How to Prove You Have a Fibromyalgia as “Medically Determinable Impairment” for SSDI?

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Social Security Disability (SSDI & SSI) for Fibromyalgia

Social Security has published a ruling that helps define when applicants with fibromyalgia should be granted disability benefits.

A lot of candidates for Social Security disability benefits the ones who apply based on fibromyalgia get rejected. The part of the motive was that Social Security does not have a disability “listing” for the condition.  (Social Security’s disability listings offer the conditions needed for numerous different impairments to be sanctioned as disabilities.) The Social Security Administration (SSA) printed a ruling in 2012 to address the issue, providing directions to disability claims surveyors and administrative law judges (ALJs) regarding how to evaluate fibromyalgia circumstances. This ruling ought to help reduce the amount of fibromyalgia applicants who are rejected at the preliminary application phase and go on to file an appeal and ultimately win disability welfares.

Despite that, a lot of fibromyalgia patients will continue to be denied welfares. If you are applying for disability constructed on fibromyalgia, it just benefits to know that how the SSA views this specific impairment (known as fibromyositis).

How Does Social Security View Fibromyalgia?

Usually, when a disability claims examiner got a situation where the motive for disability was just fibromyalgia, the point of view for an initial endorsement was poor. Disability examiners usually presented slight weight to an entitlement of fibromyalgia unless there was one more condition involved, for instance degenerative disc disease or arthritis, the one that was more possible to come with objective proof of the disease just like x-rays. Why was it? Part of the problem has to do with the nature of fibromyalgia—its signs are mostly particular and its causes are not understood. Since its symptoms differ from person to person, and for the reason that the medical career had not figured out fibromyalgia’s reasons, disability examiners were by no means certain how to categorize such circumstances. As the medical profession has started to recognize fibromyalgia better, Social Security has established new standards for evaluating fibromyalgia.

How Can You Verify You Have a Medically Determinable Impairment?

As to be selected for disability welfares, you need to have an impairment recognized by medical proof for instance medical “signs” of the disease or illness and lab tests. In other words, your impairment cannot be established merely by your reports of your symptoms. This is known as the necessity of having a “medically determinable impairment” (MDI)—the SSA has to understand medical signs of an impairment that might more likely be expected to produce your symptoms. Verifying this can be challenging with fibromyalgia, as the illness is generally categorized by subjective reports of extensive pain, dizziness, tenderness in the muscles, joints, and soft tissues, fibro fog and fatigue.

Luckily, in July 2012, Social Security allotted a ruling clarifying when fibromyalgia would bring into being as a medically determinable impairment. The ruling directs statements examiners and judges to count on conditions allotted by the American College of Rheumatology (ACR) to define whether a candidate has fibromyalgia, and so has an MDI.

To be considered an MDI first, the patient would have proof of chronic extensive pain, with pain in the back, chest or neck and the doctor must have governed out other diseases (hypothyroidism, such lupus and multiple sclerosis) over the procedure of lab tests or x-rays. Also, the patient must have one of the following:

1. Tender arguments in at least 11 of 18 tender argument regions of the body, with tender arguments befalling on both sides of the body and both above and beneath the waist. You can get a list of the tender arguments in the SSA’s latest ruling on fibromyalgia.

2. Repetitive manifestations of six or additional fibromyalgia symptoms, mainly cognitive, fatigue or memory issues (fibro fog), anxiety, non-restorative sleep, depression, or irritable bowel syndrome (IBS). Other likely symptoms consist of abdominal pain, headache, muscle weakness, seizures, Raynaud’s phenomenon, and dizziness.

The claims examiner will evaluate your medical records to see if they comprise proof of the above criteria. The examiner will read the doctor notes on your complaints of fatigue, pain, and possible cognitive complications. To evaluate the reliability of your complaints, the claims examiner can ask your doctor to offer information about the amount and time period of your impairments, his or her judgement of how well you are capable to function, what treatments were done and whether they were supportive and had side effects, and how long the doctor believes your capability to function to be restricted. The longer your medical record contains proof of fibromyalgia symptoms and treatment, the better.

What Happens If Your Fibromyalgia Is Found to Be a MDI

In case SSA defines that you have the medically determinable impairment of fibromyalgia, Social Security’s assessment is not done; actually, it has just started. The SSA will possibly create a “residual functional capacity” (RFC) assessment for you to decide if there is any work you can do, with your past work.  RFC assessment is an estimation of your capability to perform numerous exertional stages of work; let’s say, if you can’t lift more than ten pounds, you will be provided a sedentary RFC.  The SSA bases your RFC on your medical records, views from specialists and doctors, and statements from you and from your family members. In evaluating your RFC, the SSA will be dependent on on your doctor’s view as to your abilities, just like how long you can stand, walk, and sit, how much you can lift, and how well you can focus and remember guidelines. These practical restrictions are the key to showing the SSA why you can’t work.

When making your RFC, the SSA will match it to the kinds of jobs vacant for somebody with your RFC level and restrictions. If the RFC rules out every job, though sedentary work, you will be considered disable.

Get Help from Specialists

More likely in other cases, hiring a lawyer to request a rejection of welfares for fibromyalgia can surely benefit, as disability lawyers are aware of the Social Security decision on fibromyalgia (SSR 12-2p) and the modern court verdicts on when disability would be approved for fibromyalgia. This information can assist disability attorneys find errors which were made by the judge or claims examiner in the disability determination and use them to your benefit.

Also, if just a primary care internist or physician give you a fibromyalgia diagnosis, then try to make an appointment with a specialist; and a diagnosis made by a rheumatologist will be more reliable to a judge or disability examiner and will help your Social Security disability request or claim.

Written by: Dr. M Rana, MD MBBS

For Support and Discussion join the group “Living with Fibromyalgia and Chronic illness”

Reference:  Written by Beth Laurence, J.D. retrieved from Disability Secrets

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