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Fibromyalgia and Social Security Disability Benefits

If you are from US and are looking to qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits due to a diagnosis of Fibromyalgia, there are some things that you will need to prove to the SSA. Ram Meyyappan from tells here how those with Fibromyalgia can apply for SSDI and SSI benefits. He also shares what are the things we need to prove to SSA and the importance of proper legal representation.

In the United States, those who suffer from Fibromyalgia are among the many individuals who apply for Social Security Disability (SSD) benefits each year.

Social Security Disability (SSD) is a U.S. government program designed to provide financial relief to those who are unable to work due to a disability. You can apply for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. SSDI is intended for individuals who are unable to work for at least a year due to their disability and have paid into the Social Security System for 5 out of the last 10 years. SSI, on other hand, is intended for those who do not have the necessary work history.

Qualifying for SSD with Fibromyalgia

When you apply for Social Security Disability benefits the first thing you need to do is file an initial claim. This is when you fill out the claim forms provided to you by the SSA. The forms can be filled out online or you can obtain them from your local Social Security office.

When you file these forms, make sure you provide sufficient medical evidence to support your claim. If you do not provide specific medical evidence supporting the severity of your condition, your claim will be denied.

Unfortunately the SSA has yet to establish fibromyalgia as a listing in the Blue Book that the SSA adjudicators use to determine whether or not an individual qualifies for Social Security Disability benefits. Because of this, when an adjudicator is reviewing a claim based on fibromyalgia, they must determine that the symptoms that the patient is experiencing are “equivalent” to a listed medical condition. It is important to note, however, that even though the SSA does not have a listing for fibromyalgia in its Blue Book; it has made a ruling giving guidelines as to how claims based on fibromyalgia should be processed.

In order to qualify for SSDI or SSI benefits due to a diagnosis of fibromyalgia, there are some things that you will need to prove to the SSA. First and foremost, there must be documented evidence of widespread pain for a period of at least three months and this pain must be present in at least 11 of the 18 tender point sites that have been defined by the American College of Rheumatology and the Centers for Disease Control. You must also be able to prove your level of fatigue and there should be documented evidence of morning stiffness as well as stiffness after sitting for short periods of time. MRI results have also proven to be beneficial when applying for disability benefits due to fibromyalgia. You must also have medical records showing your doctor has ruled out other possible causes for your symptoms.

When you fill out your disability claim forms you will want to ensure that you have medical records that contain the evidence mentioned above and support your case for disability benefits and will provide the answers to the five questions that the SSA will use to determine your eligibility for disability benefits. These questions are:

1.       Are you working?

2.       Is your condition “severe”?

3.       Is your condition found in the list of disabling conditions?

4.       Can you do the work you did previously?

5.       Can you do any other type of work?

If your medical records are not sufficient when you submit your claim and the above five questions cannot be answered to the satisfaction of the SSA, chances are that you will be denied during the initial stage of the disability claim process. If you are, do not give up. Approximately seventy percent of applicants are denied during this stage of the application process.

SSD Application Process

As mentioned above, nearly 70 percent of disability claims are denied during the initial stage of the application process. If yours is among them, you will need to file a Request for Reconsideration. Unfortunately fewer than 20 percent of these requests are approved. This means that you will likely have to attend a disability hearing in front of an administrative law judge in order to overturn the SSA’s decision to deny your benefits. The good news is that nearly two-thirds of claimants who attend a disability hearing are awarded the benefits they need as a result of the hearing.

If you do attend a disability hearing and are still denied benefits, you can further appeal the decision with hopes of obtaining benefits in the future. The next step, which will be handled by your lawyer, is a review of your case from the Appeals Council. If the Appeals Council does not award you the benefits you need, you can take it a step further and appeal the SSA’s decision in the federal district court.

It is important to note that you should not attend a disability hearing without proper legal representation. Working with a Social Security Disability attorney is crucial if you want the best chance of a successful outcome. While some applicants prefer to wait till the hearing stage of the application and appeal process to turn to an attorney for legal help, you can actually get the help of a legal professional before you even apply for benefits. This may increase your chances of being awarded benefits during the initial stage of the application process, thereby avoiding the need for a lengthy and stressful disability appeal.

Fortunately most disability attorneys work on a contingency basis. These professionals collect only 25 percent of the back pay that you are awarded from the SSA. This means that retaining legal help in your pursuit of Social Security Disability benefits will not incur any up-front expense on your part.

 -Article by Ram Meyyappan from

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