Social Security Disability program rules for Claimants with FM

Discussion in 'Fibromyalgia Main Forum' started by bubblegum, Mar 4, 2003.

  1. bubblegum

    bubblegum New Member

    FMS and SS disability - an article

    Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For many people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow. For people suffering from conditions such as Fibromyalgia and Chronic Fatigue Syndrome, the requirements of the Social Security Act can become overwhelming. This article will explain and simplify the requirements of the Social Security disability program.

    Basically, to obtain disability benefits, the Social Security Act requires proof of a medical condition that produces symptoms that are so severe that it is not possible for the Claimant to perform any type of work. The Social Security Administration (SSA) will look at the impact the medical condition has on the ability to perform the physical and mental requirements of simple, unskilled, sedentary work. SSA is supposed to consider the remaining functional capacity, age, education and work experience in making these decisions. Issues of employability, job existence, insurability and location or desirability of alternative work are generally not considered.

    The determination of disability focuses on "objective proof" of both the medical problem and of the severity of the symptoms. “Objective proof” means the findings contained in medical tests that are not dependent on the patient’s subjective responses. A MRI, a cardiac treadmill test, a x-ray and a pulmonary function test are all “objective” tests. Asking a patient if she is in pain is “subjective.” In Fibromyalgia and CFS claims, it is often difficult to objectively prove either the existence of the disease, or the severity of the symptoms. This has caused many claims based upon these conditions to be denied - especially at the first two levels of review.

    The focus in all disability claims is upon the medical evidence, i.e. physician’s clinical findings, office notes, reports, and medical test results. That evidence is primary and is often more important than the testimony of the claimant. While a claimant's description of the impact on daily activities, social functioning and concentration is important, and must be considered by SSA, the content of the medical documentation is the primary source of evidence in deciding the claim.

    In Fibromyalgia claims the clinical notes and a report of a treating rheumatologist are most important. A 1996 decision by the Seventh Circuit Court of Appeals established that a rheumatologist is the primary source for proof of this disease. Office notes from the rheumatologist should show positive findings for the trigger points which are diagnostic for this disease. In addition, the patient should be complaining at each office visit of the fatigue and pain that are consistent with this condition. A report that establishes that all other causes for the symptoms have been ruled out helps establish the existence of the disease. Since the extent of fatigue and pain can not be measured, consistency of complaints in the various medical records will be important. The use of pain medications, even if just for trial periods, concentration impairments, and the limitations on daily activities such as housework, shopping, and social functioning, are also factors considered by Social Security Administration adjudicators.

    Chronic Fatigue Syndrome claims have been made clearer by the adoption of Social Security Ruling 99-2p. This Ruling finally acknowledges that CFS is a medically determinable impairment and describes the various findings that can establish the diagnosis. This Ruling is quite useful and can be found at the SSA’s web site,, or by contacting this law office. Generally, the focus is on a longitudinal view of the medical evidence and the extent and nature of the treatment provided by the various physicians. The clinical findings and summaries of the patient’s complaints in the office notes are critical. As to whether the symptoms are totally disabling, SSA will consider the medical opinions, as well as to the statements of the Claimant and third parties as to limitations in daily activities, concentration, and social functioning.

    Claimants who suffer from depression should also seek treatment from a mental health professional. Whether the depression is a symptom of the disease, or results from the significant impact on daily functioning, or is a separate disabling medical condition, the treatment notes and histories often lend credibility to the claim. Further, it is entirely consistent - and often true - that a person suffering the severe limitations caused by CFS and Fibromyalgia would be depressed. The depression does not usually negate the existence of the disease but instead confirms the severity of its impact. On occasion, this diagnosis provides an alternative theory for an Administrative Law Judge who wishes to award benefits but will not approve a claim based on CFS or Fibromyalgia.

    While all Social Security cases first focus on medical proof, the testimony at an administrative law judge hearing may tip the scale in favor of a sympathetic claimant. It is important that a claimant fully explain the limitations and the effects of the disease on their daily activities. Testimony, which is consistent with the medical evidence and credible, can persuade a Social Security judge to award benefits in a claim based upon Fibromyalgia or CFS.

    This article has not attempted to review the appeal procedures under the Social Security Act, or any of the applicable Rulings and related caselaw. Nothing in this article is intended to be specific legal advice or to create an attorney-client relationship. Hopefully, however, this brief analysis will provide some insight into the disability system and help people needing this assistance overcome some of the more daunting hurdles imposed by the bureaucracy.

    For further information, please contact Jeffrey A. Rabin, Jeffrey A. Rabin & Associates, Ltd., 640 Pearson St., Suite 300, Des Plaines, IL 60016. The office telephone is 1-888-LAW-0600. Email is either or Mr. Rabin is an attorney in the Chicago area who has been practicing in this area of law since 1981. He represents Claimants nationwide, is a sustaining member of the National Organization of Social Security Claimants’ Representatives and is a member of the executive board of the Social Security Disability Committee of the American Trial Lawyers’ Association.
  2. nitalynn

    nitalynn New Member

    This is a very good article. At present I have no intention of obtaining disability but I am making a copy of it and filing it away 'just in case'.
  3. EllenComstock

    EllenComstock New Member

    Thanks for sharing this article. I, too, have made a copy of it. I am still working full-time and hope to somehow continue, but you never know. In the meantime I am gathering information and filing it away.

  4. bubblegum

    bubblegum New Member

    I hope this stays on first page for a while so others will have a chance to read it also.
    Ciao 4 Now
  5. bubblegum

    bubblegum New Member

  6. Achy-shaky

    Achy-shaky New Member

    I'm in the process of filing and every bit of info helps. Thanks!!
  7. tamikim1

    tamikim1 New Member

    I hae been on short term disability since 10-11-02. The 1st 2 wks they pd but then I had to fight tooth and nail and finally recieved a ck on Jan 27th for back pay. But now they are turning me down again since 1-27-03. They told me that they wanted me to get a nerve conduction study, which my DR. ordered but like he said it will be negative because it is not a piched nerve, and of course the test was negative. Then they wanted an MRI same thing nothing pinche but it showed muscle spasms, which is what my Dr. said I have with neuralgia. Then in Dec. or Jan they daignosised me with Fibro. I do everything they want but now they say there is no objective clinical information that suppoerts my inability to work at my job. My Dr. has filled out paper work after paper work, called them several times. But to me they just think fibro is not a dibilataing disease. But i do good just to breath. The insurance company is Fort Dearborn Life Ins. Co. my emplyer is BCBS of TX and the ins is self funded. With al this stress that the ins has put me through I will never get better. Please tell me what I can do. Thank you so much,
  8. bubblegum

    bubblegum New Member

    Try calling Jeff Rabin and ask him what options you have. If he can't help you maybe he will know someone who can. You can email him at the address above and tell him "a friend from clouds referred you" Good luck and keep us posted.
    Ciao 4 Now.
  9. bubblegum

    bubblegum New Member

    I totally agree with skeesix. It is time for you to seek legal advice. Jeff Rabin doesn't work on STD, but you can try legal aid in your area. Consultations are usually always free with an attorney. Do some research on the attorney's in your area first. Find ones that specialize in Private disability insurance. Good luck and keep us posted.
  10. tamikim1

    tamikim1 New Member

    Thank you all for answering me, this is all so confusing. After reading lots on the message board, I have learned symptoms that I have and didn't even realize that it goes along with Fibro. There is so much that I thought I was just kinda crazy or thought it was something else. I wish I could find something that gave me all signs and symptoms of Fibro and CFS, everytime I go to a different specialist I make a list of things that I am going through, and of course they all have different thoughts on if it is part of either one of these diseases or not, so it is confusing. As soon as I find an attorney I will let ya'll know what is going on. Thanks again
  11. turtis

    turtis New Member

  12. bubblegum

    bubblegum New Member

    Good luck and let me know what happens.