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How Do I Get Disability Benefits Based On Fibromyalgia?

The Social Security Administration (SSA) recognizes Fibromyalgia as a medically determinable impairment that may entitle those who suffer from it to disability benefits. Fibromyalgia, like some other pain disorders, is characterized by diffuse and widespread pain of the joints, muscles, tendons or soft tissue and is commonly associated with fatigue. The unique feature of Fibromyalgia is that it is a diagnosis of exclusion, i.e., other potential causes of the symptoms must be eliminated.

In order to establish that Fibromyalgia is a severe impairment, SSA requires that several criteria must be satisfied. The first requirement is a history of widespread pain documented by medical records. Next, evidence is required from a physician who has not only diagnosed Fibromyalgia but who has conducted a specialized examination that identifies at least 11 of 18 possible “tender points.” If possible, it is best to see a rheumatologist for this examination. Additionally, evidence that other disorders that could cause the symptoms have been excluded is needed. Even if 11 tender points are not documented, however, it may be possible to establish Fibromyalgia if there is enough evidence of “co-occurring conditions” such as fatigue, cognitive or memory problems (“fibro fog”), sleep problems, depression, anxiety or irritable bowel syndrome.

Most pain disorders affect one’s mental functioning to some degree, but Fibromyalgia is known to have a particular association with cognitive problems and depression. It’s important that patients seek and remain in treatment with a psychologist or psychiatrist for those issues. Even if psychiatric treatment doesn’t seem to be helping, it will document that symptoms are present.

Once SSA is satisfied that a claimant has Fibromyalgia, they will evaluate the severity of the symptoms and limitations to determine whether the claimant is able to work on a full-time basis.  To make that determination, SSA will review the medical records and opinions from doctors and psychologists who treat the claimant as well as those experts hired by SSA to review the evidence. SSA also considers statements and testimony from the claimant and other witnesses regarding pain, fatigue, daily activities, medications (as well as side effects of medications) and other treatments. Because pain and fatigue are necessarily subjective, such statements are particularly important in cases involving Fibromyalgia.

Green & Greenberg has extensive experience helping clients with Fibromyalgia obtain disability benefits. In 2010, one of our attorneys won a significant case before the First Circuit Court of Appeals in which the Court recognized the subjective nature of the illness and the importance of evaluating properly a disability claimant’s credibility.   This decision has been influential in a number of other appeals when fibromyalgia has been misunderstood or improperly evaluated. See Johnson v. Astrue, 597 F.3d 409 (1st Cir. 2010).

The attorneys at Green & Greenberg will guide you with regard to the appropriate treatment and documentation needed to establish disability on the basis of Fibromyalgia.  We will contact your doctors and elicit their written opinions in order to establish your disability.

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David Spunzo is a Rhode Island native, a graduate of LaSalle Academy, Providence College, and the New England School of Law.