Social Security Disability for Fibromyalgia Patients

Posted March 14, 2019 by Premier Disability Services, LLC®

Fibromyalgia is one of the most complicated and least understood medical conditions. Fibromyalgia symptoms are numerous, random and diverse. Multiple systems in the body are affected. Put simply, fibromyalgia causes too many problems for a conventional doctor to manage within the confines of the current system.

Fibromyalgia can’t be easily confirmed or ruled out through a simple laboratory test. Your doctor can’t detect it in your blood or see it on an X-ray. Instead, fibromyalgia appears to be linked to changes in how the brain and spinal cord process pain signals. Because there is no test for fibromyalgia, your doctor must rely solely on your group of symptoms to make a diagnosis. Fibromyalgia symptoms include widespread body pain, fatigue, poor sleep and mood problems. But all of these symptoms are common to many other conditions. And because fibromyalgia symptoms can occur alone or along with other conditions, it can take time to tease out which symptom is caused by what problem. To make things even more confusing, fibromyalgia symptoms can come and go over time.

Fibromyalgia is also often characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. In the past, at least 11 of these 18 spots had to test positive for tenderness to diagnose fibromyalgia. But fibromyalgia symptoms can come and go, so a person might have 11 tender spots one day but only eight tender spots on another day. And many family doctors were uncertain about how much pressure to apply during a tender point exam. While specialists or researchers may still use tender points, an alternative set of guidelines has been developed for doctors to use in general practice. These newer diagnostic criteria include: (1) Widespread pain lasting at least three months, (2) Presence of other symptoms such as fatigue, waking up tired and trouble thinking, and (3) No other underlying condition that might be causing the symptoms.

Many applicants for Social Security disability benefits who apply based on fibromyalgia get denied. Part of the reason has been that Social Security doesn’t have a disability “listing” for the condition. To address the problem, the Social Security Administration (SSA) published a ruling in 2012, SSR 12-2p, giving additional guidance to disability claims examiners and administrative law judges as to how to assess fibromyalgia cases. This ruling has helped reduce the number of fibromyalgia claimants who are denied at the initial application stage and increase the number of fibromyalgia sufferers who file an appeal and eventually win disability benefits.

If the SSA determines that you have the medically determinable impairment of fibromyalgia under the new ruling, then the evaluation is not over. The SSA will develop a “residual functional capacity” (RFC) assessment for you to determine if there is any work you can do, including your past work. An RFC assessment is an evaluation of your ability to perform various exertional levels of work. The SSA bases your RFC on your medical records, opinions from doctors and specialists, and statements from you and your family members as to your abilities, such as how long you can stand, sit, and walk, how much you can lift, and how well you can focus and remember instructions. If your RFC prevents you from returning to your past work, or any other work that you can do given your age, education, and experience, then you will be found disabled.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your case!


See SSR 12-2p:

By: Joyce Trudeau of Premier Disability Services, LLC®

How Might a Gap in Medical Treatment Affect my SSD Case?

Posted March 8, 2019 by Premier Disability Services, LLC®

Medical records are the focus of every Social Security Disability (SSD) case. The Social Security Administration (SSA) will thoroughly comb through your medical records to assess the extent of your treatment in order to determine the severity of your disability.

Sometimes in an SSD case, a claimant will stop treating with a doctor. The reasons for the gap in treatment are important. If your medical records are devoid of the reason that treatment stopped, the SSA may assume that your symptoms have improved and that you are no longer disabled. It is imperative that you discuss the reason with your doctor so that it appears in your records.

If you stop treatment because you have exhausted the many different treatments recommended by your treating physician and there is no improvement in your symptoms, it can be argued that you have reached maximum medical improvement and there is nothing else your doctor can do for you. In this instance, the SSA will use all of the relevant medical records to access your eligibility for benefits.

Another reason for ceasing treatment is a claimant may not be able to afford treatment. This is true for many claimants and the SSA understands that you are not working and your financial situation may not allow for you to treat. Thus, the SSA cannot make a negative inference from your lack of treatment due to inability to access low-cost medical care or not having sufficient health insurance.

You may have been recommended for surgery by a doctor but you refuse to go through with the surgery. Your refusal to treat in this situation can be seen as a refusal to comply with medical treatment. However, your medical history and treatment can support your refusal to comply with treatment. For instance, if you have already had three surgeries without improvement it may be reasonable to decide not to have a fourth surgery.

Furthermore, for individuals with a mental disability, it is understood by the SSA that there may be periods of failing to seek treatment. This could be a symptom of your mental disability, so failing to seek treatment in this scenario would not, in and of itself, be a deciding factor as to your eligibility for benefits.

Any claimant who has a situation where they have or intend to stop treatment must ensure their reasoning is a valid reason that the SSA will accept and not hold against you. After all, your medical records are the source of accessing your credibility, as well as the nature and extent of your disability. Without this information, the SSA can infer that your symptoms are not severe enough to warrant you seeking medical help and, thus, not severe enough to prevent you from working.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

By: Thomas Klint of Premier Disability Services, LLC®

March is Brain Injury Awareness Month!

Posted March 1, 2019 by Premier Disability Services, LLC®

For more than three decades, the Brain Injury Association of America (BIAA) has led the nation in observing Brain Injury Awareness Month by conducting an engaging public awareness campaign in March of each year. The theme for the 2018 to 2020 campaign is Change Your Mind.

The #ChangeYourMind public awareness campaign provides a platform for educating the general public about the incidence of brain injury and the needs of people with brain injuries and their families. Individuals who join us to help raise awareness with the #ChangeYourMind campaign are essential to:

  • De-stigmatizing brain injury through outreach within the brain injury community
  • Empowering those who have survived brain injury and their caregivers
  • Promoting the many types of support that are available to people living with brain injury

Brain injuries are unpredictable in their consequences. Brain injuries affect who we are and the way we think, act, and feel. They can change everything about us in a matter of seconds. It is not uncommon for those who have suffered a traumatic brain injury (TBI) to experience physical difficulties as well as a change in cognitive abilities, the ability to concentrate, personality, mood changes, or social functioning. Others also have trouble with language, which can result in ineffective speech or communication. Some impairments may heal over time, and some functions may be regained some through therapy, while other impairments will not improve—or they may actually get worse over time.

If you have suffered a TBI, you may be eligible for Social Security Disability benefits. In its Adult Listings (11.18), Social Security considers TBI to be brain damage caused by skull fracture, a closed head injury, or penetration by an object into the brain tissue. To qualify for benefits under the listing for TBI, your medical records must document one of the following:

  • Disorganization of motor function in two extremities, resulting in an extreme limitation in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities, persisting for at least 3 consecutive months after the injury; OR
  • Marked limitation in physical functioning, and in one of the following areas of mental functioning, persisting for at least 3 consecutive months after the injury:
    • understanding, remembering, or applying information,
    • interacting with others,
    • concentrating, persisting, or maintaining pace, or
    • adapting or managing oneself.

If you do not meet the requirements of Listing 11.18, you may still qualify for benefits if your impairments prevent you form performing your past relevant work, or any other work available in the national or regional economy, considering your age, education, and work history.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

Adult Listings (“bluebook”):

By: Joyce Trudeau of Premier Disability Services, LLC®