On July 25, 2012, Social Security issued SSR 12.02(P) which recognizes fibromyalgia as a medically determinable impairment and establishing guidelines by which the disease will be evaluated for Social Security benefits.
There are really two sets of medical criteria from the American College of Rheumatology for the diagnosis of fibromyalgia. The 1990 criteria require the finding of 11 specific tender points. The 2010 criteria do not require the finding of tender points. Both criteria require that other causes of the symptoms be ruled out--because there is no specific medical test for fibromyalgia.
In short, having a diagnosis of fibromyalgia is not sufficient to get a disability benefit. A claimant must use medical evidence to demonstrate that his/her symptoms are so severe as to prohibit the performance of any "substantial gainful activity." Generally, this means that the claimant is not able to perform any full-time work which exists in the national economy.
Frankly, fibromyalgia cases are somewhat difficult to win, especially in persons under age 50. What I look for is good medical evidence from a claimant's treating rheumatologist. Then, I try to get written statements from the treating doctor which specify the work-related activities that the claimant cannot perform.
The biggest obstacle in getting any disability case approved is the lack of medical treatment. Often, we have claimants who are treated by someone other than a medical doctor (MD or DO)--and these providers are not recognized by Social Security as "acceptable medical sources." Also, we see claimants with fibromyalgia who do not see a rheumatologist, which is the specialist best equipped to diagnose and treat fibromyalgia.
RECOMMENDATINONS
If you have fibromyalgia (or suspect you do), I would make these recommendations from the viewpoint of a Social Security disability claim:
- Get examined by a rheumatologist.
- Follow prescribed treatment if you can.
- Be sure the person who treats you is either an doctor of medicine (MD) or doctor of osteopath (D.O.). A rheumatologist will certainly be one or the other. Nurse practitioners (CRNPs), however, are not acceptable medical sources with Social Security.
- Try to see your doctor regularly (at least 3 or 4 times a year) for management.
If you want to read Social Security's ruling on how they evaluate fibromyalgia for disability, I recommend you check out this link:
SSR 12-2(P) on Fibromyalgia
For questions about disability or representation help--contact us at the Forsythe Firm. (256) 799-0297.
