Disability when suffering from severe fibromyalgia syndrome or chronic fatigue syndrome “Many people with severe fibromyalgia syndrome (FMS) or chronic fatigue syndrome (CFS) still wish they could work. However, patients may lack the physical and mental stamina to do so on a sustained basis – with sustained being the key word here. Even when severely impacted patients can exert themselves and “push through,” they experience a delayed flare-up of symptoms a few hours or a day later.” Richard N. Podell, M.D., M.P.H. and Wendy King Ph.D., R.N., A.P.N. Why Disability Testing for FMS is Misleading; Advice for FMS/CFS Patients and their Disability Team. Fribromyalgia Network. The Mayo Clinic defines some of the common signs and symptoms of fibromyalgia as follows: “Wide spread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied. These areas of your body include the back of your head, upper back and neck, upper chest, elbows, hips, and knees. The pain generally persists for months at a time and is often accompanied by stiffness.” “Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Some studies suggest that this sleep problem is the result of a sleep disorder called Alpha Wave Interrupted Sleep Pattern, a condition which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative state of sleep. (Stage 4) Night time muscle spasms in your legs (periodic limb movement disorder or nocturnal myoclonus and restless leg syndrome) also may be associated with fibromyalgia.” Mayo Clinic The Mayo Clinic defines the screening and diagnosis processes for fibromyalgia as follows: “Diagnosing fibromyalgia is difficult because there isn’t a single, specific laboratory test. In fact, before receiving a diagnosis of fibromyalgia, you may go through several medical tests such as blood tests and x-rays, only to have the results come back normal. Although these tests may rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, they can’t confirm fibromyalgia.” “The American College of Rheumatology has established general classification guidelines for fibromyalgia, to help in the assessment and study of the condition. These guidelines state that the criteria for fibromyalgia are that you have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure. Also, you must have wide spread pain lasting for three months. In addition to taking your medical history, a doctor checking for fibromyalgia will press firmly on specific points on your head, upper body and certain joints so that you can confirm which cause pain.” Mayo Clinic Fibromyalgia cannot be held to an objective test standard. Some Federal Courts have acknowledged that fibromyalgia and its limitations are established by clinical diagnosis. Preston v. Sec. of Health and Human Services, 854 F.2d 851, 818 (6th Cir. 1988); Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 919 (7th Cir. 2003); Boardman v. Prudential Ins. CO. Am., 337 F.3d 9, 16 (1st Cir 2003). It is important to have a doctor perform the appropriate test and clinical examinations to establish a diagnosis of fibromyalgia. It is also important to keep the doctor informed of all the symptoms that occur even if you are not experiencing them at your doctor’s visit.