SSD (Social security disability) and SSI disability applications that are initiated primarily on the basis of fibromyalgia will encounter the same problems as other claims for disability, including:
1. Fairly high rates of denial at the disability application and first appeal levels (the first appeal is the request for reconsideration).
2. Lengthy waiting periods for decisions at every step in the system.
3. Incredibly long waits for social security hearings to be scheduled (a problem that has intensified in recent years and may only get worse).
4. A system that, on its face, can not only appear complex and confusing, but almost designed to result in financial disaster for most claimants.
Unfortunately, disability claims for which fibromyalgia is a primary allegation have their own specific problems, problems that are somewhat unique. One of those particular difficulties is that a claimant with this condition can find it difficult to obtain needed support from their treating physician. This can be due to a host of reasons, including, unfortunately, the fact that many doctors do not find it worth their time to provide documentary support for a patient’s disability claim, but also the fact that a certain percentage of physicians are not in support of fibromyalgia as a valid diagnosis (this despite the fact that medications are currently being approved by the FDA for the treatment of fibromyalgia).
The other problem, of course, is the fact that SSA does not expend much effort in recognizing fibromyalgia as a condition in its own right. Though there have been policy pronouncements regarding FMS, fibromyalgia still does not have a separate listing in the blue book, the social security administration’s impairment listing manual that is published under the name “Disability Evaluation under Social Security”.
Is a claim for disability benefits based on fibromyalgia an uphill climb? To some extent, it may be. However, the fact is that seventy percent of all social security disability claims that are filed with the social security administration are initially denied, regardless of the impairment. Those same claimants, if they pursue the appeals process to the level of an administrative law judge hearing and have able representation, will stand a better than sixty percent chance of being awarded benefits. Therefore, the best advice for any claimant is simply not to give up on a claim. If the initial claim is denied, file a request for reconsideration appeal. If this appeal is denied, file a request for a hearing.
What do judges look for when they hear cases based on fibromyalgia? As with all cases, the judge will look for evidence of physical or mental limitations that rule out the ability of the claimant to return to their past work. The judge will also examine whether or not these limitations rule out the ability of the claimant to perform some other type of work that might seem suitable based on the claimant’s condition, age, education, and work experience.
However, with regard to claims predicated on fibromyalgia, disability judges will also give more credence to medical evidence that emanates from specific types of treating sources. In other words, medical records obtained from a pain treatment specialist can often offer more validity than records from an internist. Likewise, a diagnosis either obtained from, or corroborated by, a rheumatologist may carry substantially more weight than a diagnosis obtained from a family physician who has no specialization in fibromyalgia or conditions involving pain or fatigue.
The author of this article is Tim Moore, a former Medicaid-disability caseworker and a former disability claims examiner for the social security administration’s DDS, or disability determination services. Tim Moore is the publisher of The Social Security and Disability Resource Center.