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Background/Purpose: The number of people receiving disability payments  in the United States has  increased substantially.  Rheumatic diseases are common causes of disability. Rheumatologists are often asked to evaluate patients for disability, even though the symptoms are often largely subjective. This situation is particularly challenging in evaluating fibromyalgia in patients.                                                                                                                                                                       We  We evaluated our patients’ claims over the past year in those applying for Social Security Disability.

Methods: A rheumatologist and a rheumatology nurse reviewed each claim sent to the Social Security Administration for disability status in 2013 and 2014 to determine how often we agreed that the claimant with fibromyalgia deserved to receive disability status. We defined disability as the inability to work at any job, indefinitely.

Results: Of the 31 Social Security applicants with fibromyalgia, the physician and the rheumatology nurse agreed that only 5 (16%) were incapable of working even in a sedentery position. Admittedly, this was a subjective determination. The evaluation process took into account the number of physical complaints, severity of pain, health assessment questionnaire, and physical examination. Sometimes patients, revealed they could perform tasks in their personal lives, but claimed incapable of doing at work. However, chronic fatigue and the level of pain can not be assessed objectively.

Of the patients with a diagnosis other than fibromyalgia, such as lupus and rheumatoid arthritis, 18 subjects requested Social Security disability, and 7 (39%) were thought by the physician and the nurse to be totally incapable of working.

Conclusion: In the majority of cases, the rheumatologist and nurse did not agree with the Social Security disability claim, especially in fibromyalgia patients. Because of the subjective nature of fibromyalgia symptoms, such as fatigue and pain, it may be difficult to render an accurate judgment regarding disability. But job modifications and periodic days off, permitted by the Family Leave Act, may be better alternatives to try before granting total disability status

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ACR Meeting Abstracts - http://acrabstracts.org/abstract/disability-in-the-rheumatic-diseases/