Fibromyalgia, a chronic condition characterized by widespread pain and tenderness, affects millions of adults in the United States. While many individuals with fibromyalgia can manage their symptoms and maintain a good quality of life through exercise and medication, others may find their ability to work significantly impacted.
This article explores the possibility of qualifying for Social Security Disability (SSD) benefits with a fibromyalgia diagnosis. We’ll delve into the Social Security Administration’s (SSA) guidelines for evaluating fibromyalgia claims, the evidence needed to strengthen your case, and the process for appealing a denial.
Fibromyalgia: A Qualifying Condition Under Specific Circumstances
The SSA doesn’t have a specific listing for fibromyalgia in its Listing of Impairments. However, a policy interpretation acknowledges fibromyalgia as a disability that can meet the criteria for SSD benefits. This means that qualifying hinges on demonstrating the severity of your condition and how it limits your ability to perform a substantial work activity.
Key Factors in Establishing Your Fibromyalgia Disability Claim
- Pain Location and Severity: Fibromyalgia pain varies in intensity and affects various areas, including joints, muscles, tendons, and soft tissue. Your medical records should document your FM diagnosis, the specific locations affected by pain, the frequency of flare-ups, and how these episodes impact your daily life.
- Medical Evidence: A strong claim relies heavily on medical documentation that proves fibromyalgia significantly limits your ability to work or perform basic tasks. A physician’s diagnosis based on the American College of Rheumatology (ACR) criteria is crucial.
The ACR criteria for fibromyalgia diagnosis involve:
* A history of widespread pain lasting at least three months, affecting all four quadrants of the body.
* At least 11 out of 18 specific tender points found to be sensitive on both sides of the body (bilateral) and above and below the waist. Common tender point locations include the base of the skull, neck, shoulders, rib cage, elbows, buttocks, hips, and knees.
* Ruling out other conditions that could cause similar symptoms.
In addition to the diagnosis, the SSA may require evidence of at least six of the following symptoms that occur frequently alongside widespread pain:
* Fatigue
* Cognitive difficulties or memory problems ("fibro fog")
* Unrefreshing sleep
* Depression
* Anxiety
Regular treatment for fibromyalgia strengthens your claim. Consistent treatment-seeking and documented progress demonstrate your efforts to manage your condition.
The Application Process and Potential for Denial
Filing for SSD benefits can be a complex and lengthy process. Unfortunately, over 70% of initial applications are denied. This can be particularly disheartening when dealing with a chronic condition like fibromyalgia.
Here are some general steps involved in the application process:
- Gather Medical Records: Compile all documentation related to your fibromyalgia diagnosis, treatment history, and functional limitations.
- Complete the Application: File your application electronically or visit your local Social Security office.
- Determination by the SSA: The SSA will assess your application based on your medical records and work history. They may request additional information or a consultative examination.
- Potential Denial and Appeals Process: If your application is denied, you have the right to appeal the decision. This multi-level appeals process can be lengthy and may involve hearings before an administrative law judge.
Seeking Legal Help for Your Fibromyalgia Disability Claim
Given the complexities of the SSD application process and the high denial rate, consider seeking legal assistance from an attorney experienced in Social Security disability law. An attorney can guide you through the application process, ensure all necessary documentation is collected, and represent you effectively during any appeals.
Finding the Right Attorney
Look for an attorney who:
- Specializes in Social Security disability law.
- Has a proven track record of success in fibromyalgia disability cases.
- Offers a free consultation to discuss your specific situation.
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Additional Considerations
It’s important to note that this article provides general information and shouldn’t be considered legal advice. The specific requirements and procedures for SSD applications may vary depending on your location. Always consult with a qualified Social Security disability attorney to discuss your circumstances and legal options.