Social Security Disability and Fibromyalgia

Fibromyalgia is a disease that causes widespread pain and tenderness. The pain and tenderness tend to fluctuate, and they can afflict different parts of the body at different times. People suffering from chronic Fibromyalgia are fatigued and frequently suffer sleep problems. They also report issues with memory and clear thinking known as “Fibro Fog.” Fibromyalgia is most common in women, often starting in mid-adulthood. Individuals at higher risk for Fibromyalgia are those who also have a rheumatic disease such as osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis.

Fibromyalgia has been a controversial disease within the Social Security disability system because there are no clear, objective tests that can diagnose Fibromyalgia. Rather, Fibromyalgia is often diagnosed when all other diseases have been ruled out by objective testing and other diagnostic methods. Without any objective or diagnostic tests to confirm the presence of Fibromyalgia or any other impairment, many Social Security judges were wary of awarding claims based on this disease because they had no sure way of knowing whether the claimants’ subjective reports of pain were authentic or manufactured.

Social Security’s Deputy Commissioner for Disability issued a memorandum in 1998 that sought to clarify Social Security’s treatment of Fibromyalgia and to expound upon what data would constitute a reliable diagnosis of Fibromyalgia for disability purposes. In that memorandum, Social Security explained that a “medically determinable impairment is established in the presence of anatomical, physiological, or psychological abnormalities that can be objectively observed and reported apart from the individual’s perceptions even in the absence of a definitive diagnosis” (emphasis added). More specifically, the memorandum explained that Social Security would use the American College of Rheumatology’s definition of Fibromyalgia in order to establish a set of criteria for Fibromyalgia in disability claims. That definition provides that Fibromyalgia involves “widespread pain in all four quadrants of the body for a minimum duration of 3 months and at least 11 of 18 specified tender points which cluster around the neck and shoulder, chest, hip, knee, and elbow regions” (emphasis added). Other signs and symptoms of Fibromyalgia would include irritable bowel syndrome, chronic headaches, jaw joint dysfunction (temporomandibular joint dysfunction), sleep disorder, and severe fatigue.

Social Security clarified these statements in a ruling effective July 2012. In that ruling, SSA stated that they “cannot rely upon the physician’s diagnosis alone.” Rather, the medical evidence must show that the doctor reviewed the person’s medical history and performed a physical exam. More importantly, SSA will only find an impairment of Fibromyalgia when all three of the following criteria are met: a) documented history of widespread pain in all four body quadrants, with skeletal pain, for at least 3 months; b) at least 11 positive tender points on both the right and left sides of the body and above and below the waist; and c) that other diseases that could cause the same symptoms have been excluded. Alternatively, the medical record should show a history of widespread pain; repeated manifestations of Fibromyalgia symptoms such as fatigue, memory problems (“Fibro Fog”), depression, and irritable bowel syndrome; and that other diseases that could cause the same symptoms have been excluded.

In summary, it can be harder to prove the existence of a disabling condition based on Fibromyalgia in disability claims because of the nature of the disease itself and the challenges in making the diagnosis. Claimants can strengthen their claims by seeing a Rheumatologist and by asking for regular tender point tests.