Over the past 20 years plus of handling social security disability cases in Pennsylvania, I have seen a significant increase in the numbers of people who have been diagnosed with fibromyalgia. Sadly, during that same time period, I have noticed a reluctance by the Social Security Administration (SSA) generally and of certain Administrative Law Judges, specifically, to recognize that fibromyalgia is a real and often debilitating condition.
To some Social Security Judges, though by no means all, a person with fibromyalgia is a person who is faking their pain. Accordingly, many fibromyalgia (FM) cases were denied quite easily because there is no objective proof of the condition. Time and medical advancements, however, have provided a better understanding of FM. As a result, this has led to an important shift in how SSA deals with FM.
Medically Determinable Impairment
Recently, the Social Security Administration formally recognized fibromyalgia as a condition that is quite real and which can be disabling. Social Security Ruling (SSR) 12-p observes that “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.”
If established, FM can now be considered by SSA as what they refer to as a medically determinable impairment (MDI). SSR 12-2p, therefore, identifies the type of evidence SSA requires in disability cases in order to establish that the FM is, indeed, an MDI.
Acceptable Medical Source
What type of evidence is required to establish that FM is an MDI? First, there has to be a diagnosis of FM. Perhaps this goes without saying, but not every person involved in the medical field is qualified to make such a diagnosis.
Furthermore, the SSA is clear that not all sources from which you receive medical treatment are considered an acceptable medical source upon which SSA will rely. Indeed, SSR 12-2p states that “A licensed physician (a medical or osteopathic doctor) is the only acceptable medical source who can provide such evidence.” This statement means that sources such as therapists, nurses, nurse practitioners, and chiropractors will not be accepted by SSA as an acceptable source.
Second, in addition to a proper diagnosis of FM, SSA has set forth specific criteria that, briefly stated, includes either: 1) a history of widespread pain in specific areas, at least 11 tender points on physical exam (for which SSA provides a diagram of all 18 tender point areas), and evidence that other disorders that could cause the symptoms or signs were excluded, or 2) a history of widespread pain, repeated manifestations of 6 or more FM symptoms, signs, or co-occurring conditions, and evidence that other disorders that could cause these repeated manifestations of symptoms, signs, or co-occurring conditions were excluded.
Of course, even if a person establishes that their FM is an MDI, this is not the end of the inquiry. Even if your FM is established, the SSA still must determine whether you are able to perform any job you worked within the past 15 years, and if not, whether you are able to perform other work to which you can make an adjustment.
If you have a Social Security Disability claim in Pennsylvania or may likely file one soon, and if fibromyalgia is an important factor in that claim, contact the disability attorneys at Trinity Law in York and Lancaster, PA and surrounding counties for help today.