There can be a variety of challenges that claimants in New York encounter when pursuing a disability case. Even conditions recognized by the Social Security Administration (SSA) can be difficult to prove qualify for benefits. One example is when an individual has been diagnosed with fibromyalgia, which can make navigating the Social Security disability program complex.

Defining Fibromyalgia as a Disability

The first issue in winning this type of case is proving the condition is disabling. The general requirements are that the person has worked recently and long enough, is unable to engage in substantial gainful activity, disability is expected to last at least a year and the claimant can’t perform previous work or adjust to other work.

But there are specific qualifications that apply to the condition of fibromyalgia that claimants must also meet to prove it’s a severe medically determinable impairment (MDI). The criteria include widespread chronic pain lasting at least three months and ruling out other possible conditions.

Additionally, one of the following also must be present:

  • recurrence of at least six symptoms (such as fatigue, depression, anxiety, cognitive problems, irritable bowel syndrome and waking unrefreshed); or
  • at least 11 of the 18 tender point sites test positive.

Proving Fibromyalgia Is Disabling 

Winning this type of disability case is dependent on having the right documentation, such as a doctor noting that the aforementioned requirements are met.

Medical records typically are requested from the past 12 months, but it could be necessary to submit earlier records. Other healthcare providers also may be called upon when requesting information. Keep in mind that important medical records include the symptoms experienced, how they have interfered with daily activities, attempted treatment and anything else of relevance.

Another type of paperwork that can help establish disability is the completion of a residual functional capacity assessment. A physician will utilize this assessment to show specific impairments. It’s also important to have documentation that shows work history. This can be done through personnel files, job performance evaluations and other paperwork.

How Treatment Can Impact a Fibromyalgia Disability Case  

Receiving a diagnosis of disability due to fibromyalgia is just one component to win a disability case. There also must be evidence that treatment has been sought to relieve symptoms. Examples include medication (for treatment of pain and depression), special exercises and therapy (physical and/or cognitive-behavioral).

It’s not enough to show that treatment was tried. The individual must establish for how he or she received treatment. When claimants have not made attempts to receive treatment or do not stick with treatment long enough, this could make it difficult to qualify for disability benefits.

Winning this type of case isn’t easy. It may necessitate seeking help from an attorney who can help collect the right documentation and organize your case to demonstrate you meet the requirements. Contact The Disability Guys at Markhoff & Millman in New York to review your case and eligibility for benefits – 866-205-2415.