely on lab tests, biopsies, and clinical observations. Common hurdles include:

• Invisible Symptoms: Fatigue, pain, and cognitive fog ("brain fog") aren't always visible, so detailed medical records and statements from doctors are crucial.

• Overlapping Conditions: Many autoimmune diseases coexist with others, requiring comprehensive evidence.

• Denials and Appeals: Initial applications are often denied (up to 70% of cases), but appeals with stronger evidence succeed more frequently.

  
  

Working with a disability attorney can help gather the right documentation, such as functional capacity evaluations or vocational expert opinions, to strengthen your case.

Steps to Apply for SSDI

1. Gather Medical Records: Collect diagnoses, treatment histories, lab results, and doctor notes detailing how your condition affects work.

2. File Your Application: Apply online at SSA.gov, by phone, or at a local office. Be prepared for a wait—processing can take 3-5 months or longer.

3. Consider Appeals: If denied, request reconsideration and potentially a hearing before an administrative law judge.

4. Seek Professional Help: An experienced lawyer can guide you through the process, increasing your chances of approval.

   
   

Final Thoughts

Yes, individuals with severe autoimmune conditions can qualify for SSDI benefits if their disorder meets SSA criteria and prevents substantial work. However, the process is complex and requires strong medical evidence.

At the Law Offices of Christopher Le, we specialize in Social Security disability claims and have helped numerous clients with autoimmune disorders navigate the system successfully.

If you're struggling with an autoimmune condition and unable to work, don't go it alone.

Contact us today for a free consultation to discuss your options. We're here to help you secure the benefits you deserve.

Disclaimer: This article is for informational purposes only and does not constitute legal advice. Eligibility for SSDI is determined on a case-by-case basis. Consult with a qualified attorney for personalized guidance.