What New SSA Rules Mean for Fibromyalgia SSDI Claims

The Social Security Administration recognizes arthritis and fibromyalgia (FM) as qualifying disabilities for Social Security Disability Income (SSDI). The SSA, however, recently changed the way that fibromyalgia will be evaluated when patients apply for SSDI.

In a July ruling, the SSA published a ruling providing guidance on the evaluation of evidence in FM claims. Following the change in procedures, it is even more important to speak with a New York City Social Security Disability eligibility attorney. This article will summarize some of the main changes in FM claims review.

Those seeking disability based on FM will need to demonstrate that they have a long-term history of pain all over their body (right and left sides of their bodies and above and below the waist). An individual suffering from FM must also show they suffer axial skeleton pain, which might manifest in the neck or the upper or lower back.

In order to receive benefits, patients must prove that they have suffered the pain for at least one year in at least 11 areas of their bodies – such as the knees, hips, buttocks, shoulders, ribs and neck, or reasonably expect to be disabled for at least one year.

The new rule requires that doctors conduct a digital palpitation test. The test uses pressure to identify tender points on the patient’s body. When the patient experiences pain during this test it is an indication of FM. This test is one of the ways to prove disability, but not necessarily the only test that can support a claim.

Exclusion of Other Medical Conditions

In order to receive disability benefits, patients must also have documented evidence of tests for other medical conditions to ensure other disorders were ruled out as the cause of their health problems. To that end, patients must demonstrate that they received tests, such as laboratory and imaging tests, from their physicians.

Experts say that these new criteria may make it difficult for those suffering from FM to receive deserved disability benefits because of the nature of the condition. In many cases, those who have suffered from FM for a long time may not always exhibit severe symptoms. Individuals with FM may also go through periods where they do not exhibit symptoms at all. In addition, many FM patients simultaneously suffer from other conditions, so it may be difficult to prove that other health issues are not the cause for their pain.

Common Symptoms of Fibromyalgia

FM is a condition where patients suffer widespread and long-term pain and tenderness throughout their tissues, muscles, tendons and joints. Those who suffer from the condition experience symptoms such as aches, shooting pains or stiffness in several areas of their body; fatigue; cognitive or memory problems; depression and anxiety disorders; and problems with sleep.

Fibromyalgia patients may receive drug treatments or physical therapy to relieve their pain. In addition, they often benefit from relaxation and stress-relief strategies.

If you have been denied disability benefits, contact an experienced attorney who can advise you of your rights and review the individual facts of your case. There are time sensitive steps to appeal a denial and an experienced New York City Social Security Disability attorney will be able to advise of next steps toward obtaining disability compensation.