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Sorting Out the Intricacies of Fibromyalgia to Prove Disability, Part 2

Published on June 5th, 2020 by Web Master

In part 1 of this post, we shared information about the challenges of a disability claim based on fibromyalgia (FM), a disease-causing widespread, chronic pain, as well as severe fatigue, confusion and a wide range of other symptoms. Because of the subjectivity and variability of symptoms, slow development of the disease and difficulty of diagnosis, an attorney’s representation can be very helpful both in developing the medical record and in advocating for proper application of the law to the complex claim.

Ruling on Fibromyalgia

The Social Security Administration (SSA) issued a Social Security Ruling (SSR) in 2012 about how the agency will handle Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims based on FM, alleged to be disabling either alone or in combination with other ailments.

SSRs do not have the force and effect of the federal Social Security Act or its regulations, but all agency employees and contractors must follow the SSRs’ direction.

Developing Medical Evidence

SSR 12-2p first explains how to establish that FM is a “medically determinable impairment” (MDI), a preliminary requirement in the disability analysis. Only a licensed doctor can provide a FM diagnosis, and that diagnosis is only reliable if the physician did a physical examination and reviewed the claimant’s medical history.

The SSR requires that the doctor provide medical evidence sufficient to meet at least one of two sets of diagnostic criteria for FM from professional associations. The ruling directs the SSA to obtain specific evidence from medical treatment as well as other evidence from “acceptable medical sources” and nonmedical sources to help determine the “severity and functional effects” of FM. One option the agency has is to order and pay for a consultative examination (CE) by a doctor who has not treated the claimant.

Should the agency drop the ball and not properly or thoroughly develop the medical record, the claimant’s attorney can see that the claim file is sufficiently supplemented, on appeal before the agency if necessary.

In part 3 of this three-part blog coming next month, our Social Security Disability attorney serving Tucson and surrounding areas will describe how the ruling directs the agency to analyze subjective complaints and the ultimate question of whether the claimant is disabled.

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