Can I Receive Social Security Disability Benefits for Fibromyalgia?

Yes. However, as you can imagine, it is not easy to obtain disability benefits for Fibromyalgia. If you have been diagnosed with this disorder, you know that there is not a simple objective medical test you can take to determine whether you have fibromyalgia. Because you cannot see Fibromyalgia on an X-Ray or MRI, many judges (and doctors for that matter) are skeptical as to the existence and severity of the impairment. That is not to say that it is impossible to receive benefits for Fibromyalgia. There are some tests such as a “pressure point test” which support a diagnosis for Fibromyalgia. Some judges are less conservative than others in evaluating these claims.

Based on Social Security Ruling 12-2p, the Social Security Administration may find that a claimant’s alleged fibromyalgia is a medically determinable impairment if the record meets or exceeds the criteria set by the Administration. Under the guidance provided in Social Security Ruling 12-2p, a claimant must present evidence sufficient to establish that his or her alleged fibromyalgia is a medically determinable impairment.

Social Security Ruling 12-2p states that fibromyalgia must be established by appropriate medical evidence that comes from an acceptable medical source, i.e. a licensed physician. The Ruling makes it clear that “we cannot rely upon the physician’s diagnosis alone,” and requires evidence that documents that the physician “reviewed the person’s medical history and conducted a physical exam.” The adjudicator is also required to conduct an analysis of the record to confirm that “the physician’s diagnosis is not inconsistent with the other evidence in the person’s case record.”

Social Security Ruling 12-2p section II recognizes two sets of criteria that are commonly used in diagnosing fibromyalgia. Section II (A) of the Ruling is based upon the 1990 American College of Rheumatology Criteria for the Classification of Fibromyalgia. Based upon these criteria, the Judge or adjudicator may find that a claimant has a medically determinable impairment of fibromyalgia if he or she has all three of the following:

1. A history of widespread pain—that is, pain in all quadrants of the body (the right and left sides of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, thoracic spine, or low back)—that has persisted (or that persisted) for at least three months. The pain may fluctuate in intensity and may not always be present.
2. At least 11 positive tender points on physical examination. The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
3. Evidence that other disorders that could cause the symptoms or signs were excluded.

Section II (B) sets out alternative criteria based upon the 2010 American College of Rheumatology Preliminary Diagnostic Criteria. Based on these criteria, the Judge or adjudicator may find that a person has a medically determinable impairment of fibromyalgia if he or she has all three of the following:

1. A history of widespread pain;
2. Repeated manifestations of six or more fibromyalgia symptoms, signs, or co-occurring conditions, especially manifestations of fatigue, cognitive or memory problems (“fibro fog”), waking un-refreshed, depression, anxiety disorder, or irritable bowel syndrome; and
3. Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.

A diagnosis of fibromyalgia without the other criteria as indicated by the Administration is not enough to establish fibromyalgia as an impairment.

Additional Information:

There are many resources on the web for additional information on Fibromyalgia. One is http://www.fibrocenter.com/. This website gives you information about your pain, symptoms, diagnosis, and treatment. It also has a Pain Assessment Tool for you to assess your pain and take the results to your next doctor appointment.

My Experience In Handling Fibromyalgia Claims: I have personally handled dozens of disability claims involving fibromyalgia in hearings before the Social Security Administration.