Is Fibromyalgia Ratable Under the AMA Guides?

Is Fibromyalgia Ratable Under the AMA Guides?

Is fibromyalgia ratable under the AMA Guides? According to Robert G. Rassp in his book The Lawyer's Guide to the AMA Guides and California Workers' Compensation, there are two schools of thought in the matter: (1) it is not ratable pursuant to language in Chapter 18 of the AMA Guides (5th Edition) in that there's currently no known biological basis for it; or (2) it is ratable by analogy applying the language in Chapter 1 of the AMA Guides (5th Edition). Then there are some rheumatologists who don't rate it but defer the rating to a psychiatrist for somatoform pain disorder or somatization disorder under the DSM-IV.

A search in the databases for workers' comp agency decisions in the various states shows this continuing debate over the ratability of fibromyalgia. Here are some examples:


Heair v. Premier Linen & Drycleaning, Inc., 2007 IA Wrk. Comp. LEXIS 333.

Claimant fell at work on February 5, 2003, injuring her left knee and ankle. Three months later she was diagnosed with costochondritis and treated for a year before she was diagnosed with fibromyalgia at the University of Iowa Hospitals & Clinics. Dr. Isaac, a board certified rheumatologist, saw the claimant 11 times from December 2004 through November 2006. He diagnosed the claimant as having fibromyalgia and ruled out costochondritis. Other doctors who reviewed claimant's case opined that her fibromyalgia was not work related and/or not ratable under the AMA Guides.

The commissioner found the claimant had proven by a preponderance of the evidence that her fibromyalgia was caused by her work accident:

  • The reports, diagnosis, and explanation by Dr. Isaac were the most convincing because Dr. Isaac is a specialist in rheumatology, had extensive contact with claimant and provided treatment to the claimant.
  • Both Iowa and federal courts have long recognized fibromyalgia as being a disabling condition and the Office of Iowa Workers' Compensation Commissioner has found industrial disability based on fibromyalgia before.
  • Dr. Isaac pointed out that it would be reasonable to assume that the fibromyalgia was triggered by the claimant's injuries since her symptoms started three months later.


Carter v. Gulf Coast Medical Center, 2004 MS Wrk. Comp. LEXIS 77.

The claimant was injured in work-related car accident on April 17, 1998.

Dr. Katz, a psychiatrist, diagnosed claimant with fibromyalgia and migraine headaches, among other things, and assigned her a 3 percent permanent partial medical impairment rating for her low back, but did not take into account the headaches or fibromyalgia because they're not included in the AMA Guides (5th Edition).

Dr. Huntwork, a rheumatologist who began seeing claimant in January 1999, testified that it is common for a traumatic event, like a motor vehicle accident, to cause and activate fibromyalgic symptoms, and that the trauma of claimant's car accident caused and activated her fibromyalgic symptoms.

The administrative judge found claimant to be permanently and totally disabled.


Richardson v. Payless Shoesource, 2002 ID Wrk. Comp. LEXIS 12.

Defendants disputed claimant's claim of tendonitis in March 1998, arguing that claimant suffered from a preexisting condition of fibromyalgia that was not caused by work-related activities.

Dr. Wiesenhutter diagnosed claimant with classical fibromyalgia, aggravated by sprains and strains. He further opined she was predisposed to fibromyalgia, that her current pain problems were not caused by her injuries, that she was medically stable some five and one-half years previously, and that she did not have any impairment. Dr. Wiesenhutter also opined that repetitive use of her structures or excessive weightbearing would cause a severe exacerbation of her pain.

Dr. Wiesenhutter opined that claimant had extensive myofascial tender points, and that they were the cause of her chronic pain. He noted a significant percentage of individuals with fibromyalgia suffered from chronic headaches and CTS-like symptoms. Dr. Wiesenhutter further opined claimant's fibromyalgia predated her industrial accidents, going back to at least 1991, and that her accidents had aggravated it. He also opined claimant's physical examination was entirely normal, and that she had no impairment because she had not suffered an anatomical injury. Dr. Wiesenhutter could not relate claimant's current condition to any specific injury or condition.

The referee found that claimant was not injured in an accident in March 1998.

The referee concluded that the claimant was not entitled to a permanent partial impairment rating, noting that the Fifth Edition of the AMA Guides state that the pain of individuals with ambiguous or controversial pain syndromes is considered unratable. With the variety of diagnoses given to claimant, her pain syndrome can only be described as ambiguous. The referee notes Dr. Wiesenhutter found claimant was not entitled to an impairment rating. Under the Guides, fibromyalgia is unratable.

Without a permanent impairment, claimant cannot have a permanent disability. Thus, the referee concluded claimant was not entitled to a permanent partial disability rating.

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