Social Security Disability Benefits For Fibromyalgia
The Social Security Administration does not include fibromyalgia in its published Listing of Impairments. Even so, you may still qualify for Social Security Disability Insurance . Social Security will evaluate your medical conditions to see if they meet or equal one of the listings. Even beyond that, you may qualify for disability benefits based on vocational standards.
Seeking Disability Benefits For People With Fibromyalgia
If you have been diagnosed with fibromyalgia, you may be wondering whether you are eligible to receive Social Security disability or SSI benefits. If your diagnosis is uncertain, you may be particularly concerned about whether you can prove that you have a disability.
At The Law Offices of Kenneth Hiller, PLLC, we are experienced at helping clients with fibromyalgia pursue disability benefits. Contact us for a free consultation with an experienced lawyer.
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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Am I Eligible For Social Security Disability For My Fibromyalgia
In the past, patients would have a difficult time requesting disability benefits for fibromyalgia. This is because the Social Security Administration doesn’t have a dedicated listing for fibromyalgia in its Blue Book of disabling conditions.
Today, the SSA offers more guidance to assist individuals who can no longer work because of fibromyalgia symptoms.
Still Denied Request A Hearing
If your claim is still denied after reconsideration, you can ask for a hearing, which will be heard by an administrative law judge.
If you haven’t already, this may be the point at which you want to get an attorney who specializes in disability claims. You and your attorney can then plead your case in person and the judge can call witnesses. You’ll also be able to look at your file and present new evidence.
Important:You could have to wait several months or even a couple of years until your hearing, depending on where you live.
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What Conditions Automatically Qualify You For Disability
Some conditions automatically qualify for disability benefits if you have a confirmed diagnosis. The Compassionate Allowances List Acute leukemia . Lou Gehrigs disease Stage IV breast cancer. Inflammatory breast cancer. Gallbladder cancer. Early-onset Alzheimers disease. Small cell lung cancer. Hepatocellular carcinoma.
Medical Requirements For Eligibility
The Social Security Disability program is designed to pay benefits to claimants suffering from medical problems causing symptoms so severe that it becomes impossible to sustain function at any type of work. Issues of employability, job existence, insurability and location or desirability of alternative work will not be considered, although age and education are often important factors. The fact that a person cannot do the work performed in the past is usually not determinative. This is a medical program that focuses upon medically proven symptoms and their impact on the ability to perform work activities.
Therefore, the focus in on function, not on diagnosis SSA often admits that Claimants have medical problems and are impaired, but denies that they are totally disabled. The debate is over what the Claimant can do despite the medical problems.
The focus in all disability claims is upon the medical evidence, i.e. the treating physicians clinical findings, office notes, reports and medical test results. This evidence is primary and is often more important than the testimony of the Claimant. While a Claimants description of the impact on daily activities, social functioning and concentration must be considered by SSA, the content of the medical documentation is the most important source of evidence in deciding the claim.
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How To Win A Fibromyalgia Disability Case The First Time
If you or your spouse has been diagnosed with a severe case of fibromyalgia, you are likely thinking about whether to apply for Social Security Disability benefits. And, because you may be concerned about generating income during this time, you want to start receiving disability benefits as quickly as possible.
We are here to help! Lets unpack how to win a fibromyalgia disability case the first time. At Crest SSD, we have years of experience and know-how to help you on the journey to receiving benefits.
Ready to get started with your disability application right now? Complete this form!There are no upfront costs to work with us. We only receive a fee directly from the Social Security Administration if you win your case no out-of-pocket expense for you!
Fibromyalgia And Your Social Security Disability Case
If you are diagnosed with Fibromyalgia, the battle is not over just because you have the diagnosis in hand. The Social Security Administration does not list Fibromyalgia as a qualifying condition in its listing of Social Security Disability impairments. Because of this, it is very common for an initial Social Security Disability claim to be denied when the application is based on a Fibromyalgia diagnosis. That does not, however, mean that you will not be able to successfully appeal the denial of your claim. Many people who have been denied at the initial stage based on a diagnosis of Fibromyalgia go on to appeal the decision and win.
If your Social Security Disability claim is based on Fibromyalgia along with another medical diagnosis, it will be much easier to have your claim approved than it will be if you are filing a claim based on Fibromyalgia alone. This is because many people do not understand Fibromyalgia and are unaware of the impact it can have on one’s ability to work. Social Security examiners are no exception to this rule.
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Filing An External Appeal
An external appeal may be more effective than an internal appeal because it allows a third party, the court system, to interpret your eligibility for benefits.
After gathering evidence to support your fibromyalgia-based disability claim, your lawyer may be able to negotiate an out-of-court settlement with the insurance carrier.
If the insurance carrier refuses to make a settlement, your lawyer may be able to defend your rights in court. The court may award you compensation if it determines the insurance carrier denied you unfairly.
How Does Social Security View Fibromyalgia
Traditionally, when a disability claims examiner received a case in which the only reason for disability was fibromyalgia , the outlook for an initial approval was poor unless another condition was involved, such as rheumatoid arthritis or spinal stenosis, one that is more likely to come with objective evidence of the disease like x-rays. Part of the reason for this has to do with the nature of fibromyalgiaits symptoms are largely subjective and its causes are not understood. Because its symptoms vary from one person to the next, and because the medical profession has not figured out FM’s causes, disability examiners aren’t sure how to classify such cases.
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Fibromyalgia & Medically Determinable Impairment
To be approved for disability benefits, you must have a Medically Determinable Impairment. This means that you will not be granted Social Security Disability only based on your reports of your symptoms. The SSA must see medical signs of an impairment that could reasonably be expected to produce your symptoms. Proving this can be difficult because fibromyalgia is usually characterized by subjective reports of widespread pain, tenderness in the muscles, joints, and soft tissues, fatigue, dizziness, and that awful so-called fibro fog.
Fortunately, Social Security issued a ruling explaining when fibromyalgia should be found as a medically determinable impairment. This ruling directs claims examiners and judges to adopt the criteria of the American College of Rheumatology to determine whether an applicant has fibromyalgia.
This ruling is already reducing the number of fibromyalgia claimants who are denied at the initial application stage and go on to file an appeal and eventually win disability benefits.
Our Social Security Disability Lawyers have compiled a list of what the SSA is looking for to determine if a case of fibromyalgia is a MDI.
Fibromyalgia And Social Security Disability
More than 12 million Americans suffer from Fibromyalgia. The condition can be very debilitating, causing depression, fatigue and widespread pain. It is no surprise that those who suffer from Fibromyalgia are often unable to work and find themselves needing to apply for Social Security Disability benefits. If you are living with Fibromyalgia and are wondering whether or not your disability claim will be successful, there are some things you need to know.
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Social Security Regulation 12
SSA needs medical evidence from an acceptable medical source to establish that you have a medically determinable Fibromyalgia disorder. Acceptable medical sources must be a licensed physician but SSA cannot rely upon the physicians diagnosis alone.
The evidence must document that the physician reviewed the persons medical history and conducted a physical exam. Moreover, the physicians diagnoses cannot conflict with or dispute other evidence in a persons case record.
SSA uses two sets of criteria to establish a diagnosis of Fibromyalgia:
How To Support Your Diagnosis And Strengthen Your Claim
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?
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Contact A Social Security Disability Attorney At 512
Can Fibromyalgia Qualify Me Eligible for Disability Benefits?
For years, the Social Security Administration would routinely deny fibromyalgia claims. This is partly because the medical community is still unsure of what causes fibromyalgia and partly because fibromyalgia presents different symptoms in different patients.
Fibromyalgia can cause complications such as:
- Chronic fatigue
- Development or worsening of depression
- Development of worsening of anxiety
- Brain fogginess or inability to focus
The Social Security Administration has a list of specific diseases and disorders that act as a manual, giving SSD application evaluators criteria for some medical impairments.
This list includes criteria for what should automatically be considered a disabling medical or mental condition. Fibromyalgia is not included in this list. However, this does not mean that your fibromyalgia does not qualify for disability benefits. Recently, the Social Security Administration changed its rule about fibromyalgia and now gives application evaluators specific guidelines when considering a fibromyalgia sufferers SSD application.
Your fibromyalgia may qualify you for benefits if you can prove that you experience chronic pain throughout your body and your doctor has ruled out diseases that could cause your symptoms.
You also must show one of the following:
- Tenderness in at least 11 tender point areas in specific parts of your body, or
- Repeated signs you suffer from six or more fibromyalgia symptoms
Filing For Social Security Disability With A Fibromyalgia Diagnosis
If an individual is disabled and can no longer work because of Fibromyalgia, that person may be entitled to disability benefits under Social Security Disability. Unfortunately, there is no listing for Fibromyalgia in Social Securitys guide to disabling conditions , so proving total disability and achieving disability benefits because of an FM diagnosis can be difficult because there are no specific criteria for approval.
If possible, it is in a claimants best interest to apply for disability benefits on the basis of Fibromyalgia in conjunction with other disabling conditions such as Degenerative Disc Disease or Rheumatoid Arthritis, mainly due to the fact that diagnoses of FM are quite difficult to make accurately. As a result, the Disability Determination Services that decide to accept or reject Social Security Disability applications are often skeptical of medical professionals using Fibromyalgia as a catchall diagnosis for symptoms of chronic pain. In addition, the DDS will often place much greater value on a Fibromyalgia diagnosis made by a medical specialist, such as an orthopedist or rheumatologist , than on one made by a family doctor, general practitioner, or mental health professional.
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Initiating A Disability Claim In North Carolina If You Are Suffering From Fibromyalgia
In order to file a disability claim through the SSA, you are required to fill out an application and provide medical documentation of your medical impairment/s that restrict you from working. You may be also required to sign release forms to allow the SSA to request any additional records that they might need in order to process and review your claim.Application forms once properly completed, can be filed online, by mail, or in-person. Many SSA offices are located throughout North Carolina.If your application is denied at the initial stage or after it was reconsidered, then you will have to request a hearing likely at one of the four Office of Hearings Operations located in Charlotte, Fayetteville, Greensboro, or Raleigh.
THE IMPORTANCE OF HAVING A SKILLED NORTH CAROLINA DISABILITY ATTORNEY
Attorney Charlie Hall has successfully handled many Fibromyalgia and similar cases throughout his long disability career and understands the rules required to be met to win a Fibromyalgia case. Currently, he sits on the Social Security Disability Specialization Committee that reviews attorney applicants for board certification in Social Security Disability Law. Over the last decade, he has trained other attorneys in how to practice in Social Security Disability law and how to handle Fibromyalgia and similar cases.
CONTACT A NORTH CAROLINA SOCIAL SECURITY DISABILITY ATTORNEY
How Can You Prove You Have A Medically Determinable Impairment
Social Security’s published ruling explains when fibromyalgia should be found as a “medically determinable impairment,” which is the first test you must pass when applying for disability. .)
The ruling directs claims examiners and judges to rely on criteria issued by the American College of Rheumatology to determine whether an applicant has fibromyalgia, and thus has a medically determinable impairment. In short, the SSA must see medical signs of an impairment that could reasonably be expected to produce your symptoms. Proving this can be difficult with FM, since the illness is usually characterized by subjective reports of widespread pain, tenderness in the muscles, joints, and soft tissues, fatigue, dizziness, and “fibro fog.”
According to the ruling, for fibromyalgia to be considered a medically determinable impairment, the patient should have evidence of chronic widespread pain, including pain in the back, neck, or chest, and a doctor must have ruled out other diseases through the use of lab tests or x-rays. In addition, the patient must have one of the following:
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What Causes Fibromyalgia
The causes of fibromyalgia are unknown. There may be a number of factors involved. fibromyalgia has been linked to:
- Stressful or traumatic events, such as car accidents
- Repetitive injuries
- Illness and
- Certain diseases.
Fibromyalgia can also occur on its own. Some scientists think that a gene or genes might be involved in fibromyalgia. The genes could make a person react strongly to things that other people would not find painful.
Can You Get Long
When you have been diagnosed with fibromyalgia or another chronic pain disorder it can feel like no-one believes you. These are serious conditions that can severely limit your ability to work and live a normal life. But insurance companies often deny long-term disability benefits for fibromyalgia or chronic pain. Find out how to fight back and get the coverage you need when you can no longer work due to the pain.
This blog post will discuss why it can be difficult to get long-term disability benefits for fibromyalgia and other types of chronic pain. It will address the problems proving pain and occupational limitations, and insurance companies tendency to discount patient reports of symptoms. It will also address how having an experienced attorney can help improve your chances to receive benefits.
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