2.3 Fibromyalgia

What You Should Know


By Jason Carney. Esq.

First, know that you can indeed be awarded Social Security disability benefits if you suffer from Fibromyalgia. Fibromyalgia is a complex medical condition characterized by widespread musculoskeletal pain in the joints, muscles, and other soft tissues, among other symptoms such as fatigue or mood disturbance, which persists indefinitely (or at least three months). Fibromyalgia’s symptoms can be severely physically and mentally debilitating.

But just having a diagnosis of Fibromyalgia is not enough; you also need to show to Social Security how severe your symptoms are, how often they occur, how long they last, and how they limit your physical and/or mental abilities. Thus, it is crucial to establish consistent treatment with your doctor or specialist, so that over time, the nature, frequency and duration of your Fibromyalgia symptoms can be established through your medical records, as recorded by your doctors.

Still, Fibromyalgia has historically been somewhat tricky to establish in a Social Security disability case, and often a Fibromyalgia claim was easier to win if it overlapped with other medical problems, or “severe impairments.” The difficulty with winning a case based on Fibromyalgia alone was primarily due to Fibromyalgia not having a “Listing” under Social Security’s disability guidelines. Social Security uses Listings to describe the specific criteria and symptoms one must establish to show disability; for example, “Rheumatoid Arthritis,” or “Coronary Artery Disease,” or “Bipolar Disorder” all have Listings describing the necessary symptoms or clinical findings to establish disability. Thus, with no Fibromyalgia Listing, it was difficult to know exactly what one needed to show to Social Security in order to establish a legitimate diagnosis of Fibromyalgia.

Fortunately, in July 2012 Social Security further clarified what is expected when alleging Fibromyalgia as a basis for disability. In Social Security Ruling 12-2p (“SSR 12-2p”), Social Security outlined the evidentiary requirements one must establish in a FibromyalgiaF disability case.

In SSR 12-2p, Social Security utilizes the 1990 American College of Rheumatology (ACR), or the 2010 ACR Preliminary Diagnostic Criteria to find that Fibromyalgia is a severe impairment under the disability guidelines. Pursuant to these criteria, a person alleging Fibromyalgia must demonstrate the following:
i. Evidence of chronic widespread pain in all quadrants of the body (meaning the right and left sides of the body, and above and below the waist);

i. Evidence that shows your doctor excluded other diseases that could cause the same symptoms (e.g. Lupus or Arthritis);

i. And one of the following:

a. At least 11 of 18 possible tender points on physical examination by a doctor. The 18 tender points are located on each side of the body at the neck, upper back, shoulders, rib cage, elbows, lower back or top of buttock, below the hip, and the inner aspect of the knee.

a. Repeated manifestations of six or more Fibromyalgia symptoms, especially fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression or anxiety, and irritable bowel syndrome.

Further, these criteria must be documented in medical records by a medical or osteopathic doctor (as opposed to a nurse practitioner or physician’s assistant). Getting your diagnosis and treatment from a specialist doctor such as a Rheumatologist or Orthopedist can be even more compelling.

But remember, as mentioned before, obtaining a valid diagnosis for Fibromyalgia pursuant these criteria in SSR 12-2p is only the beginning. You still must show how severe your Fibromyalgia symptoms are, how often they occur, how long they last, and how they limit your physical and/or mental abilities. The best way to do this is to establish consistent treatment over time with your doctor or specialist so that the nature, frequency and duration of your Fibromyalgia symptoms can be established through your medical records, as recorded by your doctors. By doing so, you will significantly improve your chances of ultimately being awarded Social Security disability benefits based on your diagnosis of Fibromyalgia.