The standard for eligibility for Social Security Disability benefits or Supplemental Security Income is not typically based on a specific medical condition. Eligibility is determined around having a medically diagnosed condition which makes a person unable to earn a “substantial” income through work. If your Fibromyalgia symptoms have interfered with your ability to work, and you can no longer sustain full-time work, it may be time to consider applying for disability benefits.
What is Fibromyalgia?
Fibromyalgia is a medical condition that causes widespread pain, tiredness, and problems with attention and memory (often called “fibro fog”). The causes of it are unclear, although it runs in families and may be tied to stress, trauma and infections. Some of our clients seem to relate their pain syndrome to a motor vehicle accident or a very traumatic event. Others have a diagnosis of Fibromyalgia and have not had any physical or mental trauma. Although there are some cutting edge studies happening, there is currently no specific blood test or x-ray imaging for fibromyalgia.
Doctors used to consider Fibromyalgia to be a “diagnosis of exclusion”. As a “diagnosis of exclusion” it used to take years for a person to ultimately receive a diagnosis of Fibromyalgia after reporting symptoms of pain to his or her doctors. Doctors would conduct laboratory tests and perform imaging to rule out all other potential diagnostic causes for the pain. Once those were negative, a diagnosis of Fibromyalgia would be made. Now, Fibromyalgia is diagnosed by a physical exam and review of a person’s clinical features, though your doctor will still work to rule out other possible causes for your symptoms.
Is Fibromyalgia a medically determinable impairment?
Fibromyalgia can certainly be debilitating. A client once reported to our attorney that she could no longer tolerate being hugged by her grandchildren because it was just too painful to be touched. Another stated she could not sit through her son’s football games and missed most of his high school season. This pain syndrome takes an emotional toll as it limits a person’s ability to engage in day to day life.
In order to allege any medical problem as a disability, a person who makes a claim for Social Security Disability or Supplemental Security Income claim must have a “medically determinable impairment”. This means that a person cannot self-diagnose Fibromyalgia based on chronic pain issues. A medical professional must be involved to conduct physical exams and make a diagnosis.
For the purposes of Social Security, in order to consider fibromyalgia a “medically determinable impairment”, the 1990 or 2010 criteria for diagnosing fibromyalgia by the American College of Rheumatology must be met. Your medical records must show that you meet one of the two tests. The criteria for each test are as follows:
*1990 ACR Criteria for the Classification of Fibromyalgia:
1: A history of pain all over the body that has lasted at least three months, and
2: 11 out of 18 positive tender points (areas on the body that are painful based on slight pressure), and
3: Evidence that other disorders that could cause the symptoms are excluded, such as imaging and bloodwork results.
*2010 ACR Preliminary Diagnostic Criteria of Fibromyalgia:
1: A history of widespread pain, and
2: Repeated manifestations of six or more symptoms or co-occurring conditions such as fatigue, memory problems, unrestful sleep, depression, anxiety, or irritable bowel syndrome, and
3: Evidence that other disorders that could cause the symptoms are excluded.
For more information see SSR 12-2p
Do you have a claim for disability based on Fibromyalgia?
A diagnosis alone is never sufficient for making a claim for disability. Once you have a “medically determinable impairment” you must show that it is so severe that it would prevent you from engaging in “substantial gainful activity”. The Social Security Administration will evaluate the severity of the impairment and typically will evaluate whether the claimant is able to perform substantial work with the diagnosis.
Fibromyalgia commonly causes body pain, fatigue and mental fog, which can make it extremely difficult to get and keep a job. Some clients report to us that they may have one good day where they feel capable of performing their chores and regular routine. However, doing those activities may cause a flare of Fibromyalgia symptoms and have them in bed for the whole of the following day. This type of flare of Fibromyalgia symptoms may lead to excessive work absences and ultimately to the loss of a job. Other clients report that they can do some things but they must work much slower than they used to, and that they must take a lot of breaks in a day. The Fibro Fog can be debilitating as clients report that they can’t think, lose focus, forget tasks and forget the content of conversations with family members. To add to this, medications that are prescribed to treat Fibromyalgia often cause extreme tiredness and make working very difficult.
What is needed to make a claim for disability based on your diagnosed Fibromyalgia?
The Administration recognizes that widespread pain and other Fibromyalgia symptoms, such as fatigue can limit a person from doing the full range of work; and may pose particular physical or mental limitations or environmental restrictions. However, as the symptoms and severity of the illness can wax and wane at times, it is critical to obtain the full picture of a patient’s treatment for fibromyalgia. The Administration has stated that it will evaluate “the intensity and persistence of an individual’s symptoms so we can determine how symptoms limit the ability to perform work-related activities“. Generally, stronger claims involve a claimant who is seeing his or her doctors regularly and who is reporting all the symptoms, problems and limitations he or she experiences over time.
The Social Security Administration, in evaluating Fibromyalgia, will look at the medical records to see ongoing evaluations and treatment. The Administration is required to request evidence for the twelve months prior to application. Our attorneys will always inform our clients that getting good, ongoing medical treatment for any impairment is central to making a claim as strong as possible.
How can you get started?
At The Law Offices of Kenneth Hiller, PLLC, our attorneys offer skilled guidance through the SSA disability application process. Our warm, compassionate staff can work with you to start an application or appeal a denial at all stages of the claims process. We have successfully represented thousands of clients. Contact our office today for a free consultation.
