It’s difficult, but not impossible, to get Social Security to grant disability benefits for fibromyalgia.
Social Security disability claims based on fibromyalgia can be some of the most difficult cases for disability applicants to win. Because fibromyalgia’s symptoms are generally self-reported, disability claims examiners and administrative law judges are often reluctant to approve fibromyalgia claims, even when an individual has received consistent treatment from a physician who supports their case.
To give yourself the best chance of a successful claim for fibromyalgia, it’s essential not only to obtain treatment, but to obtain the right treatment. The Social Security Administration (SSA) expects those with fibromyalgia to receive a proper diagnosis and regular treatment from a rheumatologist. You should also document your case to the fullest extent possible with relevant medical records, laboratory testing, opinions from doctors, and third-party statements from friends, family members, or former colleagues.
Fibromyalgia: Causes, Symptoms, and Treatment
Fibromyalgia, also known as fibromyositis, fibrositis, or fibromyalgia syndrome (FMS), is a chronic illness marked by widespread pain and tenderness in the muscle, joints, tendons, and soft tissues. It has no known cause, but may arise from a combination of genetic factors, physical injuries, emotional trauma, and lifestyle. The symptoms of fibromyalgia are many, but generally include diffuse pain or soreness, fatigue, digestive problems, dizziness, headaches, and numbness or tingling in the hands and feet. Common cognitive and psychological manifestations of the illness include memory issues (“fibro fog”), depression, and anxiety.
Treatment for fibromyalgia generally involves a fair amount of experimentation. Many physicians prescribe a combination of physical therapy, exercise, cognitive-behavioral therapy, and medication to manage the symptoms of fibromyalgia.
Social Security’s Ruling on Fibromyalgia and Disability
In July 2012, Social Security published a ruling (SSR 12-2p) to explain how disability claims examiners and judges should evaluate whether fibromyalgia constitutes a “medically determinable impairment” (MDI). (To be even considered as a basis for disability benefits, a medical condition must be a severe MDI.) Citing diagnostic criteria used by the American College of Rheumatology (ACR), Social Security found that fibromyalgia should be considered an MDI when the following two criteria have been met.
- There is evidence of widespread chronic pain that has lasted at least three months, and
- Objective tests (laboratory testing, MRIs, and x-rays) have ruled out other possible conditions.
In addition, one of the following must also be present:
- Positive tender point sites in at least 11 of 18 of tested areas, above and below the waist and on both sides of the body, or
- Repeated occurrence of at least six fibromyalgia symptoms, especially fatigue, cognitive and memory issues (“fibro fog”), waking unrefreshed, irritable bowel syndrome, depression, and anxiety.
How to Document Your Fibromyalgia Disability Case
- sitting, standing, and walking, both at a time and total in an 8-hour workday
- lifting and carrying weight
- bending, stooping, balancing, crouching, and crawling, and
- maintaining punctuality and proper attendance at work.
Obtain statements from third-parties familiar with your symptoms and limitations. Third-party reports from friends, family members, and especially former co-workers can bolster your disability case. These reports should include the individual’s first-hand observations of your physical or mental limitations, rather than providing opinions on your medical issues.
Contact an experienced disability attorney to handle your case. A disability attorney will work with you and your doctors to present the strongest possible case to Social Security. Most disability lawyers charge you a fee only if you win your case, and the attorney’s fee is collected from the backpay owed to you from Social Security.