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Fibromyalgia

How Do I Get Social Security Disability Benefits for Fibromyalgia?Fibromyalgia and Disability

The Social Security Administration does not list Fibromyalgia as one of its medical impairments. However, the Social Security Administration has published guidelines to help Administrative Law Judges determine eligibility for people seeking disability benefits due to Fibromyalgia.

If you suffer from a firbomyalgia, cannot work, and have been denied Social Security Disability benefits, call the experienced Anaheim Social Security Disability Attorneys at Howard Law and let us fight to get you the benefits you deserve.

The Social Security Administration will use the five step sequential evaluation process (described below) to determine eligibility for people seeking disability benefits due to Fibromyalgia. At Step 3 of the Sequential Evaluation Process, the Social Security Administration will see whether your claim of Fibromyalgia equates to a medical listing.

To establish fibromyalgia as a medically determinable severe impairment there must be:

  1. Evidence of chronic widespread pain, including pain in the back, neck, or chest
  2. Evidence that shows your doctor ruled out other diseases that could cause the same symptoms (the symptoms of fibromyalgia often overlap with those of lupus, hypothyroidism, and multiple sclerosis), such as lab tests and examination notes,

    and

    One of the following:

    • Tender points sites in at least 11 of 18 tender point areas of the body, with tender points occurring on both sides of the body and both above and below the waist.

    Or

    • Repeated manifestations of six or more fibromyalgia symptoms, signs, or conditions that often occur with fibromyalgia, particularly fatigue, non-restorative sleep, cognitive or memory problems, depression, anxiety, or irritable bowel syndrome.

If you have been diagnosed with Fibromyalgia, are unable to work, and have been denied Social Security Disability benefits, call the experienced Anaheim Social Security Disability attorneys at Howard Law, and let us fight to get you the benefits you deserve.

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Listing vs. Residual Functional Capacity (RFC): How Does the Social Security Administration Determine Whether I Qualify for Disability Benefits for Fibromyalgia?

Social Security disability benefits may be available for people who suffer from fibromyalgia. The Social Security Administration must first determine whether your fibromyalgia is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. The Social Security Administration will conclude that you are disabled and eligible for disability benefits if it determines that you meet or equal a listing because of your fibromyalgia.

If the Social Security Administration decides that your fibromyalgia is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

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How Can I Meet a Listing and Win Social Security Disability Benefits for Fibromyalgia?

The Social Security Administration will determine whether you are disabled at Step 3 of the Sequential Evaluation Process by evaluating whether your fibromyalgia is severe enough to equal a listing.

The term “listing” refers to a compiled list of common impairments. The Social Security Administration created a set of guidelines called the Listing of Impairments that contains the most common impairments. For each listing of a particular impairment, there is an explanation regarding the degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work.

The Social Security Administration will consider you disabled if your fibromyalgia is severe enough to meet or equal a listing.

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What is Your Residual Functional Capacity Assessment for Fibromyalgia?

If the Social Security Administration decides that your fibromyalgia is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

The Social Security Administration expressesan RFC for physical impairments in terms of whether the Social Security Administration believes you are able to do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

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Can Your Doctor’s Medical Opinion Help You Qualify for Social Security Disability Benefits for Fibromyalgia?

The role of the Social Security Administration is to conclusivelyestablish whether you are disabled based on your education, work experience, medical evidence, and your age.

The role of your doctor is to provide the Social Security Administration with informationconcerning the degree of your medical impairment by providing the Social Security Administration medical source statement that describes your capacity for work which is part of your residual functional capacity assessment. Your residual functional capacity is what you can still do despite your limitations.

The Social Security Administration must consider your treating physician’s opinion because the Social Security Administration considers it to be controlling when making its decision.

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What is the 5 Step Sequential Evaluation Process?

The Social Security Administration has created a five (5) step sequential process to determine whether an adult claimant is entitled to receive disability benefits. Children have a different test to determine eligibility.

Step 1: Substantial Gainful Activity

The Social Security Administration presumes that if you are working and that you make a certain amount of money that you are engaging in what it determines to be a substantial gainful activity (SGA). The Social Security Administration considers a person to be engaged in a SGA if that person is earning more than a certain amount of money each month (i.e. net of impairment - related work related expenses).

In 2013, the Social Security Administration has determined that a statutorily blind individual is engaged in a SGA if they earn more than $1740.00 per month while a non-blind individual must earn more than $1040.00 per month. Changes in the national average wage index usually affect the aforementioned SGA amounts.

Step 2: Severe Impairment

The Social Security Administration has determined that each claimant must either have a severe impairment or a combination of impairments. The impairment or combination of impairments must drastically limit the claimant's physical or mental ability to do basic work activities without regard to age, work history, or education. For many claimants, the level of proof at this level is minimal; therefore, they usually satisfy the Step 2 requirements and proceed to Step 3.

Step 3: Listing of Impairments

The Listing of Impairments details specific impairments that the Social Security Administration considers severe enough to prevent an adult claimant from engaging in a substantial gainful activity and in the case of a minor, the impairment has to be severe enough to cause functional limitations. There is also a durational requirement. The Social Security Administration has determined that the impairment must last for 12 months or long or result in the death of the claimant. If the claimant fails Step 3 because they do not meet or equal a listing then the case will proceed to Step 4.

Step 4: Past Relevant Work

At Step 4, if your condition is severe enough to meet the requirements of Step 2 (Severe Impairment); however, your severe impairment does not meet or equal a listed impairment that is the subject of Step 3 (Listing of Impairments), then the Social Security Administration must decide whether your severe impairment interferes with your ability to do any of the work you previously performed. The Social Security Administration likes to look at the work you performed over the past 15 years prior to the onset of your disability. If the Social Security Administration determines that your impairment does not interfere with work you previously did then you must proceed to Step 5.

Step 5: Ability to Perform Other Work

A majority of disability claims are decided at this level. If you cannot perform work you did in your past, then a determination must be made as to whether you can adjust to different types of work. The determination at this level takes into consideration your education, age, and prior work and is better known as your residual functional capacity.

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