Monday, February 18, 2013

Fibromyalgia and Social Security Disability

Fibromyalgia is a condition characterized by widespread pain, fatigue, sleep, memory and mood issues.  Very little is know about what causes this condition and there is no known cure for it.  Many of its symptoms are subjective and extremely difficult to prove with objective tests.  For this reason, Social Security claimants with a diagnosis of fibromyalgia usually face an uphill challenge in having their benefits granted.  Nonetheless, claimants with this condition, who have well documented medical records evidencing serious physical and mental limitations, should not be discouraged from pursuing their claim for benefits.    

Social Security has a disability listing that gives approval criteria for a number of conditions raging from arthritis to multiple sclerosis.  However, no specific listing exists for fibromyalgia.  Fortunately, in July 2012, the Social Security Administration issued a ruling that gives Social Security examiners a framework on how to analyze claims dealing with this condition.   The ruling directs claims examiners and judges to rely on criteria issued by the American College of Rheumatology.  Therefore, applicants with fibromyalgia must be under the regular care of a rheumatologist in order to be able to successfully make a claim for Social Security benefits.  In making the diagnosis of fibromyalgia, the doctor must make the following findings:

·         Chronic widespread pain, including pain in the back, neck, or chest

·         Evidence that shows your doctor ruled out other diseases that could cause the same symptoms (the symptoms of fibromyalgia often overlap with those of lupus, hypothyroidism, and multiple sclerosis), such as lab tests and examination notes, and

One of the following:

·         Tender points sites in at least 11 of 18 tender point areas of the body, with tender points occurring on both sides of the body and both above and below the waist. A list of the tender points can be viewed in the SSA's recent ruling on fibromyalgia. In testing tender points, your doctor should apply the approximate amount of pressure needed to blanch his or her own thumbnail. Or,

·         Repeated manifestations of six or more fibromyalgia symptoms, signs, or conditions that often occur with FM, particularly fatigue, non-restorative sleep, cognitive or memory problems (“fibro fog”), depression, anxiety, or irritable bowel syndrome (IBS). Other possible symptoms include headache, muscle weakness, abdominal pain, Raynaud's phenomenon, seizures, and dizziness.
Moreover, the rheumatologist must issue an opinion as to the claimant’s ability to carry out work related activities.

If it is found that due to fibromyalgia the claimant cannot do the work performed in the past 15 years, the Social Security Administration will see if he or she is able to adjust to other work. The Social Security Administration will consider the persons' medical conditions as well as his or her age, education, past work experience and any transferable skills that the claimant may have.  If the claimant cannot adjust to other work, the claim will be approved.  If the claimant can adjust to other work, the claim will be denied.