Do I Qualify For Social Security Disability Benefits If I Have Fibromyalgia
The Social Security Administration (SSA) doesn’t always make it easy for those with fibromyalgia (FMS) to get the Social Security Disability Insurance (SSDI) or Supplemental Security Income benefits they deserve. Many claims are denied because SSA says:
(1) Your FMS won’t keep you out of work for at least a year,
(2) Your FMS isn’t severe,
(3) You can return to the lightest job you held in the 15 years before you became disabled, or
(4) There is other work you can do in the mythical national economy based on your age, education, transferable skills and your residual functional capacity.
Not all cases of FMS are severe enough to make you eligible for Social Security Disability benefits, but Nancy Cavey has successfully represented many SSA applicants with FMS. She works to overcome the claims denial by working closely with you and your physician by showing that:
- Your limitations are too great for you to work at your old job or any other job in the national economy in view of your age, education and transferable work skills.
Ms. Cavey offers a free initial consultation and welcomes the opportunity to speak with you about your Social Security disability claim.
What Is Fibromyalgia?
FMS, whose cause is unknown, causes severe joint and body pain and fatigue that is not improved with rest. There is no gold standard test for fibromyalgia; the diagnosis is based, in part, on subjective complaints.
The American College of Rheumatology has developed criteria for the diagnosis of FMS that includes: widespread pain in all four quadrants of the body that have lasted at least three months, and 11 out of 18 positive trigger points over various parts of the body.
Other criteria were passed by The American College of Rheumatology in 2010 that include widespread pain and the use of a scale to measure the severity of the symptoms. Making a diagnosis, physicians can use one or both tests.
FMS is not a listed condition that automatically would qualify you for Social Security Disability benefits. You must have proof of the basis of the diagnosis; many Administrative Law Judges are skeptical about FMS and discount the impact of symptoms on your ability to work.
That is why it is crucial that you have an attorney who understands fibromyalgia and knows how to gather the medical and vocational evidence that is required to approve a claim.
What Are The Symptoms of Fibromyalgia and How Does SSA View FMS Claims?
FMS is a poorly understood medical condition that doctors once thought was “all in the heads” of patients. The general symptoms of FMS can include:
- Chronic pain,
- Bowel irritation,
- Chronic fatigue, and
- Cognitive difficulties, known as “fibro fog.”
It is crucial that your medical records show that you meet the criteria for a diagnosis of FMS and that your symptoms did not begin before the onset of your FMS. You must submit medical records that date back to when your symptoms began and should include the results of lab work, hospitalizations, doctor visits and medication history, including side effects of your medication.
Abnormal sleep studies, exercise stress tests and neurocognitive testing are helpful to document the basis of the FMS diagnosis and your limitations.
Because there is no listing for FMS, SSA will determine your entitlement to benefits based on medical and vocational criteria at Steps 4 and 5.
When Your FMS Makes It Impossible to Work
You must prove that you:
- Can’t return to the lightest job you held in the 15 years before you became disabled (PRW), and
- There isn’t any other work you can do in the mythical national economy based on your age, education, transferable skills and your residual functional capacity (RFC).
SSA or, ultimately an Administrative Law Judge, will answer those questions by determining your residual functional capacity. Your RFC is what you can do despite your FMS.
Residual Functional Capacity For FMS
The SSA will review your medical records at the Initial Application and Reconsideration stage of the claims process and determine your functional capacity to perform sedentary, light, medium and heavy work.
SSA medical consultants often opine that a Social Security Disability applicant can do light and sedentary work, and that will result in a claims denial. The lower your RFC the more likely that you can’t return to the lightest job you held in the last 15 years or perform other work. SSA doesn’t tell applicants or physicians about the existence and importance of properly completed RFC forms that explain:
- How far you can walk,
- How long you can stand and sit at one time and for an eight-hour work day,
- How much and how often you can lift, stoop, squat, bend during an eight-hour work day,
- Whether you have to alternate sitting and standing,
- Whether you have to take frequent as needed rest breaks throughout the day because of your persistent fatigue,
- Whether you have problems with concentration or staying on task,
- Whether you have problems with short-term memory loss that makes it hard for you to understand simple instructions,
- Whether you have good days and bad days and how many days per month you would miss from work, and
- Whether you have psychological problems, including depression or anxiety, that would interfere with your ability to work.
This is not an exhaustive list of all of the questions on a FMS or mental impairment RFC form. But you can see that having an explanation of what you can do physically, cognitively and emotionally is key to winning your case.
Many SSA cases are lost because the applicant did not obtain an RFC or the right RFC form, or because their treating physician didn’t properly complete the RFC form. That is one of the many reasons you should have an experienced Social Security attorney like Nancy L. Cavey represent you in your claim.
How Your Residual Functional Capacity Is Used At A Social Security Hearing
Many claims are denied both at the Initial Application and Request For Reconsideration stages of the claims process.
At the hearing stage, the Administrative Law Judge will determine your RFC and give hypotheticals to the vocational evaluator (VE) who will testify at your hearing. The judge will ask the VE to take into consideration your RFC, as determined by the judge, your age, education and prior work experience in determining:
- Whether you can return to the lightest job you held in the last 15 years,
- Whether there is other work you can do or could learn to do.
It is crucial that you are represented at a hearing to make sure the right questions are asked of the VE.
How Do I Get The Social Security Disability Benefits I Deserve?
FMS can interfere not only with your daily activities but with your ability to work. If you no longer can work or your doctor has told you to apply for Social Security disability, you should hire Nancy Cavey to help you:
- file your initial Social Security Disability application. The application process is confusing and designed so you make mistakes that can result in a delay or even a denial of your benefits;
- challenge a wrongful denial of your Social Security disability application or Request for Reconsideration;
- file a Request for Hearing and represent you at the hearing with the Administrative Law Judge who will decide if you get benefits. She will have your physician, if possible, complete the right RFC(s), prepare you for the hearing, prepare a hearing brief, and be prepared to cross-examine the VE.
The SSA is in the business of denying claims and will use any reason to deny your benefits. The odds of getting your Social Security benefits are greater when you are represented by experienced Social Security Disability attorney Nancy Cavey.
Contact Social Security Disability Attorney Nancy L. Cavey, Who Can Help You Regardless of Where You Live in Florida
You owe it to yourself and your family to get help today! Ms. Cavey can explain the Five-Step Sequential Evaluation process used in every claim, the claims process and how to get your disability benefits for FMS. Call today for a free consultation at 727-894-3188.