Does Fibromyalgia Qualify for Disability? Getting Fibromyalgia Disability Accommodations From the SSA

by Shay Fleming   ·  1 week ago  

Living with fibromyalgia can be incredibly challenging, and many wonder if it’s possible to get disability benefits for this condition. Fibromyalgia is a chronic disorder characterized by widespread pain, fatigue, and other symptoms that can significantly affect daily life. Understanding whether fibromyalgia qualifies for disability is essential for those seeking financial support due to their inability to work. So, can you get disability for fibromyalgia? Learn the criteria for obtaining disability benefits for fibromyalgia and uncover essential information for those affected by this condition.

Getting Social Security Disability for Fibromyalgia: Key Takeaways

  • Fibromyalgia can qualify for disability if it prevents you from working.
  • Symptoms include widespread pain, fatigue, sleep problems, anxiety, and depression.
  • SSA criteria must be met for approval, and having thorough medical documentation helps.
  • Applying for SSDI requires a work history and taxes paid into Social Security.
  • Applying for SSI does not have a work requirement but has a lower monthly payment.
  • Consulting a disability lawyer can improve your chances of approval.

What is Fibromyalgia? Symptoms and Side Effects

Fibromyalgia is a chronic condition that causes widespread pain and tenderness throughout the body. This condition is often difficult to diagnose because its symptoms overlap with those of other disorders, and there is no specific test for fibromyalgia. The exact cause of fibromyalgia is unknown, but it is believed to involve a combination of genetic, environmental, and psychological factors.

People with fibromyalgia often experience a variety of symptoms, including:

  • Widespread Pain: Persistent pain that occurs on both sides of the body, above and below the waist. This pain is often described as a constant dull ache that lasts for at least three months.
  • Fatigue: Despite sleeping for long periods, individuals with fibromyalgia often wake up tired and unrefreshed. This fatigue can interfere with daily activities and work.
  • Sleep Disturbances: Many people with fibromyalgia have sleep disorders such as restless legs syndrome or sleep apnea, which further contribute to their fatigue.
  • Cognitive Difficulties: Often referred to as “fibro fog,” these cognitive issues include problems with memory, difficulty concentrating, and mental clarity.
  • Headaches: Chronic headaches, including migraines, are common in people with fibromyalgia.
  • Irritable Bowel Syndrome (IBS): Many individuals with fibromyalgia also suffer from IBS, which causes abdominal pain, bloating, and alternating constipation and diarrhea.
  • Depression and Anxiety: The chronic pain and fatigue associated with fibromyalgia can lead to depression and anxiety, further impacting the individual’s quality of life.

The symptoms of fibromyalgia can have a profound impact on a person’s daily life. Persistent pain and fatigue can make it difficult to perform everyday activities, such as working, exercising, and even simple tasks like cleaning or cooking. The cognitive difficulties associated with “fibro fog” can impair job performance and affect personal relationships. Additionally, the emotional toll of living with a chronic condition can lead to feelings of isolation and helplessness.

Effective management of fibromyalgia often requires a combination of treatments, including medication, physical therapy, lifestyle changes, and mental health support. While there is no cure for fibromyalgia, these treatments can help alleviate symptoms and improve quality of life.

Disability Criteria From the SSA

To qualify for one of the different types of disability benefits from the SSA, you must meet specific criteria set by the Social Security Administration (SSA). In order to qualify for Social Security disability benefits, the SSA requires that your condition significantly limits your ability to perform basic work activities and that these limitations are expected to last for at least 12 months. Here’s a look at some of the key requirements for Social Security disability.

  1. Severe Impairment: Your fibromyalgia must be considered a severe impairment. This means that your symptoms must significantly limit your physical or mental abilities to perform basic work activities such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling objects.
  2. No Substantial Gainful Activity (SGA): Your earnings must be below a certain threshold. As of 2024, if you earn more than $1,470 per month (non-blind) or $2,460 per month (blind), you are generally considered able to engage in SGA and therefore not eligible for disability benefits.
  3. Duration Requirement: The SSA requires that your condition has lasted or is expected to last for at least 12 months or result in death. Temporary or short-term conditions do not qualify for disability benefits.
  4. Residual Functional Capacity (RFC) Assessment: An RFC assessment determines what kind of work activities you can still do despite your fibromyalgia. This assessment is completed by your doctor and includes:
    • Physical limitations, such as how long you can sit, stand, walk, lift, carry, and perform other physical tasks.
    • Mental limitations, including your ability to understand, remember, and carry out instructions, interact with others, concentrate, and manage work stress.
  5. Inability to Perform Past Relevant Work: The SSA evaluates whether your fibromyalgia prevents you from doing any of the work you have done in the past 15 years. If you are unable to perform any of your previous jobs, the SSA will then consider whether you can adjust to other work.
  6. Inability to Adjust to Other Work: The SSA assesses if there is any other work you could perform considering your age, education, work experience, and physical and mental limitations. If it is determined that you cannot adjust to any other type of work, you may be found disabled.
  7. Medical Documentation: Comprehensive medical records are crucial. Your medical documentation should include:
    • Records of your diagnosis and ongoing treatment.
    • Evidence of your symptoms over time.
    • Documentation of treatments and their effectiveness or lack thereof.
    • Notes from doctors and specialists about your condition and its impact on your daily life.
  8. Consistent Treatment: The SSA expects you to receive regular treatment for your condition. Consistent medical care and attempts to manage symptoms are crucial for your claim.
  9. Non-medical Evidence: Statements from family, friends, and coworkers about how fibromyalgia affects your daily life and ability to work can support your claim. These personal accounts can provide valuable insight into your functional limitations.

Meeting these criteria requires detailed and consistent documentation. Working closely with your healthcare providers to gather and organize the necessary evidence is crucial for a successful disability claim.

Is Fibromyalgia Considered a Disability by the SSA?

While fibromyalgia is acknowledged by the Social Security Administration (SSA) as a potential disabling condition, it is not explicitly listed in the SSA’s Blue Book on the Compassionate Allowances list. To qualify for disability benefits, you must provide substantial evidence demonstrating that your fibromyalgia meets the SSA’s criteria for disability.

Which Fibromyalgia Symptoms Might Qualify You For Disability?

Certain symptoms associated with fibromyalgia can significantly impact your ability to perform work-related tasks, making you eligible for Social Security disability benefits. Here are some key symptoms recognized by the Social Security Administration (SSA) that could qualify you for disability:

  1. Chronic Pain: Widespread and persistent pain in muscles, joints, and soft tissues can make it challenging to engage in physical activities required for work.
  2. Fatigue: Debilitating fatigue, despite adequate rest, can impair concentration, memory, and overall productivity at work.
  3. Sleep Disturbances: Sleep problems such as insomnia or non-restorative sleep can lead to daytime drowsiness, affecting your ability to sustain attention and perform tasks effectively.
  4. Cognitive Dysfunction: Cognitive symptoms like memory issues, difficulty concentrating, and “fibro fog” can hinder your ability to understand and follow instructions, solve problems, and make decisions at work.
  5. Mood Disorders: Depression and anxiety commonly coexist with fibromyalgia, exacerbating symptoms and impairing mental and emotional functioning, which are essential for workplace productivity.
  6. Functional Limitations: Fibromyalgia can lead to physical limitations such as reduced stamina, mobility issues, and difficulty with fine motor skills, affecting your performance of work-related tasks.

By highlighting these symptoms and their impact on your daily functioning and ability to work, you can strengthen your disability claim with the SSA. Providing detailed medical documentation and evidence of ongoing treatment and management efforts is essential to support your case effectively.

Other Medical Conditions & Comorbidities That May Help You Get Disability for Fibromyalgia

Having additional medical conditions alongside fibromyalgia can strengthen your disability claim by providing further evidence of your inability to work. Common comorbidities include chronic fatigue syndrome, depression, anxiety, and irritable bowel syndrome (IBS). These conditions exacerbate symptoms like your chronic pain diagnoses, fatigue, and cognitive difficulties, making it harder to function daily.

Comprehensive documentation of all medical conditions, including records and statements from healthcare providers, is crucial. This detailed information helps the SSA understand the full scope of your health issues. Demonstrating the combined impact of fibromyalgia and its comorbidities can make a stronger case for disability benefits. Working with a disability lawyer can also ensure thorough documentation and effective presentation of your claim.

Medical Evidence You’ll Need for Your Fibromyalgia Disability Claim

To successfully claim disability benefits for fibromyalgia, you must provide comprehensive medical evidence demonstrating the severity and persistence of your condition. This evidence should come from multiple sources to create a well-rounded picture of your health.

Medical Records

Medical records are crucial for your claim. Ensure you have detailed records from your rheumatologist or specialist diagnosing fibromyalgia. These should include documentation of your symptoms, treatment plans, and any changes in your condition over time. Records from other healthcare providers, such as primary care physicians and therapists, can also provide additional evidence of how fibromyalgia affects your daily life.

Medical Evidence

Your medical evidence should include results from any relevant tests, such as blood tests or imaging, to rule out other conditions and showcase the extent of your medical history to the SSA. Although fibromyalgia does not have specific diagnostic tests, lab results can support your diagnosis by excluding other potential causes of your symptoms. A Residual Functional Capacity (RFC) assessment completed by your doctor can also be vital, detailing how your condition limits your ability to perform work-related activities.

Evidence that Work Triggers Your Symptoms

You need to show that your fibromyalgia symptoms are exacerbated by work activities. This can include documentation from your employer about your inability to perform job tasks or records of missed workdays due to flare-ups. Statements from coworkers or supervisors about your struggles with job performance can also be valuable.

Proof of Other Conditions

If you have other medical conditions that contribute to your disability, include comprehensive documentation for these as well. Records of diagnoses, treatment histories, and how these conditions interact with your fibromyalgia are important. Statements from healthcare providers about the cumulative impact of all your conditions can strengthen your claim.

Gathering and organizing this evidence can be overwhelming, but it is essential for a successful disability claim. Working with a disability lawyer can help ensure that all necessary documentation is included and properly presented to the SSA.

How to Apply for Fibromyalgia Disability Benefits

Applying for disability benefits for fibromyalgia involves several steps and requires thorough preparation, whether you’re applying for SSI or SSDI. Here is a streamlined guide to help you through the process.

Applying for Social Security Disability Insurance (SSDI) With Fibromyalgia

If you have a substantial work history and have paid Social Security taxes, you may qualify for SSDI. To apply, you need to complete the SSA’s disability benefit application, which can be done online, over the phone, or in person at a Social Security office. Gather all relevant medical documents, including diagnosis records, treatment histories, and statements from healthcare providers. Ensure that you include a detailed Residual Functional Capacity (RFC) assessment from your doctor. Once you submit your application, be prepared to provide additional information if requested and to wait for the processing of your claim.

Applying for Supplemental Security Income (SSI) With Fibromyalgia

SSI benefits are designed for individuals with disabilities who have limited income and resources. To qualify, your income must be below a certain threshold, and you must have few assets. The application process is similar to SSDI, requiring detailed medical documentation and evidence of your financial status. Submit your application online, by phone, or in person, and include all necessary medical records, an RFC assessment, and proof of income and resources. The SSA will review your application and may request additional information.

Work With a Disability Lawyer to Improve Your Odds of Approval

Navigating the disability benefits application process can be complex and overwhelming, but working with a disability attorney can significantly improve your chances of approval for long term disability benefits. A lawyer can help you gather and organize the necessary documentation, complete the application accurately, and represent you in appeals if your initial claim is denied. Disability lawyers work on a contingency fee basis, meaning you only pay if you win your case. Their expertise can be invaluable in ensuring your claim is presented effectively to the SSA.

Shay Fleming is the SEO Content Manager at LeadingResponse. A proud graduate of Texas State University, she has been based in Austin since 2016, where she lives with her dog. Shay has contributed extensively to various domains, writing and publishing articles about real estate, investing, disability, and urban living.