Qualifying for Disability Benefits (SSDI) with Fibromyalgia in Pennsylvania

The American College of Rheumatology estimates that at least three to six million Americans live with a medical condition called fibromyalgia, which can cause serious symptoms such as numbness, pain, fatigue, and decreased memory. If your fibromyalgia is getting in the way of employment, you could be eligible for monthly disability through the SSA, or Social Security Administration.

The disability lawyers of Young, Marr & Associates can help.  We have more than 25 years of experience, and our team enjoys an almost 90% success rate compared to the industry average of just 62%.  To set up a free and confidential case evaluation, call our law offices at (215) 701-6519 in Pennsylvania today.

How to Apply for Social Security Disability

There are three ways that claimants can file a disability application with the SSA.  You can:

  1. Call the SSA at (800) 772-1213.  If you have trouble hearing, call TTY (800) 325-0778 instead.  Phone lines are staffed by SSA representatives Monday through Friday, 7 A.M. through 7 P.M.
  2. Apply online by using the SSA’s secure web portal.  Start the online process here.
  3. Apply in person by visiting a field office.  You can find the field office nearest to you by entering your zip code into the SSA’s secure office locator tool.

SSA Guidelines for Disability Benefits

There are two sets of requirements you’ll need to meet in order to be successful.  First, let’s look at the general criteria, which apply to all claimants regardless of their medical conditions:

  • You need to have a disability which is severe enough to interfere with steady employment.
  • You can’t be earning more than $1,070 per month if you’re applying for SSDI, or Social Security Disability Insurance.  If you’re applying for SSI, or Supplemental Security Income, the thresholds are lower because SSI is need-based.  However, some claimants can qualify for SSI and SSDI at the same time, which is called concurrent benefits.  Our social security attorneys can help you understand the financial criteria that apply in your situation.
  • Your disability must be long-term, meaning it has lasted (or will last) for at least 12 months.

The latter two points are fairly straightforward, but the first point is more open to interpretation: what counts as “severe”?  To help answer that question, the SSA uses a medical guide called the Listing of Impairments.  The Listing contains condition-specific criteria which the SSA’s medical examiners will use to gauge whether your condition is severe or not.

Fibromyalgia does not currently have its own listing, and in the past, claimants often struggled to be approved.  However, there’s good news: in 2012, the SSA updated its policies to be more inclusive of fibromyalgia claims, which means it’s easier to be approved now than it was just a few years ago.  As the revised policy clearly states, “FM [fibromyalgia] is an MDI [medically determinable impairment] when it is established by appropriate medical evidence.  FM can be the basis for a finding of disability.

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SSA Requirements for Qualifying for Disability with Fibromyalgia

As the new guidelines explain, the SSA may approve your fibromyalgia claim if you meet all three of the following medical requirements:

  1. You need to have “a history of widespread pain,” meaning pain in all four quadrants of the body: the left side, the right side, above the waist, and below the waist.  The SSA allows that “pain may fluctuate in intensity and may not always be present.”
  2. You need to go through a physical exam, which should turn up no fewer than 11 tender points.  Just like the general pain noted above, these tender points must be present above and below your waist, and on both the right and left sides of your body.
  3. Any evidence that could point to conditions other than fibromyalgia must be ruled out.  Many disorders can mimic the symptoms of fibromyalgia, so the SSA will want to conduct exams and lab tests to narrow down the possibilities.

Let’s say you meet requirements one and three (history of widespread pain, plus ruling out other conditions), but not requirement two (11 tender points).  Don’t worry: you can still qualify if you meet the alternative requirement of having “repeated manifestations of six or more FM symptoms, signs, or co-occurring conditions.”  These include:

  • Fatigue
  • Depression
  • Anxiety
  • Irritable Bowel Syndrome
  • Memory Problems

You can learn more about how SSA medical examiners evaluate fibromyalgia claims by reading through the SSA’s updated policy interpretation ruling.

Our Pennsylvania Social Security Attorneys Can Help File Your Fibromyalgia Disability Claim Today

If you need help with a disability claim, Young, Marr & Associates are here to assist.  To set up a private legal consultation completely free of charge, call our law offices at (215) 701-6519 in Pennsylvania.

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