Social Security Issues Ruling on Fibromyalgia

For those disabled by fibromyalgia (FM), Social Security’s latest ruling is a helpful tool in understanding how your case will be evaluated. Social Security Ruling (SSR) 12-2p recognizes that FM can be a disabling medically determinable impairment when it is established by appropriate medical evidence. It further indicates that FM is a common syndrome, which is characterized primarily by widespread pain in the joints, muscles, tendons, or nearby soft tissues that has persisted for at least three months.

Medical Evidence Necessary to Establish Fibromyalgia Disability

In order to establish disability due to FM, you must provide medical evidence of your impairment from a licensed physician, the only acceptable medical source. Your doctor’s treatment notes must show that your doctor has reviewed your medical history and conducted a medical examination. The medical records must also be consistent with the diagnosis of FM and demonstrate your doctor’s assessment of your functional abilities over time.

Social Security has adopted the criteria set forth by the American College of Rheumatology for diagnosing FM. SSR 12-2p contains the following three requirements:

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 three months. The pain may fluctuate in intensity and may not always be present.
2. At least 11 positive tender points on physical examination (see diagram below). The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
   1. The 18 tender point sites are located on each side of the body at the:
      • occiput (base of the skull);
      • low cervical spine (back and side of the neck); Trapezius muscle (shoulder);
      • supraspinatus muscle (near the shoulder blade); Second rib (top of the rib cage near the sternum or breast bone);
      • lateral epicondyle (outer aspect of the elbow);
      • gluteal (top of the buttock);
      • greater trochanter (below the hip); and
      • inner aspect of the knee.
   2. In testing the tender-point sites, the physician should perform digital palpation with an approximate force of nine pounds (approximately the amount of pressure needed to blanch the thumbnail of the examiner). The physician considers a tender point to be positive if the person experiences any pain when applying this amount of pressure to the site.

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 FM. Therefore, it is common in cases involving FM 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).

Once your diagnosis of FM is established, it is important to have your treating physician identify disabling limitations resulting from your condition. Work restrictions identified by a rheumatologist are extremely helpful in determining that your condition is disabling.

If you are unable to work due to fibromyalgia, contact Rob Levine & Associates at 866-LAW-SSDI for help with putting together the strongest case possible!