How to get disability with Fibromyalgia


Can I get disability with Fibromyalgia?

Author:Tim Moore, former Disability Examiner

Speaking as a former disability examiner, yes, you can be approved for disability with fibromyalgia. This happens routinely. However, it can be difficult for a couple reasons.

Reason 1: There is no listing in the Blue book, the Social Security list of impairments. As such, you can only be approved by showing that you cannot do your past work, or any other work, based on your age, education, work skills, and the limitations caused by your condition. This is a medical vocational allowance.

Reason 2: Often, a person's medical records will not provide the information Social Security needs to approve a claim. So let's discuss what a disability examiner or a judge at a hearing is looking for.

How does Social Security evaluate a Fibromyalgia claim?

In 2012, Social Security issued ruling SSR 12-2p, a guide for how fibromyalgia is evaluated.

Per the ruling, your diagnosis is valid if you have had fibromyalgia for at least three months, and it must come from a licensed physician. But a diagnosis is not enough. Your doctor must have reviewed your medical history and examined you specifically, testing for positive tender points (trigger points). The ruling also states that Social Security will review your doctor's records to determine if the diagnosis and medical history are consistent.

This means getting a diagnosis from a general doctor may not be that helpful. So what makes a fibromyalgia disability claim successful?

How do I qualify for disability with Fibromyalgia?

To qualify for disability with fibromyalgia or any medical condition, you'll need to file your claim and provide detailed information on your medical history and work history. This is so Social Security can properly assess your work capacity and compare it to the demands of your past work.

Since there is no listing for fibromyalgia, you'll need to prove that your condition causes enough functional limitations to rule out your ability to work and earn a substantial and gainful income. Fundamentally, this is proven through your medical records. And so for fibromyalgia you should do the following:

Get a fibromyalgia diagnosis from a pain specialist

Ideally, your diagnosis should be made by a pain specialist, or at least a doctor who knows how to conduct the physical exam for the 18 fibromyalgia trigger points on the body. Note: If a person has 11 or more of those trigger points, their fibromyalgia diagnosis is considered to be valid by the Social Security Administration.

Make sure you have been seen recently by a doctor when you apply

A disability examiner cannot approve a disability claim unless there is recent evidence (not older than 90 days) in the file. So make sure you are seen in this timeframe before you apply. If you don't have recent evidence in your file, Social Security will send you to a medical exam to obtain evidence. This is called a consultative examination, or a a CE, and they will schedule and pay for it.

How do I improve the chances of winning a Fibromyalgia disability case?

There are several things you can do to improve the chances of being approved.

To get disability, list all your conditions when you apply

Even if you are applying based on fibromyalgia, list all your conditions. Why? To determine if you lack the ability to work, Social Security needs to consider everything that is wrong with you, in addition to fibromyalgia. The more conditions and symptoms they know about, the more physical and mental limitations they may consider you to have, making it more likely for you to be awarded benefits.

List a condition even if you haven't been treated for it

Sometimes, people will not put a medical issue on a disability claim if they've never seen a doctor for it. This is a mistake. If you have depression, for example, list it even if you haven't received treatment. A combination of both physical and mental conditions can significantly reduce your ability to work in the eyes of the Social Security Administration.

Getting disability for multiple conditions

As a disability examiner, I saw that individuals who were approved for fibromyalgia usually had more than one medical condition, and they often had both physical and mental impairments. For example, Fibromyalgia claims typically involve pain, "fibrofog", anxiety or depression, and some type of musculoskeletal problem.

Common situations include a person with fibromyalgia, arthritis, and depression. Or someone with fibromyalgia, anxiety, and degenerative disc disease.

What happens if I was never treated for a certain condition?

If you put in your claim, but haven't been treated for it, you will be sent to a consultative examination. In the case of fibro fog that causes concentration and attention problems or memory impairment, Social Security may send you to a Wechsler Memory Scale to test your memory functions. Or, if you have depression, you may be sent to a mental status exam, or psychiatric exam. All of these exams will add more evidence to your claim.

Talk to your doctor

There are two things you may wish to discuss with your doctor that can potentially help your case. First, when you see your doctor, mention your symptoms and how the condition affects your daily activities. Social Security considers how your condition affects your ADLs, activities of daily living and your case is stronger when your doctor notates this in your records.

Getting a form from your doctor

Second, at some point you may ask your doctor to provide a statement for your case. This is called a medical source statement or residual functional capacity form (RFC), and a doctor can use it to explain how your condition limits your ability to do things. These forms are often a check-off list and will ask how long you can sit, or how much weight you can carry, etc. If you have a Social Security hearing coming up, your attorney will try to get a statement from one, or more, of your doctors to help win your case.

Information about fibromyalgia you may not have known

Fibromyalgia affects two to four percent of the general population. It affects women far more that men and is often associated with other conditions such as post-traumatic stress disorder, stress, anxiety, chronic fatigue, irritable bowel syndrome, and depression. In addition to other co-morbid mental conditions, some people have a cognitive dysfunction commonly known as brain fog, or fibrofog. Fibro fog may include problems with concentration and/or short and long term memory.

Despite the fact that medical studies conducted over the past thirty years indicate fibromyalgia is a disorder of the central nervous system of an unknown etiology that is associated with mental conditions rather than being a stand-alone mental disease or disorder, fibromyalgia is now recognized as a disease in its own right by the ICD, or International Classification of diseases.

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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