By: Lynne Matallana
Reprinted from FMOnline

This article is about Social Security Insurance Disability.  It does not deal with worker’s compensation, private pension disability or SSI (Supplemental Security Income.)  SSDI eligibility is based on a physical or emotional problem severe enough to keep you from working in any paying job for a minimum of one year. This means you cannot perform any job available. If however, you are over the age of 50, they are more lenient with the criteria defining “any job.” This means that they are not just considering your ability to do your old job, but rather you have to prove you cannot do any work. Your Social Security insurance status must be full and current (i.e. you have paid into Social Security while employed and you must have paid into that system within the last five years. If you have been off work for more than five years, you are not eligible).

If you became disabled and stopped working within the five years, you can apply for SSDI.  In order to apply you must contact your local Social Security in person or by telephone and request that you are sent a disability application for initial filling.  This is step one.  Besides filling out the application you will need a copy of your Social Security card, you birth certificate (for proof of age), and your last W-2. The application will ask for past employment information, your medical history, and the nature of your disability. They will request copies of treatment records and/or the names of all the doctors who have been treating you.

They will contact your doctors and request your records for you. (Note: It is helpful to your case if you have been treated by one doctor, over a long period of time, who has been diligent about documenting your visits according to the SSA “Listing of Impairments.”  This means they have listed symptoms and adaptive reactions, physical limits and dysfunctions, test results and treatments. If your doctor just notes that you have Fibromyalgia (FM), this is not enough. The SSA needs to see that you have had x, y and z complaints and that these were verified by x, y and z.

The doctor needs to note duration of time for sitting, standing and walking, the location and intensity of pain, your level of depression and your cognitive capabilities. A good entry would be: “Patient’s past work required sitting all day, patient can now sit for only 20 minutes and cannot concentrate because of medications and pain. Patient is not able to get adequate sleep due to pain and sleep dysfunction and therefore remains fatigued all the time.”  In addition, for example, if you have had various symptoms of related problems such as migraine, the doctor should document the complaint and the treatment. Migraines are one of the more tangible and acceptable symptoms of FM.

A side note:  You may want to file for disability based on one of the other problems you are having which is part of FM.  For example, if you have migraines three or four times a month, this may make you eligible for SSDI and you may not want to even mention FM.

You want all symptoms recorded in your file. They also want to know that you are seeking treatment on a frequent schedule. Even if you are frustrated with your doctor, you must show that you have had ongoing symptoms and sought out treatment for them. Finding a doctor who will be a partner is very important. Sometimes we have to be willing to pay a doctor not on your insurance plan in order to assure that you will have a fair chance at being awarded benefits.

A very important thing to remember when filling out the SSA form is to limit your information to only things that are relevant. Many of us enjoyed very successful careers and lives before FM. It is tempting to want to let them know about all the experiences, education and success you had while working.  Do not do this!  Be honest, but only answer the questions they ask. Remember that if you can do any job you are not eligible!!  Do not draw special attention to yourself.

If you are having problems in filling out the forms, you may request help from your local SS office. You may want to first get help from friends or family–this might be less stressful. After you have submitted the forms, their doctor may call you in for an examination. Cooperate to your fullest. After this, step one will be completed and you will either be accepted or denied. (Only 35% of all applications are approved at this level.)

social security disabilityDo not be discouraged. They use the same language for all denials and do not take it personally. In fact, expect to be denied, but do not give up!  Now it’s time for step two: the appeal called the “request for reconsideration.”

Again call your SS local office and request the appeal form. This form must be submitted within 60 days! Not 61 days, 60 days!  (Note: remember due to the volume of applications, there is no time limit for this determination.  The entire application process can take anywhere from a few months to over a year.  Be prepared for this.)

During the appeal stage, you may be asked for more information about your reason for disability. Remember that it is better to be specific about symptoms that can be proven.  With FM, we often have multiple symptoms. Do not go into every symptom you have. Pinpoint the ones that keep you from working full time at any job. At this step about 13% are awarded disability benefits and the other 87% are denied. Often times in the denial they will suggest alternative work. You do not have to act on these suggestions. Do not let this denial stop you! It is very important that you realize the process is not over and that you still have the opportunity to file for a hearing, step three.

Again, you have 60 days to file a request to bring your case before a Federal Judge. This usually is scheduled within 4 months and is informal and private. At this trial, you are given the opportunity to testify, as well as your doctor and other witnesses. Although some people do feel it best to work with an attorney at this point, it is not required. Do not hire an attorney who charges you up front costs. You want an attorney who will work on a contingent basis of 25% of past-due benefits or $4,000, whichever is less.  This way if you lose you do not have to pay any fees.

Some of the things your attorney can do for you are: analyze your case in terms of SS regulations, work with your doctor on reports, etc., gather evidence, prepare you for testifying at your hearing, protect your rights–and if you lose–request a new review of the Judge’s ruling by the SS Administration’s Appeal Council, which takes about 7 months.

Now for the good news: 68% of the cases taken before the judge are approved!  The process may take a long time and a lot of energy, but people with FM do win SSDI benefits.  You have to be patient and persistent and you have to be realistic…prepare your case with facts not emotion.  When you win, you will be eligible for benefits that range from $350 to $1,000 per month, dependent on your previous salary range.

You can collect benefits for the time when you were disabled, but not working or collecting benefits. Medicare starts 24 months after the onset of your disability. SSDI benefits continue until you are no longer disabled. Some benefits are awarded with a specific date, (for example: two years) when a required review will take place.

Remember there is a lot of false information and miscommunication that takes place concerning SSDI. Check with your local SS office to verify all information! It may take some time and require a lot of patience, but if you are disabled, you may well be entitled to SSDI benefits.
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