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Fibromyalgia and Social Security; How To Win Your Case!

At Marken Law Group, PS, we have helped many people with the often disabling condition of fibromyalgia get the benefits they deserve! It is important to know what Social Security has stated with respect to this often misunderstood diagnosis.

The benchmark for Fibromyalgia as it pertains to your Social Security Disability claim can be found in SSR 12-2p, which is a policy interpretation ruling issued by Social Security. I have included a link above to provide the COMPLETE policy. Fibromyalgia is what is considered a “rule-out” disorder. In other words, medical doctors arrive at the diagnosis of fibromyalgia through the process of ruling-out other disorders. This is, actually, on of the requirements for fibromyalgia to be considered a severe impairment by Social Security.

A person must meet ALL three of the following criteria:

1. A history of widespread pain;

2. Repeated manifestations of six or more FM symptoms, signs, or co-occurring conditions, especially manifestations of fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression, anxiety disorder, or irritable bowel syndrome; and

3. Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.

As in all claims, objective medical evidence of at least a 12 month duration, of fibromyalgia in this instance, is required.

Under category 1, a history of widespread pain is commonplace with persons with fibromyalgia.

Category 2 requires at LEAST 11 positive “trigger points” on physical examination. There are a total of 18 potential trigger points for pain. These tender points MUST be found to be bilateral and above and below the waist. This is a potential problem in your pursuit of disability with fibromyalgia. Many physicians simply do not do this elaborate examination with respect to trigger points and correspondingly document this in their notes. Some doctors will take the patients subjective complaints, rule out other disorders and come to a conclusion of fibromyalgia and prescribe medication. It is important your physician conduct a trigger point examination for fibromyalgia. Your attorney will be able to thoroughly review your medical records to check if a trigger point examination has been conducted. Often a fibromyalgia specific questionnaire should be provided to your doctor to focus their diagnosis and treatment. These questionnaires, which any Social Security attorney should possess and provide, can go a long way in proving disability as it relates to your fibromyalgia.

Category 3 requires a rule-out diagnosis. There needs to be objective medical evidence that your doctor tested for other potential diagnosis and through the process ended up with fibromyalgia. An initial diagnosis of fibromyalgia without other evidence of testing or considering other diagnosis will be largely disregarded by the Social Security Administration.

The next step is up to the fact finder (judge or DDS worker) to evaluate the intensity and persistence of the fibromyalgia to determine if the condition is disabling. It is worth noting that some medical experts find fibromyalgia to be under the 14.09 umbrella listing for inflammatory arthritis when considering whether one meets a listing level disability for fibromyalgia.

Fibromyalgia can be a difficult to diagnosis to live with and is a disabling condition. It is important you have an attorney who knows the law and Social Security’s policy regarding fibromyalgia to help you win your disability claim.

Marken Law Group, PS, has helped hundreds obtain disability benefits. Call today. No Benefits, No Fee!