Social Security Disability (SSDI & SSI) for Fibromyalgia

Fibromyalgia (fy-broh-my-AL-juh) is a chronic disorder characterized by widespread pain and fatigue, often accompanied by memory, mood, and sleep disruptions. Fibromyalgia isn’t yet well understood by doctors, although medical advances are starting to shed light on potential causes and treatment. New diagnostic guidelines can help identify cases of fibromyalgia that would have otherwise been dismissed or treated inadequately.

The Social Security Administration (SSA) can award disability benefits to people who have functional limitations from fibromyalgia that keep them from working full-time for at least one year. Because fibromyalgia can be difficult to demonstrate through objective testing, it’s important that you understand how the disorder is evaluated so you can gather the proper medical evidence to support your disability claim.

Is Fibromyalgia a Disability?

Social Security considers a disability to be any medically determinable impairment that prevents you from engaging in substantial gainful activity for at least 12 months. So if your doctor observes signs of fibromyalgia (such as tenderness to palpation) and you’re unable to work on a regular basis for a year or more because of your symptoms, you may qualify for disability benefits.

Because fibromyalgia doesn’t show up on medical imaging (such as X-rays or MRIs) that doctors often use to diagnose what’s wrong, many applicants for disability benefits based on fibromyalgia have historically been denied. If you’re being treated for fibromyalgia—or related impairments such as rheumatoid arthritis or spinal stenosis—it’s especially important that you provide the SSA with medical records showing how your doctor arrived at your diagnosis.

How to Show That Your Fibromyalgia is a Medically Determinable Impairment

Social Security issued a Policy Interpretation Ruling in 2012 that provides guidance for disability claims examiners and administrative law judges on how to evaluate cases involving fibromyalgia. Under SSR 12-2p, to show that your fibromyalgia is a medically determinable impairment, your diagnosis must be made according to one of the below sets of criteria.

The 1990 American College of Rheumatology (ACR) Criteria for the Classification of Fibromyalgia

SSR 12-2p states that fibromyalgia will be considered a medically determinable impairment using these criteria when the medical record contains all of the following findings:

• A history of widespread pain in all quadrants of the body (the right and left sides of the body, both above and below the waist) and axial skeletal pain (the cervical spine, anterior chest, thoracic spine, or low back)—that has persisted for at least 3 months. The pain may fluctuate in intensity and may not always be present.
• At least 11 out of 18 positive tender (or “trigger”) points on physical examination. The designated tender points occur both on the left and right sides of the body, above and below the waist. The positive tender points must be found bilaterally (on the left and right sides of the body) and both above and below the waist.
• Evidence that other disorders that could cause the symptoms, like lupus or multiple sclerosis, were ruled out (an “exclusionary diagnosis”). This could involve blood tests showing no abnormalities in thyroid function or other body systems, for example.

The 2010 ACR Preliminary Diagnostic Criteria

Another option is to meet a more recent set of diagnostic standards. The SSA can find that your fibromyalgia is a medically determinable impairment using these criteria if you have evidence of the following:

• A history of widespread pain (this is similar to the 1990 criteria).
• Repeated occurrences of at least six fibromyalgia symptoms, such as fatigue, poor sleep, mental fog, depression, anxiety, and irritable bowels.
• Evidence that other disorders that could cause this condition were excluded (also similar to the 1990 standards).

Note that there have been more recent revisions to the 2010 ACR criteria that aren’t addressed in SSR 12-2p (since the ruling was issued in 2012 and the updated criteria came out in 2016). These new criteria are similar to the previous iterations, but can give doctors a bit more leeway to make a fibromyalgia diagnosis. The 2016 diagnostic criteria are as follows:

• A widespread pain index (a measurement of how many areas of your body are affected by pain) of 7 or more and a symptom severity score (a measurement of how painful the affected areas are) of 5 or higher; or a pain index between 4 and 6 with a severity score of 9 or higher.
• Generalized pain present in at least 4 out of 5 regions (not including jaw, chest, and abdominal pain).
• The symptoms have lasted for at least 3 months.

Don’t sweat it too much if your doctor or rheumatologist used these newer criteria to diagnose you with fibromyalgia, but you may want to ask them to provide a medical source statement detailing how you meet the older criteria as well.

When Can You Get Disability for Fibromyalgia?

Even if you meet the diagnostic criteria to show that your fibromyalgia is a medically determinable impairment, that doesn’t mean that you’ll get disability benefits. Fibromyalgia isn’t one of the Blue Book listed impairments that automatically qualify you for disability, so you’ll need to further establish that your fibromyalgia causes functional limitations that rule out all jobs.

Social Security decides what kinds of jobs you can do by reviewing your medical records and activities of daily living to arrive at your residual functional capacity (RFC). Your RFC is a set of limitations on the most you’re capable of doing, physically and mentally, in a work setting. For example, a typical RFC for somebody with fibromyalgia will likely include restrictions such as:

• how long you can stand, sit, and walk during an 8-hour day
• how much weight you can lift
• whether you can crouch, stoop, kneel, and bend
• how well you can focus and remember instructions, and
• whether you need to miss days of work each month.

Documenting your limitations in these areas is the key to showing why you can't work. Social Security uses your RFC to determine whether you can perform your past work or if any other jobs are available for somebody with your limitations. For example, if you can’t lift more than 10 pounds without pain and fibro fog makes it difficult for you to finish even simple tasks, the agency will likely find that your RFC rules out all jobs.

Here's a blank RFC form for fibromyalgia that your doctor can fill out and submit to Social Security. You can click on the image below to see an example of what a helpful completed RFC for fibromyalgia might look like.

5 Tips for Getting Social Security Disability for Fibromyalgia

You can strengthen your case by understanding how Social Security disability examiners consider medical evidence. Here are some tips to help:

Tip 1: Make Sure Your Medical Records Are Complete

Your medical records are the foundation of your disability claim, so you’ll want to make sure that your treatment notes accurately reflect your fibromyalgia symptoms and limitations. The SSA will review your doctor’s progress notes to look for complaints of pain, fatigue, and cognitive difficulties like memory loss (“fibro fog”), as well as the results of trigger point examinations.

Your records should also contain information about how long you’ve been treated for fibromyalgia and what medications you’ve tried (as well as any side effects). The further back your medical record includes evidence of fibromyalgia symptoms and treatment, the better. The SSA often goes by when you started treatment in establishing a disability onset date, and an earlier onset date can mean you’re owed more in back due benefits if you’re found disabled.

Don’t forget to include any other physical or mental medical conditions you’re being treated for in your disability application. The SSA has to consider your combined impairments when determining whether you can work, so let the agency know if you have other health concerns that you’re addressing.

Tip 2: Try to Get a Referral to a Specialist

General practitioners can sometimes lean too heavily on the fibromyalgia label diagnosis when they’re having trouble diagnosing patients’ complaints. As a result, Social Security doesn’t always place a lot of weight in a diagnosis from a family doctor, which can hurt a disability claim.

You can make the SSA take your fibromyalgia more seriously if you can get a diagnosis from a doctor who specializes in bone or tissue conditions or who handles disorders involving pain and fatigue. Consider seeking out one (or more) of the following specialists to confirm your family doctor’s fibromyalgia diagnosis:

• Orthopedists focus on injuries to bones, muscles, and joints.
• Rheumatologists treat chronic muscle and joint issues, specifically inflammation.
• Neurologists specialize in the brain, spinal cord, and peripheral nervous system.
• Chronic pain or fatigue specialists handle pain management and medication.

Having a specialist who has more experience treating fibromyalgia will go a long way towards letting the SSA know that your diagnosis is legitimate.

Tip 3: Diagnoses by Mental Health Professionals Carry Less Weight

Try to avoid being diagnosed with fibromyalgia by a mental health professional. In the same way that family doctors might overuse the diagnosis, so can psychiatrists. Social Security could look at a fibromyalgia diagnosis made by a mental health professional and conclude that an applicant’s symptoms and complaints are “psychosomatic” or “all in their head.”

People with fibromyalgia often develop depression or anxiety disorders as a result of dealing with ongoing pain and memory loss. In these cases, your counselor, therapist, or psychologist should provide a diagnosis of these mental health disorders separate from a fibromyalgia diagnosis. The SSA acknowledges that mental and physical health are intertwined, and having an additional mental condition can further reduce the number of jobs you’re able to perform.

Tip 4: Find Out What's in Your Medical Records

At every level of the disability determination process, Social Security will be looking at your medical records. You shouldn't apply for disability without knowing what your records state about your condition. Many applicants have been surprised to find that a doctor who they thought would support their case didn’t keep comprehensive progress notes or provided an unhelpful RFC form.

By getting copies of your medical records before you apply, you can get a rough idea of how your case looks and decide if you need to switch to a different doctor, perhaps one who is more capable concerning your treatment and more willing to support your disability case.

Tip 5: Keep a Journal of Your Symptoms and Side Effects

Keeping a calendar or journal with your physical and medical symptoms can help when your doctor asks about your symptoms. You'll be able to say how often you have pain or fatigue or memory problems, and how many days you're unable to do certain activities.

Having a written record can also help convince the SSA that your symptoms are real and reflect a pattern of fibromyalgia. Include symptoms like fibro fog, sleep issues, and digestive issues. Make sure to include any side effects you have from taking your prescribed medications.

Do I Get SSDI or SSI for Fibromyalgia?

Before Social Security can determine whether you’re medically disabled, you’ll first need to meet the non-medical eligibility requirements for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). SSDI pays more per month than SSI, but eligibility for SSDI is determined by your work history, so you might not qualify if you haven’t worked in a long time. SSI is available regardless of your work history, but you’ll need to show that you have income and assets below certain levels.

How Do I Apply for Disability Benefits?

Social Security provides several methods for you to file for disability benefits.

• One easy way is to file your claim online. You don’t have to complete the application in one sitting, and the SSA will provide you with a tracking number so you can follow the progress of your claim.
• You can also apply over the phone by contacting Social Security at 800-772-1213 Monday through Friday between 8 a.m. and 7 p.m. If you’re deaf or hard of hearing, you can call the TTY number at 800-325-0778.
• If you prefer to file in person, you can schedule an appointment with a representative at your local Social Security field office.

For more information, see our article about applying for Social Security disability benefits.

Hiring a Disability Lawyer If Your Fibromyalgia Claim Was Denied

Most people who apply for disability based on fibromyalgia get denied at the initial level. But that doesn’t have to be the end of the road for your claim. You can appeal the denial, and if you’re denied again, you’ll have the opportunity to request a hearing before a disability judge.

At this stage, you’ll likely want to hire a lawyer to represent you and advocate on your behalf. More so than for other conditions, having an attorney for a fibromyalgia case can be critical. Disability lawyers are familiar with Social Security’s Ruling 12-2p on fibromyalgia and can make a convincing argument that symptoms such as pain, fatigue, and fibro fog prevent you from working.

If you have questions or you’d like help with your disability appeal, consider looking for an attorney who will give you a free case evaluation to determine if your fibromyalgia qualifies for benefits.