Social Security Disability
Fibromyalgia and Social Security Disability in Arizona
People with fibromyalgia are often told, in one way or another, that their condition is not real enough to count. Sometimes by an employer. Occasionally by a doctor. And frequently by the shape of a system that prefers an X-ray it can point at.
It counts. Fibromyalgia claims are won, and our office has been winning them for decades. Stephanie Lake has handled Social Security disability claims — and only Social Security disability claims — since founding the firm in 1992, and over those decades fibromyalgia has gone from a diagnosis Social Security barely acknowledged to one it has issued formal guidance on.
But these cases are won on documentation, and they are lost on documentation. Which parts of the record matter is not obvious, and it is not what most people assume.
Read the video transcript
Transcript of the video above, lightly edited for clarity.
What is your experience with fibromyalgia cases?
I have a lot of experience with fibromyalgia cases in the 23 years that I’ve been handling Social Security disability cases. Fibromyalgia in those years has come along as a very large cause of disability because of the nature of the symptoms this disorder creates. The symptoms are very disabling, as anyone who suffers from fibromyalgia can tell you. And Social Security over these years has really come to recognize that, thank goodness. They’ve issued regulations over the years that have made it easier to win if you have fibromyalgia.
In fact, as recently as July of 2012, Social Security issued a new regulation that really helped people with fibromyalgia, because it recognizes that your treating doctor can diagnose fibromyalgia — it doesn’t have to be diagnosed by a rheumatologist. That was a big change in the regulations. I still recommend rheumatology treatment, because a rheumatologist is the type of specialist that should be helping someone with fibromyalgia get the optimal diagnosis and treatment — but it’s helping win those cases.
The key symptoms that need to be recognized and documented in the records in order to win a fibromyalgia case are, of course, the tender points. Your doctor needs to check the tender points and make sure they’re writing them down. We need at least 11 tender points, and we need them documented in the record — preferably at least every six months, at least once a year, but definitely when the diagnosis is made and when it is confirmed. If those tender points are not documented in the record, the diagnosis isn’t going to be considered valid by Social Security, because the tender points are part of the American College of Rheumatology requirements for a true fibromyalgia diagnosis.
Additionally, unrefreshed sleep should be something your doctor is documenting — that experience of sleeping a lot but never feeling rested. Furthermore, widespread pain: most people do a good job of explaining this to their doctor, and it’s usually one of the initial symptoms people turn up with when they’re finding out they have fibromyalgia. But it’s still important that it gets documented in the record in order to meet the American College of Rheumatology definitions.
When it comes to winning the fibromyalgia case in front of the Social Security judges or the Social Security Administration, I always find it’s essential to document the mental aspect of the case. Fibromyalgia has physical impacts on a person, of course — but the mental results of those physical symptoms are really one of the big reasons people can’t work when they have fibromyalgia. So getting that mental result documented is what’s ultimately going to have a big impact on winning the case: either getting mental health treatment directly, or at least having your physical doctor document that you’re having problems with concentration, difficulty following through on things, or confusion.
And when it comes to winning in front of Social Security, there is so much importance put on a person’s mental functioning. Social Security will often order a mental evaluation with one of their mental health specialists to evaluate how a person is functioning mentally. People with fibromyalgia should not fight that process. They should embrace it — go and cooperate with it, in order to have it documented how their concentration is being affected, and how they are suffering from confusion as a result of their fibromyalgia or whatever mental problems they may be having in addition to it.
Why Fibromyalgia Is Harder Than It Should Be
Most disability claims lean on something a machine can see. A herniated disc appears on an MRI. A cardiac condition shows on an echocardiogram. Fibromyalgia has no such test. There is no scan, no blood panel, no imaging study that establishes it.
That creates a specific problem inside a system designed to weigh objective medical evidence. Social Security cannot decide a case on how a claimant says they feel. It needs findings in a record. And for years, fibromyalgia claimants were caught in the gap between a condition that was genuinely disabling and a file that did not look like it contained anything.
That gap has narrowed considerably, and the reason is a specific ruling.
SSR 12-2p: The Ruling That Changed These Cases
On July 25, 2012, Social Security issued SSR 12-2p, a ruling devoted entirely to how fibromyalgia is evaluated. It remains the governing guidance today.
It did two important things.
First, it confirmed that fibromyalgia can be a medically determinable impairment — a real condition Social Security must consider, rather than a complaint it can set aside for want of objective findings.
Second, and this is the part that changed daily practice: the diagnosis can come from your treating physician. It does not have to come from a rheumatologist. For claimants in rural Arizona, or anyone facing a months-long wait for a specialist referral, that mattered enormously.
Two Routes to Establishing Fibromyalgia — Most People Only Know One
SSR 12-2p sets out two alternative sets of criteria. A claimant only has to satisfy one of them, and many people — including some doctors — are only aware of the first.
Route one: the 1990 criteria
- A history of widespread pain — in all quadrants of the body, plus axial skeletal pain — persisting for at least three months
- At least 11 positive tender points out of 18, found on physical examination, on both sides of the body and both above and below the waist
- Evidence that other disorders which could cause the symptoms have been excluded
The tender point examination is a specific procedure: the physician applies roughly nine pounds of pressure at eighteen defined sites. It takes a few minutes and it has to be recorded.
Route two: the 2010 criteria
- Widespread pain lasting at least three months
- Six or more fibromyalgia symptoms, signs or co-occurring conditions — particularly fatigue, cognitive or memory problems, waking unrefreshed, depression, anxiety, and irritable bowel syndrome
- Again, evidence that other disorders have been excluded
This second route does not require tender points at all. If your doctor never performed a tender point examination — and many do not, particularly outside rheumatology — the case is not lost. It means the record has to be built the other way, around the pattern of symptoms.
Worth knowing: the American College of Rheumatology revised its criteria again after 2012, and those later revisions are not written into SSR 12-2p. Social Security still applies the ruling as issued, which is why the 1990 and 2010 frameworks remain the ones that matter for a claim.
The Three Things That Have to Be in the Record
1. Tender points, written down
If you are proceeding under the 1990 criteria, this is the finding the case turns on. Your doctor has to check for tender points and record the result. A physician who examines you thoroughly but writes "fibromyalgia, stable" has not given Social Security what it needs.
Ask for them to be documented when the diagnosis is made and confirmed, and then periodically — ideally every six months, at minimum once a year. Fibromyalgia fluctuates, and a single examination years ago is weaker evidence than a pattern.
Without tender points in the record, Social Security may not treat the diagnosis as valid, because they form part of the recognized criteria. That is the single most common reason an otherwise sound fibromyalgia claim runs into trouble.
2. Unrefreshed sleep
This one gets missed constantly, because people do not think to mention it. It is the experience of sleeping a great deal and never feeling rested — waking as tired as you went to bed.
It is a recognized feature of fibromyalgia and it belongs in your notes. Tell your doctor explicitly, in those terms, and check that it appears in the record afterwards.
3. Widespread pain
Most claimants describe this well, and it is usually the symptom that led to the diagnosis in the first place. Even so, it still has to be documented to satisfy the criteria — and "documented" means recorded in the medical file, not merely something you have told people about.
The Part That Actually Decides Most Cases
Here is what thirty years of these claims teaches, and it is not what most people expect.
Fibromyalgia obviously has physical effects. That goes without saying. But the mental consequences of those physical symptoms are one of the main reasons people with fibromyalgia cannot work — and getting those documented has the biggest impact on winning the case.
Many people know this as "fibro fog." Concentration that will not hold. Losing the thread mid-task. Difficulty following through on things that used to be automatic. A confusion and an inability to deal with things that is difficult to describe and easy to underestimate.
This matters because of how disability is actually decided. Fibromyalgia has no listing — there is no box in Social Security’s manual it can tick. Instead, cases are decided on residual functional capacity: what you can still do, sustained, in a normal work setting, day after day.
And an administrative law judge deciding whether someone can hold a job is weighing questions like these:
- How many days per month would this person be absent?
- How much of the workday would they be off task?
- Could they maintain concentration, persistence and pace?
- Would they need unscheduled breaks, and how often?
Those are the questions cognitive symptoms answer directly. Pain alone rarely settles a case. Pain plus an inability to concentrate, sustain effort, and show up reliably frequently does.
How to get it documented
Either route works: mental health treatment in its own right, or your physical doctor recording the cognitive symptoms in the notes. What matters is that somewhere in your file, a medical source has described the concentration problems, the difficulty following through, and the confusion — in specific terms rather than as a passing mention.
If Social Security Sends You for a Mental Evaluation, Go
Social Security frequently orders a consultative mental evaluation with one of its own specialists to assess how a claimant is functioning mentally.
Claimants sometimes resist this. It can feel like being doubted, or like an attempt to find something that undermines the claim.
Do not fight it. Embrace it.
That evaluation is an opportunity, not a trap. It is a chance to have exactly the material that wins fibromyalgia cases placed into the record by Social Security’s own examiner — how concentration is being affected, what confusion is present, and what other mental effects accompany the condition. A claimant who attends, cooperates and answers honestly usually leaves that appointment with a stronger file than they arrived with.
Missing it, by contrast, can mean a decision made on an incomplete record.
A Practical Checklist
- Ask your doctor to perform and record a tender point examination — at diagnosis, and periodically after
- Tell your doctor about unrefreshed sleep in those words, and check it appears in the notes
- Make sure widespread pain is documented, not just discussed
- Raise the cognitive symptoms explicitly — concentration, following through, confusion
- Keep treating. Gaps in care are read as improvement, whether or not that is what happened
- Attend every appointment, including consultative examinations
- Ask your doctor to complete a fibromyalgia medical source statement describing your functional limits — not a letter saying you are disabled, which carries no weight
That last point deserves emphasis, because it is the most common wasted effort in these cases. A note from a doctor stating that you are disabled tells Social Security nothing it can use — disability is a legal conclusion reserved to the agency. What helps is a statement describing how long you can sit, stand and walk; how often you would be absent; how much of the day you would be off task. We keep a fibromyalgia-specific form on our resources page, free to download and take to your appointment.
The Short Version
Fibromyalgia is winnable. Social Security recognizes it, has issued a ruling on how to evaluate it, and there are two separate routes to establishing it — so a missing tender point examination is not the end of a claim.
What decides these cases is whether the record contains the right things: the diagnostic findings, the sleep, the pain, and above all the cognitive effects that explain why full-time work is not sustainable.
If you are in Arizona and dealing with a fibromyalgia claim — whether you have not applied yet, or you have been denied — it costs nothing to talk it through.