Applying for Social Security Disability Benefits with Fibromyalgia

According to the Centers for Disease and Control and Prevention (the CDC), fibromyalgia affects about 4 million US adults, which is about 2% of the adult population. Most experts agree that women tend to be at higher risk of fibromyalgia than men. In fact, fibromyalgia is so prevalent that the Social Security Administration has enacted special rules for dealing with this diagnosis.

What Is Fibromyalgia?

The hallmark of fibromyalgia is widespread pain that cannot be explained by lab tests, x-rays, MRIs, or other visible and detectable abnormalities. There’s a great deal of research surrounding fibromyalgia and its causes. At the present time, the exact cause or the physiological basis for the disease is not well understood. Most experts agree that the neurological system is involved.

According to the American College of Rheumatology, in addition to widespread and unexplained pain, people with fibromyalgia tend to experience the following symptoms:

• Extreme fatigue
• Sleep problems (difficulty falling asleep, staying asleep, or feeling tired even after getting adequate sleep)
• “Fibro fog,” which typically consists of difficulties with attention and/or memory
• Extreme tenderness and sensitivity to the touch of skin and/or joints

Though less common, some individuals with fibromyalgia may also experience the following:

• Severe headaches and/or migraines
• Pain in the jaw and face, sometimes including “TMJ” syndrome
• Pelvic pain
• Digestive and urinary problems

If you or someone you love suffers from fibromyalgia and would like to seek Social Security disability benefits, call us at Nolan & Shafer, PLC for help: (231) 403-0040.

What Must Be Shown to Get Disability for Fibromyalgia?

There is something called a “Social Security Ruling” that deals specifically with fibromyalgia. The full text of this ruling can be found here. Essentially, the Social Security Administration recognizes two different ways for diagnosing fibromyalgia.

1. The first is a history of widespread pain, along with at least 11 positive tender points (these points are spread throughout the entire body), and the absence of any other physical or mental disorders that may explain the symptoms.
2. The second way to diagnose fibromyalgia requires medical documentation of a history of widespread pain, repeated manifestation of six or more fibromyalgia symptoms (see the above symptoms), in the absence of any evidence of other conditions that can explain the symptoms.

There is no “Social Security listing” specifically for fibromyalgia. However, if your symptoms are severe enough, it could be found that your fibromyalgia medically equals a different listing (for example, listing 14.094 inflammatory arthritis, or listing 12.04 for depression). For your fibromyalgia to “medically equal” a different listing, you will need very specific medical documentation, usually from specialists, to show that you meet the requirements of these listings. Our attorney can help you work to acquire the necessary medical information to support your claim.

How a Rheumatologist Can Help Your Claim

In our experience, the diagnosis of fibromyalgia is usually more or less a catchall where a patient’s pain cannot be explained by other methods, such as x-rays, MRIs, or lab tests. Some internal medicine and family doctors are very familiar with what is required for a proper diagnosis of fibromyalgia. However, unless the very specific findings are made as outlined above, it is unlikely that the Social Security Administration will place much weight on the fibromyalgia diagnosis. 

While fibromyalgia is not a form of arthritis, and typically does not result in damage to the joints (which really is what a rheumatologist specializes in), the role of a rheumatologist in your case is to rule out other rheumatic illnesses. As a result, it is usually the case that the best bet for a proper diagnosis of fibromyalgia is the seal of a rheumatologist’s opinion.

If you think you have fibromyalgia, but you cannot seem to get the proper diagnosis, asking your family doctor to refer you to a rheumatologist is probably a good idea.

The following are some of the clinics in West Michigan that specialize in Rheumatology:

West Michigan Rheumatology PLLC 
1155 E. Paris Ave. SE., #100 
Grand Rapids, MI 49546

Rheumatology Centers of Western Michigan 
6425 S. Harvey St. 
Norton Shores, MI 49444

Metro Health Park East 
4055 Cascade Rd. SE 
Grand Rapids, MI 49546

Great Lakes Center of Rheumatology 
3394 E. Jolly Road Suite C 
Lansing, Michigan 48910

What if My Fibromyalgia Doesn’t Meet the Disability Listings?

Sometimes you can’t prove any of the above conditions, but you still have back pain that makes you unable to work and medical evidence to document it. In this case, the Social Security Administration may look at your “residual functional capacity,” or RFC. The five categories of residual functional capacity are as follows:

1. Sedentary
2. Light
3. Medium
4. Heavy
5. Very Heavy

Which category you are placed in generally depends on your ability to stand and/or walk and the amount of weight you can lift consistently. However, your residual functional capacity also takes into account several other factors, including your ability to:

• Push and/or pull (including operation of hand and/or foot controls)
• Climb ramps and stairs, or ladders, ropes and scaffolds
• Balance
• Stoop, kneel, crouch, or crawl

The RFC also looks at whether you have any mental, emotional, or psychological impairments (like depression, anxiety, or bipolar disorder) that limit you to unskilled work, and whether you have any environmental limitations, such as being unable to work in extreme heat or cold, or not being up to work in an environment with fumes.

Whether or not you are found to be disabled by your fibromyalgia depends on how an Administrative Law Judge or other adjudicator weighs the medical evidence in determining your residual functional capacity. This is why it is so important to develop the medical evidence, including properly worded statements from any treating medical providers, when presenting your claim.

Denied Disability for Fibromyalgia? Don’t Give Up!

The unfortunate reality is that the majority of people suffering from fibromyalgia, even those who are clearly disabled by the health issue, are denied benefits at first. In fact, most claims must be brought before an Administrative Law Judge at a hearing.

We know that testifying before an administrative law judge is a nerve-racking process. So, in addition to preparing the medical evidence in your case, we will meet with you in person several times prior to the hearing to ensure you are prepared for any and all questions the judge may ask you during the process. Nolan and Shafer, PLC is different than many other nationwide and large firms in that you will have one attorney from the start of your claim until the end.

When you work with a disability lawyer from Nolan & Shafer, PLC, there’s no fee unless you we win your case. Call (231) 403-0040 or contact us online today to discuss your situation.