How to diagnose fibromyalgia

It can be very difficult to win Social Security disability benefits based on fibromyalgia. However,  it can be done!

While Social Security no longer considers fibromyalgia as a “imaginary” condition, or a “junk” diagnosis, you still need to make sure the diagnosis of fibromyalgia is backed up by medical findings.

I have reviewed many medical records which mention fibromyalgia, but don’t say how the doctor made the diagnosis. There is no mention of physical examinations or findings.  Social Security may throw out the diagnosis because of a lack of medical support.

Without a diagnosis, all you have are symptoms and Social Security cannot approve disability benefits on symptoms alone.

This can stop a case dead in its tracks!

So, what do you need to properly diagnosis fibromyalgia?

The National Fibromyalgia Association provides an answer:

Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized American College of Rheumatology (ACR) criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

Widespread pain in all four quadrants of the body for a minimum duration of three months

Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied

If you have fibromyalgia, and you are fighting for your Social Security disability benefits / SSI, ask your doctor if the basis for the diagnosis is documented in your file?

Do your medical records show “widespread pain in all four quadrants of the body for a minimum duration of three months?”

Do your medical records show, “tenderness or pain in at least 11 of the 18 tender points?”

Proper documentation is critical in a Social Security case. Make sure your records are complete.

Photo by Wendy Longo photography

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  • Anonymous

    Having fibromyalgia is difficult and patients really suffers from tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. Fibromyalgia is genetic so if a family member have it there is a factor that you can have it too.

    Elsie Frank,

    • ik

      With Fibromyalgia, you have to make sure your doctor diagnosis’s you correctly. If he doesn’t, then that could/would alone cause your SSDI claim to get denied. Sure would suck to have a diagnosis of Fibromyalgia just for the SSDI to say you weren’t diagnosed correctly. So, thus you have no claim for SSDI benefits.

      A rheumatologist did prescribe me medication for “Fibromyalgia like symptoms”, but yet he didn’t test me for Fibromyalgia. He didn’t say I had Fibromyalgia. I asked him if there was a test for it, but he said there wasn’t one. At that point, I figured it best to just see someone else since there wasn’t a point arguing with him that there is actually a test for it. Even though I don’t really agree with the test since the symptoms of Fibromyalgia are so so similar to Chronic Fatigue Syndrome. I think they are both the same. But if you claim “Fibromyalgia”, you have to test positive for the pressure point test.

      With regards to SSA and SSDI, you almost have to know the answers before you take the test just to pass.

  • ik

    Does this have any relevance to Chronic Fatigue Syndrome? I don’t think there is any testing or anything that can be done for that.

    • http://planet10tech.com/ TomaszStasiuk
      • ik

        I appreciate it. But I guess it depends how the SSA looks at it. As from my reading, the SSA don’t really care about diagnosis’s that have no tests. i.e. SSA recognizes Irritable Bowel Disease. There is a test for that. But the symptoms and severity can be the exact same as with Irritable Bowel Syndrome. But with Irritable Bowel Syndrome, there are no testing. So, I’ve read people commenting they’ve never heard anyone getting SSDI for Irritable Bowel Syndrome alone. Where as you could get SSDI for just having Irritable Bowel Disease since they have it in their list, and there is a test for it.

        I think it’s a scam that the SSA only takes conditions seriously that there are tests for. If your conditions and/or diagnosis has no tests, then good luck getting SSDI. As you’ll probably just have to rely on SSI instead. The other problem is there are tons of tests that have an error rate. So, you could be diagnosed with something even if you test negative. But I bet the SSA wouldn’t bat an eye to hit the “deny” button once they see “Negative” on the test report.

        i.e. there are people diagnosed with Lupas even though they test negative. Since those tests aren’t 100% accurate. So, some people with Lupas will test negative. And the problem with that is if you have to deal with the SSA.

        • http://planet10tech.com/ TomaszStasiuk

          You are putting much too strong a point on it. SSA does approve cases for conditions that do not have an objective tests. The clearest examples are *all* mental health conditions. There are no blood/x-ray/CT tests for depression, anxiety, social phobia, etc.

          You mentions CFS. Social Security has a ruling on how chronic fatigue syndrome cases should be evaluated: http://www.ssa.gov/OP_Home/rulings/di/01/SSR99-02-di-01.html

          SSA even has a fact sheet for medical professionals discussing what SSA needs in terms of evidence: http://www.ssa.gov/disability/professionals/cfs-pub063.htm

          Note: the medical standards for disability is the same under SSDI and SSI. There are reasons why individuals may qualify for one program over the other (past the DLI, not enough quarters of coverage, too much other income for SSI, etc). However, it is not because they are not disabled for SSDI, but the are disabled under SSI. The medical standard for disability does not change depending on whether a case is SSI or SSDI.