Social Security disability claims based on fibromyalgia can be some of the most difficult cases for disability applicants to win. Because fibromyalgia's symptoms are generally self-reported, disability claims examiners and administrative law judges are often reluctant to approve fibromyalgia claims, even when an individual has received consistent treatment from a physician who supports their case.
To give yourself the best chance of a successful claim for fibromyalgia, it's essential not only to obtain treatment, but to obtain the right treatment. The Social Security Administration (SSA) expects those with fibromyalgia to receive a proper diagnosis and regular treatment from a rheumatologist. You should also document your case to the fullest extent possible with relevant medical records, laboratory testing, opinions from doctors, and third-party statements from friends, family members, or former colleagues.
Fibromyalgia, also known as fibromyositis, fibrositis, or fibromyalgia syndrome (FMS), is a chronic illness marked by widespread pain and tenderness in the muscle, joints, tendons, and soft tissues. It has no known cause, but may arise from a combination of genetic factors, physical injuries, emotional trauma, and lifestyle. The symptoms of fibromyalgia are many, but generally include diffuse pain or soreness, fatigue, digestive problems, dizziness, headaches, and numbness or tingling in the hands and feet. Common cognitive and psychological manifestations of the illness include memory issues ("fibro fog"), depression, and anxiety.
Treatment for fibromyalgia generally involves a fair amount of experimentation. Many physicians prescribe a combination of physical therapy, exercise, cognitive-behavioral therapy, and medication to manage the symptoms of fibromyalgia.
Social Security has an official ruling (SSR 12-2p) that explains how disability claims examiners and judges should evaluate whether fibromyalgia constitutes a "medically determinable impairment" (MDI). (To be even considered as a basis for disability benefits, a medical condition must be a severe MDI.) Citing diagnostic criteria used by the American College of Rheumatology (ACR), Social Security found that fibromyalgia should be considered an MDI when the following two criteria have been met.
In addition, one of the following must also be present:
Remember that these criteria establish only whether your fibromyalgia is a medically determinable impairment, not whether you are disabled. Even if you satisfy the above requirements, you still must demonstrate to Social Security that you're incapable of performing your past work and any other jobs in the U.S.
While fibromyalgia cases can be some of the hardest to win, your chances will be greatly improved if you follow these bits of advice.
Get a proper diagnosis of fibromyalgia from a rheumatologist. Physicians have sometimes used fibromyalgia as a sort of "catch-all" diagnosis in cases where their patients suffer from chronic pain without any apparent cause. Thus, it is essential that your doctor, preferably a rheumatologist, has made your fibromyalgia diagnosis according to medically acceptable diagnostic techniques, which should include trigger-point testing and laboratory testing to rule out other conditions.
Make sure the SSA has all your relevant medical records. After you've filed your initial disability application, Social Security will request your medical records from at least the previous twelve months. If you've received treatment for more than twelve months, you may have to request the records on your own, or with the help of an attorney, and provide them to Social Security yourself. If your claim has been denied at the initial level (as most fibromyalgia claims are), you should continue to receive treatment and submit your updated medical records to SSA for as long as your appeal is pending.
Ask your physician to complete a Residual Functional Capacity (RFC) form. Your RFC is what you are capable of doing despite your impairments. Social Security uses your RFC to decide whether your limitations prevent you from performing full-time work. You or your attorney should ask your rheumatologist to give an opinion as to your limitations in the following areas:
Your physician should also indicate whether you would need to recline, lie down, or elevate your legs during a typical workday, and whether you'd be required to take unscheduled breaks due to pain or fatigue.
Keep a journal of your symptoms. Recording your mental and physical symptoms on a regular basis can help your doctor make the appropriate diagnosis and optimize your treatment regimen. It can also help persuade Social Security that your symptoms are persistent, severe, and legitimate. Be sure to record levels and locations of pain as well as any other symptoms you experience, such as exhaustion, insomnia, gastrointestinal issues, or emotional difficulties.
Obtain statements from third parties familiar with your symptoms and limitations. Third-party reports from friends, family members, and especially former co-workers can bolster your disability case. These reports should include the individual's first-hand observations of your physical or mental limitations, rather than providing opinions on your medical issues.
Consider getting legal help. A disability advocate will work with you and your doctors to present the strongest possible case to Social Security. Most disability representative charges you a fee only if you win your case, and the representative's fee is collected from the backpay owed to you from Social Security.