Part of the analysis to determine eligibility for disability benefits by the Social Security Administration requires proof a “medically determinable impairment”. Simply put, there must be medical documentation to show that an individual has an actual medical condition, a diagnosis, and has received some form of treatment for that condition. Generally, we look for clinical testing and objective evidence such as bloodwork, MRIs, X-rays and easily observed symptoms. Subjective complaints such as pain as then considered secondary to the medical documents.
Fibromyalgia however relies primarily on subjective complaints by an individual because the condition has no clear medical test to diagnose the condition and does not have easily observed objective symptoms. Fibromyalgia is characterized by chronic and widespread pain, fatigue, disturbed sleep, stiffness and multiple tender points.
The tender points are the only discriminating characteristic that differentiates fibromyalgia from other rheumatic diseases. Patients should have 11 of 18 tender points to meet the diagnostic criteria of fibromyalgia. But with a condition that is almost entirely based on subjective complaints, how does a claimant for Social Security Disability benefits meet the requirements to receive benefits?
The Administration and the Seventh Circuit agree that fibromyalgia is characterized not only by the above symptoms but by the lack of objective evidence. Without clinical laboratory tests for this condition, the Social Security Administration is required to carefully consider the credibility of the claimant’s complaints. They must evaluate the claimant’s complaints of pain and fatigue and the limitations on their activities of daily living. It is therefore important for a claimant to share with their doctor and the Administration, detailed examples of their daily life. When these details of daily life are evaluated by a trained medical expert, specifically the rheumatologist who treats the claimant, they become part of the clinical judgment of the trained physician. The ALJ must give greater weight to the judgment of the treating rheumatologist than his own opinion because the treating physician has more experience with the claimant and certainly more experience treating and diagnosing fibromyalgia. These claims are often evaluated for how well a claimant could be expected to maintain persistence, pace and concentration in a work-related setting. Detailed descriptions of a claimant’s activity level during the day and any problems with memory or concentration are paramount to prevailing on a claim for disability because of fibromyalgia. As a result of the need for proper medical records and individual statements, an attorney should be consulted in the process of applying for benefits.