Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. While not everyone’s symptoms are similar, individuals living with severe fibromyalgia symptoms may be eligible for Social Security Disability benefits.
What is Fibromyalgia?
Researchers believe fibromyalgia exaggerates painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals. Fibromyalgia by its nature is a diagnosis of exclusion which simply means that there are no known objective tests (like an MRI or CT scan) to diagnose this disorder.
When a medical condition like Fibromyalgia has no objective medical tests, your reported symptoms become the basis for your diagnosis. The Social Security Administration (SSA) bases proof of disability on their ability to find that your pain is the result of a medically determinable severe impairment.
Social Security Disability and Fibromyalgia
Unlike many disorders, there is no listing for Fibromyalgia in the SSA’s official “Blue Book.” This just means that instead of relying on objective evidence, the examiners will be more focused on the symptoms you experience to determine disability.
It is not uncommon for SSA to dismiss vague allegations of pain with no apparent cause. That’s why it is critical that claimants provide consistent and substantial medical evidence documenting their complaints and symptoms.
Social Security Guidelines Related to Fibromyalgia
SSA is a federal government agency that abides by various regulations. These guidelines and regulations guide operations and disability decision-making. Social Security Regulation (SSR) 12-2p relates specifically to Fibromyalgia. We’ve roughly paraphrased its meaning below.
Social Security Regulation (SSR) 12-2p (Paraphrased)
SSA needs medical evidence from an acceptable medical source to establish that you have a medically determinable Fibromyalgia disorder. Acceptable medical sources must be a licensed physician (an MD or a DO) but SSA cannot rely upon the physician’s diagnosis alone.
The evidence must document that the physician reviewed the person’s medical history and conducted a physical exam. Moreover, the physician’s diagnoses cannot conflict with or dispute other evidence in a person’s case record.
SSA uses two sets of criteria to establish a diagnosis of Fibromyalgia:
- The 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia
- The 2010 ACR Preliminary Diagnostic Criteria
1990 American College of Rheumatology Classification for Fibromyalgia
The 1990 American College of Rheumatology classification is based on the following criteria:
(1) 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). This pain must persist for at least 3 months. The pain may fluctuate in intensity and may not always be present.
(2) At least 11 positive tender points (out of 18) on physical examination (see diagram below). The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
The 18 tender point sites are located on each side of the and highlighted in the diagram below.
The physician considers a tender point to be positive if the person experiences any pain when applying pressure to the site. And, in addition to applying the above tests, successful claimants must show medical evidence eliminating other disorders that cause similar symptoms or signs.
2010 ACE Preliminary Diagnostic Criteria for Fibromyalgia
It is much easier to establish a diagnosis of Fibromyalgia according to the 2010 ACE Preliminary Diagnostic Criteria. A positive diagnosis requires all three of the following criteria to be present:
- A history of widespread pain.
- Repeated manifestations of six or more Fibromyalgia symptoms especially manifestations of fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression, anxiety disorder, or irritable bowel syndrome; and
- Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.
Diagnosis and Disability
No matter which criteria your physician uses to diagnose Fibromyalgia, it is very important that you are open, honest, and forthcoming with your doctors about your symptoms. Once SSA can establish that a person has Fibromyalgia, the agency will consider the diagnosis when they determine whether a person is disabled.
During this process, SSA will consider whether your symptoms are so severe that they prevent you from doing past relevant work. Or, that they limit you from performing other work in the future.
If you or someone you know is suffering from Fibromyalgia and would like to apply for disability, contact us today. Our local disability lawyers would be happy to offer you a free consultation on your claim.
