Medical Determination
There is a three-step process in determining the MDI for a person with fibromyalgia:
- A history of widespread pain. That is, pain in all quadrants of the body (the right and left sides of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, thoracic spine, or low back) that has persisted (or that persisted) for at least three months. The pain may fluctuate in intensity and may not always be present.
- At least 11 positive tender points (of the 18 that are considered in fibromyalgia) on physical examination. The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
- Evidence that other disorders that could cause the symptoms or signs were excluded.
Beyond Medical Evidence
As stated earlier, once proof of a medical condition is made, the SS Administration follows a procedure to determine functionality. This means they will need accurate records of your past work history, your recent work history and functions and then determine ability for future work functions.
Since fibromyalgia is not listed as a disease in the SSA Impairment Listing Manual, this second determination process is how the majority of disability cases are won.
When first applying for disability benefits, you do not have the opportunity to explain how your condition limits you, nor do you have the opportunity to have an attorney or advocate make a presentation based on the evidence of your case. This is the primary reason that first time applications are denied.
Most denials come within a few months. Once you are denied, you can appeal the decision through hiring a disability attorney. That attorney will represent you at a hearing held in front of a judge where you can argue your case.
Most disability attorneys work on a fee based on winning the case and are only allowed a certain percentage by the court and state laws. The attorney fees are taken out of your award amount prior to disbursement should you win.
The appeal process is the longest stretch of your fight for benefits, as the case can take from a year to a year and a half before it comes before a judge. Once your court date is set, it is at this point that the process of functionality is determined.
This process is called the “medical vocational” process, which is a five-step sequential evaluation decision process:
- Claimant’s current work activity. If still gainfully employed, the claimant is not eligible.
- Consider medical evidence. Look for evidence substantiating physical and mental limitations.
- Determine physical and mental residual functional capacity. This is done using medical records, physician’s testimony and medical consultants’ expertise.
- Measure ratings against demands of past work. These ratings are called RFC ratings.
- Measure RFC ratings against the demands of suitable other work for which the claimant might possibly be expected to transition to, based on medical and vocational factors. Persons beyond the age of 50 have a better chance of a favorable ruling due to the factors of education, re-training and vocational opportunity.
Keep in mind that if awarded, the monetary amount is determined by your years of work, social security deductions that have been accrued from your pay through the years, and also by the most recent quarters of work history.
Finally
On June 6th of this year I had a hearing before a judge after a wait period of 15 months from the date I submitted an appeal. My appeal was after a second denial I had received the end of the previous year.
The court process was not intimidating at all and much more pleasant than the wait had been! It consisted of my lawyer, the judge, a court reporter, a vocational expert and myself.
The judge had thoroughly studied the evidence submitted, as had the vocational expert. The questions were forthright.
Make sure you are definitive, assured and honest in your responses. Answer the questions as precisely and concisely as possible.
Once it is all said and done, breathe! I received my affirmative decision on August 3rd, a little less than two months from my court date — so expect the decision to take around 60 days.
I should be receiving my back pay within a few weeks and my first monthly check next month. I encourage you to stay the course, stay strong and follow this process through to the end!
As I have said, there are no guarantees, but I think you will be surprised what you are capable of when you are fighting for your future and your health. I’ve seen this fight in so many of you, and to me you are true heroes!
