Fibromyalgia can cause a person to experience intense and widespread pain in their joints, muscles, or tendons. The challenge to claim benefits for fibromyalgia disability comes from having to prove that it creates a medically determinable impairment preventing the person from working.
The disability attorneys at Sackett and Associates have helped individuals throughout California and nationwide with their Social Security disability claims for more than four decades. The following information explains the process for obtaining benefits for fibromyalgia through the Social Security Administration. If you have any questions or need representation with a claim, contact the disability team at Sackett Law for a free consultation and claim review.
What Is Fibromyalgia?
Fibromyalgia is a chronic condition. Although researchers have not established a cause or cure for the condition, a genetic predisposition has been mentioned as one possibility. The belief is that infections, injuries, stress, and trauma may trigger the condition in those individuals genetically predisposed to it.
Symptoms commonly associated with the condition may include:
- Fatigue and tiredness that rest does not relieve.
- Difficulty concentrating
- Widespread pain in muscles, ligaments, and tendons.
- Memory impairment.
- Sleep disorder, such as insomnia.
- Headaches and migraines.
- Jaw pain.
- Severe digestive disturbance.
- Sensitivity to light.
The pain associated with fibromyalgia can be severe. Some patients describe the pain as a burning or throbbing sensation.
Challenges Of Diagnosing Fibromyalgia
Physicians and other healthcare professionals rely on a multifaceted approach to diagnosis a patient displaying symptoms of fibromyalgia that may include the following:
- Obtaining a complete medical history from the patient, including detailed information about their symptoms, with emphasis on widespread pain that has lasted for three or more months.
- A physical examination.
- Blood tests to rule out other conditions, such as rheumatoid arthritis, lupus, and chronic fatigue syndrome.
- Diagnostic imaging.
Testing ordered by doctors depends on the symptoms reported by a patient. For example, a doctor may order a sleep study for a patient complaining of sleep disturbance along with other symptoms of fibromyalgia.
A diagnosis without the medical records, including diagnostic testing, to support it would probably not be enough to prove that a person has a medical condition that meets the disability criteria for fibromyalgia.
Social Security Disability Criteria
The SSA has two programs that pay disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI provides benefits to insured workers who are no longer able to work.
In contrast, the SSI program does not require a work history. It is a needs-based program with strict income and resource limitations.
Both programs rely on the following definition of disability when evaluating applications for benefits: A medically determinable physical or mental impairment expected to cause death or to last for at least 12 months that prevents them from doing substantial gainful activity.
If a person applies for chronic pain SSDI or SSI because of fibromyalgia, the medical documentation must establish that their condition meets the SSA standard of disability. Doing so involves a five-step sequential evaluation process.
The SSA Five-Step Sequential Evaluation Process For Fibromyalgia Disability
A medical condition must be severe to meet the SSA disability standard, so fibromyalgia disability claims go through a five-step sequential evaluation process to determine whether they do. The process includes the following:
- Step 1: Is the applicant working and doing substantial gainful work activity? If they are, they are not disabled.
- Step 2: Does the applicant have a medical condition severe enough to last for at least one year or result in death? If they do not, then they are not disabled.
- Step 3: Is the condition severe by meeting or equaling a listed impairment in the Listing of Impairments maintained by the SSA? If it is, then the person meets the disability criteria.
- Step 4: If the applicant’s condition does not meet or equal a listing, does it prevent them from doing past relevant work? If it does, the evaluation continues.
- Step 5: Does the condition prevent the person from adjusting to do other work? If it does, then the person meets the criteria.
Fibromyalgia is not a listed medical condition, but the disability attorney representing an applicant will attempt to meet other conditions in the listings or establish an inability to do past relevant or other types of work.
Contact Sackett Law To Fight For Fibromyalgia Benefits
The team of disability professionals at Sackett and Associates has the experience and knowledge of the SSA disability claims process to help you navigate the application or appeals process. Our disability lawyers work closely with your healthcare providers to obtain the medical documentation required to support a claim for SSDI or SSI disability benefits.
We understand the difficulty of living with fibromyalgia, so let Sackett Law relieve you of the burden of going through the claims process alone. Contact us today for a free consultation and claim review.
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