Fibromyalgia is a disorder characterized by widespread muscle pain and tenderness and is often accompanied by fatigue, altered sleep, memory and mood. It is a long-term chronic condition which most notably causes widespread pain. The pain can range from mild achiness to intense and unbearable discomfort. The process of diagnosis focuses on areas of musculoskeletal pain and the severity of the pain. The brain and nerves may overreact to normal pain signals. Some people experience what is known as fibromyalgia fog, or “brain fog” with memory lapses, difficulty concentrating, and trouble staying alert. The back is one of the most common places to feel pain, but it can be felt all over the body.
Fibromyalgia and Social Security Disability
If you suffer from fibromyalgia, you may be entitled to Social Security Disability Benefits depending on whether you meet the definition of “disability” under the Social Security Administration’s (“SSA”) rules and regulations. There is a five-step process or analysis that the SSA uses to evaluate each claim and determine if you are disabled. In general, to meet the definition of disability you must be unable to engage in the substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months.
SSA’s 5-Step Process
1. In the first step, SSA looks at whether or not you are working. If you are working you must not be engaging in substantial gainful activity. In the year 2020, substantial gainful activity is defined as earning over $1,260 a month. Generally, if you have no earnings or are earning under that amount due to your fibromyalgia symptoms then you move on to step two.
2. In step two of the process, you must show that your impairment or impairments are severe. To be severe, your impairment(s) must have more than a minimal impact on your ability to engage in basic work activity. SSA looks at whether your symptoms are so severe as to preclude you from engaging in substantial gainful activity. Because pain is generally a subjective symptom, SSA requires objective medical evidence to establish fibromyalgia. Your medical evidence must come from a licensed physician. Also, it is not sufficient that your physician simply diagnoses fibromyalgia in and of itself. There must be evidence accompanying a diagnosis of fibromyalgia such as from a physical examination. Specifically, a person must have all three of the following:
- A history of widespread pain- pain in all quadrants of the body, right and left sides, above and below the waist, and axial skeletal pain in the back, chest, upper back or low back, that has persisted for at least 3 months. The pain does not always need to be present and can fluctuate in intensity.
- 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 be both above and below the waist. In testing the tender point sites, the physician should perform digital palpation with an approximate force of 9 pounds. A tender point is considered positive if a person experiences any pain upon feeling the pressure.
- Evidence that other disorders that could cause these symptoms or signs were excluded or ruled out. Lab testing may include imaging and other tests.
An alternative to the above three criteria, a person must have all 3 of the following:
- History of widespread pain.
- Repeated manifestations of 6 or more 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
- Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.
Besides looking at objective medical evidence from your physician, SSA also may request evidence from psychologists, as well as others who are not physicians, and maybe even not medical sources, to evaluate the severity and functional effects of the impairment. Examples of such others are neighbors, friends, family, past employers, rehabilitation counselors, teachers and statements from SSA personnel who have interviewed you.
If SSA does not have enough information to make a decision based on the evidence in the record; it may request that an independent evaluation, or “consultative examination” be done in order to evaluate the severity and functional effects of the symptoms. SSA looks for signs and findings which support a diagnosis of fibromyalgia and can reasonably be expected to produce the pain and other symptoms alleged.
Next, SSA evaluates the intensity and persistence of the pain or symptoms to see if such would limit your capacity to work. If objective medical evidence is lacking, SSA may look at your daily activities, medications, other treatment, nature and frequency of your attempts to obtain medical treatment for symptoms, and statements by others about your symptoms.
3. In step three of the process, it is determined whether your condition meets the criteria of a listing. Social Security created a list of conditions referred to as the “listings”. If you meet or equal the criteria of a listed condition; you will be considered disabled automatically. However, Fibromyalgia is not a listed condition. Thus, if the symptoms do not equal any of the listed conditions; you would move on to step four.
4. At step 4 in the process, your residual functional capacity is determined. This is an evaluation of your level of disability as measured by your functional ability to engage in basic work activity considering your impairment of epilepsy and any other impairments. The first question that must be answered is whether you are able to do any of your past relevant work considering your residual functional capacity. If you are not deemed able to return to your past relevant work, then you move on to step five.
5. At step 5 in the process, the last and final step, it is determined whether you can return to any other work within your residual functional capacity, considering your age, education and work experience. If there are no other jobs that you can do within your residual functional capacity, then you will be considered disabled. Notably, fatigue and widespread pain may result in exertional, non-exertional and environmental limitations that would preclude you from engaging in a number of jobs.
LaBovick Law Group Can Help
If you believe fibromyalgia prevents you from working, applying for social security disability is likely the right choice for you. At the LaBovick Law Group, we provide free consultations where we will review the facts of your case to determine if this is the right program for you. Call us today at (561) 623-3681 for your free evaluation.