InsuranceThought — Blogs About Insurance

Fibromyalgia, a sometimes terribly disabling syndrome, is, unfortunately, something many of us – myself included – find ourselves having to deal with. For those whose fibromyalgia is severe enough to keep them from working consistently, it may become necessary to seek Social Security Disability Insurance (SSDI).

The following are the five steps involved in determining if an individual with fibromyalgia qualifies for SSDI:

1. Determine whether or not an individual is working according to the Social Security Administration’s definition. Basically, if you are engaging in “substantial gainful activity” (working) and earning more than $1,000 per month, you will, in all likelihood, be disqualified from receiving any disability benefits through Social Security.
2. Conclude that disability due to fibromyalgia is severe enough to significantly limit an individual’s ability to do basic work activities that are necessary for most jobs. Examples include walking, sitting, standing, lifting, pulling, pushing, reaching, handling, and carrying as well as hearing, speaking, and seeing. Further examples are understanding, remembering, and carrying out simple instructions, and responding to supervision, co-workers, and work situations in an appropriate manner.
3. Because fibromyalgia does not, at this time, have a medical listing, an adjudicator must “equate” a medical listing. Widespread pain for a minimum of three months is required to establish fibromyalgia as a medically determinable impairment. Additionally, pain on palpatation must be present in a minimum of 11 of the 18 tender point sites (identified by the American College of Rheumatology and the Centers for Disease Control. You must also present evidence of morning stiffness and/or stiffness after sitting and fatigue must be present. In order to equate a medical listing, the symptoms, signs, and laboratory findings have to be equivalent to a listing that has been established. Finding of disability is usually at Step 5 (functional limitations are so significantly eroded that the occupational base for sedentary work is impossible, therefore a finding of disabled is warranted).
4. Determine whether or not a person can perform work he or she has done in the past in spite of his or her fibromyalgia. Benefits will be denied if the SSA finds a person able to do his or her past work. If the individual is not able to do previously done work, the process continues to the fifth and final step.
5. Review work experience, education, physical/mental condition, and age to determine if there is any other job the individual is capable of performing. The SSA enlists medical-vocational rules, which vary according to age, to determine fibromyalgia disability.

It can – and likely will be – quite difficult to obtain SS disability and will most certainly take quite a while to receive the benefits; take a look at all the steps the SSA takes to determine eligibility to see whether or not you think you might qualify before stepping into the difficult process of seeking disability. I am personally in the midst of claiming disability, and, believe me, it’s not an easy task.