By Peter Casciano, Esq.
Do you suffer from fibromyalgia? Are you seeking disability benefits for your condition? Fibromyalgia is defined on WebMd as a syndrome that “affects the muscles and soft tissue.” Symptoms include:
- Chronic muscle pain
- Sleep problems
- Painful tender points or trigger points
These symptoms can be relieved through medications, lifestyle changes, and stress management.
Fibromyalgia and Disability
Historically, fibromyalgia has been difficult for doctors to diagnose and even harder to treat. As a result, disability adjudicators were skeptical of fibro and claims based on fibromyalgia have been notoriously difficult to win.
Slowly though, my colleagues and I have been seeing a subtle but steady warming to these fibromyalgia disability claims from adjudicators, particularly from the insurance companies who decide long- and short-term disability claims. This may be attributed to an emerging standard for diagnosing this syndrome: the 18-point trigger test. Commonly I see that if the doctor documents more than 10 “positive trigger points,” the patient will formally be diagnosed with fibromyalgia. A trigger point is positive if the patient experiences tenderness when pressure is applied.
Where are these trigger points? They are located on the left and right side of the body at:
- The base of the skull (Occiput);
- Front of the body at neck (low cervical);
- Shoulder meeting at the neck (Trapezius);
- Shoulder blade (Supraspinatus);
- Front of the body (second rib);
- Top of buttocks (gluteal);
- Hip (greater trochanter);
- Knee (patella);
- And elbow joint (lateral epicondyle).
The insurance companies, in addition to general skepticism, also have historically limited the length of payments to claimants with a fibromyalgia disability, using a clause in the contract entitled “self-reported illnesses.” However, case law has recently revealed that fibro claimants are routinely defeating the “self-reported illness” clause if their treating physicians are using the 18 point test and properly documenting the positive points.