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Can You Get Disability for Fibromyalgia?

Yes, the Social Security Administration (SSA) recognizes fibromyalgia as a disability. However, demonstrating you qualify for benefits is tough. Find out how to get benefits.

evident Editorial Team
November 28, 2023
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If you've been grappling with fibromyalgia that has made it difficult to maintain employment or engage in substantial gainful activity, you might wonder, "Can I get fibromyalgia disability benefits?" The answer is yes.

In 2021, numerous workers received disability for fibromyalgia and other related medical conditions. This article will cover the nature of fibromyalgia, how you can get disability for it, and the steps you should take if you believe you qualify for benefits.

Key Takeaways

Is Fibromyalgia a Disability?

Yes, the Social Security Administration (SSA) recognizes fibromyalgia as a disability.

However, individuals with fibromyalgia often face hurdles in demonstrating that their condition warrants monthly Social Security disability benefits.

According to the SSA, fibromyalgia falls somewhere between an immune system and musculoskeletal condition.

In fact, more than 36% of people receiving disability benefits have musculoskeletal disorders, making it the most common type of condition.

SSA's Definition of Fibromyalgia

The Social Security Administration defines fibromyalgia as a chronic condition characterized by widespread pain, tenderness, and fatigue.

Due to their condition, individuals may also experience sleep disturbances, mood swings, memory problems, and cognitive difficulties.

Fibromyalgia symptoms often include muscle stiffness, headaches, irritable bowel syndrome, and chronic fatigue syndrome.

Common Symptoms of Fibromyalgia

The SSA recognizes the following symptoms as indicative of fibromyalgia:

  • Widespread pain lasting for at least three months
  • Fatigue and sleep disturbances
  • Cognitive difficulties often referred to as "fibro fog."
  • Tender points in specific areas of the body
  • Repeated manifestations of other symptoms like irritable bowel syndrome and chronic fatigue

How Can You Get Disability for Fibromyalgia?

You might wonder, "How can you claim fibromyalgia disability benefits?" Generally, you can receive disability for fibromyalgia if your condition renders you incapable of working or managing daily life independently.

However, the SSA has stringent medical criteria for who can get benefits due to fibromyalgia.

Regrettably, the SSA won't simply take your word for it that fibromyalgia prevents you from maintaining a job. You'll need relevant medical records of your symptoms and their impact on your residual functional capacity.

Your best option is to collaborate with a doctor and a Social Security disability attorney to accurately document your condition.

You may also find it easier to qualify for benefits if you can apply with multiple conditions, such as fibromyalgia and chronic fatigue syndrome, depression, anxiety, IBD, IBS, migraines, other types of headaches, and more.

Requirements for Obtaining Disability for Fibromyalgia

To obtain fibromyalgia disability benefits, you must provide proof of both:

  1. the existence of a diagnosis of fibromyalgia, and
  2. demonstrate that your fibromyalgia is a severe impairment that restricts your physical or mental capabilities.

Proving You Have Fibromyalgia

To be eligible for Social Security disability benefits due to fibromyalgia, you must provide comprehensive medical evidence that not only confirm your diagnosis but also demonstrate that despite undergoing treatment, your condition is a medically determinable impairment that still hinders your ability to work or carry out daily functions.

The Social Security Administration (SSA) has set specific criteria to determine eligibility, which includes:

Trigger Point Test

One of the primary tests the SSA considers is the trigger point test. A high score on this test, particularly a score of 14 or above, can significantly bolster your case for disability benefits. Another test that may be considered, though less frequently, is the tender point test.

Consistency of Flare-Ups

Fibromyalgia is characterized by its cyclical nature, where symptoms can alleviate for a period only to return with increased severity. The SSA will assess the regularity and intensity of your flare-ups.

It's crucial to provide evidence showcasing how these flare-ups disrupt your daily life, affecting basic tasks such as walking, sitting, standing for extended durations, self-cooking, and dressing independently.

Chronic Fatigue

A predominant symptom of fibromyalgia is chronic fatigue. It's essential to demonstrate that you experience persistent fatigue even after extended periods of sleep, often exceeding 18 hours.

To strengthen your claim, ensure that you have documented evidence of this fatigue from consistent physical examination. Regularly discuss your fatigue with your healthcare providers so that their notes and diagnoses reflect this symptom.

The SSA will inquire about your typical sleeping hours and any sleep disturbances you experience. Having medical documentation to corroborate your statements will be invaluable.

Conditions Listed in the Blue Book

While the SSA's Blue Book does not officially list fibromyalgia as a qualifying condition, it's worth noting that fibromyalgia often coexists with other conditions that are recognized, including:

  • Depression
  • Inflammatory Bowel Disease (IBD)
  • Postural Orthostatic Tachycardia Syndrome (POTS)

If you have fibromyalgia in conjunction with any of these conditions, your chances of qualifying for disability benefits increase.

Even if the SSA doesn't deem your fibromyalgia as severe enough on its own, these secondary conditions can bolster your application.

Medical Documentation of Ongoing Treatment

The SSA typically requires evidence that an individual has been undergoing consistent medical treatment for their condition. This could include regular visits to a rheumatologist or another specialist, prescribed medications, physical therapy, and other treatments.

The SSA would want to see that despite ongoing treatment, the symptoms persist and hinder daily functioning and work capability.

Functional Capacity Evaluation (FCE)

An FCE is a series of tests that measure physical strength, "body mechanics", stamina, and the ability to perform specific tasks.

For fibromyalgia patients, an FCE can provide objective evidence about their physical limitations. The SSA might consider the results of an FCE to determine how fibromyalgia affects an individual's ability to perform work-related activities.

What If Your Fibromyalgia Falls Short of the Disability Benefits Criteria?

Even if your fibromyalgia doesn't fulfill the above criteria, you still have the option to claim benefits for disability. It's crucial to demonstrate that your fibromyalgia hinders your ability to work.

Getting approval for disability claims can be a tough task. It's common for initial applications to get rejected unless they strictly adhere to SSA's criteria. But this shouldn't discourage you. Disability attorneys can assist in navigating the process.

Only a fraction of applicants receive approval in the first application. You can always file an appeal and provide new medical proof, strengthening your case before an administrative law judge. At this level, your odds of approval are significantly higher.

Fibromyalgia: What Disability Benefits Can You Receive?

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The mean disability benefits for fibromyalgia payout stands at a similar rate to other conditions.

If your fibromyalgia qualifies for benefits, the SSDI maximum disability payment is based on social security taxes paid by you and your past employers. Your income and assets determine the SSI maximum.

On average, the disability benefit check for fibromyalgia ranges from $1,450.61 to $1,477.68 per month.

The maximum possible amount that someone with fibromyalgia can receive in 2023 is $3,627 per month for SSDI and $914 per month for SSI.

The easiest way to see how much you might receive in disability benefits is to create a free mySocialSecurity account.

Advice to Secure Disability Benefits with Fibromyalgia

Here are some strategies to boost your chances of a successful claim:

  • Understand the different kinds of health insurance and disability insurance to determine eligibility and the ideal time to apply.
  • Collaborate closely with your healthcare provider to ensure your medical records are comprehensive and accurately represent your fibromyalgia symptoms.
  • Consult with a Social Security disability attorney with expertise in the application process and can guide you to enhance your success rate.

What's the Next Step if Your Fibromyalgia Qualifies for Disability Criteria?

If your fibromyalgia fits the criteria, your next move is to apply for fibromyalgia disability benefits.

Apply for Disability Benefits

Make this move as soon as possible. Given the length of the process, any delay might postpone the receipt of potential benefits.

Understanding the type of disability benefits you're applying for is crucial.

  • Social Security disability insurance (SSDI) is typically accessible if you've been employed for a certain duration and can not work.
  • Supplemental Security Income (SSI) is based on your income level. Thus, even with minimal employment history, you could qualify if your income is low or nonexistent.

Consult With a Disability Attorney

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An attorney, especially one specialized in disability claims, can be an invaluable asset when navigating the complex landscape of disability benefits.

Their expertise ensures that all necessary documentation is accurately presented, deadlines are met, and the claimant's rights are protected. They understand the intricacies of the legal system and the specific criteria that the Social Security Administration looks for when evaluating claims.

Moreover, an attorney can effectively advocate on behalf of the claimant, presenting a compelling case that maximizes the chances of approval.

In the event of a denial, they are adept at handling appeals, ensuring that the claimant's case is presented in the best possible light.

Frequently Asked Questions

How often should I update the SSA about my fibromyalgia condition?

It's advisable to keep the SSA informed about any significant changes in your condition, especially if it affects your ability to work. Regular updates, backed by medical documentation, can ensure your benefits continue without interruption.

Can I work part-time and still receive disability benefits for fibromyalgia?

Yes, you can work part-time. However, there are limits to how much you can earn. If you exceed the SSA's monthly income threshold for "substantial gainful activity" (SGA), it might impact your eligibility.

Are there support groups or organizations for individuals with fibromyalgia seeking disability benefits?

Yes, many organizations, such as the National Fibromyalgia Association, offer support, resources, and guidance for individuals navigating the disability benefits process.

How does the SSA view alternative treatments for fibromyalgia, like acupuncture or chiropractic care?

The SSA primarily considers medical evidence from licensed physicians. While they might note alternative treatments in your records, traditional medical documentation from recognized specialists often carries more weight.

If I'm denied benefits, how long do I have to file an appeal?

Typically, you have 60 days from the date you receive the denial notice to file an appeal. It's crucial to act promptly to ensure your appeal is considered.

Can family members or caregivers provide statements or evidence to support my application?

Yes, statements from family members, caregivers, or even colleagues can provide additional context about how fibromyalgia affects your daily life. While these are supplementary to medical records, they can offer a more comprehensive view of your challenges.

The Bottom Line

Living with fibromyalgia can be challenging and even more difficult when it prevents you from working. However, understanding how the SSA views fibromyalgia as a disability and what criteria you need to meet can help you navigate applying for fibromyalgia disability benefits.

Remember, working closely with your doctor and possibly a Social Security program attorney is essential to ensure you have the best chance of success.