Disability Determination for Scleroderma

To qualify for disability benefits for Scleroderma, you must meet the criteria outlined by the Social Security Administration (SSA).

Scleroderma is a serious autoimmune disorder  that can either be localized to the skin or it can affect the entire body. Scleroderma has myriad symptoms that can include skin disorders, fatigue, painful swelling of the joints, and pulmonary and digestive difficulties. The causes are unknown but there may be a link to exposure to certain chemicals. Treatment and prognosis depends on the type of scleroderma you suffer from and what parts of your body it affects.  

Can I Get Disability for My Scleroderma?

Many people suffer from scerloderma but keep it mostly under control with medication. Those who are fortunate to respond well to medication can often live and work successfully for many years without much pain or fatigue. There are others, however, who have too much joint pain, progressing problems with the esophagus or lungs, or other difficulties that make it impossible to continue to work. The Social Security Administration (SSA) will consider approving you for disability benefits for scleroderma if you first meet the initial basic requirements:

  • You cannot work above the substantial gainful activity (SGA) level (in 2016, $1,130 or more a month).
  • Your disability must be expected to last at least 12 consecutive months.
  • Your disability must be “severe” (causing a more than minimal impact on your ability to do work-related activities).

If the SSA determines you satisfy these basic requirements, it will then consider whether the severity of your scleroderma meets the requirements for scleroderma established in the SSA’s Listing of Impairments. If it does, you can be automatically approved for disability.

Listing for Scleroderma

Scleroderma is described under SSA listing  14.04,  Systemic Sclerosis. The listing requires that to be automatically approved for disability based on your scleroderma, you must first be diagnosed with diffuse scleroderma, localized scleroderma (linear  scleroderma and morphea), or scleroderma with Raynaud’s phenomenon,  and experience one of the following sets of complications.

  • Scleroderma that affects  two  or more parts of your body, such as your skin, lungs, or digestive system with:
    • At least one body system that is moderately affected; AND
    • At least two of the following symptoms: unintentional weight loss, extreme tiredness, fever, or malaise (a general sensation of un-wellness or depression)  OR
  • Scleroderma with:
    • Difficulty walking without assistance because of malformations of the toes or one or both feet; or
    • Malformation of the fingers or in both hands that prevents you from performing tasks such as writing, using a computer or other similar movements; or
    • Permanent muscle loss in one or both of your legs that makes it difficult for you to walk without help; or
    • Permanent muscle loss in both of your arms that stops you from using your hands and arms to do activities such as lifting, carrying, pushing, pulling, writing or using a computer.  OR  
  • Raynaud’s syndrome with:
    • Gangrene in at least two of your arms or legs; or
    • Loss of blood supply to your toes or fingers that makes it difficult to walk without help or to use your hands and arms to do activities such as lifting, carrying, pushing, pulling, writing or using a computer.  OR
  • Frequent symptoms of systemic scleroderma with at least two of the following: unintentional weight loss, extreme tiredness, fever, or malaise (a general sensation of un-wellness or depression) with one of the following:
    • Severe limits on your ability to perform day-to-day activities (such as bathing, dressing, cooking and cleaning); or
    • Severe difficulty in maintaining social functioning (such as interacting with others or enjoying the activities you used to); or
    • Severe limits in your ability to finish jobs on time because it is hard for you to focus, your endurance is limited and you cannot work as quickly as expected.

The listing requirements for scleroderma are complex; therefore it is important that you review them with your treating physician to see whether you should qualify for benefits based on the scleroderma listing.

What If My Scleroderma Doesn’t Meet the Listing Requirements?

Even if you do not meet the listing requirements for automatic approval, you may still qualify for disability, though it will be more difficult. If you have some of the symptoms of the above listing, but not all, and your scleroderma limits  your ability to work well, the SSA will consider if you have limitations that prevent you from working a full-time job.  

How Your Illness Impacts Your Ability to Work

First, the SSA will look at the symptoms of your illness and how it limits you to determine whether it believes you can do your past work. If the SSA feels that despite your illness, you should be able to do your old job, your claim will be denied; otherwise, the SSA must decide if there is other work you are able to perform. To determine whether there is other work you can do, the SSA will consider your age, education, past work experience, and the limitations on your ability to do work-related activities because of your scleroderma. If the SSA feels there is other work you can do, your claim will be denied; on the other hand, if the SSA determines there are no other jobs you might be able to do, your claim will be approved.

Your Residual Functional Capacity

It will help your case if you ask your doctor to fill out a Residual Functional Capacity (RFC) assessment form, stating how your ability to work is affected by your scleroderma. For example, even if you are able to use your arms and hands to perform gross motor movements (like lifting), you may still have difficulty using your fingers to perform fine motor movements such as writing or typing. This would limit what kind of job you could do. Also, because scleroderma can cause significant fatigue, your doctor should state whether you would need to take unscheduled breaks during the day or whether you would be likely to miss an unacceptable amount of work due to your fatigue. If you can prove that there would be a 20% reduction in your productivity level due to your scleroderma, you would likely be approved for disability.

In addition, if your scleroderma affects specific body systems such as your heart and lungs, your RFC should discuss this; the SSA would then also consider whether the symptoms of your affected body systems are severe enough to meet another listing in the listing of impairments. For example, if your heart is affected by your scleroderma, the SSA would then look to the cardiovascular listing to see if you qualify for automatic approval.

An RFC is only as strong as the medical evidence provided to support it. Therefore, it is important to provide the SSA with as much medical evidence as possible. This includes MRIs, CT scans, x-rays, doctors’ reports, description of any medications and their side effects, results from blood tests and treatment notes from any hospital visits.

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