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How To Win A Fibromyalgia Disability Case

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How To Support Your Diagnosis And Strengthen Your Claim

Fibromyalgia and Winning a Social Security Disability Case in 2020

Record everything.Pain may be subjective, but keeping a daily pain journal to record the frequency, severity, and intensity of symptoms can strengthen your claim for benefits. Note all of your symptoms, no matter how big or small, in detailed entries that include dates, times, and what activity increased or decreased the pain.

A detailed record of your symptoms may support the information in your medical records and fill in any gaps. If your treating physician includes a review of your entries in their patient evaluation, your journal may be considered objective evidence. Since insurance companies seek often objective evidence of your diagnosis, this may be crucial to strengthening your disability claim.

Make sure your doctor is familiar with fibromyalgia. Your regular treating doctor should understand fibromyalgia and how it affects your ability to function and how disabled you are. If the doctor is not experienced in diagnosing and treating the condition, as well as filling out monthly attending physician statements certifying disability, find a specialist who is.

A doctor who can properly identify and describe the restrictions and limitations caused by fibromyalgia is crucial to supporting your disability claim.

Gather supporting documentation.

You already have a pain journal, medical records from all treating providers and the results of your 18-point tender point test do you really need more documentation?

Why Winning Disability Benefits Is Complicated With Lupus And Fibromyalgia

Lupus and fibromyalgia are the kinds of medical condition that change over time. Physical and mental symptoms might unpredictably wax and wane.

Thats difficult to explain to disability claims examiners.

Your medical records also might be complicated if you went to many different doctors searching for an explanation for your symptoms.

Fibromyalgia, in particular, doesnt often come with clearly observable, objective medical evidence to prove it is afflicting your body and affecting your ability to work. A diagnosis relies on your reports of how youre feeling.

Thats a tough hurdle for a Social Security Disability claim.

Social Security requires that a medically determinable impairment come with appropriate medical findings.

When your case reaches the level of a hearing with a Social Security administrative law judge, you might find the judge using this lack of objective diagnosis as a way to deny your disability claim for fibromyalgia.

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Obtain A Diagnosis For Fibromyalgia

There is no specific test for Fibromyalgia.After doctors rule out any other underlying conditions that may be causing your symptoms, a fibromyalgia diagnosis is made.Doctors will determine if you suffered from widespread pain throughout your body for more than three months and other symptoms such as fatigue and impaired memory.

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Summary: How To Build A Strong Case Towin Your Disability For Fibromyalgia

To summarize, the good news is that well-documented cases do get approved.

Clearly communicate how your conditions limit your ability to work.

The common mistake of Social Security Disability applicants is they focus on describing their conditions in terms of how terrible they feel. Regrettably, Social Security does not award disability on this merit.

I hope what you take away from this is that it is not about the pain you are in, but it is how pain causes limitations like those below that prevent you from doing any job:

  • Can’t sit for more than 20 minutes,
  • Can’t stand for more than 30 minutes,
  • Can’t do a sink full of dishes from a dinner for two without taking two to three breaks,
  • Feel like you have the flu 24 hours a day, seven days a week
  • Take three times longer to perform household tasks like preparing dinner, washing dishes, folding clothes, sweeping a 10 x 10 floor, and
  • Sleep 15 hours a day and still are tired.

4. Fibromyalgia sufferers often have other medical problems that are important to to be diagnosed, treated, and added to your disability case.

âFibromyalgia sufferers often have memory retention issues, so it is suggested that you do not try to commit to memory your conditions and the pain caused by them. Keep a daily pain journal that describes all of your symptoms. It is a simple way to keep track of your conditions and pain and is a great investment.

The list below is the percentage of those in the study who also described other medical symptoms.â

Is Fibromyalgia Considered A Debilitating Condition

How to Win a Fibromyalgia Disability Case

According to The American College of Rheumatology it is.

The American College of Rheumatology reports that fibromyalgia often exists with other conditions like lupus and arthritis. Many individuals report that they believe their fibromyalgia was caused as a result of a major physical injury.

Because the medical community views fibromyalgia to be its own unique condition, it is treated on its own. Curing the symptoms of co-existing conditions does not guarantee a cure for fibromyalgia.

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Winning Your Disability Case In Three Words: Frequency Severity And Duration

Reprinted from FMOnline

In a disability case, almost any symptom or limitation can be disabling but to determine whether they preclude work, the relevant questions are how frequent, how severe, and how long do they last?

A critical point I make to people who contact me every day is that their disability case is won or lost based on symptoms/limitations and not on their diagnosis! Clearly, under federal law, a disability claimant has to have a legitimately diagnosed physical and/or psychological disorder to even allege disability, but this is only the beginning of the analysis.

Disability cases are almost always won or lost based on the quality of your medical records and the subsequent opinions rendered by your treating physicians regarding your ability to sustain full-time employment. The documentation of symptoms and limitations in your medical records is critical, as it provides tremendous credibility to and an understanding of why your doctors have concluded you are unable to work.

Thus, the question becomes, How do I document the frequency, severity and duration of my symptoms and limitations?

The Ultimate Adult Function Report Tutorial

After months and months of careful preparation, I have created The Ultimate Adult Function Report Tutorial that will teach you step-by-step how to complete one of the trickiest forms Social Security requires you to complete.

You will learn why this form is so tricky and how to phrase your answers in a way that will make it very clear to Social Security how difficult things are for you.

This is the same method I use with my own clients to help them complete the form properly. The wrong answers CAN and WILL be used against you if Social Security wants to deny your claim.

Take a quick free sneak peek before you purchase the course and learn why it is so important to complete this form the correct way!

Simply click on the image below to sign up for the course. It is priced very reasonably so you can learn to complete this form without breaking the bank!

You just learned some tips and tricks on how to win a disability claim due to Fibromyalgia. But do you know how to read to read your medical records to see if they are actually supporting your disability?

Also, if you are looking to file for disability and dont know where to start, I created a course called the 5 Day File your Disability Claim Guide where I teach you every step you should take to file your claim.

Simply click on the image below and it will take you directly to the course page. Take afree sneak peek of the first lesson to see if this course is for you.

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Social Security Ruling 12

The SSA uses SSR 12-2p to evaluate fibromyalgia cases. For example, in order to find disability under fibromyalgia a person must have the following:

1. A history of widespread painthat is, pain in all quadrants of the body and axial skeletal pain that has persisted for at least 3 months. The pain may fluctuate in intensity and may not always be present.

2. At least 11 positive tender points on physical examination. The positive tender points must be found on the left and right sides of the body and both above and below the waist.

a. The 18 tender point sites are located on each side of the body at the:

  • Occiputal
  • Low cervical spine Trapezius muscle
  • Supraspinatus muscle Second rib
  • Lateral epicondyle
  • Gluteal
  • Greater trochanter and
  • Inner aspect of the knee.

b. In testing the tender-point sites, the physician should perform digital palpation with an approximate force of 9 pounds . The physician considers a tender point to be positive if the person experiences pain when applying pressure to the site.

Fibromyalgia Relies On Subjective Reporting Made By The Patient

Social Security Disability and Fibromyalgia: is there any Hope I can Win?

Second, Social Security administrative law judges are reasonably concerned about any medical condition that does not lend itself to objective testing. If a claimant has a herniated disk at L5/S1 with nerve root impingement, it can be seen clearly on an MRI scan. If a claimant has congestive heart failure, resulting in significantly reduced heart pumping capacity, the hearts pumping capacity can be measured as an ejection fraction. By contrast, the very diagnosis of fibromyalgia arises from the claimants self-reporting to her doctor and the doctors acceptance of the veracity of the claimants allegations.

Third, Social Security judges will look closely at any medical condition that requires long term use of opioid pain medications. From the judges perspective, any claimant they approve may end up receiving disability benefits for twenty, thirty even forty years, along with Medicare. A stated policy of the Social Security Administration is to return claimants to work if their condition stabilizes. Thus, claimants who consume narcotic pain medications can expect an increased likelihood of case review in years to come.

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Disability Insurance Companies Have Lawyers Shouldnt You

Because this law firm was created to focus on disability insurance, we have developed an expertise in this complex area of the law.

Our expertise in long-term disability claims means our clients have the backing of a law firm that has attorneys who:

  • Are experts in disability claims
  • Fought all major disability insurance companies and know their tactics
  • A track record of success
  • Won major disability lawsuits that created good law and
  • Recovered millions of dollars in disability benefits.
  • All our lawyers commit every day of their legal career to helping people get disability benefits from UNUM, MetLife, Prudential, Northwestern Mutual, Hartford, CIGNA, and others.

    Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.


    Can I Get Disability Because Of Fibromyalgia

    The Americans with Disabilities Act does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. Therefore, some people with fibromyalgia will have a disability under the ADA and others will not.

    Because fibromyalgia is difficult to diagnose — typically, health care providers rule out other conditions through a physical exam and various blood tests — it’s important that you do your homework before you apply for disability.

    According to federal regulations, to qualify for disability you must prove that you have a severe impairment. You also need to prove that the impairment limits your physical or mental ability to do work.

    The Social Security disability regulations define disability as “the inability to do any substantial gainful activity due to your medical or mental problem.” In addition, according to the Social Security Administration, your condition must interfere with basic work-related activities. If it doesn’t, your claim won’t be considered. Instead, Social Security will find that you are not disabled.

    The combined effect of having multiple impairments is taken into account. That can be important for many people with fibromyalgia. You must be unable to do your previous work or any other substantial gainful activity. Your age and education are considered, as well as your remaining abilities and your work experience.

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    Winning Disability Benefits For Fibromyalgia

    Getting long-term disability benefits for fibromyalgia can be particularly frustrating. Besides widespread pain and physical limitations, victims of FM must overcome credibility problems that go hand-in-hand with invisible diseases. But it can be done! Heres what you need to know.

    Fibromyalgia is a complex disorder that causes persisting, body-wide pain, often accompanied by numbness and tingling in the extremities, and muscle and joint stiffness. Pain fluctuates in intensity and may not always be present. Symptoms include fatigue, sleep problems, waking unrefreshed, headaches, memory problems , depression, anxiety disorder, and irritable bowel syndrome.

    If you live with fibromyalgia, the multitude of symptoms caused by this condition may disrupt your life so much you can no longer work. If so, its important to know:

    • You may qualify for Social Security disability benefits for fibromyalgia.
    • You may also be able to claim long-term disability benefits if you have disability insurance coverage through your employer or a private insurance policy.
    • For disabled veterans, the VA follows a fibromyalgia rating scale ranging from 10% to 40%. For Gulf War veterans, fibromyalgia is a presumptive condition. Additionally, VA now accepts pain alone as a basis of disability. These rules may improve a veterans chance of obtaining disability benefits for fibromyalgia.

    Talk To A Disability Lawyer

    How to Win a Fibromyalgia Disability Case

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    Fibromyalgia And Applying For Social Security Disability

    Fibromyalgia is not yet listed by the Social Security Administration in the Blue Book. What that means for claimants is that there are no cut and dried standards for whether you can be approved for disability benefits based on fibromyalgia. Instead, you must show medical evidence which supports one of the following:

    • Your fibromyalgia symptoms are equivalent to the symptoms in a disabling condition which the SSA does recognize in the Blue Book. For fibromyalgia, this often means showing that your symptoms exceed the requirements for disability of musculoskeletal conditions which cause generalized pain and fatigue or neurological disorders which exhibit similar symptoms.
    • Your fibromyalgia symptoms make it unreasonable to expect that you could do any sort of work you have performed over the past 15 years. If you are under 60, you will also need to show that your condition is severe enough that you cannot reasonably be expected to learn any other available job for which you are qualified .

    Many Social Security disability claimants find it helpful to have a lawyer go over the particulars of their claim with them before presenting their claim to the SSA. Fill out the form located throughout this site for a free evaluation of your disability claim by an attorney or advocate in your area.

    Social Security’s Ruling On Fibromyalgia And Disability

    In July 2012, Social Security published a ruling to explain how disability claims examiners and judges should evaluate whether fibromyalgia constitutes a “medically determinable impairment” . Citing diagnostic criteria used by the American College of Rheumatology , Social Security found that fibromyalgia should be considered an MDI when the following two criteria have been met.

    • There is evidence of widespread chronic pain that has lasted at least three months, and
    • Objective tests have ruled out other possible conditions.

    In addition, one of the following must also be present:

    • Positive tender point sites in at least 11 of 18 of tested areas, above and below the waist and on both sides of the body, or
    • Repeated occurrence of at least six fibromyalgia symptoms, especially fatigue, cognitive and memory issues , waking unrefreshed, irritable bowel syndrome, depression, and anxiety.

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    Help Your Social Security Disability Lawyer Gather The Right Evidence

    You need to put forth effort in order to help your attorney, and the most productive way to do this is to gather evidence to support your claim. Examples include long-term treatment notes from medical care providers, medical records and expert testimony showing that you have complied with treatment recommendations.

    Can I Get Long Term Disability Benefits If I Have Fibromyalgia

    How to Win Disability Benefits for Fibromyalgia

    Fibromyalgia is a disorder that causes widespread musculoskeletal pain and tenderness. If you suffer from this disorder, then you will likely have trouble sleeping and experience memory and mood issues. However, doctors have not yet determined what causes the pain associated with Fibromyalgia. This may mean that you will have trouble proving definitively that you suffer from this disorder. An insurance company may choose to deny your Fibromyalgia long term disability claim.

    Are you currently suffering from Fibromyalgia? If so, then consult with an ERISA attorney at Tucker Law Group. Our nationally recognized law firm has won hundreds of fibromyalgia disability claims and can analyze your disability policy during a free case evaluation. We know that insurance companies look for ways to deny Fibromyalgia long term disability claims. We can help you and your treating physicians present the most persuasive evidence of your disorder.

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