In July 2012, the Social Security Administration (SSA) released a new ruling that outlined exactly how disability claims processors should evaluate applications for benefits from those who suffer from fibromyalgia and chronic pain. This new ruling is excellent news for many Americans who have been diagnosed with this debilitating disease because it gives clear requirements for qualifying for first time benefits.
What Is Fibromyalgia?
Fibromyalgia is a chronic pain condition that often lasts a lifetime. Unfortunately, doctors have not been able to identify the exact cause of this illness or how best to prevent or treat it.
Fibromyalgia can present itself in a number of ways, but its defining symptom is the presence of 18 “tender points” throughout the body that cause pain for a number of consecutive months. Medical professionals agree that having at least 11 tender points is a common sign of the ailment. Other symptoms include:
- Morning stiffness and fatigue
- Sleep disturbances and insomnia
- General aches and pains
- Muscle stiffness and spasms
- Digestion issues, including abdominal pain, constipation, diarrhea, bloating, nausea, and irritable bowel syndrome (IBS)
- Memory, concentration, and cognition issues
- Anxiety and depression
- Headaches and migraines
- Fatigue and lack of energy
- Numbness and tingling
- Urinary issues, such as urgency and frequency
- Sensitivity to light, sound, or odor
- Heart palpitations
- Reduced ability to exercise
- Symptoms that change or get worse depending on time of day or other factors
Because the root cause behind these chronic pain issues is not yet known, treatment is often for the symptoms and not the source of the problem. Common fibromyalgia treatments include pain medications, therapy, sleeping aids, anti-depressants, and anti-seizure medication.
How the SSA Evaluates Fibromyalgia Claims
Fibromyalgia symptoms can be vague and can vary greatly in severity. This has made it difficult for SSA officials to fairly evaluate claims. While some fibromyalgia sufferers may be able to work, others may qualify for disability benefits based on their medical issues.
Now, under the new ruling, there are two required determining factors in every Social Security disability fibromyalgia case and a third determining factor that can be one of two factors.
In order to qualify for Social Security disability, you must:
- Have an extended history of the widespread pain that is the defining symptom of fibromyalgia. This pain should be present in all quadrants of your body and for at least three consecutive months.
- Prove that your doctors have ruled out other possible causes of your widespread pain.
- Display at least 11 of the 18 accepted tender points in the body related to fibromyalgia or display repeated occurrences of six or more common fibromyalgia symptoms, including fatigue, cognitive issues, restless sleep, depression, anxiety, and IBS.
Additionally, you must meet all of the general qualifications for Social Security disability. Specifically, your disease must be expected to last more than 12 months, you must not be gainfully employed, and you must be too disabled to work.
Fibromyalgia Claims May Still Be Difficult to Prove
Despite the new ruling, it may still be challenging to successfully prove that you have fibromyalgia, that your symptoms are severe, and that your health condition makes it impossible for you to earn a living. We can help you collect evidence for your case and get you the disability payments you deserve. Call 800-800-6353 to schedule a free, private consultation today.
by Paul B. Burkhalter Managing Partner of Morgan & Weisbrod, Board Certified in Social Security Disability Law.