What you should read First

What you should read Second.

Start with "Fibromyalgia Definition"and and then move on to the rest of the posts of dated April 24th

Thursday, January 27, 2011

Fibromylagia and Social Security Disability Insurance

Fibromyalgia is now a recognized medically determinable impairment by Social Security. I will talk about the symptoms of fibromyalgia and how these symptoms relate to a Social Security Disability or SSI claim. I will also discuss the type of treatment that Social Security recognizes for this condition. You will also read about how the limitations from fibromyalgia can help show you are disabled.


Fibromyalgia is pain in several areas or all over body with no functional or structural disease to explain the pain. It is much more common in women than in men. In fact women account for about 80% of fibromyalgia cases. The American College of Rheumatology defines fibromyalgia as a history of widespread pain lasting longer than 3 months, with pain in at least 11 of 18 tender points, and the pain can not be attributed to another illness mimicking fibromyalgia. Social Security will accept a diagnosis of fibromyalgia if a physical and neurological exam is taken by a reumatologist. Symptoms include but are not limited to headaches, muscle weakness, muscle stiffness, multiple trigger points (tender), fatigue, numbness, depression, difficulty with memory or concentration, sleep disturbance, and vestibular dysfunction. The disease is usually caused by some trauma such as sexual or physical abuse, or illness.

Social Security Ruling SSR99-2p addresses fibromyalgia and chronic fatigue syndrome. This ruling clearly shows Social Security now considers fibromyalgia to be a medically determinable impairment. To see this ruling go to Social Security's web site by clicking on the ruling SSR99-2p.

There is not a listing for fibromyalgia so unless your doctor with help from your lawyer can show you equal one of the other listings you will have to use your limitations from your fibromyalgia to show you are disabled. You should read the section on this site called "are you disabled" to understand how Social Security will determine if you are disabled. If fibromyalgia is one of your medical conditions there is a few things you should know. First, you should be diagnosed and seen regularly by a rheumatologist the diagnosis should include a physical and neurological exam including trigger points. It is important that you are being treated by a Rhemotologist because SSA gives these doctors opinion more weight when it comes to this condition. Make sure all the rheumotologist's records are submitted and that you have a fibromyalgia RFC completed by him or her in your file. The RFC specifically for fibromyalgia is extremely important because fibromyalgia has many possible limitations that cover both physical and mental limitations. Your testimony in these cases can be extremely important because so many of the symptoms are subjective. It is very important that your testimony come across to the ALJ as credible. You may even want to have someone who sees you on a regular basis testify as to what you go through dealing with your condition on a daily basis.

It is very common for a person to have fibromyalgia and other medical conditions at the same time. So keep in mind that Social Security will look at all of your medical conditions together and how they limit you.

One difficulty often seen in these cases is that many times a person suffering from this condition will have gone through many doctors trying to find out what is wrong with them. A diagnosis is often times not made for months or years. This can create problems with onset date and sometimes DLI issues (being found disabled while still covered). It is a good idea to have records that show you complaining of you symptoms to other doctors even if a diagnosis was not made yet. This way the evidence can show you actually were suffering from the condition well before you got a diagnosis and this can possibly lead to an earlier onset date.



Here is an explanation of Social Security's five-step process to determine if a fibromyalgia patient qualifies for SSDI:

1. Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $1,000 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.

2. Conclude the fibromyalgia disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs. For example:

Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
Seeing, hearing and speaking
Understanding/carrying out and remembering simple instructions
Responding appropriately to supervision, co-workers and usual work situations
Dealing with changes in a routine work setting
3. Fibromyalgia has no medical listing, so at this level of consideration, the adjudicator is required to consider “equating” a medical listing. To establish fibromyalgia as a medically determinable severe impairment, there must be evidence of widespread pain present for at least three months. There must be pain present on palpation in at least 11 of the 18 tender point sites as identified by the American College of Rheumatology and the Centers for Disease Control. There must be evidence of morning stiffness and/or stiffness after sitting for a short period of time. Fatigue is to be present. To equate a medical listing, the signs, symptoms and laboratory findings must be equivalent to an established listing. In most claims with a diagnosis of fibromyalgia, finding of disabled is usually at Step 5, i.e., functional limitations so significantly erode the occupational base for sedentary work that a finding of disabled is warranted.

4. Explore the ability of an individual to perform work they have done in the past despite their fibromyalgia. If the SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.

5. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine fibromyalgia disability, the SSA enlists medical-vocational rules, which vary according to age.

For example, if a person is:

Under age 50 and, as a result of the symptoms of fibromyalgia, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.

Age 50 or older and, due to the disability, limited to performing sedentary work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.

Age 55 or older and, due to the disability, limited to performing light work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.

Over age 60 and, due to the disability unable to perform any of the jobs he performed in the last 15 years, the SSA will likely reach a determination of disabled.

Any age and, because of fibromyalgia, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of fibromyalgia disabled.



Finding a Lawyer for your Fibromyalgia Social Security Disability Claim.

If you are looking for a lawyer for your fibromyalgia SSDI claim you should look for one who has handled many of these claims. These cases require an understanding of the disease and how to deal with the all too common skeptical eye some of those at SSA view these cases with. Many of you who have this condition have probably heard things like "it's in your head", or you have gone to numerous doctors to get a diagnosis. Attorneys who represent many disability cases know it is a medical condition and that those who have it suffer on a daily basis with little relief. Many lawyers won't even take these cases because they can be difficult to prove to an often times skeptical SSA

2 comments:

  1. Thanks for the great information on Fibromyalgia. We’ll direct our clients to your site for support – if your readers would like to learn more about receiving social security disability benefits, we have lots of resources to get them the help they need here: http://www.socialsecuritylaw.com/help-center/

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  2. Excellent info. This is one of the best plain-speak explanations of the process that I've ever seen. People should also be warned that nearly ALL SSI or SSDI claims are denied the first time. Plan to appeal! And remember that you will receive back pay to the date of the first filing or to the date you were last able to work. As a social worker, I understand this and warn my clients, but many people think that a denial means they have no hope. I've even seen a client who was both blind and in a wheel chair get denied. I had another client get denied while already in hospice with a diagnosis of less than 6 months to live. Don't get discouraged. You wouldn't be applying if you didn't need it. So don't let a bureaucrat tell you that you don't deserve it.

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