Fibromyalgia is a disorder that causes various debilitating symptoms, including muscle pain, joint aches and fatigue. Fibromyalgia has no known cure and can be highly disabling, as any disability lawyer in Chicago understands. People who suffer from this disorder and cannot work gainfully may be eligible for Social Security Disability benefits. However, they must meet several Social Security Administration criteria to prove the disorder qualifies as disabling.
Establishing a legitimate diagnosis of fibromyalgia can be challenging because many of the disorder’s symptoms are subjective and self-reported. Furthermore, some physicians may incorrectly diagnose other cases of inexplicable chronic pain as fibromyalgia. Due to these issues, the SSA establishes specific medical requirements for applicants with fibromyalgia to meet.
First, applicants must provide a diagnosis from an acceptable medical source. The SSA recognizes all licensed physicians as acceptable sources. However, for claims involving fibromyalgia, a diagnosis from a rheumatologist, rather than a general physician, may carry more weight. This is because of concerns that general physicians may mistakenly diagnose other disorders as fibromyalgia.
To support a diagnosis of fibromyalgia, applicants must prove they suffer from a specific set of symptoms. These symptoms are based on the American College of Rheumatology’s fibromyalgia classification and diagnostic criteria. If applicants cannot document these symptoms, fibromyalgia is not considered a “medically determinable impairment.” As any disability lawyer in Chicago can explain, SSD benefits are only available to people with medically determinable impairments.
Fibromyalgia is considered a medically determinable impairment if applicants meet three requirements. Applicants must document full-body pain that has persisted for at least three months. They also must provide objective tests used to rule out other diagnoses. Finally, applicants must test positive for 11 out of 18 trigger points or document six established symptoms.
The SSA establishes specific requirements for these last criteria. The trigger points must be located in all four quadrants of the body. The symptoms must be typical fibromyalgia symptoms, and they must occur regularly. Examples of acceptable symptoms include the following:
- “Fibro fog,” or memory and concentration issues
- Severe fatigue
- Fatigue upon waking
- Anxiety disorder
- Irritable bowel syndrome
The SSA assesses medical records and evidence from other sources to determine whether these criteria are met. If so, fibromyalgia is considered a medically determinable impairment. However, as any disability lawyer in Chicago can attest, applicants do not automatically qualify for benefits at this point. Applicants still must meet general requirements and prove their conditions prevent employment.
The SSA considers two financial factors to determine whether a person is eligible for SSD benefits. First, applicants can’t engage in “substantial gainful activity.” In 2015, this is work with monthly income over $1,090. Applicants also must qualify as insured based on their overall and recent earnings. The necessary amount of both depends on the applicant’s age.
Additionally, applicants must suffer from medical conditions that are expected to persist over 12 months or result in death. A well-documented diagnosis of fibromyalgia should prove applicants meet this final criterion, since fibromyalgia is chronic.
If these criteria are met, the SSA moves on to evaluating the disabling condition. First, the SSA considers whether an applicant suffers from an impairment listed in the “Blue Book” of disabling conditions. If an applicant documents a “Blue Book” condition and proves associated criteria are met, the applicant qualifies as disabled.
Fibromyalgia is not directly listed in the Blue Book, as any disability lawyer in Chicago knows. However, some conditions that are frequently associated with fibromyalgia, such as rheumatoid arthritis, appear in the book. An applicant may qualify for benefits based on one of these conditions without fibromyalgia even being considered.
Applicants who cannot qualify for benefits under a Blue Book listing may receive medical-vocational allowances. The SSA awards allowances after considering a person’s age, education, work experience and functional limitations. If these factors collectively prevent a person from reasonably finding gainful employment, an allowance may be awarded.
For people seeking medical-vocational allowances, the SSA’s assessment of residual functional capacity can be impactful. RFC describes a person’s exertional or strength limitations, along with non-exertional limitations. Memory problems, issues with dexterity and sensory losses are all examples of non-exertional limitations.
People who suffer from fibromyalgia may experience various non-exertional limitations. For example, a victim of fibromyalgia may need to take frequent breaks due to pain or fatigue. People with severe symptoms might miss work fairly regularly, and this absenteeism could be considered a functional limitation. The cognitive issues that characterize “fibro fog” may also represent non-exertional limitations.
Properly documenting these restrictions is essential for people seeking SSD benefits for fibromyalgia. Many of these limitations may not be apparent based on medical evidence alone. Fortunately, the SSA accepts other forms of documentation when evaluating RFC.
To establish a limited RFC, applicants can ask treating physicians to provide statements about their symptoms and functional limitations. A treating physician can also complete an official RFC assessment form. This form asks questions about all of the limitations the SSA considers when evaluating RFC.
Statements from non-medical sources can also help illustrate a person’s RFC. These non-medical sources could include family members, friends and co-workers. These individuals can give statements describing how fibromyalgia impacts an applicant’s functional abilities and daily life. This evidence may not carry as much weight as medical documentation and professional opinions. However, it can help supplement other evidence.
Gathering sufficient evidence to prove fibromyalgia is disabling can be challenging. To reduce the risk of claim denial, applicants may benefit from seeking legal representation. A disability lawyer in Chicago may help applicants ensure that their claims meet necessary requirements and contain adequate documentation.