Tips for Applying for Disability Benefits with Fibromyalgia

Fibromyalgia can be a highly painful and debilitating chronic illness that prevents sufferers from working. Whether you have the ability to work in a limited capacity or you are unable to work at all, disability benefits can help with the cost of care and living expenses as a way to eliminate at least a few burdens in your life during a difficult situation. Keep reading for tips on applying for disability benefits with fibromyalgia.

Signs You May Have Fibromyalgia

The signs and symptoms of fibromyalgia vary greatly from one person to the next. Individuals will experience varying degrees of pain and tenderness in specific points and specific quadrants throughout the body, including soft tissues, muscles, joints and tendons. Fibromyalgia can be highly challenging for doctors to diagnose at times as this condition is still not perfectly understood by the medical community and research continues. Some people will also experience other symptoms, such as:

• Anxiety
• Depression
• Digestive Issues
• Dizziness
• Emotional Trauma
• Fatigue
• Headaches
• Memory Issues
• Numbness or Tingling in Extremities

In the end, not everyone will experience all symptoms and some cases will be more severe than others. And they can often be the signs and symptoms of dozens of other conditions. For these complicated reasons, fibromyalgia can often be misdiagnosed or go undiagnosed altogether.

Disability Benefit Options

Individuals with a fibromyalgia diagnosis or severe symptoms, as verified by an authorized medical professional, may qualify for either Supplemental Security Income (SSI) benefits or Social Security Disability Insurance (SSDI) benefits. SSI benefits are typically reserved for individuals who are incapable of working or earning a reasonable wage to survive due to some type of disability and who meet income & asset thresholds. The SSDI benefits are reserved for individuals with sufficient work history and work credits within the Social Security system who have physical or mental restrictions that will prevent them from working for at least one year or will result in death.

These benefits can assist with necessary treatments to make the illness more manageable on a daily basis, such as PT, therapy, medication and exercise. It is important to note that it could take anywhere from five months to over a year or even longer to be approved for these benefits. During the waiting period, it is a good idea to seek out assistance from various nonprofits dedicated to assisting those with fibromyalgia. They may be able to assist in a number of ways, including with resources, tools, finances, support, connections and more.

Know the Qualifying Factors

To qualify for disability benefits based on the SSA’s Blue Book listing for fibromyalgia, it will be necessary to have a doctor verify the specific physical and mental conditions you experience, the frequency in which you experience them and that such conditions severely limit your ability to complete tasks associated with current roles and responsibilities, and that you will be prevented from working for at least one year. In the case of fibromyalgia, individuals must meet specific criteria in addition to physical or mental work limitations, such as:

Pain that lasts for at least three months within four specific areas of the body.
Within the four quadrants, individuals must experience 11 tender points out of 18.
Provide medical records and additional evidence that other conditions have been ruled out.

It is also necessary to confirm that an individual suffers from at least six repeated fibromyalgia symptoms, including anxiety, depression, fatigue, headaches, memory problems, hypersensitivity to sensations, IBS, painful menstrual cycles, restless leg syndrome, sleep issues and tingling or numb extremities.

Meeting the Listing Exactly Is Not Required

Note that it is indeed possible to qualify as disabled according to the Social Security Administration without meeting the exact definition(s) published for fibromyalgia. The main issue the SSA is concerned with is whether or not all of your medical conditions combined will prevent you from sustaining work for at least one year.

A Diagnosis Is Important

The SSA does not make it easy to receive benefits based on fibromyalgia symptoms. Another issue is that fibromyalgia is difficult to diagnose. It is important to be prepared for the fact that you may have to go through a somewhat frustrating process to receive a certified fibromyalgia diagnosis. Doctors will have to eliminate many other conditions that have similar symptoms to fibromyalgia before they can determine the right diagnosis.

This can take months, and you will likely have to complete a number of tests. Unfortunately, these tests and exams can be costly, particularly for someone who cannot work. While a diagnosis is important, it is not the end of the line if you cannot secure one. And if you do qualify for benefits, in the end, you may be eligible for retroactive payment of some medical bills associated with your condition.

If You Cannot Get a Fibromyalgia Diagnosis

A formal fibromyalgia diagnosis is not absolutely necessary to become eligible for disability benefits.

However, before you give up on an official diagnosis, or even if you receive a diagnosis from an internist or a primary care physician, it may be a good idea to speak with a rheumatologist specialist. A diagnosis from this type of specialist will likely be far more persuasive with the disability benefits application examiners as well as judges if your application is appealed.

If you cannot get a diagnosis at all, do not forget that you can still qualify based on your symptoms and limitations through a medical-vocational allowance. You can become approved based on the fact you cannot perform regular tasks because of physical or mental impairments. As part of fibromyalgia, you might experience anxiety, depression or cognitive decline that can qualify you based on mental impairments, as well. It may also be helpful if you can demonstrate that you have symptoms that overlap with more common conditions, such as degenerative disc disease and rheumatoid arthritis.

Documentation Requirements

Documentation requirements are highly specific. You will need to provide a copy of all medical records demonstrating your impairments and limitations for at least 12 months, including exams, test results, evaluations and doctor notes. Your doctor will also have to complete a letter describing your condition in full and the ways in which you are limited in your work abilities. Be sure to gather the appropriate records from all the relevant medical professionals who treat you, including General Practitioners, specialists, Physical Therapists, psychologists and others. Some people also experience application success by maintaining a symptoms journal each day to present to your doctor and the SSA. It is best to speak with a disability benefits advocate to ensure you complete and provide all the necessary paperwork correctly to increase your chances for approval.

Applications and Appeals

Typically, only around 30% to 40% of disability benefits applications are approved the first time. Do not stress too much about this figure as many people are approved during the appeals process. In many instances, the applications are not completed properly or applicants do not provide the right medical evidence the first time. If you are denied upon your initial application, it is usually important to appeal the denial rather than to reapply, as this can save a significant amount of time in the process. It might also save you money. Again, a disability benefits advocate can help with this process; it’s never a bad idea to get help from a qualified advocate.

This article is presented for general information purposes only. Nothing in this article should be taken as medical advice. Medical decisions (including whether to start, stop, or modify any treatment plan) are extremely important and should always be made with the advice and counsel of a qualified medical professional.

About Citizens Disability, LLC:

Since 2010, Citizens Disability has been America’s premier Social Security Disability institution. Our services include helping people in applying for SSDI benefits, managing the process through Reconsideration, and representing people in person at their Hearing, and if necessary, bringing their case to the Appeals Council. Our mission is to give a voice to the millions of Americans who are disabled and unable to work, helping them receive the Social Security Disability benefits to which they may be entitled. Learn more about us and disability benefits like SSDI & SSI or give us a call at (800) 492-3260.

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