If your fibromyalgia is causing problems with your ability to perform your job or do simple tasks and everyday activities, you may be eligible for Social Security disability benefits. Before you apply for disability benefits, it’s important to know how to get disability for fibromyalgia, so your claim has a better chance of approval.
Fibromyalgia and Its Impact
Fibromyalgia is a medical condition that causes a variety of health problems. The most common symptoms of fibromyalgia reported to Illinois medical professionals include widespread pain throughout the body, joint and muscle stiffness, and chronic fatigue. People who suffer from fibromyalgia may also experience other symptoms, including:
- Depression or anxiety
- Lack of concentration and focus
- Memory loss and recall problems
- Mood changes and swings
- Insomnia and sleep deprivation
- Tension headaches and migraines
Because the symptoms of fibromyalgia are vague and impact numerous bodily functions, the condition is often referred to as a “catch-all disease” that’s difficult to diagnose. Fibromyalgia symptoms mimic many symptoms that are common in other medical conditions, so an accurate diagnosis and treatment plan is often delayed. It’s not uncommon for fibromyalgia to co-exist with other medical conditions that cause chronic pain from nerve damage, pulled muscles, cystitis, spinal cord injuries, carpal tunnel syndrome, osteoarthritis and rheumatoid arthritis, and polymyalgia rheumatica, an inflammatory disorder that causes muscle pain and stiffness, especially in the hips and shoulders. Disability symptoms for arthritis and fibromyalgia are similar and difficult to identify.
Challenges Faced by Individuals With Fibromyalgia
People with fibromyalgia face many challenges in their everyday lives because symptoms are chronic, lasting for many years and often severe. Common conditions associated with fibromyalgia such as pain throughout the body, chronic fatigue, and insomnia can wreak havoc on a person’s daily life and their means of financial support from a job.
Simple everyday tasks like going to work, paying bills, cooking meals, doing laundry, cleaning the house, working in the garden, and taking care of children can become major chores that are impossible to accomplish. Chronic aches and pains, severe fatigue, and lack of sleep commonly leave fibromyalgia victims with little energy to tackle even the most basic daily tasks. Many are so fatigued they have problems just getting out of bed in the morning, much less taking care of their own needs or their family’s needs.
Disability Benefits for Fibromyalgia
Because fibromyalgia is difficult to diagnose, getting disability benefits is often complicated without help from a Social Security disability attorney who knows how to get disability for fibromyalgia by meeting the Social Security Administration’s (SSA) requirements. When the SSA reviews a disability claim, they look closely at physical symptoms, levels of impairment, documented medical evidence, and the SSA Bluebook, which shows a list of impairments that qualify for benefits. To get approved, the SSA requires proof of a disability with documented medical evidence that shows impairments have lasted or are expected to last for at least 12 continuous months.
The Disability Benefits Application Process in Illinois
In Illinois, the SSA requires all disability applicants to go through a process by submitting an application for Social Security disability benefits, providing documented medical records of diagnosis, treatment, and prognosis, and filing a claim within the proper timeline. Any misstep in the official SSA application process can result in a denied claim and loss of benefits.
When the SSA receives your application for disability benefits, they review it and forward it to the Illinois Disability Determination Services Office. This state agency is responsible for determining if a claim is accepted or denied based on supporting evidence. The process includes an automatic 5-month waiting period to receive benefits, however, there can be a waiting period up to 7 months before you actually receive your first disability payment. If your application is approved, your benefit payments will be awarded through Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Eligibility Criteria for Disability Benefits
Fibromyalgia does qualify for disability in Illinois, but getting disability for fibromyalgia depends on your work history, work credits, and medical records. This information will be used to determine if you qualify for SSDI or SSI benefits:
Social Security Disability Insurance (SSDI)
SSDI benefits rely heavily on an applicant’s work history, accumulated work credits, and payment of Social Security taxes. This is because SSDI benefits are financed through Social Security taxes paid by workers, employers, and self-employed persons. If SSDI benefits are approved, payments may be awarded to an eligible worker, as well as the worker’s family members.
Eligibility for SSDI benefits depends on a worker’s work credits based on a taxable work history. If benefits are approved, they are payable to (1) disabled or blind workers under 65 years old, (2) their spouse or widower, (3) their children, and (4) adults disabled since childhood. The amount of monthly disability benefits is based on the Social Security earnings record of the insured worker. After receiving disability insurance benefits for two years, the worker will automatically get Medicare coverage.
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) disability is based on financial needs rather than prior work history. SSI benefits are available to low-income individuals who have a prior work history or who have no work history at all. This program is financed through general tax revenues and does not relate to work credits.
Eligibility for SSI benefits requires a person to be a U.S. citizen or national, and have limited income and resources. Benefits are payable to people who meet these conditions, and who are in the following categories: (1) adults who are 65 years old or older, (2) adults who are disabled or blind, and (3) children who are disabled or blind. The monthly benefit payment varies up to the maximum federal benefit rate, which may be supplemented by the state. In most states, beneficiaries are also automatically eligible for Medicaid.
Gather Sufficient Medical Evidence
Whether you apply for SSDI or SSI benefits, the SSA requires documented medical evidence from a licensed physician that supports your fibromyalgia diagnosis and a record of how your disability affects your life. Medical evidence includes:
- A physician’s report with the date of your fibromyalgia diagnosis
- Medical records showing your fibromyalgia impairments
- Medical reports showing exams and treatments for your condition
- Medical reports showing over-the-counter and prescription medications
- Lab reports showing test results from X-rays, MRIs, and Ultrasounds
- A physician’s report showing your fibromyalgia improvement and prognosis
Working With a Disability Lawyer
Filing an SSDI or SSI disability claim is a complicated and lengthy process due to strict federal regulations imposed by the SSA. It’s important to understand how to get disability for fibromyalgia and how an attorney can help you with your application.
How can a Chicago disability lawyer help you get benefits? Many disability claims are denied without a disability attorney to ensure the proper information is submitted, follow up with SSA representatives, and oversee the claims process from start to finish. Your attorney can make sure the application contains correct information, gather important medical documentation, submit the claim to SSA on time, follow up with SSA officials, and file an appeal if the claim is denied.
Common Reasons for Claim Denials
More than 50% of Social Security disability applications are initially denied by the SSA. The most common reasons for denials include:
- Mistakes made in the applicant’s personal information
- Lack of a proper medical diagnosis by a licensed physician
- Lack of medical records and evidence to support impairments
- Lack of an applicant’s work history and work credits
- Lack of followup on SSA questions
- Failure to file an application within the proper timeline
Navigating the Appeals Process
If the SSA denies your application for disability benefits, it’s best to file an appeal rather than wait and reapply for benefits by filing a new claim. Your disability attorney can be helpful by navigating three important appeal processes:
A Request for Reconsideration
If the SSA denies a claim or reduces benefits, they will send a notice to the applicant, who then has 65 days from the date on the notice to make a written “Request for Reconsideration.” During this process, the SSA will ask for further medical documentation to support the claim.
A Request for an Administrative Legal Hearing
If a claim is denied after Reconsideration, the SSA will send the applicant a second notice. The applicant then has 65 days from the date on the notice to make a written request for a hearing before an administration legal judge (ALJ) hired by the SSA to conduct legal hearings.
A Request for Review by the Appeals Council
If the ALJ decision is not favorable, the applicant or his or her disability attorney can file one more appeal requesting a review by the Appeals Council. The applicant then has 65 days from the date of the ALJ’s notice to make a written request for review by the Council.
