Social Security Disability for Fibromyalgia and ME/CFS

Is It Possible to Be Approved for SSD With Fibromyalgia?

Contrary to what you may have read elsewhere, it IS possible to be approved for Social Security Disability (SSDI) benefits with fibromyalgia (FMS) or chronic fatigue syndrome (CFS or ME/CFS), as long as you meet the Social Security Administration's criteria.

A 2012 policy update offered guidance for evaluating claims involving fibromyalgia. The Social Security Administration also offers information on evaluating evidence of chronic fatigue syndrome.

To be eligible for benefits, you must:

• Have an adequate work history
• Be unable to work for an extended period of time
• Have an illness or injury that is unlikely to improve within the next 12 months

It's a misconception that there's a "list" of conditions that are covered by SSD. Rather than maintaining a list, the agency looks at whether an individual's symptoms are severe enough to be disabling and reasonably prevent employment.

You also have to have an adequate work history, which can pose a problem for people who become chronically ill when they're young. If you haven't worked long enough to be eligible, you may still qualify for Supplemental Security Income (SSI).

However, being approved for SSDI benefits is not an easy process by any means, and most applications are rejected on the first attempt. More people are approved during an appeals process that can take a considerable amount of time.

If you are eligible for SSD, the steps ahead will help you avoid common pitfalls and strengthen your case.

Be Diagnosed By A Specialist

First, you should have your diagnosis either made or confirmed by a rheumatologist or orthopedist. This is because the diagnoses have so often been made incorrectly that case examiners give more credence to those made by specialists than those that come from an internist, general practitioner or mental-health professional.

It also will strengthen your claim if you have another, better-understood condition such as rheumatoid arthritis or degenerative disc disease along with FMS or ME/CFS. Any overlapping conditions should go on your paperwork.

• Find a Fibromyalgia Doctor
• Find an ME/CFS Doctor

Get Your Medical Records

You'll need to get a copy of your medical records, as well as multiple other records, to submit your claim anyway, but it's a good idea to get them as soon as you start considering a claim.

Look over your records, if possible, with your healthcare provider. More than one person has been surprised to find that their records do not actually list their diagnoses. If that's the case, you'll need to have your practitioner add the correct information to your records.

You may have to pay for records, so be sure to ask your healthcare provider's/clinic's policies.

Submitting Your Application

You have several options for filing your application. It can be done online, by calling 1-800-772-1213 (TTY 1-800-325-0778), or by visiting your local Social Security Office.

Be certain you have all forms completed and have included all necessary records or your claim will be delayed.

Some people opt to hire a disability attorney to handle their initial filing, but others choose to wait until a later point. Either way, most lawyers who specialize in these applications don't get paid unless you win your claim.

Denied? Request for Reconsideration

If your claim is denied, you have the right to file a Request for Reconsideration. That will lead to a complete review of your case by someone who was not involved in the original decision.

You can also submit new evidence at this time.

Still Denied? Request a Hearing

If your claim is still denied after reconsideration, you can ask for a hearing, which will be heard by an administrative law judge.

If you haven't already, this may be the point at which you want to get an attorney who specializes in disability claims. You and your attorney can then plead your case in person and the judge can call witnesses. You'll also be able to look at your file and present new evidence.

Important: You could have to wait several months or even a couple of years until your hearing, depending on where you live.

You Can Still Appeal

If you're not successful after the hearing, you can ask for review by Social Security's Appeals Council. The council will go over all of the information and then decide to either refuse or grant your request.

Final Chance to Prove Your Claim

If the Appeals Council refuses your request or finds against your claim, you can file a lawsuit in federal district court. This is your final chance to prove your claim ... unless you want to start the entire process over again, from the beginning.

Getting to this stage can take years, so know that you could be dealing with this process for a very long time. If you're approved, though, you'll get back-pay for all the way back to the original filing date.