Many fibromyalgia disability claims are initially denied. Understanding why and the disability evaluation process can help strengthen reapplication. Legal assistance is also useful.
Fibromyalgia
Fibromyalgia is chronic, widespread pain and fatigue. It is an invisible illness that appears healthy outside. It is a case where the brain processes pain signals differently, causing increased sensitivity. It has symptoms like tender points, stiffness, headaches, numbness, and memory issues. There is currently no cure, but symptoms are managed with treatments.
Disability Benefits Fibromyalgia
Government disability programs assist those unable to work. To qualify for SSD benefits for fibromyalgia, one must meet strict criteria.
- Assess severity and duration.
- Require diagnosis proof and medical records showing history and limitations.
Evaluate case-by-case, so details are important. Approvals typically have severe, lasting fibromyalgia affecting daily life and work.
Common Reasons for SSD Denials in Fibromyalgia Cases
There are a few key reasons why many initial SSD applications for fibromyalgia are rejected:
A. Lack of Sufficient Medical Evidence
One of the main reasons for denial of SSD benefits for fibromyalgia is failing to provide enough objective medical evidence to support disability status. Since symptoms are largely self-reported, adequate proof from doctors that fibromyalgia significantly limits functioning is vital. Some tips include:
- Getting an official diagnosis from a fibromyalgia specialist like a rheumatologist, neurologist, or pain management doctor. General practitioners often lack expertise, so a specialist’s opinion carries more weight.
- Have your doctor perform a full evaluation of tender points, pain scales, trigger points, and other measurable assessments. Quantitative data is more definitive.
- Getting referrals for additional tests like MRIs, x-rays, or lab tests to rule out other conditions and build evidence.
- Maintaining complete medical records showing your treatment history, medication trials, and worsening of symptoms over time. The longer the record, the better.
- Have your doctor write a detailed narrative explaining how fibromyalgia impairs your physical and mental capacity to work. Specific limitations should be described.
Since fibromyalgia shares symptoms with other conditions like arthritis and chronic fatigue syndrome, getting an official diagnosis specifically for fibromyalgia on record is crucial. Without the specialty diagnosis, the SSA may attribute limitations to another impairment that does not meet their disability criteria. A fibromyalgia specialist can provide the SSA-required diagnosis.
Consultation with Medical Specialists
In addition to a rheumatologist or neurologist, having evaluations and medical opinions from other specialists can strengthen evidence. For example, seeing psychiatrists or therapists for mental health limitations, orthopedists for musculoskeletal problems, neuropsychologists for cognitive dysfunction, and sleep experts for nonrestorative sleep. The multi-disciplinary approach demonstrates the widespread impact of fibromyalgia.
B. Failure to Meet the SSA’s Definition of Disability
Even with adequate medical documentation, SSD applications for fibromyalgia are often denied because the SSA determines symptoms are not severe enough to prevent working and earning substantial income. To qualify for benefits, they must find that fibromyalgia symptoms prevent SGA (earning $1,260+/month). The SSA will consider Functional Limitations and Work Capacity factors.:
- How symptoms like pain, fatigue, weakness, and cognitive problems impact your ability to perform work functions and daily activities
- Your history of jobs – whether fibromyalgia has caused you to reduce hours, duties or positions due to impairments
- Estimations of your residual functional capacity (RFC) – what types of physical and mental work you can still reasonably do despite fibromyalgia limitations
- Vocational expert opinions on what jobs exist that you could still perform, if any.
Without evidence of significant functional limitations, the SSA may determine you still have enough RFC to continue working, thus denying SSD benefits. Your appeal will need to demonstrate evident reductions in your ability to sustain full-time employment due to fibromyalgia.
Seeking Legal Assistance After a Denial
Since approval rates for SSD benefits for fibromyalgia hover around 30% on initial applications, getting experienced legal help is highly recommended if you are denied. An attorney well-versed in Social Security law can:
- Review your case file and identify weaknesses in your application
- Gather and submit any missing medical evidence to satisfy SSA requirements
- Work closely with your doctors to get definitive diagnoses, tests, clinical findings and opinions
- Present the most substantial arguments highlighting how fibromyalgia prevents you from working
- Handle appeals, hearings, and other legal complexities in the SSDI process
This expert assistance can help demonstrate you meet the SSA’s stringent disability criteria and maximize your chances of getting approved after initial denial.
Appeals Process
If your SSD claim is denied, you have 60 days to file a request for reconsideration – the first appeal level. Additional medical evidence can be submitted to rectify any shortcomings identified by the SSA. If reconsideration is denied, the next step is requesting a hearing before an Administrative Law Judge (ALJ). Hearings allow your attorney to explain how fibromyalgia renders you disabled face-to-face to the ALJ. About 15% of claimants are approved at this stage. Further appeals can be filed in federal court if warranted.
Having an experienced lawyer handling your fibromyalgia disability appeal or hearing can make all the difference. They know how to strategically navigate each stage for the best outcome.
Monitoring of Disability Upon Approval of Benefit
If your SSD benefits for fibromyalgia are ultimately approved, keep in mind the SSA will periodically review your case to confirm you remain disabled. Complying with treatment plans and maintaining medical records that demonstrate your ongoing symptoms and limitations is essential. With strong evidence, the chance of continuing to receive your well-deserved SSD benefits remains high.
Conclusion
The process of qualifying for Social Security disability benefits with fibromyalgia can certainly be challenging. However, understanding why applications are often initially denied provides a roadmap for building a stronger case. The key is obtaining comprehensive medical evidence that conveys clear functional limitations, along with persistence through the multi-step appeals process. Enlisting the help of a disability attorney experienced in fibromyalgia cases can prove invaluable. With their guidance, approval is within reach. Above all, remaining committed to showing how fibromyalgia prevents you from gainful employment can lead to success. There are options and hope ahead.