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Fibromyalgia and SSDI: New Ruling by the SSA

Late last month, the Social Security Administration put into effect rules to help the SSA and administrative law judges evaluate Fibromyalgia for Social Security Disability purposes. It explains how the SSA "develop[s] evidence to establish that a person has a medically determinable impairment of fibromyalgia and how [it] evaluate[s] fibromyalgia in disability claims and continuing disability reviews under titles II and XVI of the Social Security Act."

What is Fibromyalgia / FM?

Fibromyalgia is a condition that causes significant pain in a person's tendons, joints, muscles or soft tissues. The pain occurs for at least three months.

When is Fibromyalgia a medically determinable impairment?

There are two sets of classifications that the SSA can use to determine whether someone with Fibromyalgia has a medically determinable impairment or not:

The 1990 ACR Criteria for the Classification of Fibromyalgia: Under this classification, the SSA will determine that a person has Fibromyalgia if he or she has all three of the following:

  • A history of widespread pain that has lasted for at least three months
  • At least 11 positive tender points (of 18 possible)
  • Evidence that no other disorder caused the symptoms

The 2010 ACR Preliminary Diagnostic Criteria: Under this classification, the SSA will determine that a person has Fibromyalgia if he or she has all three of the following:

  • A history of widespread pain
  • Repeated manifestations of six or more symptoms of Fibromyalgia or co-occurring conditions such as fatigue, memory problems, depression, anxiety or IBS
  • Evidence that no other disorder caused the symptoms

Applying for SSDI with Fibromyalgia

In order to receive SSDI for Fibromyalgia, a person must show he or she meets the above requirements through objective evidence. This includes medical opinions from an acceptable medical source, evidence of ongoing medical evaluations (over one year period), psychologist records (when available) and information from nonmedical sources, such as neighbors and employers.

The disability must be so severe that it limits a person from performing "any substantial gainful activity" and must last at least one year or be terminal.

Source: Federal Register, Social Security Ruling, SSR 12-2p; Titles II and XVI: Evaluation of Fibromyalgia.

Learn more about Fibromyalgia and SSDI by visiting our page on Fibromyalgia.

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