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Effective today – July 25, 2012 – the Social Security Administration (“SSA”) announced new rules for how it evaluates disability claims involving fibromyalgia.  In Social Security Ruling 12-2p, recognizes in writing for the first time that

Fibromyalgia (“FM”) 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 3 months. FM is a common syndrome.

Commonly abbreviated “SSR,” Social Security Ruling’s are written guidelines that are binding on all parts of SSA.  Though they are not statutes or regulations, they control how SSA evaluates claims.

SSR 12-2p clearly states that Social Security determined that “FM [fibromyalgia] is an MDI [medically determinable impairment] when it is established by appropriate medical evidence. FM can be the basis for a finding of disability.”

According to SSR 12-2p, “appropriate medical evidence” means:

  • Records from an M.D. or D.O. – only doctors will be acceptable (no Physician Assistants or Nurse Practitioners).
  • Medical evidence must be “objective.”
  • Supporting medical records – a diagnosis alone is not enough.
  • Doctor’s records or statements must show they 1) reviewed the claimant’s history, and 2) conducted a physical exam.
  • Physician chart notes must be consistent with the diagnosis of fibromyalgia;
  • Physician notes must document one of the following:
    1.  History of widespread pain, documentation of 11 of 18 tender points from the American College of Rheumatology 1990 standards, and evidence that other disorders have been ruled out by the doctor,
    OR
    2.  History of widespread pain, “repeated manifestation” of 6 or more of the 2010 Preliminary Diagnostic Criteria of the American College of Rheumatology signs of fibroymalgia (with particular emphasis on fatigue, cognitive/memory problems (often called “fibro fog”), waking unrefreshed, depression/anxiety, or irritable bowel, and that other conditions have been excluded as the cause of the claimant’s symptoms.
  • Longitudinal medical records (doctor notes over a long period of time) going back at leat 12 months before the date a person applies for Social Security Disability or SSI.
  • Psychologist notes are relevant to the extent they show that a person has another medically determined impairment like depression, and how their fibromyalgia is impacting that other condition.
  • Information from non-medical sources like a) neighbors/friends/relatives, b) past employers and teachers, and c) SSA employees who observe the person can be used to show how a person functions “day-to-day” and to assess the claimant’s credibility.

Once SSA determines that a person has fibromyalgia, they will follow their standard Five Step Sequential Evaluation Process.

Clearly, Social Security is trying to clarify that it requires extensive documentation of a person’s conditions and treatment.  SSA needs more than a diagnosis scratched on a doctor’s chart.  They require a full fibromyalgia evaluation and documentation of the condition over a long period of time.  Now, more than ever, it is crucial that claimants see a rheumatologist, rather than their primary care doctor, to document fibromyalgia and how it is impacting their life.

Click this to read the full text of SSR 12-2p in the Federal Register.

If you suffer from a disability from fibromyalgia, or any other condition, please call Florida Social Security Disability Attorney John Tucker for a free consultation at (866) 282-5260. 

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