Fibromyalgia is a chronic and disabling condition with pain throughout the body, fatigue, and other symptoms. Treatment can relieve symptoms, but there is no cure for the condition.
Depending on the severity of the symptoms, fibromyalgia could interfere with a person's ability to continue working and earning a living. If that occurs, monthly Social Security fibromyalgia disability benefits can ease the financial worries caused by being unable to work.
The disability professionals at the Clauson Law Firm know that it takes more than a diagnosis from a physician to prove Social Security fibromyalgia entitlement. It takes medical evidence and other forms of documentation to prove that physical or mental impairments caused by the disorder prevent you from performing your work activities.
A policy interpretation ruling by the Social Security Administration describes fibromyalgia as a “complex medical condition.” Symptoms associated with the disorder include widespread joint, muscle, tendon, and soft-tissue pain lasting for a minimum of three months.
Individuals describe the pain as being accompanied by full-body stiffness. They describe the pain as a burning, aching, or throbbing sensation. Other symptoms may include:
· Feeling tired and fatigued.
· Impaired ability to sleep.
· Thinking, memory, and concentration impairment.
· Tingling and numbness in the extremities.
· Light and temperature sensitivity.
· Sensitivity to noise and odors.
Patients diagnosed with fibromyalgia may also exhibit symptoms of the following conditions:
· Depression
· Anxiety
· Irritable bowel syndrome
· Headaches and migraines
· Facial pain
· Jaw disorders, including temporomandibular joint syndrome (TMJ)
According to the Social Security policy interpretation ruling on fibromyalgia SSD claims, only a diagnosis and medical evidence from a licensed physician will be accepted in support of a claim
for SSD for fibromyalgia. The medical documentation should include a medical history, physical examination, and treatment notes that are consistent with the diagnosis.
The SSA uses a specific definition of disability when evaluating applications for disability benefits through Social Security Disability Insurance and Supplemental Security Income programs. According to the SSA standard, a person is disabled when they cannot do substantial gainful work activities due to a medically determinable physical or mental impairment expected to result in death or to last for at least 12 continuous months.
The policy interpretation establishes the criteria for determining whether a claimant’s medical condition proves they should be approved for SSD for fibromyalgia. The medical evidence must establish that a person has three of the following:
· A history of widespread pain throughout the body that has lasted for at least three months.
· A minimum of 11 positive tender points on the right and left sides of the body and above and below the waist.
· Exclusion of other physical or mental conditions that may cause similar symptoms. The exclusion must be supported by laboratory testing and diagnostic imaging results.
The evidence in support of fibromyalgia SSD claims should be from the one-year period prior to the date of the application for SSDI or SSI. The SSA may use nonmedical evidence, such as statements from the following sources acquainted with the claimant:
· Friends, relatives, and neighbors.
· Teachers, counselors, and past employers.
· Clergy.
· Consultative examination by a treating physician or independent healthcare professional.
The SSA uses the documentation supporting the claim during the evaluation process to determine whether to approve the application for benefits.
Social Security uses a five-step sequential evaluation process to determine whether a person has a physical or mental impairment meeting the federal definition and standard for a disability:
· Step 1 considers an applicant's current work activity to determine whether they are doing a substantial gainful activity. A person doing substantial gainful activity is not disabled.
· Step 2 considers the severity of the condition. The criteria when reviewing a fibromyalgia claim focus on the pain level and other symptoms to determine whether they cause significant limitation affecting the ability to do work activities.
· Step 3 considers whether the impairment or impairments meet or medically equal any of the conditions in the listing of impairments. Listed impairments are those considered severe enough to meet the disability definition. Meeting or equaling a listing means that a person is disabled.
· Step 4 uses a person’s residual functional capacity (RFC) to determine their ability to do work they did in the past five years. RFC assesses the level of activity a person’s medical condition allows them to do.
· Step 5 uses RFC and an individual's age, vocational experience, and education to determine their ability to adjust to doing other types of work available in the national economy.
On its own, fibromyalgia does not appear as a listed impairment, so step 3 of the evaluation process focuses on determining whether it medically equals a listing. For example, listing 14.09, inflammatory arthritis, of section 14.00, Immune System Disorders, includes symptoms and complications of an array of disorders featuring joint inflammation, swelling, and tenderness.
A common mistake people make when applying for SSD benefits is focusing on a single condition. At Clauson Law, we encourage our clients to include all medical conditions in their applications.
If you have depression, migraines, or other physical or mental health conditions, include them in the application with medical evidence supporting them. The SSA can consider those conditions, as well as fibromyalgia, when evaluating your claim to increase the chances of it being approved.
Benefits through the SSDI program for fibromyalgia require that a person worked at jobs or through self-employment for a long enough duration to be covered under the program. They must also have contributed to the Social Security retirement and disability system by paying Social Security payroll taxes on their income.
The amount of monthly SSDI benefits depends on a worker's average lifetime earnings. The SSA uses your earnings as part of a formula to calculate your monthly benefit payments.
After receiving benefits for 24 months for 24 months, SSDI recipients will be enrolled in Medicare Parts A and B coverage. Part A, hospital coverage, does not require a premium payment from the SSDI recipient. However, a premium must be paid for Part B, medical coverage, unless the person opts out.
The SSI program does not have a work requirement, and the amount of the monthly benefits is established by the federal government. As a means-based program, there are limits on an applicant’s income and resources.
Applicants approved to receive SSI benefits may automatically be approved for Medicaid coverage, depending on the state where they reside. Some states require a separate application for Medicaid coverage.
The severity and debilitating nature of the pain and discomfort of fibromyalgia cannot be proven with a lab test or diagnostic imaging. Your claim needs the experience, skills, and resourcefulness of a disability attorney from Clauson Law. We know the Social Security disability benefits process and what it takes to achieve a successful outcome with a claim for fibromyalgia disability benefits.
We take the time to get to know you and understand how a chronic pain disability affects you and your ability to work. Our focus always remains on you and presenting a strong, well-documented claim from the initial application through the appeal process. When you want a disability representative that you can trust and rely on, contact Clauson Law for a free consultation.
Source: Social Security Policy Interpretation Listing of Impairments
