Can you qualify for Social Security Disability on the basis of fibromyalgia?

Here is the short version of the answer. Yes, you can qualify for disability based on fibromyalgia. But, truthfully, you can qualify for disability benefits on the basis of nearly any physical or mental medical impairment, or combination of impairments.

The social security administration evaluates all claims in either the Social Security Disability or SSI disability program on the basis of residual functional capacity. RFC is what you can still do despite your condition or conditions. Your residual functional capacity is determined by evaluating your medical record documentation, which includes records from individual doctors and hospitals (and, in the case of children, school records as well).

Once your RFC is rated, the disability system compares this (what you can still do and, conversely, what you can no longer do) to the requirements of your past relevant work. If your current condition is severe enough to preclude the possibility of returning to any of your former jobs that are considered to be past relevant work (jobs you did for a minimum period of time within the last 15 years prior to become disabled), may be considered. I say "may" because you still have to pass one other hurdle. And that hurdle is something known as other work.

Other work is a fuzzy concept for most, but it can include quite a few jobs that you might be capable of transitioning to based on your current limitations, education, and work skills. The more education you have and the greater your work skills (higher skill levels make skills more transferable), the more likely it will be that an adjudicator will determine that you can perform some type of other work, even if your condition is severe enough that you can't go back to one of your old jobs.

Back to the question, however: can you qualify for disability on the basis of fibromyalgia? Yes. But it all comes down to the limitations indicated in your medical record documentation.

It goes without saying, of course, that most medical records contain sparse information as to a patient's functionality. In other words, for the purposes of achieving a favorable disability determination, they are sometimes (often) next to useless. This is why a medical source statement (or residual functional capacity, or RFC, form) that captures the opinion of a treating physician can be so helpful to a case.

Disability examiners, however, are not directed to obtain such statements from physicians who have an established treatment history with their patients (which is mystifying...but not so mystifying if you consider that the federal disability system has an inherent oppositional stance toward claimants).

Disability representatives and disability attorneys, on the other hand, tend to submit such statements at hearings. And this fact along goes a long way toward explaining the disconnect between approval rates at the lower levels (disability application and request for hearing) versus the disability hearing level...that and the fact that administrative law judges receive and entertain such qualified information (the opinion of the treating physician) in a different context and with a different attitude.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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