Fibromyalgia may be a ‘medically determinable’ illness

by Sep 16, 2016

Home » FAQs » Fibromyalgia may be a ‘medically determinable’ illness

Fibromyalgia is a serious and painful disease. When it stops a worker in the U.S. from working, that individual may want to seek Social Security Disability (SSD) benefits. The Social Security Administration (SSA) issued a Social Security ruling explaining the evidence needed to show that an individual suffering from fibromyalgia has a medically determinable impairment (MDI), and how the agency evaluates such claims. In order to receive disability benefits, the SSA must find that there is enough objective evidence that the applicant’s fibromyalgia keeps the applicant from executing any amount of substantial gainful activity.

In general, applicants can only show that they have a MDI of fibromyalgia by providing the SSA with evidence from a licensed physician. But, the SSA cannot rely solely on the diagnosis. There must also be documentation that the physician examined the applicant and performed a review of the applicant’s medical history.

The SSA will take the physician’s treatment notes and compare them to the applicant’s diagnosis of fibromyalgia. It uses this information to determine whether they are consistent and to determine if the applicant’s symptoms have improved, remained the same or gotten worse.

The SSA will also consider the licensed physician’s assessment over a period of time of the applicant’s strength and ability to function. In general, the SSA needs evidence for the past year from the time the individual applies for benefits.

The SSA will determine that the applicant has an MDI of fibromyalgia if the above requirements are met and if either one of two additional requirements are met. One requirement is that the applicant has a history of widespread pain, has, at a minimum, 11 positive tender points on each side of the applicant’s body, and above and below the applicant’s waist, and that there is evidence that no other medical conditions could cause the same symptoms. The other requirement is if the applicant has a history of widespread pain, repeatedly shown manifestations of six or more symptoms, signs or co-occurring conditions of fibromyalgia and there is evidence that no other medical condition could have caused the same symptoms.

In the future, we will discuss how the SSA determines that an applicant is disabled due to having a MDI of fibromyalgia. Fibromyalgia can be a crippling illness, so it is important to understand how to the SSA will evaluate one’s case for the purpose of obtaining disability benefits.