Fibromyalgia causes widespread pain in the joints, muscles, tendons and other soft tissues. The pain is often very heightened and it can make it extremely difficult to function normally, let alone maintain the pace required to work 8 hours a day, five days a week.
No specific objective medical tests exist that a physician can rely on to determine whether someone has Fibromyalgia or does not have Fibromyalgia, and Social Security does not have an “impairment” listing for this condition.
Yet, Fibromyalgia can cause significant dysfunction in a person’s ability to perform even sedentary work. Because there is no x-ray, blood test or other diagnostic testing that can be done to diagnose the disease, it can very difficult to obtain Social Security Disability benefits if your Fibromyalgia causes a significant impairment in your ability to work.
So, how do you provide the required “objective medical evidence” that the Social Security Regulations require for Social Security to accept your Fibromyalgia as a “medically determinable impairment?”
Generally, Social Security defines a medically determinable impairment as an impairment that results from anatomical, physiological, or psychological abnormalities evidenced by medically acceptable clinical and laboratory diagnostic techniques that show the existence of the condition, and that supports the pain and functional deficits you are reporting.
Simply because a person has pain, even extreme or severe pain, does not mean they qualify for social security disability. The pain that they are experiencing, has to be linked to a medical diagnosis of a condition that is supported by accepted diagnostic testing/criteria.[1]
If your doctor has ruled out every possible auto-immune condition and all other conditions that could be causing your symptoms, and finally diagnosed you with Fibromyalgia, you know that some medical professionals have a good grasp on the disease, while others do not.
In order to get a diagnosis of Fibromyalgia that Social Security will accept as a medically determinable impairment, you will likely want to treat with a Rheumatologist. Rheumatologist are generally the main treatment providers for individuals suffering with Fibromyalgia, which makes a Rheumatologist uniquely qualified to help document your condition in sufficient detail to qualify for social security disability benefits.
While you are not required to have a Rheumatologist diagnose and treat your Fibromyalgia, you must use a licensed medical or osteopathic physician. In other words, if you have been diagnosed by a PA or ARNP, because they are your primary care provider, you should ask your PA or ARNP to make the proper referral to a Rheumatologist, or a doctor specialized in treating Fibromyalgia.
Treating with a specialist will not only greatly improve your ability to get benefits established, but the specialist may be able to improve your ability to function to a point where you feel you may be able to return to work.
Once you have a knowledgeable doctor, it’s important that your doctor work with you, to make sure your condition is well documented. In the past, doctors had identified 18 tender points that were common in people with Fibromyalgia, and doctors had been finding a person had Fibromyalgia if they did not have another condition that explained their symptoms, and had at least 11 of the 18 tender points when they performed their exams.
However, because Fibromyalgia symptoms can fluctuate on any given day, recent studies have found that whether a patient has 11 documented tender points on each exam, is not a clear measurement to use to diagnose or monitor the disease.
Despite recent medical opinions discounting the number of tender points that must be present, Social Security has issued a policy interpretation ruling SSR 12-2p. Regardless of recent medical advancements, Social Security still requires 11 documented tender points as well as other documented findings to accept a claimant’s Fibromyalgia diagnosis as a medical determinable impairment.
Specifically for Social Security purposes, a claimant needs the following:
1) History of widespread pain in all quadrants on both the left and right side of the body.
2) At least 11 positive tender points on physical examination, found on both sides of the body, as well as above and below the waist.
a. The 18 tender points are located one each side of the body at the:
i. Occiput (base of the skull);
ii. Low cervical spine (back and side of neck); Trapezius muscle (shoulder);
iii. Supraspinatus muscle (near the shoulder blade); second rib (top of the rib cage near the sternum or breastbone);
iv. Lateral epicondyle (outer aspect of the elbow);
v. Gluteal (top of the buttock);
vi. Greater Trochanter (below the hip); and
vii. Inner aspect of the knee.
3) In performing the testing of tender points, the physician should perform palpation with approximately 9 pounds of force.
4) Evidence that other disorders that could cause the symptoms and signs must have been evaluated and excluded (laboratory testing including complete blood counts, erythrocyte sedimentation rate, ANA, thyroid and rheumatoid factor tests, as well as any imaging that may be warranted to rule out RA or other conditions).
In addition to the above, your medical records over a 12 month period of time prior to application will be reviewed to determine if your condition is consistent with Fibromyalgia over the past year, so you want to make sure you are seeing your specialist regularly and following your doctor’s recommendations.
You will also want to make sure you have third party (witness) statements in your file from friends, family, past employers, counselors, rehabilitation therapists or teachers that have observed the difficulties you are having with your function.
I prefer to use your most recent past employer, if possible, because that person can offer testimony about what your job duties were, and the challenges they observed. That employer can testify if you missed several workdays because of your health, or testify about the accommodations that they tried to make to help you be able to continue working.
Even if you did not leave your last employer on friendly terms, that employer will likely be willing to complain about how you were not able to do your job, which is exactly the type of evidence that helps support the position that you cannot work full time.
Lastly, if you have Fibromyalgia and have been denied social security disability benefits, I highly recommend you obtain an attorney to represent you in your social security disability appeal.
Fibromyalgia can be very difficult to prove in sufficient detail for Social Security to grant benefits, so having an experienced advocate can greatly improve your chances of getting a favorable decision.
