Social Security Ruling Aids Disability Determinations for Lupus and Fibromyalgia

Clients often come to me with diagnoses of both lupus and fibromyalgia. Representing you if you have both lupus and fibromyalgia brings a unique set of challenges.

You may have a history of different treating doctors while searching for an explanation for your symptoms. It’s difficult explaining a set of physical and mental symptoms that might unpredictably wax and wane.

Fibromyalgia, in particular, does not come with objective medical evidence to prove its existence. This last hurdle is especially troublesome in a Social Security Disability claim. Social Security requires that a “medically determinable impairment” come with appropriate medical findings. Some judges use this lack of objectivity as a way to deny disability claims based upon fibromyalgia.

Thankfully, on July 25, 2012, the Social Security Administration issued a special Social Security ruling to help you if you suffer from fibromyalgia and need disability benefits. This ruling applies to any adult or child case where fibromyalgia is an alleged impairment. The ruling is particularly useful in a claim for both lupus and fibromyalgia because it allows us to argue the fibromyalgia as a disabling impairment along with the lupus.

According to the ruling, fibromyalgia may be a medically determinable impairment when it is established by appropriate medical evidence. This “appropriate medical evidence” first includes a diagnosis by a licensed physician, meaning an MD or a DO. Secondly, your diagnosis must be consistent with the existing medical records. Lastly, your diagnosis must meet the criteria required by either the 2010 American College of Rheumatology Preliminary Diagnostic Criteria or the 1990 American College of Rheumatology Criteria for the Classification of Fibromyalgia.

THE 2010 AMERICAN COLLEGE OF RHEUMATOLOGY PRELIMINARY DIAGNOSTIC CRITERIA REQUIRES ALL THREE OF THE FOLLOWING:

1. A history of widespread pain;
2. Repeated manifestations of six or more fibromyalgia symptoms, including manifestations of fatigue, cognitive or memory problems, waking unrefreshed, depression, anxiety disorder or irritable bowel syndrome;
3. Evidence that other disorders that could cause these repeated manifestations of symptoms, signs or co-occurring conditions were excluded.

THE 1990 AMERICAN COLLEGE OF RHEUMATOLOGY CRITERIA FOR THE CLASSIFICATION OF FIBROMYALGIA REQUIRES ALL THREE OF THE FOLLOWING:

1. A history of widespread pain;
2. At least 11 positive bilateral tender points;
3. Evidence that other disorders that could cause the symptoms or signs were excluded.

If you’re seeking disability as a result of lupus and fibromyalgia, it’s essential you see your doctor on a regular basis so you get the necessary diagnosis and note the existence of the appropriate diagnostic criteria.

In addition to your diagnosis and diagnostic criteria, your doctor will also be in a position to complete function evaluations submitted by your attorney. Armed with the proper diagnosis, documented diagnostic criteria, completed functional capacity evaluations and Social Security’s ruling, you now have a better chance for success to get disability benefits if you suffer from lupus and fibromyalgia.

Article provided by attorney Gary Bimberg, a partner in Levine Benjamin law firm. Mr. Bimberg exclusively handles Social Security disability claims throughout the country. He may be reached at 1-800-675-0613 or www.levinebenjamin.com.