May newsletter

December 2022

Fibromyalgia Disability Claims:
Helpful Information

Fibromyalgia (FM) patients face particularly difficult issues getting Social Security disability benefits.

social security benefitsNot only are the markers indicating the disease difficult to document, the symptoms of chronic pain and fatigue are impossible to objectively prove or measure. Since the Social Security Administration (SSA) regulations strongly favor objective medical evidence of the impairment and the symptoms, claimants suffering from Fibromyalgia have always had an uphill battle.

SSA issued a ruling for evaluation of Fibromyalgia claims a number of years ago. While the Ruling did not help as much as if SSA would include this disease in its Listings of Impairments, it does control decision making and eliminates the discussion of whether Fibromyalgia is a real disease. The ruling did not change the burden upon the claimant to prove the severity of the symptoms, and how those symptoms make sustained work impossible. However, the formal recognition of the disease and its impact on the lives of people suffering from this condition was an important event for FM patients. This ruling has had a significant impact on disability claims based on FM.

Highlights include:

  1. SSA finally acknowledged FM to be a medically determinable impairment that can be the basis of disability;
  2. Guidelines have been established for treating physicians to follow to document the diagnosis;
  3. While the ruling did not materially change the burden of proving the severity of the symptoms, it did remind decision-makers of the importance of non-medical observations;
  4. The clinical charts of the treating medical specialists are still the primary source of evidence.

The focus in any disability claim is on whether the claimant can prove that symptoms are so severe that it is impossible for them to sustain any full-time work activity. In FM cases, the focus should be on the word “sustain.” The claimant may be able to perform short term activity, but if it is documented in the charts that those short bursts of activity raise fatigue and pain levels, then sustained work may be impossible.

The ruling focuses on tests established by the American College of Rheumatology (ACR). Criteria include:

  1. History of widespread pain in all four quadrants of the body;
  2. At least 11 positive tender points found bilaterally, and above and below the waist on repeated exams;
  3. Medical exclusion of other disorders that could cause these symptoms;
  4. Repeated evidence of 6 or more FM symptoms, or co-occurring conditions, examples include: fatigue, cognitive or memory problems (the Ruling uses the phrase “fibro fog”), unrefreshing sleep, depression and anxiety.

Patients must be reminding their rheumatologist to be performing the tender point testing, as that is not typical practice.

This Ruling reinforces the idea of a “longitudinal” review of the records. Generally, the more consistent the treatment, and the more consistent the descriptions of the symptoms, the more credibility will be given to the medical charts. Teaching this to claimants when the application is filed is critical to ultimate success in the application process and a key role for experienced representatives.

Free Seminar:

If your organization would like a free presentation on Fibromyalgia, or other chronic medical problems, and disability, please contact our office to make arrangements.

If you want more detail on SSDI and SSI eligibility then we should schedule an in-service with your organization.

Just give us a call!

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