SSR 12-2p, may equal listing 14.09D
Fibromyalgia and Social Security Disability
Because fibromyalgia has no Blue Book listing, SSA first decides under SSR 12-2p whether a licensed physician's records establish it as a medically determinable impairment. It then compares its effects to listing 14.09D for inflammatory arthritis, and if they fall short, assesses what work you can still do.
Fibromyalgia leaves little on an x-ray or a blood panel, so SSA wrote a ruling just for it. SSR 12-2p, titled Evaluation of Fibromyalgia and effective July 25, 2012, sets the criteria for proving the condition exists and explains how SSA weighs symptoms that change from week to week.
We represent adults with fibromyalgia in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims. This page covers the two diagnostic routes in the ruling, the comparison to listing 14.09D, the residual functional capacity (RFC) route, the records that matter, and the patterns behind denials.
No Blue Book listing
SSR 12-2p
Spine, joints and pain
SSA evaluates it under the ruling and listings explained below.
How does SSR 12-2p establish fibromyalgia for a disability claim?
The physician's findings then have to satisfy one of two sets of criteria drawn from the American College of Rheumatology.
Under SSR 12-2p, only a licensed physician can supply the medical evidence that establishes fibromyalgia, and SSA will not rely on the diagnosis alone. The record must show the physician reviewed your medical history and conducted a physical exam, and the diagnosis must not be inconsistent with the other evidence in your file. The physician's findings then have to satisfy one of two sets of criteria drawn from the American College of Rheumatology.
The 1990 criteria have three parts. The first is a history of widespread pain in all quadrants of the body, including axial skeletal pain in the cervical spine, anterior chest, thoracic spine or low back, that has persisted for at least 3 months. The ruling notes the pain may fluctuate in intensity and may not always be present. The second is at least 11 positive tender points out of 18 sites, found on both the left and right sides of the body and both above and below the waist. The third is evidence that other disorders that could cause the symptoms or signs were excluded.
The 2010 criteria keep widespread pain and the exclusion of other disorders. In place of tender points, they require repeated manifestations of six or more fibromyalgia symptoms, signs or co-occurring conditions. The ruling names fatigue, cognitive or memory problems, waking unrefreshed, depression, anxiety disorder and irritable bowel syndrome among the symptoms. Its co-occurring conditions include chronic fatigue syndrome, interstitial cystitis, migraine and restless leg syndrome.
Can fibromyalgia equal listing 14.09D for Social Security?
SSR 12-2p states that fibromyalgia cannot meet a listing because it is not a listed impairment. SSA instead decides whether it medically equals one, and the ruling names listing 14.09D for inflammatory arthritis as its example. That choice fits the condition: 14.09D measures recurring flares and their effect on daily life rather than joint damage on imaging.
Listing 14.09D requires repeated manifestations, at least two constitutional symptoms or signs, and a marked limitation in one of three areas. The 14.00 immune system rules define constitutional symptoms or signs as severe fatigue, fever, malaise or involuntary weight loss. For fibromyalgia, severe fatigue and malaise carry most of the weight. Severe fatigue means a frequent sense of exhaustion that results in “significantly reduced physical activity or mental function”, and malaise means frequent feelings of illness, bodily discomfort or lack of well-being that have that same effect.
The three areas are activities of daily living, social functioning, and completing tasks in a timely manner because of deficiencies in concentration, persistence or pace. The cognitive or memory problems named in the 2010 criteria belong in the third. SSA describes repeated as occurring on average three times a year, or once every 4 months, with each episode lasting 2 weeks or more. Shorter episodes that come substantially more often, or less frequent episodes that last substantially longer, can also qualify. A marked limitation means the symptoms interfere seriously with the activity, without requiring total inability.
The RFC route for fibromyalgia disability claims
Widespread pain and associated symptoms such as fatigue may produce exertional limitations, which affect lifting, carrying, standing and walking.
A fibromyalgia claim that does not equal 14.09D is decided on residual functional capacity, which SSA uses to decide whether you can do your past work or other work. SSR 12-2p recognizes that fibromyalgia symptoms can wax and wane, so a person may have bad days and good days. For that reason, SSA considers a longitudinal record whenever possible rather than a single visit.
The ruling identifies two kinds of limits. Widespread pain and associated symptoms such as fatigue may produce exertional limitations, which affect lifting, carrying, standing and walking. Pain and other symptoms may also produce nonexertional physical or mental limitations. In practice those can include trouble sustaining attention and a reduced work pace.
An RFC built only on a good-day examination understates the condition. The file needs to show how often the bad days come, how long they last, and what you cannot do on them, because that frequency is what the RFC has to capture.
Evidence that decides a fibromyalgia disability claim
The physician's examination record is the foundation. Under the 1990 route, it should record the tender point examination by site and side. Under the 2010 route, it should name the six or more symptoms, signs or co-occurring conditions and show they recur. Either way, the record needs the exclusion work-up. SSR 12-2p lists laboratory tests used to rule out other disorders, including complete blood counts, erythrocyte sedimentation rate, anti-nuclear antibody, thyroid function and rheumatoid factor.
Beyond the diagnosis, these records carry the claim:
- Longitudinal treatment notes from acceptable medical sources showing ongoing evaluation and treatment, which the ruling calls especially helpful
- Notes that track whether symptoms change over time, so SSA can check consistency with fibromyalgia
- A record of the medications and other treatments you have used and their effects
- Rheumatology or pain management notes describing flares, their frequency and their length
- Mental health records when depression or anxiety is part of the symptom picture
When SSA evaluates the intensity of your symptoms, the ruling points to the nature and frequency of your attempts to obtain treatment and the medications and treatments you have used. Steady care is evidence in its own right.
Why are fibromyalgia disability claims denied?
Under the ruling, only a licensed physician is an acceptable medical source for establishing fibromyalgia.
A common pattern in denied files is a diagnosis without the work behind it. A chart lists fibromyalgia as a problem, but no note documents tender points or the 2010 symptom count, and no note shows other disorders were ruled out. SSR 12-2p says SSA cannot rely on the diagnosis alone, so the impairment is never established.
A second pattern is a diagnosis from a provider who is not a licensed physician. Under the ruling, only a licensed physician is an acceptable medical source for establishing fibromyalgia.
A third is normal test results read as normal health. In a fibromyalgia file, normal labs are part of the exclusion evidence the criteria require, and a file should present them that way. Claimants whose joint findings are abnormal should also read our arthritis disability page, since inflammatory arthritis is evaluated under its own listing.
Fibromyalgia Disability Claim Questions
Will SSA send me to its own doctor for a fibromyalgia exam?
SSR 12-2p says SSA may purchase a consultative examination at its expense, but it will not purchase one solely to determine whether you have fibromyalgia in addition to another impairment. The ruling prefers a source with access to longitudinal information about you, though SSA may rely on a consultative exam without it when that exam is the most probative evidence.
Do I need 11 tender points to qualify for fibromyalgia disability?
No. Tender points are part of the 1990 criteria only. Under that route, the examiner uses digital palpation with an approximate force of 9 pounds, and at least 11 of 18 sites must be positive. The 2010 criteria replace tender points with repeated manifestations of six or more symptoms, signs or co-occurring conditions, so either route can establish the impairment.
Do statements from my family help a fibromyalgia claim?
SSR 12-2p says SSA may consider information from nonmedical sources, naming neighbors, friends, relatives and clergy, as well as past employers, rehabilitation counselors and teachers. Because fibromyalgia symptoms fluctuate, someone who sees you on bad days can describe limits a clinic visit misses. These statements add to the physician's evidence and do not replace it.
Sources: SSR 12-2p, Evaluation of Fibromyalgia; SSA Blue Book, 14.00 Immune System Disorders (Adult).
Free case review
A condition that keeps you from working deserves a complete file
Tell us where your claim stands and what your records show. We respond within 3 business hours, and there is no fee unless you win.