WHAT IS FIBROMYALGIA?
Fibromyalgia is a chronic condition that affects about 5 million Americans. The hallmark of fibromyalgia is muscle pain throughout the body, typically accompanied by:
- Sleep problems
- Anxiety or depression
- Specific tender points
Symptoms can also include joint stiffness, difficulty swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. The American College of Rheumatology (ACR) defines fibromyalgia as “widespread pain in all four quadrants of the body for a minimum duration of 3 months and at least 11 of the 18 specified tender points which cluster around the neck and shoulder, chest, hip, knee, and elbow regions.”
CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR FIBROMYALGIA?
Fibromyalgia pain and fatigue can impact your ability to work. Social Security Disability benefits may be available to you.
If you are not engaging in gainful activity due to Fibro, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.) The SSA has accepted that fibromyalgia can constitute a medically determinable impairment. (See my previous post on Social Security Ruling 12-2p concerning the evaluation of disability applications for Fibromyalgia.)
Generally, to establish fibromyalgia as a medically determinable severe impairment, you must show:
- Widespread pain for at least three months.
- Pain on palpation in at least 11 of the 18 tender point sites (as identified by the American College of Rheumatology).
- Morning stiffness or stiffness after sitting for a short period of time.
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. There is currently no listing for fibromyalgia, but it is possible that your related symptoms/conditions meet a listing.
If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your fibro), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
TIPS FOR SSDI APPLICATION FOR FIBROMYALGIA
- Make sure a fibromyalgia diagnosis is in your medical records. We’ve mentioned this before for long-term disability, but it is also true for SSDI, “know your medical records.”
- Make sure your medical records document ALL of your symptoms and limitations. Your medical records should not just document your pain. Let your doctor how often you feel the symptoms, how severe each symptom is, and how long each episode lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
- See a specialist. A fibromyalgia diagnosis from an orthopedist, rheumatologist, or a chronic pain or fatigue specialist will carry more weight than the same diagnosis from a family physician or internist professional.
- See a mental health professional. If you are suffering from depression or anxiety, see a mental health professional to diagnose, treat, and document these conditions. Fibro is often accompanied by or is the cause of mental health conditions. However, it is important that the actual fibromyalgia diagnosis comes from a specialist and not your counselor, therapist, or psychiatrist. (see above)
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
- Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you get denied, know if you should appeal the decision or reapply for disability.
- If you need assistance, contact an attorney who specializes in Social Security Disability and has experience obtaining SSDI benefits for Fibromyalgia. Call Loyd Bourgeois at 985-240-9773