Fibromyalgia may be difficult to diagnose, but this disease is very real and the impact it can have on an individual can be truly debilitating. For those suffering from fibromyalgia, maintaining steady, gainful employment may not be possible. These individuals may seek financial support in the form of Social Security disability benefits. With fibromyalgia proving so difficult to diagnose, however, qualifying for benefits may be an uphill, but not impossible, battle.
What Is Fibromyalgia?
Those who suffer from fibromyalgia generally experience tenderness and muscle pain throughout the body. This is also commonly accompanied by other issues with memory, mood, fatigue, sleep issues, restless leg syndrome, sensitivity to light, noise, and temperature, issues with bladder or bowel control, and numbness and tingling in the arms and legs.
Additionally, while a physical condition, fibromyalgia is commonly associated with mental illnesses such as anxiety, depression, and post-traumatic stress disorder (PTSD). Although fibromyalgia is a very real disease, it is often diagnosed after ruling out other causes of one’s pain. Currently, the causes of fibromyalgia remain unknown, though many believe there are both environmental and genetic components.
If you suffer from fibromyalgia it can be debilitating and prevent you from being able to work. But luckily, it may also qualify you for Social Security Disability (SSD) benefits.
Qualifying for SSD Benefits
Despite the significant impact that fibromyalgia can have on your life, it’s important to understand that being diagnosed with the disease doesn’t mean you will automatically receive SSD benefits. Rather, it’s the decision of the Social Security Administration (SSA). The SSA will look at its “Blue Book” requirements when making this determination.
Blue Book Requirements
The SSA will look at the Blue Book to see if the applicant meets the following criteria:
- A history of widespread pain that has persisted for a minimum of three months. This does not require that pain be constantly present or to the same degree. Widespread pain includes pain in all quadrants of the body.
- A minimum of 11 positive tender points on a physical examination. These points must be located on both the left and the right sides of the body, above and below the waist. (The physician must test the tender-point sites per the requirements of the Blue Book).
Qualifying for Social Security Disability Benefits with Fibromyalgia
Fibromyalgia symptoms can closely mirror those of other diseases. Additionally, proper diagnostic testing for fibromyalgia is not always conducted. To compound the difficulty of diagnosing fibromyalgia, there are many self-reported symptoms that are not always visible to those other than the individual suffering from the condition. All of this is to say that insurance companies and those government agencies tasked with distributing disability benefits can view claimants suffering from fibromyalgia with great trepidation.
While difficult, it is still possible to qualify for Social Security disability benefits if you have fibromyalgia. The Social Security Administration (SSA) will want to evaluate your medical condition to see if it equals one of its listings of qualifying medical impairments. If you have a medically determinable impairment and your medical condition prevents you from working in a substantial gainful activity job, you may qualify for benefits.
Because fibromyalgia can be so commonly misunderstood by those in the Disability Adjudication Services office as well as administrative law judges in the Office of Disability Adjudication and Review, the SSA issued Social Security Ruling (SSR) 12-2p to shed light on fibromyalgia as a disabling condition. The ruling defines fibromyalgia as pain in the joints, muscles, tendons, or nearby soft tissue that has persisted for a minimum of 3 months. The ruling requires that for fibromyalgia to be considered a medically determinable impairment, there must be evidence of diffuse chronic muscle pain impacting four quadrants of the body in addition to the spine.
In order to test for fibromyalgia, medical professionals may apply standard pressure to 18 tender points on the body. Should 11 or more tender points to both the right and left side of the body in addition to above the waist yield pain when standard pressure is applied, then a fibromyalgia diagnosis can be issued. SSR 12-2p states that a claimant must not only have a history of diffuse chronic pain but also exhibit six or more repeated fibromyalgia symptoms which may include:
- Chronic fatigue syndrome
- Poor restorative sleep
- Difficulty concentrating
- Anxiety
- Depression
- Temporal-mandibular joint dysfunction (TMD)
- Chronic migraines or tension headaches
- Chest pain
- Nausea
- Loss or change in taste
- Irritable bowel syndrome
- Irritable bladder
Furthermore, SSR 12-2p requires other disorders which may lead to similar symptoms manifesting themselves to be excluded. Adjudicators must take into account the opinions of treating doctors of the claimant as well as other acceptable medical sources including psychologists and psychologists. Additionally, family members and others who know the claimant may make statements that could be informative regarding the establishment of a claimant’s fibromyalgia diagnosis.
HOW TO APPLY FOR SSD & SSI BENEFITS FOR FIBROMYALGIA
Applying for Social Security Disability (SSD) and Supplemental Security Income (SSI) benefits for fibromyalgia can be challenging, as the condition isn’t easily diagnosed through standard medical tests. However, with proper preparation and documentation, you can improve your chances of approval. Here’s a step-by-step guide to help you through the process:
1. Understand the Requirements:
- To qualify for SSD or SSI benefits, you must prove that fibromyalgia severely limits your ability to work. The condition must meet the criteria set by the Social Security Administration (SSA), which includes widespread pain lasting at least three months, along with other symptoms such as fatigue, sleep disturbances, and cognitive issues.
2. Gather Medical Evidence:
- Collect thorough medical records from doctors who specialize in fibromyalgia, such as rheumatologists. Include documentation of your diagnosis, treatment history, medications, and how the condition impacts your daily life. Detailed statements from your physician about your limitations are critical.
3. Track Your Symptoms:
- Keep a detailed symptom diary, noting pain levels, fatigue, and other daily challenges. This can help provide a clearer picture of how fibromyalgia affects your ability to function and work.
4. Meet the SSA’s Criteria for Fibromyalgia:
- The SSA uses guidelines that include tender point examinations and evidence of repeated manifestations of six or more fibromyalgia symptoms, such as fatigue, irritable bowel syndrome, and cognitive or memory problems.
5. Complete the Application:
- Apply online through the SSA website or visit your local Social Security office. Be prepared to provide personal information, medical records, work history, and details about how fibromyalgia limits your ability to work.
6. Be Honest and Detailed:
- Clearly describe how fibromyalgia affects your daily life and work capacity. The more specific you are about your limitations, the better your chances of approval.
7. Consult a Disability Attorney:
- Consider working with a disability attorney who understands fibromyalgia and can guide you through the application process. An attorney can help gather evidence, prepare your application, and represent you in appeals if your initial claim is denied.
8. Prepare for a Potential Denial:
- It’s common for initial applications to be denied. If this happens, don’t be discouraged. You have the right to appeal, and having an attorney can significantly increase your chances of success in the appeals process.
9. Stay Persistent:
- The application process can be lengthy and frustrating, but persistence is key. Follow up regularly with the SSA and provide any additional information requested promptly.
Applying for SSD and SSI benefits for fibromyalgia requires patience, detailed documentation, and often legal support. Roeschke Law, LLC specializes in assisting clients with complex disability claims, including those for fibromyalgia. Contact us today for personalized guidance and to improve your chances of securing the benefits you deserve.
If you suffer from fibromyalgia and wish to apply for Social Security disability benefits, do not delay in reaching out to Roeschke Law for assistance. We can help you navigate the process, comply with application requirements, and help present the strongest possible case for benefits. Contact us today.