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Social Security disability claims are not supposed to be decided based on the gender of the applicant. Reliance on the apparently neutral mechanism of clinical medical evidence, however, has a disproportionate impact on women bringing disability claims based on fibromyalgia. Recognizing and identifying disability has been delegated by Congress and the Social Security Administration almost entirely to physicians, based upon a misguided and mistaken belief that clinical medical evidence evaluated by a trained physician will answer with certainty whether an individual claimant is capable of working. Fibromyalgia, a diffuse syndrome characterized by excess pain that is overwhelmingly diagnosed in women rather than men, is not easily shown with clinical evidence. The disabling aspect of fibromyalgia is widespread and prolonged pain, supported only by a patient’s subjective reports, and even the diagnosis is made on the basis of whether a patient describes pain at specific points on her body. Fibromyalgia claims thus provide a case study for evaluating the effectiveness and objectivity of the disability evaluation process. This article explains why the Social Security Administration relies so heavily on clinical medical evidence, traces the history of excess pain claims and why they are so difficult to evaluate, and explains why the current standards disproportionately disadvantage female fibromyalgia claimants.