It's Tough, But Can Be Done

UNDER the current disability claim process, people with fibromyalgia syndrome (FMS) who apply for United States Social Security disability benefits face a struggle. According to Joshua Potter, an attorney specializing in representing clients seeking disability benefits, "The process can take a long time, but you've got to remember not to give up, not to abandon your application, and most important: don't start over again." ¹

If you care about someone with FMS, or you have fibromyalgia, this article will provide you a general overview of the application process for Social Security disability benefits. It is not intended to provide legal advice.

Deciding to Apply

Beginning with the decision to apply, a person diagnosed with fibromyalgia, and his or her family, must prepare to answer some difficult questions ².

1. Is the person eligible? In order for a person to qualify for Social Security disability benefits, the person must have worked long enough and recently enough under Social Security.

2. Does the person qualify for disability? A person is considered disabled if "you are unable to do any kind of work for which you are suited and your disability has lasted or is expected to last for at least a year or to result in death." ³

3. Can the person handle the physical and emotional demands of applying for disability? "Making the decision to seek government financial help and struggling through the claim process will be physically and emotionally difficult." ⁴ In order to make the process less difficult, talk with your loved one and address concerns either one of you may have. Inquire how you can be supportive. Ask other knowledgeable people (such as an attorney, support group leader, trusted friend, and so on) for their additional support and encouragement.

4. Can the person live on no income for a year? The claim process can take several months or even more than a year. A chance for disability benefits is diminished if the applicant earns more than $500 a month. Receiving income from a pension or other disability payment may also affect the applicant's claim. In addition, if fibromyalgia symptoms are severe, the person may have to cease work entirely and rely heavily on a spouse, partner, family or friends for financial support. Although it may an uncomfortable subject to discuss, the person with FMS and his or her family should address concerns about resources and create a financial plan.

5. Does the person have the stamina to deal with a lengthy claim process? Filing a disability claim and following it through can be overwhelming to a person with fibromyalgia. Pain, fatigue, difficulty with concentration, and short-term memory loss, are all symptoms that get in the way. Your loved one may need your help and the help of friends, relatives, health care providers, an attorney, and support group members. Electing a specific person to act as an advocate for the applicant may be a necessity, and should be taken into consideration.

Where to Begin

If your loved one decides to apply for Social Security disability benefits, preparation for the claim process should begin as soon as possible. Offer your support to your loved one to help accomplish the following tasks:

1. Become educated about the process of filing a disability claim (see resources listed at the end of this article)

2. Make an appointment at the local Social Security Administration (SSA) office to obtain up-to-date information about the claim process. During the visit obtain several copies of the necessary disability claim forms. If a SSA office is not located nearby, call Social Security's toll-free number, 1-800-772-1213, or visit the Social Security website, www.ssa.gov

3. Enroll the help of healthcare professionals. Doctor reports and medical tests are two important pieces of evidence used to determine whether or not the applicant qualifies for disability. Every office visit should include a report from the patient, or a test by the doctor, of the patient's diminished ability to perform basic functions—standing, sitting, lifting, walking, carrying—problems with memory and concentration, problems with medication, and anything else that may be pertinent ⁵.

4. Decide whether or not to hire an attorney who specializes in disability issues. The National Organization of Social Security Claimants' Representatives (NOSSCR) refers people to private attorneys specializing in Social Security claims law (1-800-431-2804)

5. Start collecting and organizing the necessary evidence

The Needed Evidence

The determination of disability benefits takes longer to process than other Social Security benefits, approximately 60 to 90 days. "It takes longer to obtain medical information and to assess the nature of the disability in terms of your ability to work." ⁶ However, the length of time can be shortened by providing the documents and information listed below ⁷:

• The Social Security number and proof of age of the person applying for benefits

• Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated the person and dates of treatment

• Names of all medications the person is taking

• Medical records from the person's doctors, therapists, hospitals, clinics, and caseworkers

• Laboratory and test results

• A summary of places where the person worked in the past 15 years, the kind of work done, and a description of the major physical and mental demands of each job

• A copy of the person's W-2 Form (Wage and Tax Statement), or if the person is self-employed, a federal tax return for the past year

The Social Security Administration denies vague claims more quickly. Therefore, applicants should identify all significant impairments in his or her application. Applicants should also try to submit complete medical documentation at the very time they file their claim papers. If an attorney has been hired to handle your loved one's disability claim, the attorney will also be able to help gather the necessary information.

What to Expect

The SSA processes disability claims in sequential steps. The steps include an initial application, usually followed by a denial, a request for reconsideration, and then a request for a hearing.

The process begins when the claim is filed at your SSA office. The process can also start by calling SSA's toll-free number, 1-800-772-1213. Your loved one will be asked the nature of his or her disability, his or her doctor's name, address, and phone number, and the details of your loved one's last job. The SSA will then investigate your loved one's medical history, capacity for lifting, walking, sitting, standing, work history, citizenship, and insurance coverage. This investigation can take several months ⁸.

"Winning a favorable decision means that you get an award within three or four months after filing your claim." ⁹ If the claim is denied, and appealed, it can take fourteen-plus months for a final decision on the case.

Throughout the disability claim process, it is essential to respond in a timely fashion. When Social Security notifies the applicant of its decision, the applicant has only 60 days to appeal the decision and proceed on to the next step. For more information about appeals, contact Social Security and ask for the factsheet The Appeals Process (Publication No. 05-10041).

When the Claim is Approved

Once Social Security decides your loved one is disabled, he or she will receive a disability check dating back to the sixth full month from the date Social Security decides the disability began (but no more than one year of back benefits can be paid). Your loved one will also receive a booklet describing his or her responsibilities as a Social Security beneficiary: What You Need To Know When You Get Disability Benefits (Publication No. 05-10153).

Both your loved one and you should read this booklet carefully and keep it in a safe place with other valuable papers. Since fibromyalgia often causes memory problems, you may need to help your loved one understand and remember the information within this booklet.

For More Information

There are several excellent resources available to help navigate through the process of applying for Social Security disability benefits.

1. Fibromyalgia Association of Greater Washington (FMAGW) offers a Social Security Information Packet. The packet contains important information for FMS patients and their families about applying for Social Security Disability Insurance (SSDI): booklets on SSDI and Supplemental Security Income (SSI) from the Social Security Administration, brochures from the National Organization of Social Security Claimants' Representatives, articles on fibromyalgia and SSDI, and other resource information.

Cost: $3.00

Send your check/money order to:
FMAGW, 13203 Valley Drive, Woodbridge, VA, 22191-1531
Phone: (703) 790-2324
Fax: (703) 494-4103
Website: www.fmagw.org

 

2. The Social Security Administration publishes a variety of booklets on available Social Security benefits. Contact your local SSA office, or call toll-free 1-800-772-1213, and ask to receive these Social Security booklets:

Disability Benefits (Publication No. 05-10029)
Also available online at: www.ssa.gov/pubs/10029.html

Supplemental Security Income (Publication No. 05-11000)
Also available online at: www.ssa.gov/pubs/11000.html

The Appeals Process (Publication No. 05-10041)
Also available online at: www.ssa.gov/pubs/10041.html

 

3. Disability Workbook for Social Security Applicants: Managing Your Application for Social Security Disability Insurance Benefits, Fourth Edition, by Douglas M. Smith, Attorney at Law, Physicians' Disability Services, Inc. 1997 (140 pages, softcover)

This workbook answers questions such as: What is Social Security Disability Insurance? How do I prove disability? How do I appeal when benefits are denied? How do I get and organize evidence? How do I monitor my case? How do I respond to continuing disability reviews? The book includes worksheets, charts, frequently asked questions, and more.

Cost: $19.95 plus $4.50 for shipping/handling.

Send your check/money order to:
Physicians' Disability Services, Inc. P.O. Box 827 Arnold, MD 21012
Phone: (410) 431-5279

 

4. The Fibromyalgia Advocate: Getting the Support You Need to Cope with Fibromyalgia and Myofascial Pain Syndrome, by Devin Starlanyl, M.D., New Harbinger Publications, 1998 (377 pages, softcover)

This resource guide will help fibromyalgia patients and their families navigate Social Security, Worker's Compensation, Medicare, COBRA, HMO bureaucracies, disability insurance, and the Americans with Disabilities Act. It also offers tools to establish constructive relationships with medical professionals, employers, family members, and friends.

Cost: $18.95

Available at bookstores or from New Harbinger Publications.
Send check/money order or Visa/MasterCard
(call for applicable shipping/handling charges) to:
New Harbinger Publications 5674 Shattuck Avenue Oakland, CA 94609
Phone: (800) 748-6273 or (510) 652-0215
Fax: (510) 652-5472

Summary

"The prospects for winning your disability claim and getting benefits quickly are improving. Social Security Administration (SSA) officials report a significant increase in the approval rate for disability benefit claims at the initial decision level." ¹⁰

In order to take advantage of the increasingly favorable conditions, help your loved one take charge and prove his or her case. "In a nutshell, document everything." ¹¹ Details of your loved one's loss of ability to carry out daily activities are more important than vague statements, such as "She can't work" ¹².

Although it may be tempting to minimize health problems when talking to others who don't have fibromyalgia, Social Security officials need to hear the reality of how your loved one's condition affects your family's life.

Don't give up and good luck!

2. Samson and Macaluso, "Disability for Fibromyalgia."

3. Social Security Administration, "Disability Benefits," publication no. 05-10029 (1997).

4. Samson and Macaluso, "Disability for Fibromyalgia," paragraph 4.

5. ME Williamson, Fibromyalgia: A Comprehensive Approach, (New York: Walker and Company, 1996).

6. Social Security Administration, "Disability Benefits," 8.

7. Social Security Administration, "Disability Benefits."

8. Williamson, Fibromyalgia.

9. DM Smith, "1998 Update: Prospects Improve for Winning a Social Security Disability Claim Quickly," Fibromyalgia Frontiers 6, no. 3, May/June (1998).

10. Smith, "1998 Update," 9.

11. Williamson, Fibromyalgia, 163.

12. Williamson, Fibromyalgia.