By Chris Sharry on October 24th, 2024 in Disability, Disability Claims, Social Security Disability
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Symptoms often begin after an event, such as physical trauma, surgery, infection or significant psychological stress. In other cases, fibromyalgia symptoms gradually accumulate over time with no single triggering event. Eligibility to qualify for disability with fibromyalgia can be complicated.
What Can You Do to Improve Your Chances of Approval?
1 Ask your doctor or rheumatologist if your diagnosis meets the 1990 ACR criteria for the classification of Fibromyalgia.
Based on these criteria, Social Security Administration (SSA) may find that a person has an medically determinable impairment of Fibromyalgia if he or she has all three of the following:
a. A history of widespread pain—that is, pain in all quadrants of the body (the right and left sides of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, thoracic spine, or low back)—that has persisted (or that persisted) for at least 3 months. The pain may fluctuate in intensity and may not always be present.
b. At least 11 positive tender points on physical examination. The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
The 18 tender point sites are located on each side of the body at the:
-
- Occiput (base of the skull);
- Low cervical spine (back and side of the neck); Trapezius muscle (shoulder);
- Supraspinatus muscle (near the shoulder blade); Second rib (top of the rib cage near the sternum or breast bone);
- Lateral epicondyle (outer aspect of the elbow);
- Gluteal (top of the buttock);
- Greater trochanter (below the hip); and
- Inner aspect of the knee.
c. Evidence that other disorders that could cause the symptoms or signs were excluded.
2. Make sure all of your longitudinal medical records documenting your diagnoses, symptoms and diagnostic testing are complete and submitted timely.
In disability claims, most of the information needed to prove your claim is documented in your medical records. Submitting your records timely and making sure that the disability examiners and/or Administrative Law Judge has all of the information needed to decide your claim is critical to the outcome of your case.
3. Document Your Pain With a Pain Diary.
The information you record in your pain journal can help you identify triggers and patterns related to your pain; for example, the time of day you’re likely to have a flare-up or if elevated stress levels increase your pain. Recording key observations over time can help you and your physician recognize patterns that impact your treatment and note successful parts of your treatment that reduce your pain.
It is important to record any information that may have an effect on or be associated with the pain. This may include:
- Time and date
- Recent activities and potential triggers
- Location of pain (e.g. lower right side of back)
- Feeling of pain (e.g. sharp, burning, dull, steady, throbbing)
- Severity of scale (e.g. on a scale from 0 to 10)
- Duration and frequency of pain
- Factors that ease pain (e.g. cold compresses, heat, repositioning)
- Exacerbations of pain (e.g. moving, temperatures, time of day)
- Efficacy of pain relieving medications
4. Asking your Doctor for a Medical Opinion
Having a persuasive opinion from your doctor about your medical limitations can make or break your Social Security disability case. These opinions, however, must be from a doctor that you have treated with long enough to be able to support the opinion. This opinion must also be consistent with the treatment you’ve received from this doctor that has been documented. Submitting a general letter from a doctor that is not validated in the medical records will not be helpful.
Expert Assistance with Your Fibromyalgia Disability Claim
Fibromyalgia can be a difficult condition to manage, and receiving Social Security disability benefits for fibromyalgia can provide essential support for those unable to work due to their symptoms. By following these steps—ensuring your diagnosis meets the necessary criteria, maintaining comprehensive medical records, documenting your pain, and obtaining a strong medical opinion—you can improve your chances of a favorable outcome. If you or a loved one are struggling to obtain Social Security disability benefits for fibromyalgia, contact Sharry & Monfette for expert legal guidance. We are here to help you navigate the complexities of the claims process and advocate for your rights.
