SSA Establishes Criteria for Fibromyalgia

As of July 25, 2012, Social Security Ruling 12-2p is in effect. According to the Social Security Administration, this Social Security Ruling (SSR) provides 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.

Fibromyalgia is a complex medical condition characterized by widespread musculoskeletal pain joints, muscles, tendons, or nearby soft tissues that has persisted for at least 3 months. It is often accompanied by fatigue, sleep, memory and mood issues. As with any claim for disability benefits, before the Social Security Administration find that a person with an MDI of fibromyalgia is disabled, they 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, the Social Security Administration describes the evidence they need to establish an MDI of fibromyalgia and explain how they evaluate this impairment when they determine whether or not the person is disabled. According to the ruling, the Social Security Administration will find a MDI of fibromyalgia if a physician diagnoses the condition based on the 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia, or the 2010 ACR Preliminary Diagnostic Criteria.

According to the 1990 ACR Criteria for the Classification of Fibromyalgia, the Social Security may find that a person has an MDI of FM if he or she has all three of the following:

1. A history of widespread pain-that is, pain in all quadrants of the body (the right and left sides of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, thoracic spine, or low back)-that has persisted (or that persisted) for at least 3 months. The pain may fluctuate in intensity and may not always be present.

2. At least 11 positive tender points on physical examination. The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.

3. Evidence that other disorders that could cause the symptoms or signs were excluded. Other physical and mental disorders may have symptoms or signs that are the same or similar to those resulting from fibromyalgia. Therefore, it is common in cases involving fibromyalgia to find evidence of examinations and testing that rule out other disorders that could account for the person's symptoms and signs. Laboratory testing may include imaging and other laboratory tests (for example, complete blood counts, erythrocyte sedimentation rate, anti-nuclear antibody, thyroid function, and rheumatoid factor).

If the Social Security Administration determines that a person has an MDI of fibromyalgia, their claim continues to follow the five-step evaluation process that all other claims are evaluated under. As for all claims presented to the Social Security Administration, the most important issue at hand is objective medical evidence. According to the new ruling, "When a person alleges fibromyalgia, longitudinal records reflecting ongoing medical evaluation and treatment from acceptable medical sources are especially helpful in establishing both the existence and severity of the impairment."

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