It seems to be increasingly difficult for many of our clients to get access to a rheumatologist. But a rheumatologist consultation can be so very critical in a disability claim for any number of conditions. Rheumatologists are board certified internists who are qualified by additional training in the diagnosis and treatment of diseases like: osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, fibromyalgia, lupus, Sjogren’s, and other autoimmune diseases. Rheumatologists can also play a role in the diagnosis of genetic disorders like Ehlers-Danlos syndrome.

This is not to say that a diagnosis and treatment of these conditions by your treating physician alone is not enough to support your claim for disability. The Social Security rules clearly state that it is. Your primary care physician will run tests like x-rays and MRIs to document, for example, the extent of joint destruction caused by arthritic processes and will order tests looking for markers of these diseases in your blood. But a rheumatologist has particular expertise in these areas and an examination by a rheumatologist with confirmation of the diagnosis adds weight to your claim.

A comprehensive examination for fibromyalgia can be particularly important. Fibromyalgia is essentially chronic pain and an accompanying constellation of symptoms that is not caused by an obvious source. Social Security defines it as a history of widespread pain – pain in all quadrants of the body and axial skeletal pain – that has persisted for at least three months. A diagnosis of fibromyalgia is a presently made based on an interview of the patient and review of the patient’s medical history, including use of the widespread pain index (WPI), a measure of the number of painful body regions. Social Security will either want to see documentation of 1) a history of widespread pain, with 2) repeated manifestations of six of more FM symptoms, signs or co-occurring conditions (fatigue, cognitive or memory problems (“fibro-fog”), waking unrefreshed, depression, anxiety or irritable bowel syndrome); and 3) evidence that other disorders are not the cause. The Social Security Administration will also accept the 1990 American College of Rheumatology Fibromyalgia Diagnostic Criteria which required that the examination show at least 11 out of 18 positive tender points on physical examination. This “tender point” requirement was eliminated by the College of Rheumatology in their 2010 revisions, and therefore many examinations do not check for tender points, or, more commonly, simply state something like “tender points exist in a normal fibromyalgia distribution” without explicitly naming which or how many locations were tender to the touch. Some administrative law judges can get hung up on this absence.

If you have lost your ability to work due to one of these systemic diseases, it is important to document the impact of your disease through medical care. Social Security will want to see treatment records which document not only the diagnosis of the problem, but the severity of the symptoms and that you have followed doctor orders to the best of your ability without improvement. One issue you may need to discuss with your doctor is how to document the symptoms. The doctor may not want to see you in person every time you have a swollen joint or a psoriatic outbreak. But you may be able to do a video consultation or even submit photographs by email that will document the severity of a flare.