Tuesday, April 14, 2009

Can you qualify for social security disability with fibromyalgia?

This question is not new in the least. However, that fact is irrelevant to the asker of the question who posted this question on her blog and then microblogged it a la Twitter.

Here is the short version of the answer. Yes, you can qualify for disability based on fibromyalgia. But, truthfully, you can qualify for disability benefits on the basis of nearly any physical or mental medical impairment, or combination of impairments.

The social security administration evaluates all claims in either the social security disability or SSI disability program on the basis of residual functional capacity. RFC is what you can still do despite your condition or conditions. Your residual functional capacity is determined by evaluating your medical record documentation, which includes records from individual doctors and hospitals (and, in the case of children, schools as well).

Once your RFC is rated, the disability system compares this (what you can still do and, conversely, what you can no longer do) to the requirements of your past relevant work. If your current condition is severe enough to preclude the possibility of returning to any of your former jobs that are considered to be past relevant work (jobs you did for a minimum period of time within the last 15 years prior to become disabled), then...you may be considered. I say "may" because you still have to pass one other hurdle. And that hurdle is something known as other work.

Other work is a fuzzy concept for most, but it can include quite a few jobs that you might be capable of transitioning to based on your current limitations, education, and work skills. The more education you have and the greater your work skills (higher skill levels make skills more transferable), the more likely it will be that an adjudicator will determine that you can perform some type of other work, even if your condition is severe enough that you can't go back to one of your old jobs.

Back to the question, however: can you qualify for disability on the basis of fibromyalgia? Yes. But it all comes down to the limitations indicated in your medical record documentation.

It goes without saying, of course, that most medical records contain sparse information as to a patient's functionality. In other words, for the purposes of achieving a favorable disability determination, they are sometimes (often) next to useless. This is why a medical source statement (or residual functional capacity, or RFC, form) that captures the opinion of a treating physician can be so helpful to a case.

Disability examiners, however, are not directed to obtain such statements from physicians who have an established treatment history with their patients (which is mystifying...but not so mystifying if you consider that the federal disability system has an inherent oppositional stance toward claimants).

Disability representatives, on the other hand, tend to submit such statements at hearings. And this fact along goes a long way toward explaining the disconnect between approval rates at the lower levels (disability application and request for hearing) versus the disability hearing level...that and the fact that administrative law judges receive and entertain such qualified information (the opinion of the treating physician) in a different context and with a different attitude.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

How does Social Security Disability use your Work History?
Social Security Disability and Past Work (the relevant period)
Disability Determination - applying for SSD
Appeal your disability determination

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Blogger cindacrawford said...

Thanks for providing such good information about the subject of disability and Fibromyalgia. Many people do not understand how a determination is made or what kind of hoops they must jump through to get one. The only thing I would add to the conversation is to refer folks to the Social Security Regulation 99-2p, which anyone can find on the Internet. It gives the specific wording concerning "definition of disability" for the illnesses Chronic Fatigue Syndrome and Fibromyalgia. You're welcomed to read more about this subject on my blog in two 2009 entries, March 16th and March 30th. Find it at http://www.healthmattersshow.com.

Thanks, Cinda Crawford
Host of the Health Matters Show

2:49 PM  
Blogger Disability Blogger said...

Hi Cinda, I responded to your comment here:

How Does Social Security Evaluate Fibromyalgia Claims?

3:58 PM  

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