Social Security Evaluation of Disability Based Upon Fibromyalgia

Fibromyalgia

The Social Security Administration (SSA) issued a new ruling for evaluation of disability based upon Fibromyalgia (FM). The ruling does not change the burden upon the claimant to prove the severity of the symptoms, and how those symptoms make sustained work impossible. If you are looking for a Social Security evaluation of disability based upon fibromyalgia, simply the acknowledgement of the disease and its potential impact on the lives of people suffering from this condition is an important event for FM patients. Highlights:

  1. SSA finally acknowledges FM to be a medically determinable impairment that can be the basis of disability;
  2. Guidelines are established for treating physicians to follow to document the diagnosis;
  3. The ruling does not materially change the system already in place to determine the severity of the symptoms from FM when determining total disability. It does remind decision-makers of the value of non-medical observations.
  4. The clinical charts of the treating medical specialists are still the primary source of evidence.

The focus in any disability claim is on whether the claimant can prove that symptoms are so severe that it is impossible for them to sustain any full-time work activity. The issue is not whether you can perform your prior work, or whether you can get a job. SSA is deciding whether you have proved that you cannot function at ANY basic full time work task.

The ruling provides two means of proof, both are dependent upon the content of the treating physician’s medical charts. Both focus on tests established by the American College of Rheumatology (ACR). Criteria include:

  • History of widespread pain in all four quadrants of the body.
  • At least 11 positive tender points found bilaterally, and above and below the waist.
  • Medical exclusion of other disorders that could cause these symptoms.
  • Repeated evidence of 6 or more FM symptoms, or co-occurring conditions, examples include:
  • Fatigue
  • Cognitive or memory problems (the Ruling uses the phrase “fibro fog”)
  • Unrefreshing sleep
  • Depression
  • Anxiety

This Ruling reinforces the idea of a “longitudinal” review of the records. Generally the more consistent the treatment, and the more consistent the descriptions of the symptoms, the more credibility will be given to the medical charts.

Contact us if we can be of assistance for a Social Security evaluation of disability based on Fibromyalgia.

Further Resources:

National Fibromyalgia Association – Helping to bring awareness and legitimacy to fibromyalgia (FM).

Fibromyalgia Network – Overview of fibromyalgia pain and fatiguing symptoms, treatment, diagnosis, doctor referrals, research, diet, and coping.

SSA Fact Sheet on Fibromyalgia – The following guidelines will help you understand the kind of information SSA needs to evaluate disability claims based on Fibromyalgia.

 

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