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On Fibromyalgia

In July of 2012 Social Security issued a new ruling, SSR 12-2p, recognizing Fibromyalgia as a “complex medical condition characterized primarily by widespread pain in the joints, muscles, tendons, or nearby soft tissues that has persisted for at least 3 months.”  This ruling acknowledges that Fibromyalgia can be the basis for a finding of disability.  It also recognizes that Fibromyalgia is a common condition.

As with any other disability claim, medical evidence of the impairment is a critical component in proving the disability.  A licensed physician (medical or osteopathic doctor) is the only source that can establish that you have a medically determinable impairment, i.e., the diagnosis of Fibromyalgia.

Social Security recognizes two sets of criteria as valid for diagnosing fibromyalgia.  First is the definition established by the 1990 American College of Rheumatology (all 3 criteria must be met):

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 3 months. The pain may fluctuate in intensity and may not always be present.
2. At least 11 positive tender points on physical examination (sediagram below).  The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.

a.  The 18 tender point sites are located on each side of the body at the:
● Occiput (base of the skull);
● Low cervical spine (back and side of the neck);
● Trapezius muscle (shoulder);
● Supraspinatus muscle (near the shoulder blade);
● Second rib (top of the rib cage near the sternum or breast bone);
● Lateral epicondyle (outer aspect of the elbow);
● Gluteal (top of the buttock);
● Greater trochanter (below the hip); and
● Inner aspect of the knee.

b. In testing the tender-point sites, the physician should perform digital palpitation with approximate force of 9 pounds (approximately the amount of pressure needed to blanch the thumbnail of the examiner).  The physician considers a tender point to be positive if the person experiences any pain when applying this amount of pressure to the site.

3. Evidence that other disorders that could cause the symptoms or signs were excluded.  Other physical and mental disorders may have symptoms or signs that are the same or similar to those resulting from Fibromyalgia.  Therefore, it is common in cases involving Fibromyalgia to find evidence of examinations and testing that rule out other disorders that could account for the person’s symptoms and signs.  Laboratory testing may include imaging and other laboratory tests (for example, complete blood counts, erythrocyte sedimentation rate, anti-nuclear antibody, thyroid function, and rheumatoid factor).

The second definition that Social Security will accept as valid in establishing a diagnosis of Fibromyalgia is based upon the 2010 American College of Rheumatology Preliminary Diagnostic Criteria.  Again, all three of the following must be present:

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 unrefreshed, 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.

The weight to be given to the doctor’s diagnosis of fibromyalgia and assessment of your limitations will depend on how familiar the doctor is with you and your condition.  In other words, if the doctor has treated you for a period of time and has records which detail his/her examination findings, and these findings are consistent with your symptoms and complaints and the diagnosis of Fibromyalgia, this opinion will be given considerable weight.

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