Social Security Disability is a U.S. federal insurance program that provides monthly benefits to qualifying individuals who have paid into the program but are now unable to work due to their disabling condition. Each year, many of the over 5 million Americans with fibromyalgia apply for Social Security Disability benefits because they are no longer able to work full-time due to their fibromyalgia symptoms.
Getting approved for Social Security Disability benefits can often be a long and difficult process for anyone. Those applying for disability due fibromyalgia can face an even more difficult road due to the often invisible nature of the condition and general lack of understanding in the medical community and society. Fortunately, in July 2012 the Social Security Administration helped clarify the policy for declaring that a person is disabled due to fibromyalgia by issuing Policy Interpretation Ruling SSR 12-2p.
The ruling specified the sequential evaluation process that disability examiners and judges should use to determine if someone applying for disability with fibromyalgia should be classified as disabled:
Current work status. If you’re currently working and making more than $1,090 per month, then you are not eligible to receive disability benefits and your application will be rejected.
Severity of impairment. Your medical condition must be so severe that it interferes with basic work-related activities. Generally, you must prove a history of widespread pain and have medical evidence of having at least 11 positive tender points of the 18 listed in the 1990 American College of Rheumatology criteria.
Does the impairment medically meet or exceed one of the SSA’s listed conditions. Fibromyalgia itself is not a listed condition so the determination must be made if the impairment is medically equivalent to one that is such as inflammatory arthritis. If the finding is that your condition is at least equivalent to a listed condition, then you may be approved at this point. But if not, then the process continues to step 4.
Can you do the work you previously did? Your condition must prevent you from performing the work you previously did. If the SSA decides you have the ability to perform in a job that you previously had, then your disability claim will most likely be denied.
Can you do any other type of work? The SSA will apply complicated work-vocational guidelines (also known as “grid rules”) based on your past history of employment, education and age. At this point, they are trying to determine if you could reasonably be expected to transition to a different type of work that would still accomodate your disability. Applicants who are 50 or older have an advantage at this step in the process because allowances are made knowing that it’s harder for older individuals to transition to a new line of work.
Things to keep in mind when applying for disability benefits with fibromyalgia:
a. About 70% of first-time applications for Social Security Disability benefits are declined. The percentage is likely much higher than that for people applying due to fibromyalgia. The advice that we often hear from people who were turned down but ultimately got approved: “don’t give up.” The system is far from perfect but generally those that truly qualify will eventually get approved. But you must be willing to fight for your benefits and jump through all the hoops of the application process to get there.
b. Many people recommend getting the help of an experienced disability attorney or advocate. These firms typically work to help you get approved for benefits on a contingency basis. This means that you pay nothing unless you get approved, and when you do they get a federally restricted one-time fee based on the amount of backpay that you are awarded. Click here for a free disability evaluation from an experienced disability attorney or advocate.
c. Medical records and support from your medical professional are critically important to getting approved for disability benefits. We recommend that you tell your doctor that you are going to apply for disability benefits and ensure that he or she will provide medical evidence that supports your claim. If not, then you should consider a new doctor before applying. Many people also recommend getting a diagnosis of fibromyalgia from a specialist such as a rheumatologist rather than a general practitioner since the diagnosis by a specialist is likely to carry more authority with disability examiners and judges.
d. As mentioned in Step #5 above, there are special rules that can make it easier for individuals who are 50 or older to get approved. If you applied and were denied when you were under 50, you should try again when you turn 50 due to the the more accomodating rules for those over 50.
Please tell us about your experiences applying for disability with fibromyalgia and share your tips with others in our community!