Social Security Disability and Fibromyalgia

Tuesday, November 23, 2010

(Adapted from http://www.disabilit … ty_fibromyalgia.html, with edits to spelling and grammar.)

At the moment, there is no federal entry in Social Security Disability’s Listing of Impairments manual for the condition known as Fibromyalgia, also known as fibromyositis and Myofacial Pain Syndrome (the disability listings, of course, provide the approval criteria for a number of different impairments ranging from amputations to seizure disorder). However, California placed fibromyalgia on the list of qualifying disabilities in 2010.

Many claimants with fibromyalgia apply for disability, and many go on to win their cases. For this reason, the fibromyalgia disability claimant who’s been denied should not give up on their case. Instead, they should pursue their disability claim through the appeals process, keeping in mind how the Social Security Administration views this particular impairment.

Exactly how does Social Security Disability view Fibromyalgia?

As with all disability claims, after a person files at the Social Security Office, their case is transferred to DDS (Disability Determination Services), the agency responsible for making decisions on Disability cases.

When a case arrives at DDS, it is assigned to a specialist, or Examiner, who orders medical records and uses these records to make a determination. In other words, approve a disability claim, or deny it.

Unfortunately, when an Examiner receives a case in which the only allegation (reason for disability) is Fibromyalgia, the outlook for approval is not good. In fact, Social Security Disability will generally give little weight to such a claim unless another condition is involved, such as arthritis or degenerative disc disease.

Why is this? Part of the problem has to do with the nature of Fibromyalgia itself. Fibromyalgia is an impairment whose causes are not fully understood. And though it may be a legitimate disability in and of itself, because its symptoms and speculated causes vary so much from one person to the next, disability Examiners are never sure how to classify such cases. Therefore, it helps a social security case considerably if a Fibromyalgia diagnosis has been made in conjunction with another diagnosis, preferably one of a musculoskeletal nature.

For example, if a claimant makes a disability claim and the chief impairments are either Fibromyalgia and Rheumatoid Arthritis, or Fibromyalgia and Degenerative Disc Disease, the Fibromyalgia allegation will automatically carry more weight. This is because, in such cases, Fibromyalgia will be seen as a logical and plausible extension to what are generally thought of as “more proven” impairments.

Additionally, and this is very significant, a Fibromyalgia diagnosis made by an Orthopedist or Rheumatologist will seem very logical to a disability Examiner and, as a result, will also strengthen a Social Security disability claim.

This is in direct contrast to situations where the Fibromyalgia diagnosis has been made by an Internist, or “family doctor”.

When a personal physician renders a Fibromyalgia diagnosis, without a corroborative diagnosis by a specialist, it has the appearance to a disability Examiner of a label that’s been used by a doctor…simply for lack of a better way to label a patient’s pain.

And, often, and unfortunately, this is exactly the case. Many times when family doctor’s are unable to find reasons for the pain their patients feel, they diagnose “Fibromyalgia” as the cause. Disability Examiners see this routinely in the records they review.

The effect this has is not helpful for a Social Security Disability case because it dilutes, in the eyes of the disability Examiner, the significance of this particular ailment.

Obviously, this is not the fault of the disability claimant who is suffering from Fibromyalgia and is struggling to get their case approved. But it is helpful to understand how the disability process works in this regard and to consider how Social Security Examiners sometimes view applications where this illness is alleged.

Posted by admin at 13:18:19
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