July 9, 2014

Social Security Disability Benefits for Fibromyalgia in Indiana

Fibromyalgia is a condition where a person experiences widespread pain and painful responses to pressure.  Fibromyalgia may also be associated with depression, anxiety, and other stress related disorders.  Other symptoms may be, but are not limited to the following:

  • Fatigue
  • Sleep disturbances
  • Joint stiffness
  • Bowel/bladder issues
  • Numbness/tingling
  • Cognitive dysfunction
  • Difficulty swallowing

The cause of fibromyalgia is unknown.  Currently, it is believed to involve a combination of genetic, environmental, psychological, and neurobiological factors.  There is some evidence that certain genes increase the risk of developing fibromyalgia.  These happen to be the same genes that are associated with other functional somatic syndromes and depression.

Lifestyle may also contribute to developing fibromyalgia.  Stress is believed to be a factor in developing fibromyalgia.  Lifestyles like such as smoking, obesity, or lack of physical activity may also increase the risk in developing fibromyalgia.

A single test to diagnose fibromyalgia does not exist.  Most doctors diagnose patients with a process called a differential diagnosis.  This means that the doctors take into consideration the patient’s age, gender, symptoms, medical history, and other factors to narrow down the diagnosis to the most likely option.

The American College of Rheumatology (ACR) defines fibromyalgia with the following criteria:

  • A history of widespread pain lasting more than 3 months, affecting all 4 quadrants of the body (both sides, above and below the waist).
  • Tender points – there are 18 designated tender points (even though a person may feel pain in other areas).  However, a diagnosis is not based on the tender points alone.

Fibromyalgia is not degenerative or fatal, but the chronic pain is persistent.  Most patients report that their pain does not improve over time.  There is no universally accepted treatment or cure for fibromyalgia.  Some doctors do recommend psychological therapy, medication, and/or exercise to help with the symptoms.

The Social Security Administration (SSA) does not have a direct listing for fibromyalgia.  However, this does not mean that you are not eligible for Social Security disability benefits. Currently, the SSA has a section of it’s Social Security Rulings (SSR) that addresses fibromyalgia.  It is listed in section 12-2p.  The purpose of the SSR is to add guidance on how to evaluate the evidence and establish that a person does have a medical condition.  This section in particular addresses the condition of fibromyalgia.  Section 12-2p helps guide the SSA on how to look at the evidence to correctly evaluate the claimant for the condition of fibromyalgia.  The SSR looks at two main things for fibromyalgia; a history of widespread pain for more than three months and 11 positive out of 18 possible tender points (very similar to the ACR definition above).

You may be eligible for benefits based on the fact that your disability keeps you from working. We must prove to the SSA that you have a residual functional capacity (RFC) low enough that you cannot work a job for eight hours per day.  Some things that Social Security might look at in determining you RFC may include:

  • Sitting, standing, and walking limitations
  • Lifting and carrying limitations
  • Postural limitations
  • Limitations of manipulation with your hands

If you have any other questions concerning fibromyalgia and the SSA, you may want to dive deeper into Social Security’s SSR for fibromyalgia.  It outlines exactly how the SSA will evaluate your medical records for fibromyalgia.

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