Fibromyalgia and Disability

By Dr. Edward F. Group III, DC, ND, DACBN
updated on 06/29/2006 at 12:36PM

Fibromyalgia is an arthritis related condition that affects millions of Americans each year. It causes chronic pain and fatigue as well as depression, headaches, vertigo, and decreased cognitive functioning. The symptoms of fibromyalgia adversely affect the quality of life for its sufferers, and negatively impact their ability to be competitively employed. A recent study in the US found that approximately twenty five percent of patients who suffer from fibromyalgia are receiving disability payments. Applying for Social Security Disability benefits can be extremely time-consuming, confusing, and frustrating. Here’s what you need to know to make the process go more smoothly.

What Is Fibromyalgia?

Fibromyalgia is a very common illness that affects millions of Americans. It is similar to rheumatoid arthritis, in that the suffer feels constant and chronic pain. But unlike arthritis, fibromyalgia does not affect the joints. Fibromyalgia is medically defined as a condition that causes widespread pain throughout the body and pain when touched at several of the designated tender points along the body. These tender points include areas around the head, neck, shoulders, buttocks, elbows, and knees.

What Is Disability?

The Social Security Administration defines disability as "an inability to perform any substantial gainful activity because of a medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months." To further explain this definition, in Social Security terms, "substantial gainful activity" means work that "(a) involves doing significant and productive physical or mental duties; and (b) is done (or intended) for pay or profit." You cannot receive Social Security disability benefits if you:

Are currently working even though you are ill
Are capable of working
Have recovered within 12 months of the onset of a disabling illness
Have no medically determinable impairment

How Do I File A Claim For Disability Due To Fibromyalgia?

Your health care provider should advise you of the option to file for Social Security disability benefits when as soon as it appears that you will not be able to work because of your fibromyalgia for 12 consecutive months. With this prognosis, you can begin filing the appropriate paperwork within 6 months of disease onset.

Claims for Social Security disability benefits are made at the local Social Security District Office, either in person or by telephone (800-772-1213). You can perform the initial filing yourself, alerting the government to the fact that you are unable to work, the nature of your disease, the name of your health care provider, and your vocational background. You will need to involve your physician and an attorney for the subsequent steps in the disability process.

Once you have filed your claim, the Social Security Administration (SSA) will gather information about your medical, vocational and administrative status.

Medical Information: The SSA will request information from your health care provider on the status and prognosis of your condition, including your capacity for lifting, walking, sitting, and standing.
Vocational Information: The SSA will ask for a description of the duties you were performing and the date you last worked.
Administrative Information: The SSA will need you to produce proof of citizenship and any medical insurance you currently hold.

Fibromyalgia Disability: Filing For Appeal

If your initial claim for social security benefits is denied, you can appeal to have your case reconsidered. However, this appeal must be made to the Social Security Administration within 60 days of from the mailing date of your rejection. The Social Security Administration will not have a legal basis to hear the matter if the filing is late.

You may wish to consult an attorney for this portion of the filing process. The attorney will charge 25% of back benefits - moneys that would have been received if payment of benefits had begun at the onset of illness - and he or she cannot legally receive any fees without approval by the Social Security Administration.

Fibromyalgia: Requesting a Hearing

If your request for reconsideration is also denied, you may request a hearing into the matter. As with your appeal, this request must be made within 60 days of the mailing date of the appeal rejection. The request for a hearing will result in a trial before an administrative law judge. This trial will usually occur within 4 months of filing the request. You will definitely want an attorney with you to assist you in handling your case. Your attorney will work closely with both you and your health care provider to present your case before this judge. If this trial also results in a finding that you are not disabled, you can make an appeal to the Appeals Council, but this appeal must be completed within the jurisdictional 60 days. In most instances, however, the Appeals Council decision, will uphold the decision of the trial judge.

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