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VA Disability Benefits for Lupus

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Lupus is a challenging autoimmune disease that can severely impact an individual’s ability to work and live comfortably. For a veteran, securing VA disability benefits for lupus is a critical part in managing their health and financial stability.

Understanding how to get service-connected and secondary service connections for this disease, as well as how you can be rated, will help ensure you receive the compensation you deserve.

How Do I Get Service Connected for Lupus?

To qualify for VA disability benefits for lupus, you must establish a direct service connection. This requires you meet three essential criteria: 

  • Current Diagnosis: You will need a formal diagnosis of lupus from a recognized medical professional.
  • In-Service Incident: There must be an event or exposure during military service that triggered or aggravated your lupus.
  • Medical Nexus: A medical nexus must connect your lupus diagnosis to the in-service event or exposure.

Additionally, you’ll want to gather comprehensive medical evidence. This includes service treatment records, medical records showing your diagnosis and treatment and any statements from fellow service members corroborating your symptoms during service.

Secondary Service Connection for Lupus

Lupus can also lead to a variety of secondary conditions, which can also be service-connected and help increase a veterans overall VA rating, and ultimately their compensation and benefits.

Conditions that arise or worsen due to lupus include:

  • Kidney Disease (Lupus Nephritis): damage to the kidneys from chronic inflammation.
  • Heart Disease (Lupus Carditis): Inflammation of the heart or its surrounding tissues.
  • Lung Disease (Lupus Pneumonitis, Pleuritis): Inflammation of the lungs or the lining of the lung cavity.
  • Neurological Disorders (CNS Lupus): Cognitive dysfunction, headaches and seizures.
  • Blood Disorders (Anemia, Thrombocytopenia): Low red blood cell or platelet counts.
  • Arthritis: Inflammation and pain in the joints.
  • Skin Conditions (Discoid Lupus, Photosensitivity): Chronic skin rashes and sensitivity to sunlight.
  • Raynaud’s Phenomenon: Reduced blood flow to fingers and toes causing them to turn white or blue.
  • Fibromyalgia: Widespread musculoskeletal pain and fatigue.
  • Osteoporosis: Weakening of bones due to chronic steroid use for lupus treatment.
  • Vasculitis: Inflammation of blood vessels.
  • Peripheral Neuropathy: Numbness and tingling in the extremities.
  • Pulmonary Hypertension: High blood pressure in the lungs’ arteries.
  • Sjögren’s Syndrome: Dry eyes and dry mouth due to the immune system attacking moisture-producing glands.

To establish a secondary service connection, you must show that your lupus caused or aggravated another condition. Provide medical records and expert opinions linking these secondary conditions to your lupus.

Secondary Connection by Aggravation

If you had lupus before you joined the military and your condition worsened because of your time in service, you could qualify for benefits through aggravation. 

This means your military duties or the environment you were in exacerbated your lupus beyond its natural progression. Examples of this could include:

  • Lupus-related fatigue: If military duties exacerbate the chronic fatigue associated with lupus, leading to decreased performance or increased need for rest.
  • Skin flare-ups or worsening of prior lesions: Exposure to harsh environmental conditions, such as extreme head or cold during service, worsening lupus-related skin conditions.
  • Gastrointestinal issues: Stress and diet changes during service aggravating lupus-related gastrointestinal problems, like irritable bowel syndrome (IBS).

If you have another condition that was aggravated by your Lupus, such as pre-existing Raynaud’s Phenomenon or Fibromyalgia, you can use your medical records to show that the Lupus aggravated the condition beyond its natural progression.

Is Lupus a Presumptive VA Disability Under the PACT Act?

Currently, lupus is not listed as a presumptive condition under the PACT Act. This means that veterans must establish a direct or secondary service connection to receive benefits for lupus. 

The PACT Act focuses on conditions linked to specific exposures, such as burn pits and herbicides like Agent Orange, but lupus is not yet included in this list.

What’s the VA Rating for Lupus?

The VA rates lupus based on the severity and frequency of flare-ups. The ratings are as follows:

  • 10%: Exacerbations occur once or twice a year with intermittent symptoms.
  • 60%: Exacerbations occur two or three times a year and last a week or more.
  • 100%: Frequent and severe flare-ups causing significant health impairment.

The VA will also consider your ability to work. If lupus significantly limits your ability to maintain substantially gainful employment, you might qualify for Total Disability based on Individual Unemployability (TDIU) benefits.

The C&P Exam for Lupus

During a Compensation and Pension exam, the VA will assess the severity of your lupus. This exam involves:

  • Reviewing your medical history and symptoms.
  • Conducting a physical examination.
  • Asking about how lupus affects your daily life and ability to work.

You can prepare for the exam by gathering all relevant medical records and documenting your symptoms and the impact they have on your day-to-day life and work.

During this process, there are typically a series of questions that you need to answer. You may be asked to list any types of complications you have from your condition, such as nutritional deficiencies, the part of the body impacted, the development of conditions like sclerosis or rheumatoid arthritis (and proof of this), as well as other factors. You can expect the process to take under 30 minutes in most cases.

Be honest and detailed in your responses, and consider bringing someone with you to the appointment who can advocate for you, if needed.

How a Gulf War Veteran Won His Appeal for a Lupus VA Rating

This is a summary of a real VA claim won by a veteran for lupus. All identifying information has been removed.

A veteran appealed the denial of service connection for multiple conditions, including systemic lupus erythematosus. 

He argued that the lupus diagnosis, along with other conditions, were in fact related to his service and provided evidence to support this. 

The Board of Veterans’ Appeals examined the medical records, service treatment records and lay statements provided by the veteran.

Outcome

The Board granted service connection for the veterans lupus. 

The decision was based on the “benefit of the doubt” doctrine, which states that when there is an equal balance of positive and negative evidence, the claim should be resolved in favor of the veteran. 

The veteran successfully demonstrated that his lupus symptoms were connected to his service, meeting the criteria for a direct service connection.

Factors That Helped Win the Case

  • Benefit of the Doubt Doctrine: This doctrine played an important role in the favorable outcome, as the evidence was clearly balanced.
  • Comprehensive Medical Evidence: The veteran presented detailed medical records and lay statements that effectively linked his lupus to his military service.
  • Gulf War Service Connection: The veteran’s service in the Gulf War and potential exposure to environmental hazards were significant in establishing the connection between his lupus and military service.

Have you been diagnosed with lupus and had your claim for benefits denied by the VA? Contact Hill & Ponton today for a free case evaluation and let us fight to get you the compensation you deserve.

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Content Reviewed by

Cassandra Crosby

Cassandra Crosby, Claims Advocate Avatar

Cassandra, an Accredited Agent and claims advocate for Matthew Hill & Shelly Mark’s teams, reviewed the information provided in this post.

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