Changing the Way We Evaluate Fibromyalgia

Claimants diagnosed with fibromyalgia have long faced an uphill battle due to the symptoms inherent in their disease.  For the most part, those symptoms included pain that was hard to explain. Many Administrative Law Judges (ALJs) took advantage of this fact and would deny claims based on fibromyalgia by finding that the plaintiff was not credible or by finding that there was no medical evidence to support the claimant’s allegations of pain.

For many years creative attorneys tried to sidestep those ALJs who refused to acknowledge fibromyalgia as a legitimate impairment.  In most cases, the best argument was to base the claimant’s disability on Chronic Fatigue Syndrome.  This is because there is a considerable overlap of symptoms between Chronic Fatigue Syndrome and Fibromyalgia Syndrome.

As recently as this year, a district court remanded a case when the ALJ improperly “failed to consider fibromyalgia as a medically determinable impairment.”  Small v. Astrue, 840 F.Supp.2d 458 (D.Mass. 2012).  The ALJ based his decision on two erroneous grounds: 1) a medically determinable impairment may not be established on the basis of symptoms alone, and 2) a medically determinable impairment must be demonstrated by medical signs and laboratory finding.

Social Security Ruling (SSR) 12-2p, issued on July 25, 2012, changes the way ALJs evaluate claimants with fibromyalgia. SSR 12-2p states that fibromyalgia can now be the basis for a finding of disability.  A claimant can establish the basis for a finding of disability based on fibromyalgia in one of two ways:

Either by satisfying the 2010 Preliminary Diagnostic Criteria:

  1. A history of widespread pain;
  2. Repeated manifestations of six or more FM symptoms, signs, or co-occurring conditions, especially manifestations of fatigue, cognitive or  memory problems (“fibrofog”), waking un-refreshed, depression, anxiety disorder, or irritable bowel syndrome;
  3. Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.

Or by satisfying the 1990 ACR Criteria:

  1. A history of widespread pain;
  2. At least 11 positive bilateral tender points; and
  3. Evidence that other disorders that could cause the symptoms or signs were excluded.

SSA will require specific documentation of objective medical evidence to establish the criteria set forth above.

With or without the help of a lawyer, getting Social Security Disability benefits for claimants with fibromyalgia is now much easier than ever before.