Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin condition characterized by painful, deep-seated nodules, abscesses, and tunnels that form under the skin, often leading to extensive scarring. The lesions typically occur in areas where skin rubs together, such as the armpits, groin, and buttocks. The designation of HS as a disability is not automatic with diagnosis, but depends entirely on the context—such as employment protection or financial assistance—and the documented severity of the individual’s physical limitations.
Understanding the Legal Standard for Disability
A medical diagnosis alone does not determine disability status; rather, it is the extent to which the condition impacts a person’s life that matters. The general legal standard defines a disability as a physical or mental impairment that substantially limits one or more major life activities. These major life activities include basic functions like walking, sitting, standing, lifting, bending, communicating, and caring for oneself. For an individual with HS, chronic pain and inflammation from abscesses in the groin or perineum can make sitting or walking difficult. Lesions in the armpits (axillae) can also restrict the ability to lift or reach with the arms.
The presence of sinus tracts and extensive scarring can cause contractures, which are permanent fibrous scar tissues that tighten the skin and prevent normal joint movement. The legal status is determined by the functional consequences of the disease, such as the inability to perform routine movements without severe pain. An individualized assessment is required to determine if the physical symptoms create a substantial limitation on major life activities.
HS and Workplace Protections Under the ADA
The Americans with Disabilities Act (ADA) provides anti-discrimination protection for individuals in the workplace if their HS substantially limits a major life activity. This law requires employers with 15 or more employees to provide reasonable accommodations to qualified employees, unless doing so would create an undue hardship on the business. Reasonable accommodations are modifications to the job or work environment that allow an individual to perform essential job functions. The employee and employer must engage in an interactive process to determine appropriate modifications based on the specific limitations caused by HS.
For employees with HS, accommodations often relate to minimizing friction, managing pain, and allowing for wound care.
Common Workplace Accommodations
- A padded or specialized ergonomic chair to reduce pressure on lesions in the gluteal or perineal region.
- A standing desk or permission to alternate between sitting and standing throughout the workday.
- Modified uniforms made of looser-fitting, breathable fabric to prevent friction and irritation.
- A workspace closer to a restroom for necessary wound dressing changes and hygiene during flare-ups.
- Flexible scheduling or the option for temporary remote work to manage severe flare-ups or medical appointments.
These adjustments allow the employee to continue performing their job functions without exacerbating the physical symptoms. The ADA focuses on ensuring equal opportunity and preventing discrimination, not on providing financial assistance.
Qualifying for Social Security Disability Benefits
The criteria for financial assistance through the Social Security Administration (SSA) is significantly more stringent than the ADA standard. To qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), an individual must prove they are unable to engage in Substantial Gainful Activity (SGA). This inability must be expected to last for at least 12 months. The SSA evaluates HS under its Listing of Impairments, specifically Section 8.00 for Skin Disorders.
Hidradenitis Suppurativa is evaluated under Listing 8.09, which covers chronic conditions of the skin or mucous membranes. To meet this listing, a claimant must demonstrate that their chronic skin lesions or resulting contractures have persisted for at least three months despite prescribed medical treatment. Furthermore, the condition must cause severe functional limitations, such as the documented inability to use both upper extremities independently to initiate, sustain, and complete work-related activities. This limitation would apply if lesions in both armpits make it impossible to use the arms for working tasks.
Alternatively, the condition may qualify if it results in the inability to stand or walk to the extent needed for work, due to lesions or contractures affecting both lower extremities, the perineum, or the inguinal region. If an applicant’s HS does not meet the specific criteria of a listing, the SSA proceeds to a Residual Functional Capacity (RFC) assessment. The RFC determines the maximum amount of work-related activity an applicant can still perform despite their limitations, considering factors like their age, education, and prior work experience. For HS, the RFC assessment focuses on how pain, drainage, and limited mobility affect the ability to sit, stand, walk, lift, and handle objects. This is the final step in determining if any job in the national economy can be performed.