Fibromyalgia and Disability

Fibromyalgia is a painful pathological condition which does not have a clear cut cause. It is also known by the names of fibromyositis and fibrositis. Fibromyalgia is characterized by severe pain spread throughout the joints, tendons, and the soft tissues. There is no known cause of Fibromyalgia but may happen due to a combination of genetic factors, certain physical injuries or traumas, emotional trauma, and unhealthy lifestyle.

The classic symptoms of fibromyalgia include but not limited to diffuse pain or soreness, excessive fatigue, problems with digestion, dizziness, headaches, and numbness or tingling in the upper and lower extremities. Fibromyalgia may also cause some issues with memory impairment along with anxiety and depression. Fibromyalgia does not have a well defined treatment plan as some of the other disease conditions do and involves quite a bit of experimentation and combination of different medications to calm down the pain along with lots of physical therapy and exercise.

Now coming to the question of Disability Benefits for Fibromyalgia, in majority of the cases the outlook for getting disability benefits just for a diagnosis of fibromyalgia is extremely poor unless Fibromyalgia is accompanied by certain other medical conditions like arthritis or disc disease precluding the individual to be gainfully employed in any capacity for a significant period of time. This is because Fibromyalgia in itself does not have a known cause and the symptoms caused by it are usually subjective and can hardly be proved objectively and hence SSI/SSD have never been quite sure as to how to classify cases of Fibromyalgia.

In any case, if an individual with a known diagnosis of Fibromyalgia who has pain that is significant enough to not allow him or her to sit, stand, lift, bend, push or pull to any significant degree without acute onset of pain and has an associated diagnosis of arthritis or a degenerative disc disease can apply for Disability for Fibromyalgia.

Can You Get Disability Benefits for Fibromyalgia?

Can You Get Disability Benefits for Fibromyalgia?

In order to be considered for Disability Benefits for Fibromyalgia the claimant needs have an impairment which can be proved by way of objective evidence like radiological studies in the form of x-rays, CT or MRI scans and other laboratory data. Along with these reports, the claimant should also have detailed documentation of the medical records right from the time of the diagnosis of Fibromyalgia up until the most recent followups where the physician should clearly mention as to the inability of the claimant to function in any way or form due to Fibromyalgia. Additionally, the claimant must have what is called as Medically Determinable Impairment or MDI which is causing symptoms significant enough to preclude the claimant from working under any capacity.

In order to be considered for an MDI, the claimant need to have documented evidence of chronic pain in the back, neck, or chest, and the treating physician should have ruled out other disease condition that may cause similar symptoms such as lupus, hypothyroidism, or multiple sclerosis. The claimant should have documented proof of these in the form of radiological studies, progress notes from the physician, and other lab data that the physician must have performed in order to rule out these conditions. Additionally, the claimant should have the following:

Tender points in at least 11 of 18 tender point areas of the body. These tender points should be on both sides of the body and not unilateral and above and below the waist line area of the body.

Repeated bouts of at least six symptoms of Fibromyalgia namely fatigue, memory problems, sleep depravation, depression, anxiety, and/or irritable bowel syndrome.

The SSA will take a close look at the medical records furnished by the claimant to see if the records include the above mentioned factors. The SSA will also take a close look at the medical reports of the treating physician as to what treatments have been rendered to the claimant, what has been the response of the claimant to the treatments provided, and whether the claimant has been compliant with the treatment recommendations of the treating physician. The SSA will also take a look at any functional limitations which the treating provider may have imposed on the claimant based on the symptoms such as whether the claimant can sit, kneel, bend, twist, focus and concentrate on a task and the like. The more comprehensive the claimant's medical records are the better are the chances of the claimant to get Disability Benefits for Fibromyalgia.

What are the Chances of Getting Social Security Disability Benefits Due to Fibromyalgia?

If the SSA is convinced that the claimant has medically determinable impairment or MDI then the next step towards assessment for granting disability benefits will be conducting a residual functional capacity evaluation or RFC to check whether there is any other suitable work which the claimant can do depending on the qualifications, restrictions, and age of the claimant and whether with the present condition the claimant will be able to perform his or her prior work. During an RFC, the ability of the claimant to stand, sit, walk, lifting ability, and the ability to handle instructions and focus on a given task will be assessed. Once an RFC is completed, the SSA will try and look for a job best suited for the claimant based on the functional and mental limitations caused due to Fibromyalgia. If the RFC rules out the possibility of the claimant being employed under any capacity for a substantial period of time then the claimant will be granted Disability Benefits for Fibromyalgia.

Why is it Important to Hire an Disability Attorney For Winning Disability Benefits For Fibromyalgia?

Even if a claimant has enough documented evidence favoring his or her claim, if it is not presented in front of the judge in an appropriate way, the claimant may not be able to get the decision in his or her favor. For this, the claimant needs to hire an experienced disability attorney who can prepare and present the claimant's case in the best possible way so that Disability Benefit is granted for Fibromyalgia.

An experienced SSD attorney would have significant knowledge as to what the judge might require of the claimant during the hearing and what are the other relevant information that needs to be furnished in front of the judge at the time of hearing to win a disability claim. It should be noted here that an SSD attorney gets paid only after the claimant has been granted disability benefit, thus the attorney does all he or she can to get the claimant disability benefits

Conclusion:

In summary, if an individual has a confirmed diagnosis of Fibromyalgia along with conditions like arthritis or disc disease to such an extent that they are unable to be gainfully employed in any position and have enough credible evidence supporting their claim needs to work in close relationship with the treating physician and an experienced SSD lawyer or attorney so as to get qualified for Social Security Disability Benefits for Fibromyalgia.

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Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 5, 2017

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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