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Jul 24, 2012

New Ruling On Fibromyalgia

     Social Security will publish in the Federal Register tomorrow a Ruling 12-2p on the evaluation of fibromyalgia in disability claims. The ruling states that "FM [Fibromyalgia] is an MDI [Medically Determinable Impairment] when it is established by appropriate medical evidence. FM can be the basis for a finding of disability." The ruling specifies that either the 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia or the 2010 ACR Preliminary Diagnostic Criteria may be used to determine if the claimant has FM as a MDI. 
     As to determining Residual Functional Capacity, the Ruling states that (footnotes omitted):
Widespread pain and other symptoms associated with FM, such as fatigue, may result in exertional limitations that prevent a person from doing the full range of unskilled work in one or more of the exertional categories ... People with FM may also have nonexertional physical or mental limitations because of their pain or other symptoms. Some may have environmental restrictions, which are also nonexertional.
      The problem with the Ruling is that it demands that a physician write down a long list of the factors used in the ACR criteria which led to the diagnosis of FM. Even rheumatologists don't do that generally any more than psychiatrists record each factor leading to a diagnosis of major depression. If you're a specialist, you may "know it when you see it" without bothering to record each step leading to the diagnosis.

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    Anonymous Anonymous said...

    Since the requirements are pretty clear, just have your clients bring them to their doc appointments. If they have FM, should be pretty easy to come up with a checklist for a doc to fill out that satisfies the requirements of this ruling.

    1:53 PM, July 24, 2012  
    Anonymous Anonymous said...

    If you're a specialist, you may "know it when you see it" without bothering to record each step leading to the diagnosis.

    Under that criteria, are you willing to accept ALJ's who make decisions on cases based on their ability to know it when they see that someone is disabled or not...bypassing a need for them to rationalize their decision?

    1:57 PM, July 24, 2012  
    Anonymous Anonymous said...

    Anon 1:57, the difference is that doctors treat patients and keep records and notes solely for the treatment of the patient. They don't prepare records with the mindset that in 2 years they will need to be produced for an SSD case. ALJs, on the other hand, are required by law to proceed with a 5-step sequential evaluation and to document specific findings at each step with the explicit knowledge that their findings may be reviewed by the Appeals Council or the federal courts. That's a mighty big distinction.

    2:35 PM, July 24, 2012  
    Anonymous Anonymous said...

    Yes it is a big distinction. Under your theory, shouldn't the ALJ be able to document his specific findigns with actual medical data, not just the "i know it when I see it" gut feel of a doctor paid by an attorney?

    2:59 PM, July 24, 2012  
    Anonymous Anonymous said...

    The problem as I see it is that FM has become a garbage can diagnosis- when a gp has a patient complaining of pain and they can't find any positive findings, FM becomes the diagnosis and they start throwing meds at them. Or a new patient presents, says they have it and that is the end of that, the diagnosis is carried forward ad infinitum. Why should that be enough?

    3:59 PM, July 24, 2012  
    Anonymous Anonymous said...

    Fibromyalgia is almost always associated with affective disorder. This is a standing joke in FO's. Virtually every allowance involving fibromyalgia has an accompanying personality disorder, and not depression related to pain as the mythology tries to portray. However, since almost all cases involve females, political correctness prevents this info from ever being included in explanations of fibromyalgia. In fact, I theorize that fibromyalgia is a physical manifestation of real pain stemming from the mental disorder, through the nervous system.

    9:40 PM, July 24, 2012  
    Anonymous Anonymous said...

    It is called "crazy lady syndrome" for a reason.

    7:36 AM, July 25, 2012  
    Anonymous Anonymous said...

    I always thought there should be some sort of fibromyalgia listing or pain disorder listing. The problem is the subjectivity of the pain.

    This ruling probably helps. But some ALJs just do not buy FM as a real disorder. It really probably comes down to credibility. Thanks for the post.

    3:08 PM, July 25, 2012  
    Anonymous Anonymous said...

    There is a listing -- 12.07 for somatoform disorders

    3:23 PM, July 25, 2012  

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