Understanding Lupus as a Disability

For veterans living with lupus, navigating the Department of Veterans Affairs (VA) disability benefits system can be as challenging as managing the disease itself. If you’re wondering “is lupus a VA qualifying disability?” the short answer is yes—but securing benefits requires understanding specific criteria and processes.

Lupus (Systemic Lupus Erythematosus or SLE) is a chronic autoimmune disorder where the body’s immune system mistakenly attacks healthy tissues and organs. This results in widespread inflammation that can damage multiple body systems, including the joints, skin, kidneys, blood cells, brain, heart, and lungs.

Veterans with lupus typically experience a wide range of symptoms that may include:

• Extreme fatigue and persistent fever
• Joint pain, stiffness, and swelling (arthritis)
• A distinctive butterfly-shaped rash across the face (malar rash)
• Skin lesions that worsen with sun exposure (photosensitivity)
• Oral ulcers in the mouth or nose
• Hair loss
• Chest pain, often exacerbated by deep breathing
• Shortness of breath
• Headaches, confusion, and memory problems (“lupus fog”)
• Raynaud’s Phenomenon (fingers and toes turning white or blue in cold conditions)
• Gastrointestinal issues
• Swelling in the extremities (edema)

What makes lupus particularly challenging is its unpredictable nature, with symptoms that fluctuate between periods of flare-ups (exacerbations) and remission. While lupus affects predominantly women (9 out of 10 cases), it can impact anyone regardless of gender, age, or background.

Is Lupus Recognized as a VA Qualifying Disability?

Yes, lupus is unequivocally recognized as a qualifying disability by the VA. The Department of Veterans Affairs acknowledges both Systemic Lupus Erythematosus (SLE) and cutaneous lupus (which primarily affects the skin) as conditions that can significantly impair a veteran’s ability to function and work.

However, a critical distinction exists: simply having a lupus diagnosis isn’t sufficient to receive VA disability benefits. To qualify for compensation, veterans must establish a “service connection”—demonstrating that their lupus is linked to their military service in some way.

How to Establish Service Connection for Lupus

Establishing a service connection for lupus can be more challenging than for conditions with obvious in-service incidents or injuries. This is partly because lupus has a genetic component and its onset can be gradual and difficult to pinpoint. Veterans typically need to meet three key criteria:

1. Current Diagnosis

A formal diagnosis of lupus from a qualified medical professional is the essential first step. This diagnosis should be clearly documented in your medical records and should specify whether you have SLE, cutaneous lupus, or another variant.

2. In-Service Event, Injury, or Illness

You must provide evidence of an event, exposure, or illness that occurred during military service that could have caused or aggravated your lupus. This might include:

• Exposure to environmental toxins or chemicals
• Extreme stress situations
• Certain medications
• Sun exposure or other environmental factors

3. Medical Nexus

A medical opinion (known as a “nexus statement”) from a healthcare provider that explicitly links your current lupus diagnosis to the in-service event or exposure is crucial. This statement should explain, with medical reasoning, how your military service likely caused or contributed to your lupus.

Four Methods to Establish Service Connection for Lupus

When filing for VA disability benefits for lupus, veterans can pursue four primary pathways to establish service connection:

1. Direct Service Connection

This method requires proving that a specific event or exposure during service directly caused the onset of lupus or significantly worsened a pre-existing, non-service-connected lupus condition. Veterans need to identify the specific in-service trigger and provide medical evidence linking it to their current lupus diagnosis.

2. Chronic Illness Presumption

Lupus is included on the VA’s list of chronic diseases that may be presumed service-connected if the condition manifests to a compensable degree within one year of discharge from military service. This presumptive service connection is significant because it means veterans don’t need to pinpoint a specific in-service event—they only need to show that symptoms began within that one-year window, even if formal diagnosis came later.

3. Aggravation of a Pre-existing Condition

If a veteran had lupus before joining the military, but their service significantly worsened the condition beyond its natural progression, service connection may be granted based on aggravation. This requires medical evidence comparing the condition’s severity before and after military service.

4. Secondary Service Connection

If lupus develops or is aggravated as a result of another service-connected disability, it may qualify for benefits on a secondary basis. For example, some studies suggest links between severe PTSD and autoimmune disorders, including lupus.

VA Disability Ratings for Lupus

The VA uses specific diagnostic codes to rate lupus based on the severity and frequency of its manifestations:

Systemic Lupus Erythematosus (SLE)

SLE is rated under Diagnostic Code 6350 with the following criteria:

• 10% rating: Exacerbations occur once or twice a year, or the veteran has been symptomatic during the past two years
• 60% rating: Exacerbations lasting a week or more occur two or three times per year
• 100% rating: The condition is acute, with frequent exacerbations producing severe impairment of health (may include hospitalization or serious organ complications)

Cutaneous Lupus (Skin-Predominant)

Cutaneous lupus is typically rated using the General Rating Formula for the Skin under Diagnostic Code 7806:

• 60% rating: Lesions involving more than 40% of the entire body or exposed areas, OR constant/near-constant systemic therapy required over the past 12 months
• 30% rating: Lesions involving 20-40% of the entire body or exposed areas, OR systemic therapy required for 6 weeks or more (but not constantly) over the past 12 months
• 10% rating: Lesions involving 5% to less than 20% of the entire body or exposed areas, OR intermittent systemic therapy required for less than 6 weeks over the past 12 months
• 0% rating: Lesions involving less than 5% of the entire body or exposed areas, AND only topical therapy required over the past 12 months

Alternatively, cutaneous lupus may be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801-7805) if that is the predominant disability.

Combined Ratings and Predominant Disability

When lupus affects multiple body systems, the VA will evaluate the veteran under either:

1. The specific lupus codes (DC 6350 or DC 7806/7809), OR
2. By rating the residuals under the appropriate body systems (e.g., joints, kidneys, heart) and combining those separate ratings

The VA assigns the rating method that results in the highest overall compensation. It’s important to note that ratings under DC 6350 and DC 7809/7806 cannot be combined—the VA will use one or the other.

Secondary Conditions Related to Lupus

Lupus can lead to numerous secondary conditions that may qualify for additional VA disability benefits. When these conditions are connected to service-connected lupus, they can increase a veteran’s overall combined disability rating. Common secondary conditions include:

• Kidney disease (Lupus Nephritis)
• Heart disease (Lupus Carditis, atherosclerosis)
• Lung disease (Lupus Pneumonitis, Pleuritis, Pulmonary Hypertension)
• Neurological disorders (cognitive dysfunction, headaches, seizures, peripheral neuropathy)
• Blood disorders (anemia, thrombocytopenia)
• Arthritis
• Skin conditions (beyond initial lupus rashes)
• Raynaud’s Phenomenon
• Fibromyalgia
• Osteoporosis (often due to steroid treatment)
• Vasculitis (inflammation of blood vessels)
• Sjögren’s Syndrome (dry eyes, dry mouth)

To service-connect these secondary conditions, veterans must provide medical evidence and a medical nexus linking the secondary condition to their service-connected lupus.

The VA Claims Process for Lupus: Step-by-Step Guide

1. Gather Comprehensive Evidence

Collect all relevant medical records documenting:

• Lupus diagnosis
• Symptoms and their frequency
• Treatment history
• Impact on daily activities and work
• Service records showing potential exposures or events
• A strong medical nexus opinion linking lupus to military service

Lay statements from you and others who witnessed your symptoms can provide valuable supporting evidence.

2. File Your Claim

Submit VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits) online, by mail, or in person. You can file an “Intent to File” to establish an earlier effective date while gathering documentation.

3. Attend the Compensation and Pension (C&P) Exam

The VA will schedule a C&P exam with a VA or contracted medical professional who will:

• Review your records
• Conduct an interview and physical examination
• Assess the severity and impact of your lupus

During this exam, be honest and detailed about all your symptoms, including the frequency and severity of flare-ups and how your condition affects your ability to work and perform daily activities.

4. Await the VA’s Decision

The VA reviews all evidence and the C&P examiner’s report to determine service connection and assign a disability rating.

5. Appeal if Necessary

If your claim is denied or you receive a lower rating than expected, you have the right to appeal the decision within one year. During the appeal, you can submit additional evidence, including stronger medical opinions or lay statements.

Common Challenges and Tips for a Successful Claim

Why Lupus Claims Get Denied

Many lupus disability claims are denied or receive low ratings due to:

• Insufficient medical evidence
• Lack of a clear medical nexus
• Inconsistent documentation of symptoms and flare-ups
• Incomplete understanding of how lupus impacts the veteran’s specific condition

Tips to Strengthen Your Claim

Document Everything

Keep a detailed log of symptoms, flare-ups (frequency, duration, severity), treatments, and how lupus affects your daily activities and ability to work.

Seek Consistent Medical Care

Regularly see doctors (VA and/or private) and ensure all symptoms are documented in medical records. Inform your healthcare providers about your military service history.

Obtain a Strong Medical Nexus

Work with a medical professional who understands both lupus and the VA system to get a well-reasoned medical opinion linking your condition to service.

Prepare for the C&P Exam

Review your medical history and be ready to articulate the full scope of your symptoms and limitations to the examiner. Bring documentation of flare-ups if possible.

Consider Secondary Claims

Be aware of potential secondary conditions caused or aggravated by lupus and file claims for them if applicable.

Seek Professional Assistance

Navigating the VA system can be complex. Veterans Service Officers (VSOs), accredited veterans disability lawyers, or other qualified representatives can provide invaluable guidance through the process.

Total Disability Based on Individual Unemployability (TDIU)

Veterans whose lupus symptoms prevent them from maintaining substantially gainful employment may be eligible for Total Disability based on Individual Unemployability (TDIU), even if their schedular disability rating is less than 100%.

TDIU pays benefits at the 100% rate. Generally, to qualify based on a single disability, that condition must be rated at least 60% disabling. For multiple disabilities, one must be at least 40% with a combined rating of 70% or more.

The VA assesses the functional impact of service-connected lupus on the veteran’s ability to work, considering education, training, and work history. For veterans severely impacted by lupus, TDIU can provide essential financial support when working is no longer possible.

Securing The Benefits You Deserve

Lupus is indeed a recognized and ratable disability by the VA. While the claims process can be challenging, understanding how to establish service connection, document symptoms properly, and navigate the rating system significantly improves your chances of receiving appropriate compensation.

Remember that thorough medical documentation, a strong medical nexus, and detailed reporting during the claims process—especially during the C&P exam—are crucial for a successful claim. Don’t hesitate to seek assistance from a VSO or an accredited attorney if you encounter obstacles.

Veterans who have served our country deserve comprehensive support for conditions like lupus that may be connected to their service. By understanding your rights and following the guidance outlined in this article, you can work toward securing the VA disability benefits you’ve earned through your sacrifice and service.

At Allveteran.com, we seek to help veterans connect with resources that may make all the difference. To find out your disability rating, take our free medical evidence screening today!