About the disorder

Fibromyalgia affects two to four percent of the general population. It affects women far more that men and is often associated with other conditions such as post- traumatic stress disorder, stress, anxiety, chronic fatigue, irritable bowel syndrome and depression. In addition other co-morbid mental conditions, some people have a cognitive dysfunction commonly known as brain fog. Brain fog may include problems with concentration and/or short and long term memory.

Considering the co-morbid conditions associated with fibromyalgia it is not hard to understand why Social Security and many medical professionals have considered fibromyalgia a mental rather than a physical condition.

However, medical studies conducted over the past thirty years indicate it is a disorder of the central nervous system of an unknown etiology that is associated with mental conditions rather than being a stand-alone mental disease or disorder.

Fibromyalgia symptoms are very much like other arthritic conditions such as rheumatoid arthritis or osteoarthritis. It causes widespread pain that can affect the entire body, although most suffers have tender points or trigger points of pain. Doctors have located eighteen trigger points on the body, if a person has eleven or more of those trigger points they receive a diagnosis of fibromyalgia.

How the social security administration evaluates Fibromyalgia cases

Social Security requires objective medical evidence to support a diagnosis of fibromyalgia. Unfortunately, lab tests (i.e. blood work) and imaging tests are useless for establishing fibromyalgia or its potential severity.

So what can you do to provide Social Security with objective medical evidence? Make sure that your medical file contains a diagnosis of fibromyalgia, trigger point testing results, and documentation of your medications, treatment, response to treatment, and limitations.
Social Security disability is about function more than specific conditions. It is especially important to have a well-documented history of the limitations associated with your condition. Social Security disability examiners must make a determination as to how restrictive your residual functional capacity (what you are able to do in spite of the limitations imposed upon you by your fibromyalgia) is–and if your RFC prevents you from being able to perform any your past jobs or any other kind of job.

If the disability examiner finds that you are not able to do any of your past jobs or any other jobs due to the restrictions of your fibromyalgia you may be approved for disability benefits.

Additional information:

What kind of cases win disability benefits?

Can you qualify for disability benefits with this condition?

Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records. This includes whatever statements may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis).

It will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).

Why are so many disability cases lost at the disability application and reconsideration appeal levels?

Speaking as a former Disability Claims Examiner, I can state that there are several reasons:

1) Social Security makes no attempt to obtain a statement from a claimant’s treating physician. By contrast, at the hearing level, a claimant and his or her disability attorney will generally obtain and present this type of statement to a judge;

2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. At the hearing level, of course, this is exactly what happens. And a number of disability representatives will also take such steps even earlier, at the reconsideration appeal level;

3) Disability judges, unlike disability examiners who decides cases at the first two levels of the system, can make independent decisions without being overturned by immediate supervisors–which happens frequently.

Article – SSDRC is authored by Tim Moore