Can I receive SSDI for fibromyalgia? Tips for application

What Is Fibromyalgia?

Fibromyalgia is a chronic condition that affects about 5 million Americans. For those suffering from this debilitating illness, navigating daily life can be overwhelming, especially when dealing with the associated muscle pain throughout the body.

As a social security disability lawyer, I understand how challenging it can be for those with fibromyalgia to maintain employment and manage their symptoms, which often include:

• Fatigue
• Sleep problems
• Anxiety or depression
• Specific tender points

Symptoms can also include joint stiffness, difficulty swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. The American College of Rheumatology (ACR) defines fibromyalgia as “widespread pain in all four quadrants of the body for a minimum duration of 3 months and at least 11 of the 18 specified tender points which cluster around the neck and shoulder, chest, hip, knee, and elbow regions.”

Can I Receive Social Security Disability Benefits for Fibromyalgia?

Fibromyalgia pain and fatigue can impact your ability to work. Social Security Disability benefits may be available to you.

If you are not engaging in gainful activity due to Fibro, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.) The SSA has accepted that fibromyalgia can constitute a medically determinable impairment. (See my previous post on Social Security Ruling 12-2p concerning the evaluation of disability applications for Fibromyalgia.)

Generally, to establish fibromyalgia as a medically determinable severe impairment, you must show:

• Widespread pain for at least three months.
• Pain on palpation in at least 11 of the 18 tender point sites (as identified by the American College of Rheumatology).
• Morning stiffness or stiffness after sitting for a short period of time.
• Fatigue.

At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. There is currently no listing for fibromyalgia, but it is possible that your related symptoms/conditions meet a listing.

If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your fibro), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.

Tips for SSDI Application for Fibromyalgia

1. Make sure a fibromyalgia diagnosis is in your medical records. We’ve mentioned this before for long-term disability, but it is also true for SSDI, “know your medical records.”
2. Make sure your medical records document ALL of your symptoms and limitations. Your medical records should not just document your pain. Let your doctor know how often you feel the symptoms, how severe each symptom is, and how long each episode lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
3. See a specialist. A fibromyalgia diagnosis from an orthopedist, rheumatologist, or a chronic pain or fatigue specialist will carry more weight than the same diagnosis from a family physician or internist professional.
4. See a mental health professional. If you are suffering from depression or anxiety, see a mental health professional to diagnose, treat, and document these conditions. Fibro is often accompanied by or is the cause of mental health conditions. However, it is important that the actual fibromyalgia diagnosis comes from a specialist and not your counselor, therapist, or psychiatrist. (See above)
5. See your doctor regularly and keep your appointments.
6. If you can, provide evidence of a long work history.
7. Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
8. Include information from nonmedical sources to support your medical claims. Gather information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
9. Keep a journal. Make regular notes about your impairment, level of function, and treatments.
10. If you get denied, know if you should appeal the decision or reapply for disability.
11. If you need assistance, contact a Social Security Disability attorney who has experience obtaining SSDI benefits for Fibromyalgia. Call Loyd Bourgeois at 985-240-9773

Myths About Fibromyalgia

Fibromyalgia is a relatively common health condition associated with widespread sensitivity and pain in the muscles and joints. Fibromyalgia sufferers generally experience constant tenderness but the severity can change. Other symptoms include memory/concentration issues (“fibro fog”), general malaise or not feeling well, fatigue, and gastrointestinal issues. While fibromyalgia was described in medical literature as early as the early 1800s, it is still largely a mystery to the medical community.

Some common myths about fibromyalgia are (1) it’s not real, (2) it only affects older women, and (3) the pain is minimal and does not really affect daily living.

Because the most common symptoms of fibromyalgia are pain and tenderness, and because pain is a subjective symptom that is difficult to measure, many people believe fibromyalgia is fake. Many people and some doctors believe it’s all in the patient’s head. Knowledgeable doctors and sufferers of fibromyalgia know this is not true.

While the exact mechanism of fibromyalgia is not known, it is a diffuse, complex pain syndrome characterized by patterns of muscular tenderness in the body at known trigger points.

The American College of Rheumatology has clinical guidelines on making a fibromyalgia diagnosis.

Their guidelines require an evaluation of the trigger points (19 in total), symptoms lasting at least 3 months, and no other health problem that may explain the pain and symptoms. It is certainly not a made-up disease to doctors who have studied and treated it.

The second myth is that fibromyalgia only affects older women. While the National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that between 80 to 90 percent of fibromyalgia diagnoses are for women, this means a significant number of men are also affected by the disease.

At least one study has shown that the median age of female fibromyalgia sufferers was between 45–50 but that symptom onset occurs around 35–40. The study further found fibromyalgia onset occurring before age 18 about 10% of the time and after age 50 about 10% of the time.

Thus, fibromyalgia is not just an older woman’s disease – it can be experienced by young and old, men and women.

Another persistent myth is that fibromyalgia pain does not affect daily life. Fibromyalgia pain can be so severe that many people simply are unable to carry on many functions of daily life. Fibromyalgia can cause other symptoms as well such as chronic fatigue, depression, headaches/migraines, irritable bowel syndrome, and morning stiffness. These symptoms along with the pain and tenderness, impact the everyday life of sufferers.

The reality is that fibromyalgia is a debilitating disease that severely limits the quality of life of those diagnosed with it. Medications such as pregabalin, Lyrica, Cymbalta, and others are prescribed for treatment. Secondary symptoms can be treated with antidepressants and other over-the-counter pain relievers. More recently, doctors have found patients can limit symptoms with regular exercise, healthy diets, and lots of restful sleep. Many doctors also recommend aerobic exercises, acupuncture, and massage therapy.

I have seen first-hand the difficulty someone suffering from fibromyalgia has in their daily life. I know it is a real disease and have been honored to help a few fibromyalgia patients fight for the benefits they need and deserve.