Social Security Issues New Fibromyalgia Ruling

 Posted on August 11, 2012 in Social Security Disability

On July 25, 2012, the Social Security Administration (SSA) issued Social Security Ruling, SSR 12-2p; Titles II and XVI: Evaluation of Fibromyalgia. The purpose of the ruling is to give guidance as to how the government establishes that fibromyalgia is a medically determinable impairment and how to evaluate the condition in Social Security disability benefits claims. How does the ruling change the landscape for people suffering from fibromyalgia applying for disability benefits?

If you are applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you will have to survive a five step sequential evaluation process to demonstrate that you are in fact disabled. Many people suffering from fibromyalgia are denied disability benefits at the early stages of the disability process. At step one, Social Security evaluates whether a claimant is performing substantial gainful activity.

At step two, the government will consider whether your medical condition is severe. Until SSR 12-2p was issued, SSA had no formal guidance how to evaluate fibromyalgia claims. In fact, there are still many people out there that refuse to acknowledge fibromyalgia as a severe medical condition or that it even exists. With SSR 12-2p, SSA now has guidelines to determine whether a claimant's fibromyalgia survives step two of the process. To do this, a judge will review the longitudinal record and the physician's medical charts and focus their attention to two tests established by the American College of Rheumatology (ACR): 1990 ACR Criteria for the Classification of Fibromyalgia and 2010 ACR Preliminary Diagnostic Criteria.

At step three, SSA must determine whether a claimant meets or medically equals a listed impairment. Fibromyalgia cannot meet a listing because one does not exist. Claimant's suffering from fibromyalgia could at best equal a listing, one common one to equal is 14.09D. To be clear, even after issuing SSR 12-2p, claimant's suffering from fibromyalgia still cannot meet a listing. This means that most claims will have to move on to the next step in the sequential evaluation process.

At steps four and five, the government must use a Residual Functional Capacity assessment to determine whether the claimant with fibromyalgia can perform past relevant work or any other work that exists in significant numbers in the national economy. Even with the guidelines set forth in SSR 12-2p, it is still the claimant's burden to demonstrate how the symptoms of fibromyalgia make sustaining full-time employment near impossible.

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