How can my doctor help me get disability benefits for fibromyalgia?

Question: I turned 50 this month of January 2014. I became ill in 2004. I have 10 years of medical records, doctors’ appointments, and tests. I went out on disability once in 2006; the doctor stated CFS/fibromyalgia. I lost my job in 2010…laid off due to low work they said, but it was due to illness. One doctor diagnosed me in 2005 with lime disease from tests….another said, Lyme and CFS/fibro.

I have upcoming appointments with pain management, allergies, and a second neurologist and rheumatologist. The first rheumatologist gave me physical therapy appointments…going to them, but suffer after with pain.

I suffer from weak legs that feel heavy and pins and needles, shakes and tremors, can’t walk more than 10-15 minutes, slowly. Also have tremors in arms and hands, stiff joints, radiating pain, sore painful joints, fatigue and burning shins. Acid reflux that can’t be cured, allergies that clogged my face with pain. Back constantly cracks and gives pain. Forearm and thumb move by themselves when writing or typing to long. Pain too. Constipation and other stomach issues are there as well.
How would I best go about asking my primary care physician (PCP) to help me? He knows my situation and has included notes about it in my records. If I send a letter to each doctor I have seen, are they required to include the letter in my records? This letter would describe my illness and how it affects me daily. Would my doctor charge me to fill out the RFC or write a letter? Would a chiropractor be helpful in my case?

Answer: You are doing the right thing by setting up doctors’ appointments. When you’re at the doctors’ offices, tell them as much as possible about your symptoms. You can follow up with a letter if you wish (whether or not the letter goes into your medical record, you can submit a letter and/or pain diary to Social Security with your disability application). When you apply for Social Security disability, the agency will request your complete medical records from all doctors that you list on your disability application.

Since you are applying for fibromyalgia, Social Security will be most interested in the opinion of the rheumatologist. Ask the rheumatologist to fill out a residual functional capacity report for you. You can use our blank RFC form for fibromyalgia. This form will elicit the exact answers from your doctor that Social Security needs to know; it was developed to correspond closely with Social Security’s criteria for getting disability based on fibromyalgia (see the details in Nolo’s article on Social Security’s requirements for getting disability for fibromyalgia). Here are some of the questions the fibro RFC asks of your doctor:

  • Does the patient meet the 2010 diagnostic criteria for fibromyalgia as defined by the American College of Rheumatology?
  • Which of the patient’s tender points are positive for pain?
  • How long have the patient’s symptoms lasted?
  • How long can the patient walk, how much can the patient lift, etc.
  • Does the patient suffer from fibro symptoms such as fatigue, cognitive and memory problems, irritable bowel syndrome, depression, anxiety, and/or lack of restful sleep?

Some doctors will charge a fee for filling out this type of form (it is quite long), but since it will be critical to your disability case, it’s well worth it to spend a hundred dollars or so on it. If you have trouble getting your rheumatologist to fill out the form, read Nolo’s article on getting your doctor to help with your disability claim.

As to your other doctors, Social Security will not take into account a chiropractor’s opinion on your diagnosis, but may consider his or her opinion on how your activities are limited. Again, since rheumatologists are specialists in fibromyalgia, Social Security will give their opinion the most weight. If cognitive or mental issues add to your inability to work, a neurologist’s opinion may be helpful as well. Your PCP’s opinion can also be helpful, not so much on the diagnosis of fibromyalgia, but to supplement the rheumatologist’s opinion on the details of your claim. Your PCP can bolster your credibility (adding their opinion that you’re not a malingerer, or faker), give a longitudinal (historical) view of your symptoms, and can specify what your limitations are. Your PCP should fill out a second fibromyalgia RFC to record these details and submit it to Social Security as well.