Many people who suffer from fibromyalgia (FM) are denied Social Security benefits when they apply to the Social Security Administration (SSA) for disability. Administrative law judges (ALJs) and claims examiners are often reluctant to approve applications for FM for a number of reasons. The primary reason is that there is no listing for this condition in the Social Security “Blue Book” Listing of Impairments. Another reason is that examiners place less significance on an FM claim unless the applicant has some other type of condition along with it. If the secondary condition had medical evidence—for example, blood tests or x-rays—the claim is given more weight. Because the symptoms of FM can present like symptoms of other illnesses, the causes aren’t clear, and diagnosing the symptoms can be subjective, disability examiners are not always sure how to classify cases of FM. However, as researchers and medical personnel have learned more about FM, Social Security now has new standards for how to assess this condition.
To address these issues, the SSA published a new ruling that helps examiners and ALJs evaluate FM, even if the symptoms can’t be confirmed or validated by definitive testing, as with conditions such as degenerative disc disease or rheumatoid arthritis. The ruling should help those who are initially denied benefits to win during the appeals process.
Medically Determinable Impairments and the New 2012 SSA Fibromyalgia Ruling
To be eligible for Social Security benefits, you must have medical evidence of that disease that’s established through blood tests, scans, x-rays, and other definitive tests. Your impairment cannot be determined through personal accounts and details of your symptoms. Thus, you’re required to have a “medically determinable impairment” (MDI), and there must be medical signs of the impairment that the SSA can see cause your symptoms. But because these symptoms are often difficult to prove—widespread pain throughout the body, tenderness in the joints, muscles, and soft tissues, fatigue, fibro fog, and dizziness—it’s not easy to get a Social Security claim for FM approved.
In 2012 however, Social Security issued a new ruling defining when FM is considered an MDI. The ruling stated that examiners and ALJs were to use criteria established by the American College of Rheumatology to decide if an applicant’s FM was an MDI. This determination is made in the following ways:
The patient needs evidence that he suffers from widespread, chronic pain that has lasted for at least three months. The pain must be in his chest, neck, or back. Through the use of lab tests or x-rays, a doctor must have eliminated other diseases such as multiple sclerosis and lupus as the cause of the symptoms.
The patient must show signs of one of the following: Eleven of eighteen “tender points,” in specified tender point areas on the body. These tender points must be felt above and below the waist and on both sides of the body. Six or more FM symptoms must occur repeatedly, particularly memory problems, depression, anxiety, fatigue, or irritable bowel syndrome (IBS). A patient can experience other symptoms, including muscle weakness, seizures, and dizziness.
The examiner will review your medical records to ensure that they include enough evidence based on these criteria. After reading your doctor’s notes, the examiner may ask for more information: data on how long you’ve experienced your impairment; the doctor’s opinion of how well you can function on a daily basis or at a job; the type of treatments you were given and if you suffered any side effects; and the period of time he expects that your activity will be reduced. It’s important to note that these criteria only establish that your FM is an MDI; it does not establish whether you’re disabled. Even if you meet the listed criteria, you must prove to the SSA that you can’t work at your current job or any other U.S. job.
However, even with the new ruling, it is still possible that FM sufferers will continue to see their benefits denied initially. Even if they’ve been under a doctor’s care for an extended period of time for this condition, applicants may still need to appeal their claims.
We Can Help
If you suffer from symptoms of FM that make it impossible to sustain gainful employment, and you’ve been denied benefits in the past, the SSA’s new ruling you help you appeal the decision. If you need help applying for Social Security Disability benefits, or you’ve applied and were denied, call Cuddigan Law at 402-933-5405. We’ll schedule an appointment to discuss your eligibility for compensation.