Dealing with fibromyalgia can be devastating as this condition causes widespread and chronic pain throughout the body.
Some experts believe that this disease causes the body to feel pain at higher levels, but there is nothing concrete.
The constant angst from this condition can be overwhelming both physically and emotionally.
Many patients feel that working a job is nearly impossible due to the fatigue, nerve pain, anxiety, and dysfunction. Looking to the Social Security Administration for help is the last resort.
Fibromyalgia Is Not Considered A “Disability”
However, the SSA does not have fibromyalgia as a disability “listing.” According to the SSA’s approved list of illnesses, this one does not make the cut.
Consequently, the sister disease, lupus, does as well as many other autoimmune conditions.
What is an Autoimmune Disease?
There is no cure for fibromyalgia. However, there are many treatment options available. The goal is to focus on pain management.
Some experts believe that this condition is best classified as an autoimmune disorder.
In this type of disorder, many symptoms are similar to other illnesses in this category.
According to Adrienne Dellwo, an expert in the field, the problem is that there is not sufficient evidence.
There needs to be proof that this disease produces autoantibodies that harm surrounding tissues, which makes it difficult to place under this category.
An autoimmune disorder is an illness that causes the body to attack the healthy cells.
Once the body is done destroying the healthy cells, it starts on the immune system.
The healthy cells now become harmful bacteria or a dangerous virus. Your body goes to war trying to fight off these harmful cells. It makes autoantibodies.
The attacks cause further damage to the healthy tissues, but it also creates inflammation at the site.
There is not sufficient evidence that indicates that fibromyalgia causes damage to bodily tissues, so it cannot be classified as an autoimmune disorder.
This illness is not difficult to identify as the symptoms are like other autoimmune disorders.
In many cases, fibromyalgia patients will have one or more diseases at the time of diagnosis.
Other common conditions include lupus, rheumatoid arthritis, restless leg syndrome, hypothyroidism, myofascial pain syndrome, and Lyme disease.
What Happens When The SSA Receives A Fibromyalgia Case?
The outlook for a fibromyalgia claim is reduced when the claims examiner sees that the only reason for the disability is this condition.
Unfortunately, examiners do not give much credit to this illness unless there is another condition involved.
If the claim has degenerative disc disease or arthritis, then it is more likely to be approved that without it. Objective evidence is needed, like x-rays to show that the condition warrants disability.
It sounds confusing, and many people do not understand this logic when fibromyalgia causes so much pain, and it can be debilitating.
The real issue is the nature of the condition. The symptoms of this disease are not understood, and that makes them mostly subjective.
Fibromyalgia Symptoms Are Diverse
Each person affected by this condition can have different symptoms. In Parkinson’s disease, each patient has the hallmark tremors and facial mask, but each patient with fibromyalgia can present differently.
Alas, the medical community understands this condition better, and new standards are being developed to assess claims for this disease.
Since this is an ongoing problem within the SSA, they published a ruling in 2012 to address the issue.
According to the National Pain Report, more than 58 percent of people suffering from this condition are unable to work. With such staggering numbers, something must be done to help.
2012 Ruling Gives Fibromyalgia Patients Hope
The ruling gave administrative law judges and disability claims examiners direction on how to assess these claims.
The SSA disability listing provides criteria that are needed for many impairments to be approved. However, it does not address every condition.
Under the category of fibromyositis, most clients are denied and end up going through the appeals process to win.
Even so, many people still get turned down for benefits because the SSA does not have sufficient evidence to prove that this condition is a valid reason for disability payments.
How Does The Social Security Administration View Fibromyalgia?
Examiners look for medical evidence. They want “signs” that you cannot function as before.
They will review lab tests, CT scans, MRIs, and anything else that you present as verification of your claim.
They must see signs of the disease, and it must impact your body in a way that causes your daily routine to be altered. The burden of proof is on you to show the SSA that you are disabled.
They can send you for medical examinations to rank your limitations because they do not hand out those award letters so quickly.
Some people feel that their impairment only needs to be established by the medical reports.
A “medically determinable impairment” is not sufficient, especially with this illness.
The SSA needs to see signs of that impairment too, which is why they often have third-party examiners help.
Proving Fibromyalgia Symptoms Is Difficult
Proving fibromyalgia symptoms can be next to impossible. Things like “fibro fog” is not easy to determine.
While a medical examiner can see signs of pain and see the signs of tenderness in the muscles and soft tissues, some days are better than others.
What if the day of your medical appointment comes and the fibromyalgia symptoms are subdued?
Since this condition has a hallmark of having “flare-ups,” it is hard to predict what each day brings.
As part of the revision in 2012, the SSA stated that fibromyalgia patients should be approved based on classification as a medically determinable impairment.
Additionally, the ruling urges examiners and judges to use the American College of Rheumatology criteria when deciding a case.
Understanding A Medically Determinable Impairment
According to the SSA, a patient must have evidence of the widespread pain problems that are chronic. to have a medically determinable impairment. These issues must include but are not limited to the chest, back, neck and legs.
The doctors must rule out other conditions such as lupus, multiple sclerosis, and hypothyroidism.
The SSA needs a series of tests that are concurrent with the diagnosis. In addition to the other requirements, patients also must have one of the following:
11 Tender Points
There are 18 tender points in the body. A person must present with points on both sides of the body, and they must be both above and below the waist.
The SSA has a list of tender points for ruling on fibromyalgia to help with those filing their claim.
Six Or More Fibromyalgia Symptoms
They look for documentation of six or more symptoms. These symptoms can include anxiety, irritable bowel syndrome, cognitive and memory issues, fatigue, depression, anxiety, headaches, muscle weakness, seizures, dizziness, abdominal pain, Raynaud’s phenomenon, and non-restorative sleep.
Each claim has an assigned examiner. The examiner will review the records to see if the application meets all the criteria set forth above.
To further assess the credibility of the complaints, the examiner needs the doctor’s input.
It is not uncommon for an examiner to ask the physician to document symptoms. The SSA needs their opinion of your ability to function.
Also, they will want to know what treatments have been tried, the side effects involved, and if there were any improvements.
Lastly, the SSA wants to know how long the doctor expects your function to be limited. Is this condition going to last 12 months or more?
It is better for your claim when your medical records include treatments and all the failed attempts to bring relief. Do not expect the SSA to go out of their way to build a case for you.
When is Fibromyalgia Ruled A Medically Determinable Impairment?
Though it is a significant hurdle to have the SSA rule that you have a medically determinable impairment, the battle is far from over. It is just the first step. Next, the SSA must develop your RFC or residual functional capacity.
What is the RFC?
The residual functional capacity or RFC is an assessment given by the SSA. The goal of this test is to determine if there is any work suitable for you in your condition.
While you may not be able to work as you once did, this will determine if there is anything comparable that you can do.
Part of the RFC assessment is to look at previous work history. They also will evaluate your ability to perform at various exertion levels.
The SSA wants to see if you can lift at least 10 pounds. If not, then they will conduct your RFC based on sedentary tasks.
The RFC is not a physical test that you must take, instead, they gather information from your doctors, medical specialists, and statements from family members about your abilities. The doctor’s opinion holds the most weight here.
Important in determining the RFC is how long you can walk, sit, and stand. Also, they need to see how well you can follow directions, how well you can focus, and how much you can lift.
These all determine your functional limitations and are vital to proving your claim. If you say you cannot work, then these tests need to prove it.
Once your RFC has been completed, the SSA compares it to the jobs that match your RFC level and limitations.
If there are no jobs able to be performed at your RFC level, then the final ruling is disabled.
Experts at Social Security Disability Secrets say its the most important evaluation in your disability process.
The Key To Winning A Fibromyalgia Claim
Many fibromyalgia patients end up in court trying to get their disability approved. Once you get to this point, there are a few things that can help you turn your case into a victory. Follow these steps:
Always Speak in Specifics
Never tell the judge you “hurt all over.” Instead, be very specific about your pains. If you cannot sit at the computer for extended periods because of severe neck pain, tell them about it.
Never speak in generalities, you must be very direct so that they can understand a day in your life.
Prove You Cannot Work 8 Hour Days
Many people think that getting disability means you cannot work at all. No, the only thing the SSA needs to prove is that you cannot work as you previously did. The judge just needs to see that you cannot work an eight-hour day without pain.
Keep a Journal
Because fibromyalgia is so wide-spread and chronic, keep a writing of your symptoms. If you tried to run the vacuum cleaner and were overcome by pain, then you need to detail that in your journal. A journal may be a significant piece to showing the SSA a day in your life.
Have A Vocational Expert At The Hearing
A vocational expert is an excellent advocate for a person filing a claim. They can speak on behalf of the employers.
A person who has chronic headaches misses a ton of work, and can only work part-time is not going to have an easy time finding a job. They can help you win your claim.
Get A Diagnosis From A Rheumatologist
If you have received your diagnosis from your primary care physician or an internist, you should see a specialist.
A rheumatologist seems to be more credible in the eyes of the SSA. The disability examiner or judge will view this information as a strength of your case.
Get An Attorney To Help!
There are many medical conditions where a person can easily win a disability claim without help.
In some cases, the SSA will fast-track the claim if they feel that the situation warrants. However, when dealing with fibromyalgia, it seems to be an uphill battle.
Hiring an attorney seems to be beneficial in these instances more so than in other cases.
Disability lawyers are very familiar with the ruling SSR 12-2p that pertains to fibromyalgia.
Having proof of the latest court decisions on disabilities granted in similar situations can undoubtedly benefit your case.
Your attorney’s knowledge can help find errors made either by the claims examiner or the judge. Anything that you can use to your advantage is beneficial.