Q I heard it is very hard to receive SSDI for fibromyalgia. Many people in my support group say they have been denied Social Security benefits. Is SSDI as hard to obtain as it sounds?
Fibromyalgia is the second most common musculoskeletal condition after osteoarthritis. Persons with fibromyalgia suffer widespread muscle and joint pain, fatigue, and other symptoms. Because fibromyalgia can make it difficult for a person to engage in many life activities, it can lead to depression and social isolation.
In the past, the Social Security Administration (SSA) denied most applications in which the only diagnosis was fibromyalgia. In part, this was because of conflicts within the medical community. While fibromyalgia certainly can be debilitating, the label “fibromyalgia” refers to a list of symptoms that can vary from person to person. Many family doctors used fibromyalgia as a catch-all diagnosis, when no cause for symptoms could be found.
Because of this, disability examiners were not sure how to classify the disorder. Applications were more likely to be approved if the applicant had a second diagnosis, especially a musculoskeletal disability such as rheumatoid arthritis or degenerative disc disease.
Fibromyalgia is becoming better understood. While the cause of fibromyalgia still is unknown, doctors have found differences in the blood work and brain chemistry of those with fibromyalgia. This allows a more certain diagnosis.
In July 2012, the Social Security issued a ruling allowing fibromyalgia to be a medically determinable impairment (MDI) if the applicant meets certain conditions.
In order for fibromyalgia to qualify as an MDI, the following must be true:
- There must be medical documentation of chronic widespread pain, including pain in the back, neck, or chest.
- The doctor must document that he has ruled out other diseases that may cause the same symptoms through lab tests and other medical exams.
In addition, one of the following must be true and well-documented:
- There is pain in at least 11 of 18 possible tender point areas of the body. The tender points must occur on both sides of the body. There must be tender points both above and below the waist. Or,
- The patient must exhibit a minimum of six fibromyalgia symptoms, including: fatigue, non-restorative sleep, cognitive or memory problems, depression, anxiety, or irritable bowel syndrome (IBS).
Need help? Our SSDI attorneys can help you fill out your application and gather the documentation you need to support your SSDI claim. To learn more, request a free copy of Massachusetts disability attorney John Keefe’s book, Unlocking the Mystery - The Essential Guide for Navigating the Social Security Disability Claims Process, or contact Keefe Disability Law at 888-904-6847.