People with fibromyalgia could qualify for Social Security Disability

People suffering from fibromyalgia may qualify for Social Security Disability Insurance if they meet the required criteria, rehab counselors

People in North Carolina, and throughout the U.S. are affected by fibromyalgia. This disorder has potentially debilitating effects, which can make it difficult, or impossible, to work. As a result, many who are suffering from fibromyalgia are also faced with concerns over how they will pay for their medical treatment and deal with their lost wages. In some cases, however, those diagnosed with fibromyalgia may qualify for Social Security Disability Insurance.

What is fibromyalgia?

According to the Mayo Clinic, fibromyalgia is a musculoskeletal condition. Although the exact etiology of this disorder is unknown, the symptoms often develop following an infection, a surgical procedure, a psychological stress or a physical trauma. Fibromyalgia is characterized by pain throughout the body.

In addition to widespread pain, people with fibromyalgia often experience fatigue, as well as sleep, mood and memory issues. Additionally, headaches, lower abdominal cramping or pain, and depression are also common symptoms of fibromyalgia.

Criteria for evaluating fibromyalgia

In order to qualify for SSDI, a person must first have received a diagnosis from a licensed physician. Social Security will review the medical history and treatment records of those applying for benefits. This will allow Social Security to confirm the fibromyalgia diagnosis, as well as identify whether the applicant's symptoms have worsened, improved or stayed stable.

Beyond a diagnosis, Social Security has two sets of criteria for meeting the qualifications of fibromyalgia. Applicants need only meet the 2010 or the 1990 criteria. The 2010 criteria stipulates that people must meet the following:

  • They must have a history of widespread pain.
  • Applicants must have recurrent manifestations of at least six or more co-occurring conditions, signs and symptoms of fibromyalgia.
  • There must be evidence that other conditions that might cause the applicant's symptoms have been ruled out.

Under the 1990 criteria, those with a history of pain throughout the body, a minimum of 11 positive tender points on both sides of the body and above and below the waist, and proof that testing ruled out the possibility of other conditions may also qualify.

What documentation is required?

In order to determine if people meet the necessary criteria, Social Security requires certain documentation. Those seeking benefits must provide medical records for the 12-months prior to their application date from an acceptable medical provider. These records must show they have received ongoing evaluations and treatment for their condition. In some cases, Social Security may also request evidence from other medical professionals, such as a psychologist, to further document the functional effects and severity of an applicant's condition.

Beyond medical records, Social Security may also seek documentation from other sources. This could include family, friends, neighbors, clergy, former employers, teachers or rehab counselors that can speak to the effects fibromyalgia has had on an applicant. Sometimes, Social Security may also seek a consultative evaluation if a decision cannot be reached based on the evidence and documentation provided.

Seeking legal guidance

It is common for people throughout North Carolina to have their SSDI claim denied, even with a proper diagnosis and the necessary documentation. This may serve to increase the devastating impact that fibromyalgia can have on people, and their families. As such, it may benefit those seeking these types of benefits to consult with a legal representative. Working with an attorney may help them to understand the process, as well as their rights and options.

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