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Skin Disorders and Social Security Disability
By Pitt Dickey

Did you know that the largest organ that your body has is your skin? About 15% of your body weight is your skin. Unfortunately your skin can develop various health problems, some of which can be so serious that the impairments can prevent people from being able to work. The Social Security Administration (SSA) issued new guidelines which will be effective on 9 July 2004 for evaluating disability claims from people with health problems that involve their skin. This column will examine how these new guidelines will govern Social Security disability claims based upon skin disorders.

The basic rule used in evaluating all Social Security Disability Insurance Benefits claims is that the claimant's disability must be the result of a medically determinable physical or mental impairment that is expected to result in death or to last at least 12 months. If you have been diagnosed with a serious skin condition the new rules will determine on your disability claim.

The new SSA rules for evaluating skin disorders cover the following impairments: Ichthyosis which is a general group of disorders characterized by noninflammatory scaling of the skin; bullous diseases which have extensive skin lesions that have persisted for over three months despite continuing medical treatment - bullous diseases include pemphigus, erythema multiforme bullosum, epidermolysis bullosa, bullous pemphigoid, and dermatitis herpetiformis; chronic infections of the skin or mucous membranes with extensive fungating (growing like a fungus) or ulcerating (a lesion through the skin or a mucous membrane resulting from loss of tissue) with extensive skin lesions; dermatitis which includes psoriasis, dyshidrosis, atopic dermatitis, exfoliative dermatitis, allergic contact dermatitis with extensive skin lesions; hidradentitis suppurativa which a condition of swollen inflamed lesions that involves both arm pits, the groin, or lower pelvis area; genetic photosensitivity disorders which include Xeroderma pigmentosum (XP)which is a condition that causes the person to be extremely sensitive to exposure to light - persons with XP are considered to be disabled since birth by the SSA; and burns which have caused extensive skin lesions.

The SSA will require medical documentation of each of these conditions which will show the onset, duration, frequency of flare ups, prognosis of the skin disorder, location, size and appearance of the lesions. The SSA will evaluate the severity of the skin disorder by the extent of the skin lesions, the frequency of the flare ups of the skin lesions, the effect of the symptoms including pain on the patient, the type of treatment the patient is receiving and any side effects from the treatment.

The SSA defines "extensive skin lesions are those that involve multiple body sites or critical body areas and result in very serious limitation." Examples of very serious limitations are limitations of the motion of joints, limitations the use of more than one extremity, skin lesions on the palms of both hands that seriously limit the ability to grip and grasp, lesions of the soles of both feet which seriously limit the person's ability to walk.

The SSA does not require that the lesions be there continuously 12 months at a time. Many skin conditions have flares which occur and then go into remission. The frequency of the flares will be considered by the SSA to determine if the person could maintain full time employment during the periods of remission. The SSA considers the symptoms of the condition which may impose limitations on the patient's ability to work including pain. Side effects from the treatment prescribed are also considered by the SSA to see if the side effects of treatment would prevent the person from working. A person must have undergone at least three months of medical treatment before the SSA can determine if the person has a severe impairment.

These new skin disorder listings do not cover such health problems as skin cancers or connective tissue disorders or immune system disorders such as systemic lupus erythematosus, scleroderama or Sjogren's symptoms all of which are evaluated under separate specific criteria for disability rating.

Genetic photosensitivity disorders such as Xeroderma pigmentosa (XP) meets the listing for disability if the person's medical diagnosis supported by clinical and laboratory tests is that of XP. A person with XP has an extreme sensitivity to ultraviolet light and has to remain out of it to avoid the development of skin cancers by remaining in a "highly protective environment". The SSA defines the inability to function outside of a highly protected environment to mean the person "must avoid exposure to ultraviolet light (including sunlight passing through windows and light for unshielded fluorescent bulbs), wear protective clothing and eyeglasses, and use opaque broad spectrum sunscreens in order to avoid skin cancer or other serious effects."

Burns from chemical, electrical or thermal sources can effect various parts of the body. The SSA uses the Listings which cover the part of the body affected by the burns to make its evaluation as to whether the burn meets the disability requirement for the award of benefits. If the person is still undergoing surgical treatment to repair the burns, the SSA uses a specific listing to evaluate the burn. If the surgical treatment has been completed, then the SSA will use the new listing to evaluate the limitation of the burns on the person's ability to work.