How To Win A Fibromyalgia Disability Case
People suffering from fibromyalgia suffer from chronic pain, debilitating migraines, and can have temporary issues with memory as well.
Between all of these symptoms combined, people with fibromyalgia may find themselves unable to find consistent work, forced to take sporadic leaves of absence for medical reasons, or just find it difficult to find a job they are capable of performing in spite of their condition.
Fortunately, the Social Security Administration offers disability coverage to those individuals deemed to have a disability that prevents them from working.
While this coverage is available, fibromyalgia cases can be very difficult to win. This is in part due to fibromyalgia being a sort of ‘if all else fails’ diagnosis.
It’s essentially the diagnosis one would get once all other causes for the symptoms have been ruled out. This makes fibromyalgia not only very hard to diagnose but also just as hard to prove when making a disability claim.
Being thorough, organized, and taking the necessary steps prior to filing your claim may not guarantee success, but it will greatly increase your chances of being awarded disability benefits. There are a lot of steps to take in preparing your case, but the first step is the most important.
Get Your Diagnosis
It may seem like common sense, but without a diagnosis, you have no case. Due to the nature of the disease, getting a fibromyalgia diagnosis can be difficult, as it requires doctors to rule out any other possible underlying conditions that may cause your symptoms. Once you have a diagnosis, it’s time to look into the condition a little deeper.
See a Specialist
If your doctor made your initial diagnosis, or if their tests were simply inconclusive, you will want to get a referral to speak with a specialist, such as a rheumatologist, who has more experience treating and diagnosing conditions such as fibromyalgia.
The specialist will often provide a more accurate and detailed diagnosis, as well as more focused treatment options and care for your condition.
What If I Can’t Get a Diagnosis?
If your normal doctor isn’t giving you the support you need and is simply treating your symptoms, making no progress towards a diagnosis, then it is time to seek out a second opinion. Getting a diagnosis is essential for filing a disability claim, and you also deserve to get proper treatment for your condition.
Gather Your Records
The next step is to gather all of your medical records. Be sure to include your initial diagnosis in those records as well, even if it isn’t the most detailed account of the condition.
That record will give the Social Security Administration a timeline as to when the condition was confirmed with a positive diagnosis.
Make sure you include records detailing treatment as well. If your records don’t accurately portray your condition or are unclear, seek out a doctor who can more clearly articulate and document your condition.
Filling Out Your RFC
Having your doctor fill out a fibromyalgia residual functional capacity (RFC) will help detail clearly and succinctly how the condition affects your day to day life.
Fill the form out with your doctor, and make sure that the form specifies how the condition limits you physically and mentally, as well as impairs or prevents your ability to work.
Gather Non-Medical Evidence
You should also gather any other evidence of your condition, be it a diary that documents your day to day issues and struggles with the condition, testimonials from relatives, friends or family, and work records that show gaps in employment or leaves of absence specifically due to the condition.
This will help paint a broader picture outside of just the medical records. The Social Security Administration usually requests a record of employment showing any leaves of absence due to your condition at some point in the application process, so having this documentation early will save you some time.
Should You Get an Attorney?
The short answer is yes, though it’s not mandatory. Having an attorney will help you navigate the claims process, and the attorney will be able to help evaluate the strength of your case and help you find information to include to help strengthen your claim.
An attorney can also assist with the appeals process if you get denied. Since you only have 60 days from the notice of denial to file an appeal, it’s helpful to already have an attorney on retainer if and when you reach that point.
How Do I Get an Attorney?
Retaining an attorney is a fairly simple process. It mostly just takes a little research. The best way to find a good disability attorney is to ask friends, relatives, or any other attorneys you may know who might be able to refer you to someone.
If you can’t get a referral that way, look up a local bar association online and reach out to them. They should be able to provide you with a number of disability attorneys who can assist you.
Go In For a Consultation
The best thing about most disability attorneys is that they work off of a contingent fee basis, meaning they only get paid if they win the case. The consultation is free, and it a good way for both you and the attorney to feel each other out.
You should ask questions and get as much information as you can, including how long the claim process will take, what additional records the attorney may need, how much their fees are if they do win your case, and how many similar cases have they been successful within their career. This will give you an idea of if this attorney is a good fit for you.
Make a Decision
From here, it’s up to you if you want to retain an attorney for filing the claim. Having a disability attorney assisting with the claim greatly increases your chances of success, as they know their way around the Social Security Administration claim process, as well as access to resources that you as an individual might not. They can also help with the appeals process if it comes to that.
Can I File My Claim Now?
With all of the information and medical records on hand, it’s finally time to file your disability claim. You can apply a number of ways.
You can either apply online, over the phone or in-person at your local Social Security Administration Office. When applying, be sure to have your medical records, social security number, contact information, medical provider information, employment history, and tax information available.
If you need further assistance with the process, This is a YouTube video from the Social Security Administration’s official YouTube channel explaining the process.
Now, What Do I Do?
Now comes the easiest, but the most stressful part. Now you wait for the Social Security Administration to review your documents and make a decision on your claim.
This can be a lengthy process, taking from 3-5 months. During this process, the Social Security Administration will review all of your documentation to confirm that your condition falls under their definition of a disability.
According to the Social Security Administration’s definitions, you can be considered to have an applicable disability if:
- If you are working, you make less than $1,220 USD per month.
- If your condition is severe, limiting your physical and mental abilities for at least 12 months.
- If your condition is found on the list of disabling conditions.
- If you can not do the work you did previously.
- If you are unable to do any other kind of work.
The Social Security Administration may occasionally request additional information from you, like work records, additional medical records, or other documents.
If necessary, try to get these documents submitted as soon as possible in order to expedite the claim process. The claim process is already long enough as is, and it is of no benefit to you to drag it out any longer than it has to be.
If you do have an attorney, check in with them occasionally for any updates to see how your case is proceeding.
I Won My Case!
Congratulations! All that is left to do is accept your disability benefits. Depending on your preferred payment method, you may need to provide some banking information such as accounts and routing numbers for things like direct deposit.
I Lost My Case!
If you lost your case, there’s still hope. If you haven’t already retained an attorney, retain one as soon as possible and have them assist with preparing your claim for the appeals process. You only have 60 days from the date of denial to file an appeal, so you are on a bit of a strict time limit.
You’ll also want to make sure your attorney has enough time to properly prepare your appeal, so notify them of your denial as soon as it comes in so they can begin working on it for you. When filing for an appeal, just like your initial claim, you can file online, over the phone, or in person.
What’s Involved With Appeals?
There are generally four levels to the appeal process. The first stage is a reconsideration of the claim by someone not involved in the original claim process. You can present any new evidence for consideration at this stage as well.
If you disagree with the results of the review, you can request a hearing by an administrative judge. The judge will review all of the evidence, question any witnesses, as well as rely on medical experts you present.
Be expected to testify to your own experiences, but also be advised you are allowed to question those called to the stand as well. It’s highly advisable to have an attorney if you plan on taking the appeals process to this level.
If you disagree with the results of the hearing, you can have it reviewed by the appeals council. The appeals council will review the claim and subsequent hearing, and make a decision. If they agree with the initial ruling, you will be notified by letter of the denial.
The final step in the process is to have the appeal be heard by filing a suit to have the case taken to federal court. If you are trying to appeal at this level, an attorney is almost necessary for any chance of success.
Is There Anything Else I Should Know?
While this is a long process of preparing documents and filling out forms, it’s important to get it done and submitted as early as possible once you have a diagnosis.
The reason for this is that the Social Security Administration will backdate payment on your claim to the date you applied, but can not backdate it any further. To ensure you are getting the most money out of your claim, file early.
You will also want to see a doctor regularly in order to improve your chances of getting approved. Getting continued treatment and routine checkups show that you need continued treatment for your condition, and long gaps between doctor visits may indicate the condition is not severe enough to warrant disability coverage. Doctors are also more inclined to cooperate if you are seeing them on a consistent basis.
No matter how frustrating the process gets, or if your case is mishandled, try to remain cordial with the SSA employees or individuals representing you.
These people can have multiple cases to handle and hundreds of phone calls to make on a daily basis, and being rude or taking out your frustration on them may just end up moving your case to the bottom of their to-do list.
Lastly, don’t call the toll free number for updates. The toll-free number is more for general inquiries and assistance with the filing process, and they generally won’t have enough detailed information about your specific case or be familiar enough to give you accurate information.
Instead, call the office which is handling your case or the office you submitted your disability application to. If your case is the appeals process, reach out to the Office of Disability Adjudication and Review.