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SSI & SSDI FAQs »

Fibromyalgia

1. What if a claimant has fibromyalgia; what must a judge or physician find if he or she is to be eligible for SSI or disability benefits?

Fibromyalgia is a disease that interferes with a claimant’s functional capacity.  A rheumatologist is the best type of doctor for the claimant to see and with whom to treat.  A good doctor can diagnose, document and relate the nature, frequency and length of contact with the patient and determine whether the claimant meets the criteria of the American College of Rheumatology for the diagnosis of fibromyalgia.  Such a physician would have to opine that the patient’s impairments have lasted or can be expected to last at least twelve months and clinically identify and document all of the patient’s symptoms like multiple tender points, non-restorative sleep, chronic fatigue, morning stiffness, muscle weakness, subjective swelling, numbness and tingling, breathlessness, anxiety, and depression.

A good rheumatologist can also opine that certain emotional factors contribute to the severity of the patient’s symptoms and functional limitations inclusive of the spine, chest, legs, hands, and arms.  These document the nature, frequency, and severity of the patient’s pain and also identify factors that would precipitate pain. A good rheumatologist  can also opine that the patient’s impairments (physical impairments plus any emotional impairments) are reasonably consistent with the symptoms and functional limitations described in his or her evaluation and determine how long during a typical workday the patient’s experience of pain or other symptoms would be severe enough to occasionally, frequently, or constantly interfere with attention and concentration needed to perform even simple work tasks and to what degree the patient would be able to tolerate work stress,  and identify the side effects of the claimant’s medications that may have implications for working, e.g., dizziness, drowsiness, stomach upset, etc.

As a result of the patient’s impairments, a rheumatologist or other physician can estimate the patient’s functional limitations if the patient were placed in a competitive work situation, for example for how long the patient could walk without rest or severe pain; sit at one time, e.g., before needing to get up, etc.; or stand at one time, e.g., before needing to sit down, walk around, etc., in an 8 hour workday (with normal breaks);  or if the patient would need to include periods of walking around during an 8 hour work day, and how long or frequently this would happen each time or if the patient would need a job which permits shifting positions at will from sitting, standing or walking, and that while engaging in occasional standing/walking, the patient would need to take unscheduled breaks during an 8-hour workday, and how often this would happen and the patient would have to rest  before returning to work.

2. What is the American College of Rheumatology’s definition of Fibromyalgia?

According to the definition of Fibromyalgia by the American College of Rheumatology (ACR), Fibromyalgia is defined as a disorder in patients as “widespread pain in all four quadrants of the body for a minimum duration of 3 months and at least 11 of the 18 specified tender points which cluster around the neck, shoulder, chest, hip, knee and elbow regions with development of other clinically documented over time.”  Possible symptoms include IBS, chronic headaches, TMJ, dysfunction, sleep disorder, severe fatigue, and cognitive dysfunction.

With reference to the American College of Rheumatology standards for the diagnosis of fibromyalgia as under the ACR guidelines, are as follows:

  1. The patient had a history of widespread pain which includes pain on the right and left sides of the body.
  2. The patient had pain above and below the waist.
  3. The patient had pain (meaning a force of 4 kilograms on the tender point is “painful” and not simply “tender”) in at least 11 of 18 tender point sites on digital palpation.
  4. The patient’s pain had been documented as “tender” and the medications the patient is on for fibromyalgia would reasonably be expected to reduce “pain” in these tender areas.
  5. It was thought that should the patient should not be taken be taken off said medications.
  6. The intended effects of the medication or side effects would interfere with the patient’s ability to maintain attention, concentration or focus for 8 hours of an 8 hour day.