Can You Get SSDI for Antiphospholipid Syndrome?
TL;DR: Yes. Antiphospholipid syndrome (APS) is an autoimmune disorder that causes abnormal blood clotting, leading to deep vein thrombosis, pulmonary embolism, stroke, and recurrent pregnancy loss. When APS causes organ damage from clotting, or when the anticoagulation treatment itself creates work restrictions, you can qualify for SSDI. The SSA evaluates APS under Listing 14.00 (immune system disorders) and under whatever organ system has been damaged by the clotting.
APS makes your blood clot when it should not. The antiphospholipid antibodies attack cell membranes and trigger clotting in arteries and veins. A single clot can cause a stroke, pulmonary embolism, kidney damage, or limb-threatening ischemia. Many people with APS require lifelong anticoagulation, which carries its own risks and restrictions. And catastrophic APS, where clotting occurs simultaneously in multiple organs, can be rapidly fatal.
SSA Listings for APS
| SSA Listing | When It Applies |
|---|---|
| 14.00 (Immune system disorders) | APS as autoimmune condition with documented organ involvement |
| 11.04 (Vascular insult to brain) | If APS caused stroke with residual deficits |
| 4.11 (Peripheral arterial disease) | If APS caused peripheral clotting with tissue damage |
| 6.05 (Chronic kidney disease) | If APS damaged the kidneys |
SSA evaluates disability claims using the Blue Book, which lists qualifying conditions and the specific criteria each must meet. If your condition matches a Blue Book listing, approval is more straightforward. Even if your condition does not match a Blue Book listing exactly, you can still qualify through a medical-vocational allowance. This considers your age, education, work experience, and functional limitations together. Consistent treatment records are critical. SSA looks for ongoing documentation showing your condition limits your ability to work, not just a single diagnosis.
Medical Evidence the SSA Needs
- Positive antiphospholipid antibodies (anticardiolipin, anti-beta2 glycoprotein I, lupus anticoagulant) confirmed on two occasions 12 weeks apart
- Documentation of clotting events: DVT, PE, stroke, TIA
- Imaging confirming clots: Doppler ultrasound, CT angiography, MRI
- Anticoagulation records and INR monitoring
- Documentation of organ damage from clotting
- If associated with lupus: lupus documentation
- Hematologist treatment records
Request your medical records directly from each provider rather than relying on SSA to gather them. SSA requests can take months, and records sometimes get lost in the process. Include records from every provider you have seen for your disabling conditions, even if a visit seemed minor. Gaps in treatment history are one of the most common reasons for denial. Medical records from the past 12 months carry the most weight, but older records help establish the onset date. A treatment history spanning several years shows the condition is persistent, not temporary.
Common Denial Reasons
- Anticoagulation expected to prevent further clots. While blood thinners reduce risk, they do not eliminate it. Document breakthrough clotting events and the activity restrictions anticoagulation imposes.
- Antibodies positive but no clotting events. APS requires both antibodies and clinical events. Antibodies alone do not qualify.
- Organ damage not documented. If APS caused stroke, document the residual cognitive and motor deficits. If it damaged kidneys, document kidney function decline.
A denial does not mean your case is over. About 2 out of 3 initial SSDI applications are denied, and many of those denials are overturned on appeal. Read your denial letter carefully. It tells you exactly why SSA denied your claim. The most common reasons are insufficient medical evidence and SSA determining you can still perform some type of work. You have 60 days from the date on your denial letter to file an appeal. Missing this deadline means starting over from scratch, so mark it on your calendar immediately.
Compassionate Allowance
Standard APS is not on the Compassionate Allowance list. Catastrophic APS with multi-organ failure may qualify for expedited processing.
SSA evaluates disability claims using the Blue Book, which lists qualifying conditions and the specific criteria each must meet. If your condition matches a Blue Book listing, approval is more straightforward. Even if your condition does not match a Blue Book listing exactly, you can still qualify through a medical-vocational allowance. This considers your age, education, work experience, and functional limitations together. Consistent treatment records are critical. SSA looks for ongoing documentation showing your condition limits your ability to work, not just a single diagnosis.
Function Report Tips
- Describe restrictions from anticoagulation: bleeding risk, activity limitations, dietary restrictions
- Detail residual effects from clotting events: stroke deficits, breathing problems from PE
- Explain the frequency of medical monitoring: INR checks, specialist visits
- Describe the fear and anxiety associated with the risk of another clotting event
- Note any cognitive changes from micro-clots or stroke
APS claims need documentation of both the autoimmune condition and its consequences. ClaimPath builds SSA-compliant disability documents for $79, saving the 25% attorney fee.
Related Condition Guides
Report any changes within 10 days of the change occurring. This includes starting or stopping work, changes in your medical condition, moving to a new address, or receiving other benefits. You can report changes online through your my Social Security account, by calling SSA at 1-800-772-1213, or by visiting your local SSA office. Keep a record of what you reported and when. Failing to report changes can result in overpayments. SSA will recover overpayments by withholding future benefits, and in some cases, overpayments can reach thousands of dollars.
What to Do Next
- Check the date on your denial letter and mark your 60-day appeal deadline on a calendar. Missing this window means restarting the entire process.
- Request a complete copy of your SSA file (called the 'exhibit file') so you can see exactly what evidence the reviewer had, and identify any gaps you need to fill.
- Get an updated RFC form from your treating doctor that addresses the specific reasons listed in your denial. If SSA said you can do sedentary work, your doctor needs to explain why you cannot.
- Contact a disability attorney for a free case evaluation. Most work on contingency, so you pay nothing unless you win.
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Frequently Asked Questions
Can You Get SSDI for Antiphospholipid Syndrome??
Yes. Antiphospholipid syndrome (APS) is an autoimmune disorder that causes abnormal blood clotting, leading to deep vein thrombosis, pulmonary embolism, stroke, and recurrent pregnancy loss. When APS causes organ damage from clotting, or when the anticoagulation treatment itself creates work restrictions, you can qualify for SSDI. The SSA evaluates APS under Listing 14.00 (immune system disorders).
How does the Compassionate Allowance program work for antiphospholipid syndrome?
Standard APS is not on the Compassionate Allowance list. Catastrophic APS with multi-organ failure may qualify for expedited processing.
What information should I include in the function report for an antiphospholipid syndrome claim?
APS claims need documentation of both the autoimmune condition and its consequences. Describe restrictions from anticoagulation: bleeding risk, activity limitations, dietary restrictions. Detail residual effects from clotting events: stroke deficits.