Can a fibromyalgia disability case be won at the early stages of the claims process?

I am asked this question by fibromyalgia clients often, and the answer is yes, but there’s a big asterisk there. You see, to win your fibromyalgia disability case early on, you need to meet certain criteria which may be hard to achieve.

First of all, you will need to obtain strong support from your treating physician. You will have to submit solid medical records along with your claim for benefits, and these medical records must clearly show that you have a firm fibromyalgia diagnosis and that it interferes with your ability to perform work in major ways. Things like discussions of pain levels and extent of fatigue are the types of things that will need to be present in such records in order for you to even have a chance at winning early.

Another way of possibly winning early is if your condition meets a Listing – which is essentially the SSA’s definition of severe/disabling fibromyalgia. Anything that falls short of meeting that definition/description will fail to meet the listing. Here, again, your medical treatment records must be extensive and consistent. Also, a form completed by your physician which tracks the listing can help. Such a form, which is structured as an easy to read checkbox type of document, will ideally make the adjudicator reviewing your case recognize that your condition meets a listing. This will increase your chances at an early approval.

There is one final way to possibly win a fibromyalgia claim early, and that is to Meet a Grid Rule. Like meeting a listing, this may sound mysterious, but it’s really quite simple (especially if you are over the age of 50). Here’s an example: Let’s say that you don’t meet a listing. Well, you can still win if you have a physical impairment like fibromyalgia, you have limited work and educational history, and you are 50 years old or older. If you meet these criteria, consider taking a look at the “grid rules.” You may fall under a certain grid rule and therefore automatically qualify. The grid rules, however, can sometimes be difficult to understand, so that is why it is a great idea to talk to a disability attorney about winning disability benefits based on the grids.

State Agency adjudicators are known to issue positive decisions in grid cases. That’s why it is imperative that you stress that your case is a grid case and point out the specific grid. Like I said, an attorney can help.

Finally, it is also important to note that State Agency adjudicators are usually underpaid and overworked. They are often given very limited authority, and they are quick to deny cases, even if they are deserving. Consider asking the adjudicator to give your file to a medical consultant or even a supervisor in the State Agency office. That may be your last chance at winning your fibromyalgia disability case early.