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Fibromyalgia claims for Social Security Disability require more proof

| Sep 26, 2014 | Social Security |

Fibromyalgia affects more than 5 million people, according to estimates from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. This condition causes physical symptoms, such as pain and fatigue, as well as reduced memory and concentration. These effects can make it challenging for victims to perform certain tasks and remain gainfully employed. Unfortunately, treating fibromyalgia can be difficult.

Social Security Disability benefits may be available to people afflicted with fibromyalgia. However, the Social Security Administration establishes strict standards that people with this condition must meet to qualify for benefits.

“MDI” status

Under a rule the SSA established in 2012, people with fibromyalgia must prove the condition is a “medically determinable impairment.” Fibromyalgia qualifies as an MDI if the following criteria are met:

  • Chronic pain occurs in all four quadrants of the body and in the axial skeletal region. The pain does not have to last continuously, but it must be documented for at least three months.
  • Other possible conditions have been ruled out with objective evidence. Objective evidence includes x-rays, MRIs and blood tests.
  • The affected individual experiences tenderness in 11 of 18 tender points, or the individual displays at least 6 fibromyalgia symptoms. Symptoms include cognitive problems, fatigue and anxiety disorder.

Various forms of evidence can prove these requirements are met. Physical examinations and tests can verify tender points and eliminate other conditions as causes. Descriptions from the individual can establish pain frequency, severity and location, along with other symptoms. Statements from people who know the individual, including family and co-workers, can help prove symptoms that cannot be objectively measured.

If these criteria are fulfilled, fibromyalgia is considered an MDI. However, the individual is not automatically considered disabled. The SSA still must evaluate whether the individual is unable to work.

The disability determination

 During this stage, the SSA evaluates the individual’s medical records and work history. The SSA may recognize that an individual can no longer perform a current job due to fibromyalgia, especially if the job is physically demanding. However, the SSA may decide someone with fibromyalgia is capable of a less strenuous job.

Applicants can improve the odds of claim approval by submitting a Residual Functional Capacity form. This form allows a treating physician to detail the physical and mental limitations the fibromyalgia causes. The physician may also note whether the individual would need special accommodations during work, such as unscheduled breaks or a place to lie down.

This documentation can make claim approval more likely. Still, with conditions such as fibromyalgia, making a successful claim can be difficult. Most victims can benefit from speaking with a Social Security Disability attorney about supporting an initial claim or appealing a previously denied claim.