How will Social Security's new ruling SSR 12-2p affect my Fibromyalgia claim?

The Social Security Administration (SSA) issued SSR 12-2p which concerns evaluation of disability applications for Fibromyalgia (FM).  This SSR is important to FM patients in Louisiana because SSA finally acknowledges this severe and debilitating disease is a valid diagnosis and a potential basis for disability.

Quick summary of SSR 12-2p:

  1. SSA acknowledges Fibromyalgia is a medically determinable impairment that can be the basis of disability;
  2. Guidelines are established for treating physicians to follow to document the diagnosis;
  3. This ruling does not really change the system already in place to determine the severity of the symptoms from FM when determining total disability, but it reminds SSA adjudicators and ALJs of the value of non-medical observations.
  4. The medical records of the treating medical specialists remain the primary source of evidence.

SSR 12-2p – Proving the Diagnosis

Fibromyalgia and SSDI: Explanation of Ruling 12-2p

The Ruling provides two means of proving the diagnosis of Fibromyalgia. Both are dependent upon the content of your treating physician’s medical charts. Both focus on tests established by the American College of Rheumatology (ACR). The alternatives for proving diagnosis are:

  1. Proof of 1990 ACR Criteria, including all three of the following:
    1. History of widespread pain in all four quadrants of the body (both left and right, above and below the waist) along with a history of spinal pain, which has persisted for at least 3 months at varying levels of intensity: and,
    2. At least 11 positive tender points found bilaterally, and above and below the waist. The physician must document the positive tender point findings and indicate the use of approximately 9 pounds of force;
    3. Medical exclusion of other disorders that could cause these symptoms.
  2. Proof of 2010 ACR Preliminary Diagnostic Criteria, including all three of the following:
    1. History of widespread pain as noted above;
    2. Repeated evidence of 6 or more FM symptoms, or co-occurring conditions. Some examples include:
      1. Fatigue
      2. Cognitive or memory problems (“fibro fog”)
      3. Unrefreshing sleep
      4. Depression
      5. Anxiety
      6. Irritable Bowel Syndrome (IBS)
      7. Muscle weakness
      8. Headaches
      9. Cognitive problems
      10. Reynaud’s phenomenon
      11. Bladder issues
    3. Medical exclusion of other disorders that could cause these symptoms.

These criteria are not new or surprising. Many ALJs in New Orleans Social Security Disability hearings are aware of the variety of symptoms related to FM. The Ruling, though, may cause ALJs to require more careful documentation from the treating physicians. This ruling does provide fibromyalgia patients who want to apply for social security disability a guideline for discussing symptoms with their doctor.

Some issues that may result from this Ruling include, but are not limited to documentation of “9 pounds of force” in tender point testing. How many tests will be enough? How often do these symptoms have to be noted to satisfy SSA? What if other comorbid conditions do exist?

SSR 12-2p – Proof of Symptoms and Disability

This Ruling reinforces the idea of a “longitudinal” review of the records. Generally, the more consistent the treatment and complaints of pain and other symptoms, the more credibility will be given to your doctor’s medical records. A longer treatment history with increasing pain and other symptoms along with decreasing functionality can be very helpful in proving your FM and disability.

While medical records are heavily considered and hold the most weight, other sources of medical information are often helpful.  This ruling reminds SSA of the importance of these records, from other treatment providers such as counselors, neighbors, clergy, past employers, relatives, and friends.

The Ruling does acknowledge repeatedly that FM symptoms and signs may vary in severity over time. This is a helpful observation. Adjudicators and ALJs are reminded to review “all relevant evidence in the case record.” The point is made, however, that SSA can rely upon a one-time consultative examination if an FM applicant has no other probative records. Those one-time consultative examinations rarely reveal much to support FM claims.

The Ruling does note that symptoms such as pain and fatigue may preclude the ability to do even unskilled work. However, the challenge remains that there are no medical tests that can prove the existence of pain or fatigue, and, more important, no test that measures the severity of these symptoms. These symptoms must be clearly and consistently noted in the treatment records to be considered credible by an ALJ.

Therefore, it cannot be restated often enough: the critical evidence in any disability application is the treating records of the treating specialist. SSA generally gives greater weight to treating rheumatologists and pain specialists in FM cases than to general practitioners. The decision makers will read every note from every treating source. Make sure you are communicating your symptoms at every visit. Do not assume that because the doctor “knows” about your symptoms that they are being documented. If your limitations and problems are not in the medical charts it will still be difficult to persuade SSA of their severity. While SSA will have to consider other evidence, they will still primarily focus on the medical documentation.

Conclusion

SSR 12-2p eliminates any last vestige of doubt about the existence of Fibromyalgia as a severe medical problem which can cause a patient to be totally disabled under the Social Security Act. This is great news for Houma & Metairie Social Security Disability claimants.  The Ruling does not change what you will have to prove to obtain disability benefits, but it does provide clear guidance that will prove useful in meeting your burden.

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Loyd J. Bourgeois
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Disability and Personal Injury Attorney