By Jacob Madden
Long COVID has left an estimated 1.6 million Americans unable to work. Those experiencing Long COVID face long-term neurological issues, heart problems, lung damage, and myriad other complications following an initial bout with COVID-19.
Though some who are incapacitated by Long COVID will eventually be able to return to work, others may never work again. Going forward, we must find a way to account and provide for these individuals. Here I suggest a potential solution in amending the Social Security Administration’s Blue Book to include Long COVID in the evaluation of disability benefits.
To determine whether an individual qualifies for disability benefits, the Social Security Administration (SSA) maintains the Blue Book, formally known as Disability Evaluation Under Social Security. Essentially, the Blue Book is a list of medical conditions and disability criteria that the SSA checks when deciding whether someone should receive disability benefits. While having a medical condition identified in the Blue Book does not guarantee a person will be eligible for benefits, and a person does not necessarily have to have a condition recognized in the Blue Book to be eligible for benefits, the Blue Book nonetheless plays a significant role in the SSA’s benefits determinations.
Adding Long COVID to the Blue Book would not be unprecedented. Under the Blue Book’s Neurological Disorders category, we find post-polio syndrome. Post-polio syndrome is when an individual who had polio, anywhere from 15 to 40 years ago, begins experiencing complications including muscle weakness, mental and physical fatigue, and joint pain. In more severe cases, individuals will experience visible muscle weakness and atrophy. Though it may sound strange, and is fortunately rarely life-threatening, post-polio syndrome is not uncommon. Out of every 100 people who had polio, an estimated 25 to 40 people have post-polio syndrome.
The Blue Book fundamentally requires someone suffering from post-polio syndrome seeking to claim disability benefits to have severe symptoms, rendering them unable to work. For example, someone suffering from post-polio syndrome may be eligible (not guaranteed) to receive benefits if they have bulbar and neuromuscular dysfunction resulting in acute respiratory failure requiring mechanical ventilation. Another possibility for eligibility is if someone has marked limitation in physical functioning, accompanied with difficulties understanding, remembering, or applying information. Of course, acute respiratory failure and difficulties understanding can be caused by a variety of conditions, not just post-polio syndrome. The focus here is twofold: (1) do you have this condition? (2) do you have one or more associated complications?
The same focus is readily applicable to Long COVID. (1) Do you have Long COVID? (2) Do you have one or more of the associated complications? If yes to both, you may be eligible for disability benefits.
This first question will require the SSA to define Long COVID, which will likely be a contested process. For example, individuals at the SSA will have to decide which symptoms constitute Long COVID, and how to verify/corroborate a diagnosis, among other questions. Adding to the challenge is the fact that Long COVID is a novel condition, and so research on it is scant (but growing). Despite these challenges, this is a necessary reckoning: insurers of all stripes will need criteria for understanding and evaluating Long COVID claims going forward.
Once the SSA has defined Long COVID and its associated complications, it can decide which Long COVID complications may be eligible for benefits, as it does with other medical conditions in the Blue Book. Recurring headaches likely would not be counted, whereas respiratory failure likely would and should be, as it is for other conditions. In fact, many of Long COVID’s health complications can already be found in the Blue Book, under categories of Respiratory Disorders and Cardiovascular System, among others.
Recognizing Long COVID in the Blue Book directly is an important first step toward making sure those who need help, and those who are no longer able to work, are taken care of.
Though the future of COVID-19 and Long COVID is uncertain, we can still provide some certainty to those who are still dealing with lingering, incapacitating effects of the disease. The government should take a readily available, proactive approach to this issue by having the SSA amend the Blue Book to include Long COVID in its determination of disability benefits. This will help to ensure that those most in need of assistance are able to get it.
Jacob Madden is a third-year student at Yale Law School.