Fibromyalgia is a chronic condition that can cast a long shadow over every aspect of a person’s life. Characterized by widespread musculoskeletal pain, debilitating fatigue, and cognitive difficulties, it can make even the simplest daily tasks feel like monumental challenges.
If you’re living with fibromyalgia, you know that the physical and emotional toll can be immense. You may have had to reduce your work hours, take extended leaves of absence, or even stop working altogether. This can lead to significant financial strain and uncertainty, leaving you to wonder: “Is fibromyalgia a disability?” and whether you’re eligible to receive benefits.
The answer is yes, you can. However, winning a disability claim for fibromyalgia can be a complex and challenging process. The very nature of the condition, its “invisibility” and reliance on subjective symptoms, makes it difficult to prove to the satisfaction of the Social Security Administration (SSA).
This guide from National Disability Benefits will walk you through everything you need to know about getting disability for fibromyalgia.
Is Fibromyalgia Officially a Disability?
One of the most common questions people have is whether fibromyalgia is officially recognized as a disability by the SSA. The answer is both yes and no, and it’s important to understand the distinction. While fibromyalgia is not a “listed” impairment in the SSA’s Blue Book (a manual of conditions that automatically qualify for disability benefits), the SSA does recognize it as a severe medical condition that can be the basis for a disability award.
The primary challenge with fibromyalgia claims lies in its “invisible” nature. Unlike a broken bone that can be seen on an X-ray or a heart condition that can be detected with an EKG, there is no single, objective medical test that can definitively diagnose fibromyalgia. The diagnosis is typically made based on a combination of your reported symptoms, a physical examination of tender points, and the elimination of other possible medical conditions. This reliance on subjective evidence can make it difficult to convince the SSA of the severity of your limitations.
It’s also crucial to understand the difference between a medical diagnosis and a legal disability. Having a doctor’s diagnosis of fibromyalgia is the first step, but it’s not enough to win a disability claim. To be considered disabled by the SSA, you must prove that your condition prevents you from engaging in “substantial gainful activity” (SGA). In other words, you have to show that your symptoms are so severe and persistent that you are unable to perform the duties of any job, not just your previous one.
Building a Strong Case for Your Fibromyalgia Claim
Because of the challenges associated with fibromyalgia claims, building a strong and well-documented case is essential. The more evidence you can provide to support your claim, the better your chances of success.
Here are some key areas to focus on:
- The Power of Consistent Medical Records: Consistent medical treatment is the cornerstone of any successful disability claim, and this is especially true for fibromyalgia. It’s crucial to have a long-term treatment history with a specialist, such as a rheumatologist, who is experienced in diagnosing and treating fibromyalgia. Your medical records should provide a detailed account of your symptoms, the treatments you’ve tried (including medications, physical therapy, and other interventions), and their effectiveness (or lack thereof). Regular visits to your doctor will not only ensure you’re receiving the best possible care but also create a comprehensive medical record that demonstrates the ongoing severity of your condition.
- Documenting Your Daily Limitations: One of the most effective ways to demonstrate the impact of fibromyalgia on your life is to keep a detailed journal of your daily symptoms and limitations. This journal should be a candid and honest account of your struggles with pain, fatigue, “fibro fog,” and other symptoms. Be specific about how these symptoms affect your ability to perform daily tasks, such as cooking, cleaning, shopping, and personal care. For example, instead of simply writing “I was in pain today,” you could write “I woke up with widespread pain that made it difficult to get out of bed. I was only able to stand for 10 minutes to make breakfast before I had to sit down.”
- Meeting the SSA’s Evidentiary Criteria: In 2012, the SSA issued a ruling that provides specific guidance on how to evaluate fibromyalgia claims. To meet these criteria, you’ll need to provide evidence of the following:
- A history of widespread pain that has persisted for at least three months.
- Evidence that your doctor has ruled out other conditions that could cause your symptoms.
- Either 11 positive tender points on physical examination (out of a possible 18) or a combination of widespread pain and other co-occurring symptoms, such as fatigue, cognitive problems, and irritable bowel syndrome (IBS).
How the SSA Determines If You Can Still Work
Once you’ve submitted your application and medical evidence, the SSA will assess your ability to work. This is a multi-step process that involves determining your “residual functional capacity” (RFC) and considering your age, education, and work history.
- Your Residual Functional Capacity (RFC): Your RFC is an assessment of what you can still do despite your limitations. A claims examiner at the SSA will review your medical records and other evidence to determine your physical and mental limitations. For example, they will assess your ability to sit, stand, walk, lift, carry, and perform other physical tasks. They will also consider your mental limitations, such as your ability to concentrate, follow instructions, and interact with others. The more restrictive your RFC, the more likely you are to be found disabled.
- The Role of Your Age and Work History: The SSA’s “grid rules” are a set of guidelines that are used to determine whether a person is disabled based on their age, education, and work history. These rules are particularly important for applicants over the age of 50. In general, the older you are, the less likely the SSA is to expect you to adjust to a new type of work. If your RFC prevents you from performing your past work, and you are over 50, you may be found disabled even if you are technically capable of performing other, less demanding jobs.
- The Importance of Co-Occurring Conditions: Many people with fibromyalgia also suffer from other medical conditions, such as depression, anxiety, IBS, and chronic migraines. It’s crucial to include all of your medical conditions in your disability application, even if you don’t think they are as severe as your fibromyalgia. The SSA must consider the combined effect of all of your impairments when determining whether you are disabled. Including these co-occurring conditions can help to paint a more complete picture of your overall health and limitations, and it can significantly strengthen your claim.
Strengthening Your Application and Finding Support
In addition to providing comprehensive medical evidence and documenting your daily limitations, there are other steps you can take to strengthen your application and increase your chances of success.
- The Value of Third-Party Statements: Written statements from people who are familiar with your condition and its impact on your life can be incredibly valuable. These statements can come from your doctors, former employers, family members, and friends. A detailed letter from your doctor that outlines your specific limitations and explains why you are unable to work can be particularly persuasive. Statements from former employers can provide evidence of your work-related limitations, and statements from family and friends can offer a personal perspective on how fibromyalgia has affected your daily life.
- Don’t Give Up After a Denial: It’s important to know that initial denials are very common for fibromyalgia claims. In fact, the majority of disability applications are denied at the initial level. If you receive a denial, don’t give up. You have the right to appeal the decision, and many people who are initially denied are ultimately awarded benefits on appeal. The appeals process can be long and complex, but it’s often worth the effort.
- Navigating the Complex Process: Proving a fibromyalgia disability claim requires specific and detailed evidence. The process can be overwhelming, and it’s easy to make mistakes that can jeopardize your claim. To ensure your application is as strong as possible, many people seek guidance from advocates at National Disability Benefits who specialize in these complex cases. An experienced disability advocate can help you gather the necessary medical evidence, complete the application paperwork, and represent you at all levels of the appeals process.
Contact National Disability Benefits today for more information
At National Disability Benefits, we understand the unique challenges of fibromyalgia claims, and we’re here to help. Our team of experienced advocates can provide you with the guidance and support you need to win the benefits you deserve.
Contact us today for a free consultation and to learn more about how we can help you with your fibromyalgia disability claim.
