Disability Appeals in North Carolina  -   33 Years Experience
David R. Paletta
Disability Attorney

Raleigh, Durham, Chapel Hill, Boone
North Carolina

(919) 491-5643

Fibromyalgia and Disability

Published by David Paletta

Fibromyalgia is a complex medical Disorder characterized by widespread pain in the muscles and joints that persists for more than 3 months.  My fibromyalgia clients often tell me they "hurt all over".  

Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. Fibromyalgia is most common among women aged 20 to 50.

Fibromyalgia is difficult to accurately diagnose because all objective tests such as x-rays and blood analysis are normal. The most reliable way to diagnose fibromyalgia is through a physical exam by an experienced rheumatologist.

When I had my 1st fibromyalgia case 20+ years ago, many doctors did not believe this Disorder was a real medical condition.  Many disability Judges did not recognize fibromyalgia as a legitimate impairment.  Fortunately, those days are over.

In 2012 the Social Security Administration adopted SSR 12-2p that sets forth the procedure it will use to evaluate fibromyalgia.  This Ruling requires the following evidence in order to establish fibromyalgia as a medical impairment.

First, you must have a physical exam by a licensed doctor.  Second, the findings from the physical exam must be consistent with either the 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia  
(see http://www.rheumatology.org/Content.aspx?id=17409)  or
the 2010 ACR Preliminary Diagnostic Criteria 
(see www.rheumatology.org/practice/clinical/classification/fibromyalgia/fibro_2010.asp).

To satisfy this 2nd requirement, an individual seeking disability needs records from a rheumatologist. Simply having your family doctor say you have fibromyalgia is not enough. A one time evaluation by a rheumatologist is not enough. 

By definition, the symptoms of fibromyalgia are subjective. Thus, SSA will use the two-step process set forth in to SSR 96-7p to evaluate the severity of fibromyalgia symptoms. Evidence of fibromyalgia which meets requirements 1 and 2 above satisfies the first step of SSA's two-step process for evaluating symptoms.  

Once fibromyalgia is established per SSR 12-2p, SSA will use the criteria of SSR 96-7p to evaluate the severity of the symptoms.  The kinds of evidence SSA considers includes:

1. The limitations in daily activities caused by chronic pain;

2. The location, duration, frequency, and intensity of the pain;

3. Factors that precipitate and aggravate the pain;

4. The type, dosage, effectiveness, and side effects of medication the individual takes or has taken to alleviate pain;

5. The number and variety of treatments or medical procedures the individual receives or has received for relief of pain;

6. The number of visits to health care providers seeking pain relief.

7. The number of different health care providers the individual has seen in an effort to find pain relief.

8. The emotional impact of chronic pain.

Due to the nature of this Disorder, ALL fibromyalgia cases are difficult to prove.  I believe an individual needs at least 12 months of treatment from a rheumatologist in order to have a meaningful prospect of proving disability to disability Judge.  Moreover, it is important for your treating rheumatologist to be willing to support your application for disability.  

The good news is that disability Judges are more understanding of fibromyalgia than they used to be.
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