Epstein-Barr Virus and Qualifying for Disability Benefits

Summary: Can I get disability benefits if I am suffering from the effects of Epstein-Barr Virus?

Epstein-Barr virus is not listed by the SSA so to be approved for disability it must be shown the severity of the condition is equal to an impairment listed or that the condition prevents an applicant from working

Epstein-Barr virus is a member of the herpes virus family and one of the most common human viruses.

Though 95% of adults are infected at some point in their life, most do not show any symptoms and develop an immunity to it. Epstein-Barr virus (EBV) can cause chronic fatigue, joint pain and difficulty concentrating, but because these symptoms and others rarely last even 12 months, it is unlikely that an individual would be considered disabled with a diagnosis of EBV alone.

Even though most cases resolve on their own, occasionally EBV leads to complications and an increased risk for other conditions, such as:

•   Rupture of the spleen
•   Hepatitis
•    Type 1 diabetes
•   Anemia
•   Myocarditis (inflammation of the heart muscle)
•   Immune system infections
•   Blood infections
•   Multiple Sclerosis
•   Dermatomyositis
•   Sjogren’s syndrome
•   Systemic lupus erythematosus
•   Rheumatoid arthritis
•   Conditions that affect the nervous system, such as encephalitis, meningitis, Guillain-Barre syndrome.

These conditions and accompanying symptoms can cause you to miss work and jeopardize your ability to maintain employment.

Epstein-Barr Virus and Qualifying for Disability Benefits.

Epstein-Barr virus is not listed as an impairment in Social Security’s Blue Book so in order to be approved for Social Security Disability benefits with EBV an applicant must show:

•    The severity and extent of their condition is equal to or greater than an impairment listed in the Blue Book; OR
•   Their condition prevents the applicant from working at any job they have experience for or for which they could be trained.

An applicant’s condition must last or be expected to last 12 months; if Social Security determines the applicant’s condition will not last at least 12 months, their application will be denied.

Additionally, the applicant must not earn more than $1,550 per month (2024) (known as Substantial Gainful Activity or SGA).

Before assessing an applicant’s limitations, Social Security will want to confirm that EBV has caused a “medically determinable impairment” or MDI.

For example, if an applicant’s main symptom is chronic fatigue, Social Security will evaluate their condition according to its listing for chronic fatigue syndrome. Social Security will need objective medical evidence, such as an antibody test. If Social Security determines an applicant’s symptoms are severe, it will next evaluate the applicant’s physical and mental limitations to see if they qualify for disability by conducting a residual functional capacity assessment (RFC). Many people applying for disability with EBV have chronic fatigue syndrome and cannot work an 8-hour day, or have pain in muscles and joints that limits their ability to lift objects or bend. Some individuals have difficulty concentrating and cannot complete tasks in an acceptable amount of time. As a result, some applicants are unable to perform even unskilled labor.

When filing a claim for disability with EBV, you should ask your doctor to provide a statement describing in detail how EBV limits your abilities and affects your daily activities.

Include all medical documentation for EBV as well as medical records for any other disabling conditions you might have. Continue to see your doctor when applying for SSDI. The Social Security Administration wants to make sure you have followed prescribed treatments and wants to know how you have responded.

If you have Epstein-Barr virus, but your disability does not match one of Social Security’s impairment listings, you may still be eligible for Social Security Disability benefits if you have another impairment; for example, arthritis or diabetes.

Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work (called a medical vocational assessment), taking into account whether or not you are able to drive, your age, and level of education.

Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable.

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.

What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.

There are four steps to the Social Security appeal process:

1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.    If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.    Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Most SSDI claims are initially denied and the denial rate for conditions like EBV is considerably higher.

If you have Epstein-Barr virus and it has impacted your ability to work, you should seriously consider consulting an attorney. A qualified Social Security Disability lawyer can review your case, saving time and improving your chances for success.

Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.