Fibromyalgia is one of the most complicated and least understood medical conditions. Fibromyalgia symptoms are numerous, random and diverse. Multiple systems in the body are affected. Put simply, fibromyalgia causes too many problems for a conventional doctor to manage within the confines of the current system.
Fibromyalgia can’t be easily confirmed or ruled out through a simple laboratory test. Your doctor can’t detect it in your blood or see it on an X-ray. Instead, fibromyalgia appears to be linked to changes in how the brain and spinal cord process pain signals. Because there is no test for fibromyalgia, your doctor must rely solely on your group of symptoms to make a diagnosis. Fibromyalgia symptoms include widespread body pain, fatigue, poor sleep and mood problems. But all of these symptoms are common to many other conditions. And because fibromyalgia symptoms can occur alone or along with other conditions, it can take time to tease out which symptom is caused by what problem. To make things even more confusing, fibromyalgia symptoms can come and go over time.
Fibromyalgia is also often characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. In the past, at least 11 of these 18 spots had to test positive for tenderness to diagnose fibromyalgia. But fibromyalgia symptoms can come and go, so a person might have 11 tender spots one day but only eight tender spots on another day. And many family doctors were uncertain about how much pressure to apply during a tender point exam. While specialists or researchers may still use tender points, an alternative set of guidelines has been developed for doctors to use in general practice. These newer diagnostic criteria include: (1) Widespread pain lasting at least three months, (2) Presence of other symptoms such as fatigue, waking up tired and trouble thinking, and (3) No other underlying condition that might be causing the symptoms.
Many applicants for Social Security disability benefits who apply based on fibromyalgia get denied. Part of the reason has been that Social Security doesn’t have a disability “listing” for the condition. To address the problem, the Social Security Administration (SSA) published a ruling in 2012, SSR 12-2p, giving additional guidance to disability claims examiners and administrative law judges as to how to assess fibromyalgia cases. This ruling has helped reduce the number of fibromyalgia claimants who are denied at the initial application stage and increase the number of fibromyalgia sufferers who file an appeal and eventually win disability benefits.
If the SSA determines that you have the medically determinable impairment of fibromyalgia under the new ruling, then the evaluation is not over. The SSA will develop a “residual functional capacity” (RFC) assessment for you to determine if there is any work you can do, including your past work. An RFC assessment is an evaluation of your ability to perform various exertional levels of work. The SSA bases your RFC on your medical records, opinions from doctors and specialists, and statements from you and your family members as to your abilities, such as how long you can stand, sit, and walk, how much you can lift, and how well you can focus and remember instructions. If your RFC prevents you from returning to your past work, or any other work that you can do given your age, education, and experience, then you will be found disabled.
See SSR 12-2p: https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html