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.
Because fibromyalgia doesn't show up on medical imaging (such as X-rays or MRIs) that doctors can use to diagnose the disorder, many applicants for disability benefits based on fibromyalgia have historically been denied. Fortunately, the Social Security Administration (SSA) has published a ruling providing guidance on how to assess fibromyalgia cases that has increased disability approvals for people with fibromyalgia.
Under Social Security's definition, any "medically determinable" severe impairment that substantially interferes with your ability to work full-time, for at least 12 months, is a disability. If you're being treated for fibromyalgia—or related impairments such as rheumatoid arthritis or spinal stenosis—the SSA will want to see medical records from a doctor that show symptoms and signs supporting a fibromyalgia diagnosis.
In order to qualify for disability benefits, you'll first need to meet eligibility requirements for 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.
Once you've established that you meet the "non-medical" standards for one or both of the disability programs, you'll have to show that your fibromyalgia is a severe impairment. According to the SSA's Ruling 12-2p, your medical records will need to document the following:
A disability claims examiner for the SSA will review your medical records to see if they include evidence of the above criteria. The examiner will focus on your doctor's 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. Social Security might contact your doctor and ask them to provide information about:
The further back your medical record includes evidence of fibromyalgia symptoms and treatment, the better. Social Security frequently uses the date that medical treatment began when establishing an onset date for disability, and an earlier onset date can mean you're owed more in back due benefits if you're found disabled.
Just having a diagnosis of fibromyalgia isn't enough for the SSA to determine that you're disabled—you still have to show that your "residual functional capacity" (RFC) prevents you from doing any type of work on a full-time basis.
Your RFC is a set of limitations on the most you're capable of doing, physically and mentally, in a work setting. Social Security bases your RFC on your medical records, doctors' opinions, and your activities of daily living. A typical RFC for somebody with fibromyalgia will likely include restrictions such as:
Documenting functional limitations in these areas is the key to showing why you can't work. Social Security will use your RFC to determine whether you can perform your past jobs 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 SSA will likely find that your RFC rules out all jobs. (Here's an RFC form that your doctor can fill out and submit to Social Security.)
You can strengthen your case by understanding how Social Security disability examiners consider medical evidence. Here are some tips to help:
If you're applying for disability benefits due to fibromyalgia, make sure you have an actual diagnosis of fibromyalgia (or "fibromyositis") with a date in your medical records. Because fibromyalgia is a "differential diagnosis"—meaning that it's diagnosed after ruling out other conditions—doctors sometimes mention to patients that they "might have fibromyalgia" before they've arrived at a formal conclusion.
Don't forget to include any other physical or mental medical conditions you're being treated for in your disability application. While claims examiners and administrative law judges have become more receptive to awarding benefits due to fibromyalgia since Ruling 12-2p, applications based on fibromyalgia alone face an uphill climb. 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.
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 handle disorders involving pain and fatigue. Consider seeking out one (or more) of the following specialists to confirm your family doctor's fibromyalgia diagnosis:
Having a specialist who has more experience treating fibromyalgia will go a long way towards letting the SSA know that your diagnosis is legitimate.
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 further reduces the number of jobs you're able to perform.
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 physician—perhaps one who is more capable concerning your treatment and more willing to support your disability case.
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.
Social Security provides several methods for you to apply for disability benefits.
For more information, please see our article about applying for Social Security disability benefits.
Most people who apply for disability based on fibromyalgia get denied at the initial application stage. But 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 in other cases, hiring 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.
Updated February 23, 2023