For years people with fibromyalgia who are unable to continue working at a full-time job have struggled and worried about whether they would qualify for Social Security Disability. Finally, last week the Social Security Administration issued a ruling providing guidance on how they develop evidence to establish that a person has a medically determinable impairment (MDI) of fibromyalgia, and how they evaluate fibromyalgia in disability claims and continuing disability reviews under titles II and XVI of the Social Security Act. This ruling went into effect on July 25, 2012.
For a complete copy of the ruling, including footnotes, references and a tender point diagram, see Social Security Ruling, SSR 12-2p; Titles II and XVI: Evaluation of Fibromyalgia in the Federal Register. Following is a copy of the core elements of the ruling that I think would be of most interest to people with fibromyalgia.
Fibromyalgia is a complex medical condition characterized primarily by widespread pain in the joints, muscles, tendons, or nearby soft tissues that has persisted for at least three months. FM is a common syndrome. When a person seeks disability benefits due in whole or in part to FM, we must properly consider the person's symptoms when we decide whether the person has an MDI of FM. As with any claim for disability benefits, before we find that a person with an MDI of FM is disabled, we must ensure there is sufficient objective evidence to support a finding that the person's impairment(s) so limits the person's functional abilities that it precludes him or her from performing any substantial gainful activity. In this Ruling, we describe the evidence we need to establish an MDI of FM and explain how we evaluate this impairment when we determine whether the person is disabled.
FM is an MDI when it is established by appropriate medical evidence. FM can be the basis for a finding of disability.
I. What general criteria can establish that a person has an MDI of FM?
Generally, a person can establish that he or she has an MDI of FM by providing evidence from an acceptable medical source.A licensed physician (a medical or osteopathic doctor) is the only acceptable medical source who can provide such evidence. We cannot rely upon the physician's diagnosis alone. The evidence must document that the physician reviewed the person's medical history and conducted a physical exam. We will review the physician's treatment notes to see if they are consistent with the diagnosis of FM, determine whether the person's symptoms have improved, worsened, or remained stable over time, and establish the physician's assessment over time of the person's physical strength and functional abilities.
II. What specific criteria can establish that a person has an MDI of FM?
We will find that a person has an MDI of FM if the physician diagnosed FM and provides the evidence we describe in section II.A. or section II. B., and the physician's diagnosis is not inconsistent with the other evidence in the person's case record. These sections provide two sets of criteria for diagnosing FM, which we generally base on the 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia(the criteria in section II.A.), or the 2010 ACR Preliminary Diagnostic Criteria(the criteria in section II.B.). If we cannot find that the person has an MDI of FM but there is evidence of another MDI, we will not evaluate the impairment under this Ruling. Instead, we will evaluate it under the rules that apply for that impairment.