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Qualifying for Social Security Disability with fibromyalgia in Missouri and Illinois

A potentially debilitating condition, the effects of fibromyalgia may prevent people from working. However, they may qualify for SSDI benefits.

Fibromyalgia is a medical condition that affects people in Missouri, Illinois and throughout the U.S. Due to its potentially debilitating effects, those who have this disorder may struggle, or be altogether unable to work. This may leave people with concerns over lost wages and how they will provide for themselves and their families, as well as how they will pay for their medical care. Under some circumstances, however, people diagnosed with fibromyalgia may be eligible for Social Security Disability Insurance.

What is fibromyalgia?

Characterized by widespread pain throughout the body, fibromyalgia is a musculoskeletal disorder. The exact cause of this condition is not known. However, people commonly develop symptoms after surgical procedures, infections, physical traumas or psychological stresses.

Beyond pain that is often described as a constant ache, people with fibromyalgia often experience a range of symptoms, including lower abdominal cramping and headaches. Additionally, mood, memory and sleep issues are also symptoms commonly associated with this disorder.

What is the criteria for evaluating fibromyalgia?

Before people can qualify for SSDI, they must first be diagnosed by a licensed physician. In order to make its determination, Social Security reviews the medical histories and treatment records of those seeking benefits. This allows the agency to confirm the diagnosis, and identify whether the applicants’ symptoms are improving, stabilizing or worsening.

In addition to receiving a diagnosis, Social Security has two sets of criteria for fibromyalgia. To be eligible for benefits, people must meet either the 1990 or the 2010 criteria. Under the 1990 criteria, the qualifications include the following:

· Evidence that other possible conditions have been ruled out

· At least 11 positive tender points on both sides of the upper and lower body

· A history of widespread pain

The 2010 criteria stipulate that applicants must have recurrent manifestations of at least six signs, symptoms and co-occurring conditions of fibromyalgia. Additionally, those applying for SSDI under these criteria must have a history of widespread pain and be able to provide evidence showing other conditions that might be causing their symptoms to have been ruled out.

What documentation is needed?

Social Security requires specific documentation to determine whether applicants meet the qualifying criteria. People must provide their medical records for the 12-months preceding their application dates from an acceptable physician. In addition to showing their diagnosis, these records must indicate they have received ongoing evaluations and treatment for their ailment.

Sometimes, the agency may request evidence from other medical providers, including psychologists, to further demonstrate the severity and functional limitations resulting from applicants’ conditions. Should the agency be unable to reach a determination based on the documentation and evidence submitted, it may seek a consultative evaluation.

Working with a lawyer

Even with a proper diagnosis and the necessary documentation, people throughout Missouri and Illinois commonly have their SSDI claims denied. For those with fibromyalgia, such denials may only increase the overwhelming impact that the condition may have on people and their families. Thus, it may benefit those seeking Social Security Disability benefits to seek legal guidance. An attorney may help them understand their options and the associated requirements, as well as guide them through the claims process.

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