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Does Social Security recognize fibromyalgia as a disability?

By   /  March 3, 2016  /  18 Comments

fibromyalgia-social-security-disabilityFibromyalgia as a Medical Condition

Social Security recognizes fibromyalgia to be a medical condition. To qualify for benefits based on fibromyalgia, your condition—like any other medical condition for which people claim disability—must be severe enough to be disabling and must be supported by medical evidence. For more information about Social Security’s disability requirements, see our articles “What Is Disability According to Social Security Law?” and “How Does the Social Security Administration Apply Social Security Laws to Determine If I Am Disabled?”

Challenges to Getting Social Security Disability Based on Fibromyalgia

Claims for disability caused by fibromyalgia are complicated by three factors. First, many of the symptoms are subjective; that is, there isn’t a test or observation that can prove the symptoms or their severity. For this reason, sometimes disability due to fibromyalgia can be hard to prove. A further complication is that a diagnosis of fibromyalgia may be hard to substantiate because some of the symptoms, such as joint and muscle pain, fatigue, and mental fuzziness can stem from other diagnoses. Receiving care from a rheumatologist who has diagnosed you with fibromyalgia can be helpful in supporting the diagnosis and the level of limitations that you have. A third challenge in establishing disability is that many people with fibromyalgia are able to work, especially in sedentary or light work.

Lawyers for Social Security Disability

For all these reasons, it would be a good idea to hire a Social Security attorney who has experience with fibromyalgia claims to help you file your original Social Security Disability claim or your appeal, if your claim has been denied, especially if you have worked in sedentary or light work in the past. If you already have a claim or appeal pending, it is not too late to enhance your chances for approval by retaining legal representation. If you are wondering how to afford a lawyer, see our article “How Do Social Security Disability Attorneys Get Paid for Representing You in Your Disability Claim?”

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  • Published: 11 months ago on March 3, 2016
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  • Last Modified: December 1, 2016 @ 9:58 pm
  • Filed Under: Claims Process
  • Alicia Johnson

    I am a RN my license is in hold, no doctor will sign for me to go back to work Bc of nurse practice law and adverse reaction could happen to me, I was in major car wreck 5 years ago and settled and all that money is gone to help pay for my son and I a home, I have a disability attorney I was denied twice and once before ALJ who didn’t let me answer without cutting me off and making me cry, my attorney filed suit against him but of course they won’t find one of thier own in the wrong ever, we are now under appeal again, waiting on a hearing with another ALJ, since then I have been diagnosed by a rheumatologist with fibromyalgia and fatigue, I need to see a new doctor for chronic fatigue syndrome as my rheumatologist doesn’t diagnose that??? There is not a single moment I am not in pain, the pain is so bad in my feet and hands I literally wish I could cut them off my body, I am 48 with a Masters in Nursing, and because of this they believe I can still use my mind, but I have tried to tell them in the last 5 years I am loosing my mind, I am depressed and will see a psychiatrist next week, I am on Prozac for anxiety and occasionally had severe panic attacks, I have almost every symptom of fibromyalgia and chronic fatigue syndrome, I have had every test known to woman, all negative, I honestly don’t understand if disability knows the horror of fibromyalgia then why it’s so difficult to give disability to us? No one wants to collect the pennies of disability by having this monster, I would go back to work tonight if someone said they would take this monster away, truly it’s a sad and hopeless system ran by judges and lawyers and doctors that are trying to save the state money, the same money I worked and paid into since I was 15, yet if I had destroyed my kidneys or heart from illegal drug use and alcoholism I would get disability the very first try.

    • Kay Derochie

      Dear Alicia,

      With the diagnosis from a rheumatologist and a new psychiatric evaluation, you may have a better chance of approval at the second hearing.

      Sincerely,
      Kay

  • Denice

    I was hurt at work 3yrs ago . Was on work comp until March 2015 , settled. Applied for SSD in March 2015 was denied 2xs now waiting for court date. I was told in June my case was expedited and it would be 30 to 90 days. It’s now mid Oct. and still have not heard anything. They refuse to tell me anything since I have a lawyer. She keeps telling me to be patience. I have degenerate disk disease, a herniated disc , 2 bulging discs, 1is on my sciatic nerve, chronic pain, fibromyalgia, depression and anxiety. I don’t know what it’s like to have a pain free day. I did have my local Congress woman make an inquiry on my behalf…that’s how I know my case was expedited. When they called in early June they were told it was already expedited. Actually haven’t even heard from my lawyer since Feb or March. Don’t know how much longer I can go on just my husband’s pay.its putting stress on my 28yr marriage. Any advice? THANK-YOU

    • Kay Derochie

      Dear Denice,

      Basically all you can do now is wait and stay under the care of your physician. An expedited status can cut the time somewhat but usually not as much as you were told. Without any expedited standing, hearing wait times run from twelve to twenty-four months depending on geographic area. You can look up your hearing office at https://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html to see what their usual wait times are.

      Sincerely,
      Kay

      • Denice

        Thank-you

        • Kay Derochie

          You are welcome, Denice.

  • Eric

    I am currently going through the appeal process and have to see a Hearing’s officer next friday. I have been in and out mental institution twice this past year for Major Depression and Suicidal tendencies. I have been through a group already and am currently seeing a therapist and psychiatrist as well as have a service coordinator. I have also just been diagnosed with Fibromyalgia by my Doctor, as I have been in pain this past year and just never really thought anything about it as I had been dealing with my mental health but I just could not handle the pain anymore as it was only getting worse. I also suffer from Severe Migraines at least twice a week that can last 3 to 4 days. I am so stressed out worrying about what my chances are as well as everything else that my psychiatrist is worried about me.

    • Kay Derochie

      Dear Eric,

      Be sure that all your recent mental health treatment information has been submitted to the hearing office and any documentation that exists as to the severity and duration of the migraines and fibromyalgia symptoms. If they haven’t been, try to get the records to take to the hearing;it’s late to mail them now. If you can’t get them, at the hearing tell the judge that you have additional medical records to submit and request that the hearing record be held open for you to get and submit them. Your chances will be best when you have submitted everything you can. (Of course, if you have an attorney, discuss all this with the attorney.)

      Sincerely,
      Kay

  • Stacey

    I had to quit working for two reasons. I constantly had migraines, pain in my joints, back, neck, shoulders that hurt so bad I felt like I was having a heart attack on a daily basis and had called out of work excessively due to the migraines.
    I’ve been unable to work since October 2015. I had to give up my insurance and benefits so I haven’t been able to see Drs as much as I’ve needed to. My blood work came back fine, no lupus,Lyme disease, RA, or anything else so one Dr just told me it’s fibromyalgia and put me on lyrica.
    I also have horrible anxiety, and depression. I’ve been on Celexa and Klonopin for a long time.
    I suffered from around March 2015 with this constant pain and flu like aches that make it impossible to even do light housework or pretty much anything. All I can do to keep from hurting is be still and not pick up or move too much. This has led to deeper depression and hopelessness because I can’t work and get a paycheck, I can’t do the things I want to do. I used to be up and busy always doing something and working.
    I need SSD but how in the world can I make anyone know and feel this pain that’s taken my life away from me? I’ve never been a lazy person but now my house…inside and out looks horrible and I can’t do a thing about it. I can’t afford a Dr that could help me because I lost my insurance. I should have gone to Drs before I had to quit working but after working it was all I could do just to get myself home and lay down. But the biggest reason I didn’t tell me Dr earlier is because I didn’t want her thinking I wanted pain pills like an addict, that’s the first thing Drs think you want when you tell them you have pain. So I don’t have a lot of medical records to show proving how bad I’ve gotten. I’ve always had to work hard manual jobs because I have learning disabilities, I can’t concentrate or remember important things and I’ve lost hearing in my right ear so I can’t hear good at all.
    Any advise you can give me on what I need to do to prove how my abilities and life has been taken away. I’m a financial burden on my husband that’s disabled and barely able to pay all our bills plus my prescriptions and copays for the Dr. I need on SSD so bad to afford getting help from Drs and my prescriptions and just basic necessities around the house and bills.

    • Kay Derochie

      Dear Stacey,

      I suggest that you file an application for Social Security Disability (SSD). At that time also inquire about Supplemental Security Income (SSI) if your husband’s Social Security is less than $1,150 before reduction for Medicare premiums. List all the doctors you have seen and provide contact information for the doctors and anywhere you had testing done to rule out illnesses. Also state lack of insurance has curtailed your getting care. Be sure to list the learning disability and deafness in one ear.

      If you can possibly get an appointment with a rheumatologist for evaluation and have a copy of your test results sent to him or her first, it could be helpful to your claim because usually a diagnosis of fibromyalgia made my a rheumatologist carries more weight than by a general practitioner. For current care, check with your local state or county social services office to see if you qualify for Medicaid.

      Sincerely,
      Kay

      Sincerely,
      Kay

  • max

    im unemployed, 3 weeks ago i was rushed in to emegency surgery for a perforated bowl . i nearly died. ive had so many complications, namouna. fluid around lungs, my surgeon tells me at least 3 months before even thinking about any thing . am i elagable for short term help. out of work over one year not rec. any assit, from any one , my brother . supports me

    • Kay Derochie

      Dear Max,

      To be eligible for Social Security or Supplemental Security Income disability, you have to be expected to be disabled (not just unemployed) at least twelve months. If it starts to look as if that will be the case, file an application. In the meantime, check with your local social services office to see if you qualify for food stamps, Medicaid, or a short-term disability benefit (a few states have a short-term disability benefit).

      Sincerely,
      Kay

      Sincerely,
      Kay

  • Regina

    I GOT MARRIED TO MY HUSBAN ON SEPTEMBER 10 2013 AND I WAS CUT OFF MY SSI AND I WAS TOLD THAT MY HUSBANDS SSI MONEY IS NOW BOTH OURS MY HUSBAN REFUSES TO PUT ME ON THE BANK ACCOUNT I HAVE NO ACCSESS TO THE MONEY AND HAVE NOT THE ENTIER TIME WE HAVE BEEN MARRIED I HAVE LOST MY CAR AND EVERYTHAING I OWN BECAUSE HE REFUSES TO GIVE ME ANY MONEY. WE ARE SEPARATED NOW AND HE HS NOW CHANGED BANK ACCOUNT INFORMATION. I HAVE LET SSI KNO ABOUT THE SEPARATION AND THAT HE HAS NOT SAPORTED ME AT ALL IM WONDERINGIF THERE GOING TO PAY ME BACK FROM WHEN THEY CUT ME OFF OR WHAT AND WHAT I SHOULD DO IF THEY ARE NOT GOING TO

    • Kay Derochie

      Dear Regina,

      The law deems (considers) spouses living together are a family unit financially responsible for each other regardless of whether one spouse withholds money from the other. For this reason, you will not receive any back pay for the time your lived together. Benefits will start the month after you separated.

      Sincerely,
      Kay

    • veronica vega

      Dear Regina,
      I have been denied on being my two children’s payee . I do not understand, I do not have any felonies nor been in jail. My ex has been to social security bashing me I think might be the reason. They have assigned me to a payee who never tells me anything about how much my children receive and they also never turned in paperwork of a reevaluation which my children receive less than half of their benifits . I had to go to social security and complain. I requested that my husband be my payee but they said it would be a conflict of interest. Can I appeal . I feel like I am being discriminated. I have been trying to be my kids payee since 2012. What can I do . Please help me with this. Thanks

      • Kay Derochie

        Dear Veronica,

        It sounds as if you might need assistance from some agency that offers advocacy for disabled individuals. If you have a mental illness, you might try contacting National Alliance on Mental Illness (NAMI) to see if they have a local chapter that could assist. If you have mental retardation, you could contact the Association for Retarded Citizens (ARC).

        Sincerely,
        Kay

  • My husband, Dennis, got hurt at a job about two years ago with a back injury. He went through the workmans comp system here in Oklahoma but his employer fought it all the way. He was misdiagnosed as torn muscles and sent to physical therapy which hurt him even more. In fact, he has three herniated discs from his L1 to S1. He is not eligible for surgery due to the position of the discs. Only three people have been operated on with his condition and two died on the operating table and the third is in a wheelchair so no Doctor would operate on him at all. He ended up with only $11,000 due to attorney fees, loans, child support, etc. His settlement was only around $30,000 to begin with. His workman comp attorney told him he had to wait 2 years to file for disability. Well, that $11,000 went real fast and we had no money. He has a high school education and has only worked in the oilfield doing manual labor all his life. He is 45 years old in March of 2014. No company would hire him with a back injury plus he cannot do any kind of manual labor anymore. Finally someone did hire him about a year ago and they didn’t ask about any back injury or why he was out of work for 2 years. It is a manual job loading sand onto trucks from railroad cars and it is killing him. His sheer will and determination is the only thing making him go to work. He worked doing that for about 6 months, then he went into the scale house when someone else quit so that helped as it is an office job scaling the trucks in and out of the yard. He was able to do that. However, the manager that hired him got fired so now there is someone else in charge. They sent him to Texas to work temporarily and he got reinjured down there and had to go to the emergency room and saw a chiropractor when he got back home. That helped but is so expensive even with insurance he had to stop going. I think that Dr. might have hurt him worse with the cracking of his back so what helped there was the massage and hot rock therapy. He has bleeding from his rectum and the chiropractor thought he might have had a stroke or heart attack so sent him to Oklahoma Heart Hospital who said he didn’t and it wasn’t his heart so they sent him to an internist who sent him to a digestive disease specialist who said he had bacteria in his gut and put him on medicine for it. He also said the bleeding from his rectum was from hemoroids but surgery wouldn’t help but only hurt him worse. He had a cat scan and a colonoscopy. He still has severe chest pains that have only gotten worse. In the meantime, his new manager at work is a black man and has gotten rid of all the white people at work and hired his black buddies. He wanted the previous manager to hire one of his friends but instead he hired my husband so the new manager actually is a racist and hates all white people and hates my husband cause he is white. There were only two white people left at work so the mgr made them work a shift alone. Everyone else has a scale house operator and a loader except these two. So now my husband has to load trucks and it is killing him. He can hardly walk or stand up straight. He is in constant pain. He cannot do anything else except struggle to make it to work. He cannot mow the yard or walk the dogs or do anything around the house. He only works and tries to sleep during the day as he works nights. He cannot even sleep very well due to the back pain and it is getting worse every day. He is very tough but I have seen him cry with the pain and he is talking about killing himself. The other white person got his leg broke last month at work cause he was alone and in a hurry and he got workmans comp and everything paid for. My husband saw an ad for Laser Spine Institute on TV so I called them and they say they can help but we need $1000 for the surgery and his insurance, Cigna, will cover the rest. If we can come up with $250 they will do it and we can pay out the rest. I am not sure what exactly they will do for him. We need to go for consultation and another MRI, etc. We haven’t scheduled that yet cause we don’t have $250. This is my question. He is afraid he will be fired if he tells his boss he needs off work for the surgery plus he will need 3 to 4 weeks off after, maybe 5 or 6 weeks. His boss claims there is no light duty at work and won’t let the guy who broke his leg come back to work until he is cleared by his doctor, not even for light duty scale house work. I work only part time so I cannot help as I cannot find a better job. My husband has applied at every job he thinks he can do but with no luck. I have done research on SSI so I know it takes a couple of months to process it and then 5 or 6 more months to actually get it, plus he makes around $1400 per month now so that is over the guidelines. He just cannot continue to work, it is just killing him. He cannot just quit as we have no money to live on. He is afraid he will be fired if he has the back surgery yet he cannot continue like this. We cannot live on nothing until if or maybe he gets SSI. We are between a rock and a hard place as they say. I am going to try to borrow the money for the back surgery but what are his chances after that to get SSI? I know he has to be unable to work for at least 12 months. What do we live on until then? We have no family to go to for help. We cannot afford an attorney to sue his work and the manager there now. If he does, you know they will fire him. He is sick every day he goes there and can hardly struggle through it. His manager is hoping he will just quit if he makes it hard enough on him. He is ready to just lay down and die or kill himself. Should he go ahead with the back surgery and file for SSI at the same time? Wait and have the back surgery and hope he doesn’t get fired? He doesn’t have short term or long term disability as it was so expensive he couldn’t afford it at work. He has child support to pay for another year and a half. Should he try to get short term disability and long term, then have the back surgery, then file for SSI? What to do? I can see why people need an attorney for SSI as I have read the articles and it is very confusing. He has worked since he was 16 years old so has paid enough in. If the back surgery is successful, then he can continue to work but not if he gets fired. He has applied for any and every other job he can but no luck there. No one will hire him with a back injury. What should we do?

    • Kay Derochie

      Dear Moreta,

      Your husband’s situation is complicated because he did not file for Social Security Disability (SSDI) when he was first injured. However, if your husband was off work an entire twelve months before returning to work, there are some SSDI provisions that could help him now–specifically the Trial Work Period and the Extended Period of Eligibility. Please note that what I am about to describe below will apply only if he was off work a full twelve months before beginning his current employment.

      Your husband could file an SSDI claim while still working, claiming the first date he was injured two years ago as his date of disability. When he files the claim, he should ask in writing on the disability statement that the first nine months of his return to work be treated as a Trial Work Period {TWP}. Benefits are paid during a TWP. Then during the thirty-six months after the end of the Trial Work Period, Social Security pays benefits for months in which the worker does not more than $1,070. This means that if your husband is approved back to his initial injury and the Trial Work Period and Extended Period of Eligibility are granted, he could receive back pay of up to twelve months before the application was filed (but not for months after the Trial Peri ends). Then he could stop work for the surgery and have benefits reinstated under the Extended Period of Eligibility. There would be some processing time involved but you and he would have the back pay to help see you through.

      In filing this claim, it will be important to carefully include all information about his medical treatment and his limitations since the original application. Also because he is under age fifty, he will have to make a case for being unable to perform any occupation, not just heavy work. If he had trouble doing the scale house work, he needs to explain the problems.

      Another thought is that he might contact Vocational Rehabilitation of the State of Oklahoma to see whether he would qualify for retraining services, possibly with a living stipend. He might even ask whether they would pay the $1,000 co-pay or part of it to help him stay employable.

      If he was not off work a full twelve months, then the above provisions won’t apply. He can nevertheless apply for benefits as soon as he stops work for the surgery if it is expected he will be disabled for a year.

      You ask whether he should “get” short-term disability (STD)and long-term disability (LTD), but you also say that he did not enroll in the insurance because of the cost. Enrollment in employer-sponsored STD and LTD is usually only allowed during open enrollment period, which is usually at the end of the year. Many LTD policies(and some STD policies) have pre-existing condition exclusions, meaning benefits won’t be paid for a condition that began before the insurance policy came into effect unless disability starts after the person has been insured for a period of time, usually six or twelve months. Your husband should look at policy provisions before purchasing the insurance to review for pre-existing condition provisions, if any.

      If he stops work for the surgery, your family might qualify for food stamps or energy assistance to help with heating costs. You could also contact the health and human services department of your state to see whether it has any temporary cash assistance for disabled persons.

      Sincerely,

      Kay

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