* Unless your disability is catastrophic (such as terminal cancer, a heart condition so bad that you are on a heart transplant waiting list, total paralysis of both legs, etc.), applying for Social Security Disability benefits can be lengthy and frustrating experience. Patients filing for disability benefits depend on their doctors to provide the evidence that proves to the Social Security Administration (SSA) that they are legally disabled. SSA can be hard to convince; especially if you don't know where to start and how to find the help needed.
CFIDS
of America Support
Group Article
September
2001
How
to Apply for Social Security Disability Insurance benefits if you have
Fibromyalgia
By Lynne Matallana, Executive Director
Reprinted
with permission from the National Fibromyalgia Awareness Campaign, 2415 N. River
Rd., #200, Orange, CA 92865. Phone 714/921-0150 and fax at 714/921-8139.
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 is when you apply for Social Security Disability 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 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 status must be full and currently
insured (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 stopped working and then became disabled within the five years, you can
apply for SSDI. In order to apply you must contact your local Social Security
Administration (SSA) Office 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,
your birth certificate (for proof of age) and your last W-2. The application will ask for past employment information,
your medical history, and what is wrong with you. They will request copies of
treatment records and/or the names of all the doctors who have been treating
you. They can 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 by the SSA's
"LISTING OF IMPAIRMENTS" STANDARDS. (A copy can be requested from:
Office of Medical Evaluation of the Office of Disability, SSA, 6401 Security
Blvd., Baltimore, MD 21235). This includes a listing of 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. Patients 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 uch
as a 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 on going 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 Social Security office. You may want to first get help from friends or
family - this might be less stressful. After you have submitted the forms, the
SSA's 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).
Do
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 SSA local office and request the appeal form. This form must be
submitted within 60 days! Not 61 days, 60 days. 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 four 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 is best to work with an
attorney at this point, it is not required. Do not hire an attorney, who will
charge 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
SSA regulations, work with your doctor on reports, gather evidence, prepare you
for testifying at your hearing, protect your rights. If you lose, your attorney
can request a new review of the Judge's ruling by the SSA's Appeal Council,
which takes about seven 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, and 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 SSA office to verify all information! It
may take some time and require a lot of patience, but if you are disabled, you
are entitled to SSDI.
To
receive a SSDI application, call 800 772-1213 or visit their web site at http://www.ssa.gov/odhome/.
Other
resources:
National
Fibromyalgia Partnership (NFP)
614 457-4222
Fibromyalgia
Network
800
853-2929
http://www.fmnetnews.com/
Oregon
Fibromyalgia Association
http://www.myalgia.com
National Organization of Social Security Claimants' Representatives
(NOSSCR)
800 431-2804
http://www.nosscr.org