Eligibility For Social Security Disability With Fibromyalgia
Fibromyalgia is a complex medical condition characterized by widespread pain. Fibromyalgia syndrome affects the joints, muscles and soft tissue. Symptoms include chronic muscle pain, fatigue, sleep problems, and painful tender points or trigger points, which can be relieved through medications, lifestyle changes and stress management.
A recent Social Security Ruling, SSR 12-2p, issued in 2012, addresses when fibromyalgia should be found as a medically determinable impairment. This ruling provides guidance on how SSA develops evidence to establish that a person has a medically determinable impairment. A claimant for disabilty benefits will be found eligible if they satisfy either of two sets of criteria set forth in SSR 12-2p:
The 1990 ACR Criteria for the Classification of Fibromyalgia
A claimant may be found to have a medically determinable impairment of fibromyalgia if he or she has all three of the following:
- A history of widespread pain – 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.
- At least 11 positive tender points on physical examination (of 18 tender point sites). A tender point is positive if the person experiences any pain when applying pressure. The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
The 18 tender point sites are located on each side of the body at the:
- Occiput (base of the skull);
- Low cervical spine;
- Trapezius muscle (shoulder);
- Supraspinatus muscle (near shoulder blade);
- Second rib (top of rib cage);
- Lateral epicondyle (outer aspect of the elbow);
- Gluteal (top of the buttock);
- Greater trochanter (below the hip); and
- Inner aspects of the knee.
3. Evidence that other disorders that could cause the symptoms or signs were excluded.
The 2010 ACR Preliminary Diagnostic Criteria
- A history of widespread pain;
- Repeated manifestations of six or more Fibromyalgia symptoms, signs, or co-occurring conditions, especially manifestations of fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression, anxiety disorder, or irritable bowel syndrome;
- Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.
Once it is established that a person has a medically determinable impairment, SSA will evaluate the case under the sequential evaluation process to determine whether the person is disabled. SSA will consider the severity of the impairment, whether the impairment medically equals the requirements of a listed impairment, and whether the impairment prevents the person from doing his or her past relevant work or other work that exists in significant numbers in the national economy. For more information on the 5-step sequential evaluation process for Social Security Disability, please click here for our post.