Scleroderma, or systemic sclerosis, is a chronic autoimmune disease characterized by the overproduction and accumulation of collagen, causing hardening and tightening of the skin and connective tissues. Severity varies widely, ranging from localized skin involvement to widespread damage affecting multiple internal organs. For individuals with this diagnosis, qualification for financial support depends entirely on the degree of physical limitation and the documented impact the disease has on a person’s life.
The Legal Definition of Disability
A diagnosis of a chronic illness like scleroderma does not automatically qualify a person for disability benefits. The system uses a strict legal definition that focuses on functional capacity rather than the name of the disease itself. To be considered disabled, an individual must have a medically determinable impairment that is expected to result in death or has lasted, or is expected to last, for a continuous period of at least 12 months.
The central legal requirement is the inability to engage in Substantial Gainful Activity (SGA). SGA is defined by an earnings threshold, meaning a person’s income must fall below a certain monthly amount to demonstrate they are not working at a sustained, gainful level. The government’s definition of disability is primarily an administrative and economic one, separate from a treating physician’s medical diagnosis.
Meeting Specific Medical Requirements
For systemic sclerosis, the Social Security Administration (SSA) maintains a list of medical criteria known as the Listing of Impairments. Scleroderma is evaluated under the criteria for Immune System Disorders. Meeting this listing results in a finding of disability without further vocational analysis.
A claimant meets this listing if the disease severely affects two or more organ systems (e.g., lungs, heart, kidneys, or gastrointestinal tract). At least one system must be affected with moderate severity. The claimant must also experience two constitutional symptoms, such as severe fatigue, fever, malaise, or involuntary weight loss. Documented evidence of severe organ damage, like pulmonary fibrosis or renal crisis, provides the clearest path to meeting this listing.
The listing also includes criteria for severe circulatory and musculoskeletal complications. Disability can be found if a claimant has severe manifestations of Raynaud’s phenomenon, such as gangrene in two or more extremities or ischemia with open sores. Fixed contractures or irreversible atrophy in the hands or feet that prevent fine motor skills or the use of assistive devices for walking can also meet the medical requirement.
Evaluating Work Limitations
If scleroderma does not meet the criteria in the Listing of Impairments, the claim proceeds to an evaluation of the Residual Functional Capacity (RFC). The RFC is an administrative assessment that determines the maximum amount of work-related activity a claimant can still perform despite medical limitations. This step is crucial for individuals whose symptoms are significant but do not reach the extreme severity required by the listing.
The RFC assessment considers both physical and mental limitations, including the cumulative effect of chronic pain, severe fatigue, and reduced stamina common with scleroderma. Skin tightening and stiffness in the hands can be documented as a manipulative limitation, making fine motor tasks difficult.
Shortness of breath from lung involvement or joint pain can limit a person’s ability to stand, walk, lift, or sit for prolonged periods. The SSA uses the RFC to decide if the claimant can perform their past work or any other less-demanding job in the national economy.
By documenting limitations in sitting, standing, lifting, and concentration, the RFC proves that the condition’s overall impact makes sustained, full-time work impossible. A treating physician’s detailed report is highly influential in establishing these functional limitations.
Steps in the Application Process
Applying for benefits begins with the initial application, requiring comprehensive information about work history and medical treatment. The process relies heavily on objective medical evidence, including doctor’s notes, laboratory results, imaging scans, and hospitalization records, to establish the severity of the scleroderma. Applicants must ensure their medical records are current and clearly document the functional limitations imposed by the disease.
The application is sent to a state agency called Disability Determination Services (DDS), which makes the medical decision. Many initial applications are denied, meaning claimants must be prepared for the appeals process.
The appeals process typically follows these steps:
- Reconsideration.
- A hearing before an Administrative Law Judge (ALJ).
- Review by the Appeals Council.
The success of the claim depends on the quality and completeness of the medical documentation provided at every stage. Consistent compliance with prescribed treatments and regular medical visits are also important, as they demonstrate the condition is being actively managed. Filing the application as soon as the condition prevents work is advisable, as the process can be lengthy.