Fibromyalgia/Myofascial Pain Syndrome Handout # 2 - Social Security Disability

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http://www.pendulum.org/related/FMS/fm-pain.htm

Fibromyalgia/Myofascial Pain Syndrome Handout # 2

Devin Starlanyl MD

Social Security Disability

This was well covered in an article titled

" Helping Fibromyalgia Patients Obtain Social Security Benefits " , by

W. Potter. Esq. (attorney), in the September 1992 edition of

" The Journal of Musculoskeletal Medicine " . The Social Security

Administration (SSA) defines disability as " An inability to

perform any substantial gainful activity because of medically

determinable physical or mental impairment...for a continuous period

of not less than 12 months. " Claims are made at the SSA District

Office in person or by telephone (800-772-1213). They will ask you

the nature of FMS, your physician(s), and job background. The SSA

will then investigate your: medical history initial description of

condition, including capacity for lifting,walking, standing, &

sitting; job history, date last worked,description of past work; and

proof of citizenship and insurance, status. A response from this

may take 6 to 8 months. The physician-reviewer who is part of the

reviewing team is usually not a practicing physician and probably

knows little or nothing about FMS or MPS. Initial applications for

disability are routinely denied. Be prepared. An appeal must be

made to the SSA within 60 days of its mailing. The SSA will not have

a legal basis to hear your appeal if it's late. This appeal is

called a " request for reconsideration " . This appeal may be made at

the SSA District Office or through an attorney who deals with these

cases. The attorney will charge 25% back benefits from the time

when you are unable to work. This request triggers an in depth

investigation of your problem and abilities, including your medical

charts. You may have to be examined by a physician working for the

Disability Determination Service. To quote from the article,

" Frequently, waits are long, examinations are brief, and medical

records are not available for review by the SSA physician, who is

paid approximately $88 for the examination and report. " Again, it is

usual that the request is denied. There is no time limit to this

determination, and can take 6 months or more. The denial usually

will have suggestions for alternative work, which usually has no

relation to your work history. You don't have to act on these

alternatives. At this time, you must file a " request for hearing "

within 60 days. This will result in a trial by a judge, usually

within 4 months. At this time, " experts in forensic medicine and

trial advocacy are needed. " You will testify, as well as your

physician. If the judge rules that you are not disabled, you

may appeal to the Appeals Council within 60 days. Their decision,

usually within 7 months, almost always agrees with the judge.

This may be appealed by filing suit in the US District Court.

An attorney for this must have a special license. Usually, if

anything, the District Court will return the matter for a new

hearing (a remand). This is based on the initial application.

Now you understand why they call us " patients " ! The key is a

comprehensive medical chart and report. Your physician must be

familiar with the SSA " Listing of Impairments " . This is contained in

" Disability Evaluation Under Social Security, " available from the

Office of Medical Evaluation of the Office of Disability, SSA, 6401

Security Blvd., Baltimore, MD 21235. Of course, there is no specific

listing for FMS or MPS. Sometimes people have to utilize other

headings, since we often have many of the criteria for psychiatric

or other disability. Your doctor must have a detailed medical

record for you. Not only your medical signs and symptoms but

adaptive reactions, physical limits and dysfunctions. " Every

patient visit should result in entries concerning physical

capacities (verified with measured weights);time durations for

sitting, standing, and walking (by history); the nature, location,

and intensity of pain (by history); psychosocial and adaptive

behavior, including the ability to interact appropriately with

others, follow instructions, and adhere to a regular schedule; and

the complex of depressive symptoms. " You must be incapable of

performing ANY work, although there is some flexibility in this rule

if you are over age 50. Most work requires regular attendance, the

ability to concentrate and follow instructions, etc. " A claimant's

case is greatly furthered by a report that reads: 'Patient's past

work required sitting all day, analysis of complex data, and lifting

to 10 lb. Now the patient can sit a maximum of 20 minutes, cannot

concentrate because of medications and pain, and is always exhausted

because of lack of sleep. Patient is irritable, argumentative and

misses appointments. Measured lifting is now to 3 lb. Cannot and

should not work....' " If the medical notes on your chart are

vague, forget benefits. You are orchestrating your medical team.

Make sure your key player, your physician, is caring, careful

and understanding. He should specify your pain, and list those

thingsthat make it worse. A complete report, if supported by a

good medical record, need only be two to three pages long. The

fact that FMS isn't on the " List of Impairments " is a real

minus. We have to educate ourselves and others. This includes

writing congressmen, etc. congressmen, etc.plain SSA disability

benefits range from $350 with Medicare starting 24 months after onset

of FMS. Benefits are payable as of one year before application.

Supplemental Security Income is payable from the application.

The cards are even more stacked against people trying to get

a positive settlement on an insurance case. The Fibromyalgia

Network had a good article on this in the July 90 edition. Radnor,

an attorney, pointed out that many doctors don't believe there is

such a disease as FMS, and the symptoms are psychological. You often

have to see several physicians before obtaining a diagnosis of FMS.

You say you are in pain, but where's the proof? Your tests are

normal. O. , attorney, says a big issue is that studies

indicate patients are predispose to FMS genetically. Both attorneys

state flatly that orthopedic surgeons don't, as a rule, believe in

FM. Clearly, education is needed.

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