How to Win a Fibromyalgia Disability Case | Cook and Associates

How to Win a Fibromyalgia Disability Case

Fibromyalgia Disability Case

Fibromyalgia is still a poorly understood medical condition. Because doctors don’t understand much about it, winning your disability claim based on a fibromyalgia diagnosis can be very difficult. But don’t worry, with the right tools and guidance you can win your disability case.

In the past, the social security administration would deny a disability claim filed by someone diagnosed with only fibromyalgia. These disability cases would only be approved if accompanied by a diagnosis of another condition like lupus, spinal stenosis, or rheumatoid arthritis. Disability judges used to rule that fibromyalgia did not qualify as a “medically determinable impairment”. But in 2012, things changed when the social security administration issued guidelines for evaluating the condition. You can read that ‘policy interpretation ruling’ here :

There are several things you must do in order to win your disability benefits based on being diagnosed with fibromyalgia. First. It is very important to present enough documented medical evidence to the administrative law judge who will review your claim. This evidence can come from your family doctor, but it is best if you can get records from a rheumatologist.

The social security administration likes to see consistent medical documentation of your condition for at least one year before you file your claim. The disability judge will look for medical evidence that you have reported the following symptoms to your doctors:

  1. A history of widespread pain
  2. A history of signs and symptoms associated with fibromyalgia, as listed by the administration such as tender points near certain joints, muscle pain, chronic fatigue, abdominal cramps, trouble sleeping, and mental symptoms such as insomnia, anxiety or depression.
  3. Evidence of chronic fatigue, sleep disturbance, pain and fatigue, and related mental conditions such as anxiety and depression.
  4. Evidence of concurrent conditions.

Medical records are absolutely the most important thing to have when you apply for disability. Thorough documentation is 100% the key to your success. Make sure to gather records from all of the professionals you see, not just your family doctor or rheumatologist. If you see a psychiatrist, psychologist, counselor, pain management specialist, nurse practitioner, or even an acupuncturist, their input and records can be valuable. Make sure to gather all of the records from these varied offices and keep updating every time you have an appointment. If you have a disability attorney, he or she should help you do this.

Another good resource for evidence that is often overlooked are letters and statements from friends and family members. If there are people close to you who would be willing to write a letter on your behalf, make sure to discuss this with your attorney.  If there is someone close to you who sees you struggle everyday with your daily activities, their testimony can be very helpful to your case.

The judge will also look at whether you are truly unable to work. If you are employed in any substantial gainful activity, you will not be approved for disability.

Social security judges will also consider a ‘residual functional capacity assessment’ form completed by your treating physician. Again, it is best of you can get your rheumatologist to complete the form for you. This form will help the judge understand how much activity you can tolerate on a daily basis. Sometimes doctors will be hesitant to fill out functional capacity forms. Your attorney may be able to write a letter on your behalf to convince the doctor to do so.

The social security listings have never included fibromyalgia as a medical impairment. But this will not matter if you can prove to the disability judge that your impairment “equals a listing” such as inflammatory arthritis. Even if your disability does not “equal a listing”, you can still use the residual functional capacity forms to prove that you can no longer perform any substantial gainful activity. So you can still win your disability case!

Social security disability cases can be hard to win for people with fibromyalgia and chronic fatigue. Remember the keys to your success are thorough medical records, corroborating testimony, helpful doctors, and being your own advocate about receiving adequate care.

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