Social Security Administration passes new Disability Ruling for those with Fibromyalgia!
September, 2013
What does this mean?
This Social Security Ruling (SSR) provides guidance on how we develop evidence to establish that a person has a medically determinable impairment (MDI) of fibromyalgia (FM), and how we evaluate FM in disability claims and continuing disability reviews under titles II and XVI of the Social Security Act (Act).[1]
When did it go into effect?
Effective date was July 25, 2012.
Publication date was July 25, 2012
Federal Register Volume 77, No.143, Page 43640
http://www.socialsecurity.gov/OP_Home/rulings/PDF/2012-17936.pdf
Where can I go to learn more?
What is needed for a diagnosis of Fibromyalgia?
Introduction
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.[2] When a person seeks disability benefits due in whole or in part to FM, we must properly consider the person's symptoms when we decide whether the person has an MDI of FM. As with any claim for disability benefits, before we find that a person with an MDI of FM is disabled, we must ensure there is sufficient objective evidence to support a finding that the person's impairment(s) so limits the person's functional abilities that it precludes him or her from performing any substantial gainful activity. In this Ruling, we describe the evidence we need to establish an MDI of FM and explain how we evaluate this impairment when we determine whether the person is disabled.
Policy Interpretation
FM is an MDI when it is established by appropriate medical evidence. FM can be the basis for a finding of disability.
- What general criteria can establish that a person has an MDI of FM? Generally, a person can establish that he or she has an MDI of FM by providing evidence from an acceptable medical source.[3] A licensed physician (a medical or osteopathic doctor) is the only acceptable medical source who can provide such evidence. We cannot rely upon the physician's diagnosis alone. The evidence must document that the physician reviewed the person's medical history and conducted a physical exam. We will review the physician's treatment notes to see if they are consistent with the diagnosis of FM, determine whether the person's symptoms have improved, worsened, or remained stable over time, and establish the physician's assessment over time of the person's physical strength and functional abilities.
- What specific criteria can establish that a person has an MDI of FM? We will find that a person has an MDI of FM if the physician diagnosed FM and provides the evidence we describe in section II.A. or section II. B., and the physician's diagnosis is not inconsistent with the other evidence in the person's case record. These sections provide two sets of criteria for diagnosing FM, which we generally base on the 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia[4] (the criteria in section II.A.), or the 2010 ACR Preliminary Diagnostic Criteria[5] (the criteria in section II.B.). If we cannot find that the person has an MDI of FM but there is evidence of another MDI, we will not evaluate the impairment under this Ruling. Instead, we will evaluate it under the rules that apply for that impairment.
A. The 1990 ACR Criteria for the Classification of Fibromyalgia. Based on these criteria, we may find that a person has an MDI of FM if he or she has all three of the following:
- 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 3 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.
a. 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.
b. In testing the tender-point sites,[6] the physician should perform digital palpation with an approximate force of 9 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.[7] 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).
from Medicinenet
from Medscape
The 2010 ACR Preliminary Diagnostic Criteria. Based on these criteria, we may find that a person has an MDI of FM if he or she has all three of the following criteria[8]:
1. A history of widespread pain (see section II.A.1.);
2. Repeated manifestations of six or more FM symptoms, signs,[9] or co-occurring conditions,[10] especially manifestations of fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed,[11] depression, anxiety disorder, or irritable bowel syndrome; and
3. Evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded (see section II.A.3.).
This information is all from the Social Security website,and can be found here;
http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html They also have much more information there such as; documentation needed to prove your diagnosis, additional information that might be collected, types of tests, etc. The usual things that apply to anyone who is applying for Social Security Disability, or SSD.
If you would like more information on Fibromyalgia please
The National Fibromyalgia and Chronic Pain Association.
They are a fantastic resource and will help you through this difficult diagnosis. They also have a wonderful newsletter and in the latest issue you can read all about how this SSD Ruling came about!
As a side note; many CRPS patients who have CRPS for a few years seem to have a greater tendency to develop Fibromyalgia.
Or you can visit our website;
Peace, Keith Orsini
PS - If you have any comments regarding this article either post them here or send them to Keith at RSDHope.
PSS - Don't forget to get your copy of the National CRPS Awareness Ribbon from the American RSDHope website.
Information for this article from the SS website -
