Selected Immune Disorders and Disability (2022) / Chapter Skim
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1 Introduction
1 Introduction
Pages 13-28
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From page 13... ...
: 1. Provide an overview of the current status of the diagnosis, treat ment, and prognosis of select immune system disorders, including systemic lupus erythematosus, scleroderma, polymyositis, Sjögren's syndrome, and inflammatory arthritis, but excluding HIV, in the U.S.
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From page 14... ...
5. For the immune system disorders identified in task 1, identify to the degree possible the functional limitations associated with each disorder, including physical functioning limitations, mental func tioning limitations, limitations resulting from common treatments, and variations in functioning (for example, during flare-ups vs.
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From page 15... ...
SSA makes individual decisions on each case based on all the evidence they receive. In responding to the Statement of Task, the committee introduces background information related to immune disorders, followed by the concepts of disability and functional status.
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From page 16... ...
As previously mentioned, there are more than 100 autoimmune disorders, and multiple organ systems can be affected, with rheumatic diseases such as SLE and RA forming a subset of these conditions. "Immune disorders" include autoimmune disorders, but also include immunodeficiency disorders, which may be hereditary or acquired and are beyond the scope of this report.
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From page 17... ...
Note that the arrows in the diagram are always double-pointed, since the relationships can involve feedback. Similarly, the immune conditions discussed throughout this report and their impact on functioning and disability can be strongly mediated by contextual factors and environmental factors in particular, including cold environments or direct sunlight.
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From page 18... ...
For the immune disorders discussed in this report, it is important to consider the contextual factors, interrupters, and accommodations, and their effects on functional capacity, which can be self-reinforcing in both positive and negative dimen sions. Next, the committee describes the details of how functional status in immune system disorders is evaluated in practice.
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From page 19... ...
For adults, the Listings describe, for each of the major body systems, impairments that SSA considers to be severe enough to prevent a person from doing any gainful activity, regardless of his or her age, education, or work experience -- a 2 Rheumatology includes a study of systemic autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, Sjögren's disease, scleroderma, polymyositis, and others. 3 The adult listings are available at http://www.ssa.gov/disability/professionals/bluebook/ AdultListings.htm.
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From page 20... ...
Immune system disorders that cause dysfunction in one or more components of the immune system are evaluated at step 3 of the sequential evaluation process under Listings 14.00 and 114.00, for adults and children, respectively. SSA organizes the discussions of immune system disorders into three categories: autoimmune disorders; immune deficiency disorders, excluding human immunodeficiency virus (HIV)
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From page 21... ...
SSDI benefits can be withheld if beneficiaries consistently engage in earning at a substantial gainful activity level; however, other sources of income do not affect benefit receipt. SSI is a categorical welfare program, with no work requirement, recent or otherwise, but with a means test that limits eligibility to individuals with $2,000 or less in assets.
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From page 22... ...
SSA identifies Sjögren's syndrome, polymyositis and dermatomyositis, SLE, systemic sclerosis, and undifferentiated and mixed connective tissue disease under one diagnostic code, although they are distinct clinical entities, thus limiting the information available to the committee. After Initial Disability Determination The committee was unable to find information on the specific rates of award for SSDI or SSI applicants who allege disability due to an immune disorder.
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From page 23... ...
s Adult children Diagnostic group # % # % # % # % All disabled workers Ankylosing spondylitis or other spondyloarthropathies 7,119 3.5 6,865 3.6 120 2 134 3.9 Gout 5,326 2.7 5,240 2.7 74 1.2 12 0.3 Immune deficiency disorders, excluding HIV infection 6,431 3.2 6,120 3.2 109 1.8 202 5.9 Inflammatory arthritis 121,079 60.4 114,956 60.2 4,256 69.5 1,867 54.3 Sjögren's syndrome, polymyositis and dermatomyositis, 58,539 29.2 55,830 29.2 1,528 25 1,181 34.3 systemic lupus erythematosus, systemic sclerosis, and undifferentiated and mixed connective tissue disease Systemic vasculitis 2,109 1.1 2,031 1.1 35 0.6 43 1.3 Total 200,603 100 191,042 100 6,122 100 3,439 100 Men Ankylosing spondylitis or other spondyloarthropathies 4,699 9.5 4,587 9.4 15 7.5 97 10.3 Gout 4,631 9.3 4,592 9.5 (X)
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(X) Immune deficiency disorders, excluding HIV infection 4,628 3.1 4,411 3.1 105 1.8 112 4.5 Inflammatory arthritis 90,149 59.7 84,700 59.4 4,127 69.7 1,322 53 Sjögren's syndrome, polymyositis and dermatomyositis, 51,662 34.2 49,163 34.5 1,507 25.5 992 39.8 systemic lupus erythematosus, systemic sclerosis, and undifferentiated and mixed connective tissue disease Systemic vasculitis 1,348 0.9 1,286 0.9 (X)
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From page 25... ...
that is not surgically treatable, or age 46 1/2 or older.6 The committee notes that there are not specifically defined automatic diary date categorizations for other non-HIV immune conditions under consideration that do not improve, such as myositis with full muscle atrophy. The committee describes the appeal process and diary date determination because the lifelong courses of the immune disorder diseases under consideration in this report combined with the diseases' pattern of flares and remission can make it difficult for examiners to get a full understanding of the disease's impact on a person's ability to work.
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From page 26... ...
In its Statement of Task to the committee, SSA included text indicating that it recognizes that people may have difficulty accessing care or particular forms of treatment; however, some do so successfully, and the agency receives information about those treatments in the medical records. SSA makes individual decisions on each case based on all the evidence it receives, but cannot take access into consideration.
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2019. Annual statistical report on the Social Secu rity Disability Insurance Program, 2019.
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28 SELECTED IMMUNE DISORDERS AND DISABILITY Varadé, J., S Magadán, and Á.
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