Fibromyalgia Disability Claims

March 13, 2013

Fibromyalgia is a condition that may prevent someone from working. In these situations, the person may be able to apply for short term disability benefits, long term disability benefits, or Social Security disability benefits. When it comes to filing a claim for disability benefits, it can be challenging for claimants to prove that their fibromyalgia is disabling. These challenges appear in claims to both insurance companies and the Social Security Administration ("SSA").

Those who suffer from fibromyalgia experience chronic, widespread pain and fatigue, but the objective test results may not show this. Unlike conditions such as Multiple Sclerosis or degenerative disc disease, fibromyalgia does not appear in MRIs or x-rays. Because fibromyalgia is a disorder which does not appear in medical imaging or blood tests, it can be a difficult condition to diagnose. If a fibromyalgia patient is applying for disability benefits, they should follow these steps to document proof of their disability:

1. Maintain regular medical treatment
Although it may seem like common sense, many disability claims are denied because the claimant does not maintain regular treatment with a physician. Fibromyalgia may cause chronic pain and fatigue, which makes getting to the doctor difficult at times. But if the claimant does not regularly see his or her physicians, then the medical documentation will not support a disability. According to the rules of the Social Security Administration, "a licensed physician (a medical or osteopathic doctor) is the only acceptable medical source who can provide such evidence." SSR 12-2p. Therefore, treatment with a medical doctor is absolutely necessary in the evaluation of fibromyalgia. A nurse practitioner, nurse, physician's assistant, psychologist, and chiropractor, are not considered licensed physicians. Keep in mind that this does not mean a fibromyalgia patient should stop treatment with providers that are non-licensed physicians. It simply means that the patient should make sure that their treatment includes visits with a licensed physician.

2. Rule Out Other Possible Conditions
Because fibromyalgia is a disorder that is difficult to diagnose, the appropriate testing should be conducted to rule out other conditions that could be causing the claimant's symptoms. In Social Security Ruling 12-2p, the SSA specifically requires "[e]vidence that other disorders that could cause the symptoms or signs were excluded." Among the laboratory testing identified by the SSA in its ruling, is complete blood counts, erythrocyte sedimentation rate, anti-nuclear antibody, thyroid function, and rheumatoid factor. SSR 12-2p. These tests are necessary to rule out diagnoses such as Lupus, Rheumatoid Arthritis, and other conditions that may cause similar symptoms to fibromyalgia. If these conditions are not ruled out, then a diagnosis of fibromyalgia may be more readily challenged by an insurance company or the SSA.

3. See a Rheumatologist
Unfortunately, many fibromyalgia patients are never referred to an appropriate specialist and maintain treatment with only a family doctor to treat their fibromyalgia. In order to accurately document the symptoms of fibromyalgia and receive appropriate treatment, the claimant should seek a referral to a rheumatologist. A rheumatologist is the appropriate specialist for a patient with chronic widespread pain and should be familiar with the signs and symptoms of fibromyalgia.

4. Report Your History of Widespread Pain to Your Physicians
The patient should specifically report to their rheumatologist about their history of widespread pain, i.e. pain that is in all quadrants of the body (the right and left side of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, and low back) - that has persisted for at least three months. SSR 12-2p. This information is not only necessary for the rheumatologist to understand the extent of the patient's fibromyalgia, but it is also important in documenting a disability.

5. Request a Tender Point Examination
Although fibromyalgia does not appear in medical imaging or blood tests, one important test may indicate a patient's fibromyalgia: a tender point examination. A rheumatologist should be qualified to conduct a tender point examination, which occurs when the physician applies an approximate force of 9 pounds to 18 different tender point sites over the patient's body. If the patient experiences pain when this pressure is applied, the physician considers the patient to have a "tender point." If the physician finds at least 11 positive tender points out of the 18 possible tender points, then the claimant's widespread pain is consistent with a diagnosis of fibromyalgia.

6. Report All of Your Symptoms to Your Physicians
Symptoms of fibromyalgia typically vary from patient to patient, but there is a list of common fibromyalgia symptoms. In the Social Security's Ruling, 12-2p, the SSA requires repeated manifestations of six or more fibromyalgia 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." In addition, the following symptoms, signs, or co-occurring conditions are listed in the SSA's diagnostic criteria for fibromyalgia:

[M]uscle pain, irritable bowel syndrome, fatigue or tiredness, thinking or remembering problems, muscle weakness, headache, pain or cramps in the abdomen, numbness or tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud's phenomenon, hives or welts, ringing in the ears, vomiting, heartburn, oral ulcers, loss of taste, change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, or bladder spasms...irritable bowel syndrome or depression...anxiety disorder, chronic fatigue syndrome, irritable bladder syndrome, interstitial cystitis, temporomandibular joint disorder, gastroesophageal reflux disorder, migraine, or restless leg syndrome.
SSR 12-2p. If you experience these symptoms, please report them to your physicians in order to properly document the severity of your fibromyalgia.

Filing a disability claim for fibromyalgia can be challenging because of the nature of the medical condition. If your claim for disability benefits has been denied or terminated, contact the O'Ryan Law Firm today so that we can investigate your claim. Ph: 317-255-1000.