Fibromyalgia (FM) is one of the most common allegations to appear on a Social Security Disability application, but this impairment can be one of the most difficult to prove in a disability case. It is a debilitating condition, characterized by diffuse pain in the joints, muscles, tendons, and soft tissues.
Establishing the Diagnosis:
In order for a diagnosis of FM to be considered for disability, FM must be a medically determinable impairment (MDI), which means that it must be diagnosed by an acceptable medical source (AMS) and shown to meet the specific criteria necessary to establish this diagnosis. An AMS for the diagnosis of FM is an MD. However, a diagnosis of fibromyalgia made specifically by a rheumatologist can be even more persuasive, as these providers specialize in tissue disorders.
Per the 1990 ACR Criteria for the Classification of Fibromyalgia, a person may be found to have an MDI of fibromyalgia if he or she has all three of the following: 1) A history of widespread pain that has persisted for at least three months; 2) At least 11 positive tender points on physical examination, which must be found bilaterally (both sides of the body) and both above and below the waist; and 3) Evidence that other disorders that could cause the symptoms or signs were excluded.
Alternatively, the 2010 ACR Preliminary Diagnostic Criteria can also establish the MDI of fibromyalgia via the same test above, except in lieu of the trigger point test, the claimant must have six or more signs, symptoms, and co-occurring conditions. These include fatigue, cognitive issues, memory issues (often called “fibro fog”), depression, anxiety and irritable bowel syndrome. (See Social Security Ruling 12-2p).
Obtaining a Medical Opinion:
Due to the very specific requirements for a diagnosis of fibromyalgia, it is critical to discuss your symptoms with your doctor and ensure the appropriate tests are administered. In addition to the diagnosis, evidence of your level of function is critical to your claim. Be sure to talk with your doctor about all of your symptoms, explain how these symptoms impact your activities of daily living and make certain your doctor adequately documents your report in the record.
If possible, ask your treating provider (preferably a rheumatologist), to complete a residual functional capacity (RFC) form. This form documents the physician’s opinion regarding your limitations, including how long you can stand, walk and sit, how much weight you can lift and carry, and your ability to maintain attendance in a work setting. A diagnosis alone, with no functional information, will not be enough to win your case.
Additional Helpful Evidence
In addition to the medical diagnosis, current medical records and an opinion from your treating provider, there are other ways to improve your chances for success. One way is through keeping a diary of your pain and symptoms. FM can result in good days and bad days, and often there is no way to predict how you will feel on a particular day. It can be helpful for both adjudicators at the initial and reconsideration levels and for administrative law judges (ALJ) at the hearing level to see a day-to-day account of your symptoms. Additionally, it can be helpful to obtain written statements from friends, family members, and former employers offering personal observations of your limitations.
Due to the complexity of a disability case involving fibromyalgia, it is beneficial to consult a disability attorney to help you present the strongest case possible. At Russell and Hill, PLLC, we have experienced Social Security Disability attorneys available to represent you in the often confusing process of obtaining benefits. Contact us today for more information or to schedule a consultation.
SSR 12-2p link: https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html).