Fibromyalgia (FM) is one of the harder conditions to get approved for as a disability in the United States.
Because the symptoms are often self-reported, you’ll need medical documents and a doctor to support your case. However, it’s possible to have a successful claim for FM.
Keep in mind that your best chance of getting approved for disability is to have:
- relevant medical records
- laboratory testing
- doctors’ opinions
- statements from friends, family members, and co-workers
Read on to learn what the Social Security Administration (SSA) requires and how you can build your case for a fibromyalgia disability claim.
The SSA is responsible for evaluating all disability applications. When reviewing your case, the SSA will determine if you have a medically determinable impairment (MDI) of FM.
The criteria and requirements for claiming disability due to FM are extensive. They include:
- symptoms of pain in joints, muscles, and surrounding tissues that must be severe and present for at least 3 months
- documented evidence that rules out other conditions
- statements from you and others about any restrictions on, or inabilities to perform, your daily activities
- whether FM prevents you from working
- six or more ongoing signs or symptoms of FM
These signs or symptoms may include:
- problems with memory or cognition, also known as fibro fog
- irritable bowel syndrome (IBS)
- waking up exhausted
In the past, doctors would check 18 specific points (11 or more of the 18 tender points were required to support the diagnosis) to see how many of them were painful when pressed firmly.
While the new guidelines from the American College of Rheumatology (ACR) don’t require a tender point exam, it might be helpful to document the painful areas to assess improvement with medical management.
Although the SSA already requires a doctor’s diagnosis, they’ll still evaluate your history of symptoms to determine whether you’re capable of work.
Documentation is the key to a successful disability case. This means more than supplying the SSA with your medical records. If your symptoms result in missed workdays, your employer may need to provide a statement saying so.
Overall, your application should contain:
- a confirmed diagnosis from a rheumatologist
- dates of your medical visits, as provided by your doctors, caseworkers, and hospitals
- contact information for your doctors, caseworkers, and hospitals
- your current and relevant medical records, which may include information such as your medications, lab test results, or psychologist visits
- a Residual Functional Capacity (RFC) assessment about your impairments that your doctor fills out
- a summary of your previous jobs
Keeping track of your symptoms
It’s also helpful to keep a fibromyalgia diary. This can help you track all the days you experience pain and how it interferes with your normal daily routine.
You can take into account:
Assessment by your rheumatologist
Your rheumatologist can also give a professional opinion on your limitations. This includes an assessment of your ability to:
- sit, stand, and walk in an 8-hour workday
- lift and carry heavy loads
- conduct fluid movements like bending, balancing, or crawling
- maintain punctuality and attendance at work
The SSA takes all documentation into consideration before making a decision on your disability application. Once you submit your application, a team of doctors that works with the SSA will evaluate all of its components.
The team of doctors will also include a psychologist to see if FM has resulted in any mental impairment. These impairments are based on:
- speed of information processing
The team interprets your medical information and attempts to predict the impact of your condition on your overall function and well-being.
When you’re ready to apply for disability benefits, you can apply:
Until March 2020, you were also able to apply for benefits at your local Social Security office. However, in-person service is currently suspended due to the COVID-19 pandemic.
The SSA says you can apply for benefits as soon as you receive a fibromyalgia disability diagnosis.
It’s best to apply for benefits once you become disabled. The SSA states that there’s a 5-month waiting period before your benefits begin. Moreover, it may be 7 months before you receive the first payment.
You’re eligible for benefits in the sixth full month after the SSA determined that your disability began.
For example, if the SSA determined that your disability began in January, then your benefits would begin in July. However, your payment for the July benefits wouldn’t be issued until the following month, August.
In some cases, the SSA will request additional documents to process your disability claim. Providing everything you need in advance may help shorten the waiting period.
Disability benefits can help if FM prevents you from working at least 1 year.
The average cost for annual fibromyalgia treatment can add up to over $11,000 a person. This amount may be even higher if your health insurance doesn’t cover all your treatments.
Disability can help with the costs, especially if you’re unable to work. When you’re ready to apply, check out the SSA’s Disability Starter Kit for more information.