Fibromyalgia and Getting Disability Benefits

Fibromyalgia and Getting Disability Benefits

What’s the secret to getting disability benefits for fibromyalgia? This painful condition is more common than many people think. Luckily, the Social Security Administration (SSA) passed a 2012 law regarding Americans with fibro who apply for disability benefits. We’ll explain what the SSA looks for, which evidence will best support your claim and how your doctor can help you qualify below.



Step 1: Confirming Your Social Security Disability Insurance (SSDI) Coverage Status

Before the SSA evaluates your fibromyalgia, they must confirm you meet all other disability requirements. To do this, you must:

  1. Have worked at least 5 in the last 10 years full time in jobs where you paid FICA/Social Security taxes
  2. Be at least 18, but younger than 65 years old on the date you apply for benefits
  3. Not currently receive some Social Security benefits
  4. Earn less than $1,260/month from all income sources combined (i.e., child support, alimony, etc.)

That first requirement is what gets most applicants turned down. Once you stop working for 60 months, your federal disability insurance coverage automatically ends. And if you apply for disability while you’re working, the SSA won’t approve your claim.

Step 2: Evaluating Your Fibromyalgia Symptoms Under SSA Disability Guidelines

Next, you should know what the SSA looks for when reviewing fibromyalgia claims for disability. As you probably know, no fibromyalgia test exists. Instead, most doctors look at many different symptoms that persist over time to make a diagnosis. And, in fact, that’s exactly what the SSA looks for in your disability claim. Here are the three steps your claims examiner will take when reviewing your claim for fibromyalgia:

  1. Do you have a history of widespread pain affecting all four quadrants of your body and your spinal area for 3+ months? In other words, have you experienced pain in your left side, right side, above and below your waist all at the same time? You don’t need to suffer constant neck, lower back and chest pain to qualify. But if your fibro pain doesn’t meet that three-month minimum requirement, you likely won’t get approved for SSD benefits.
  2. Do you feel pain in at least 11 of your body’s 18 “tender points” when a doctor applies standard pressure? The SSA has a helpful diagram showing these “tender points” mapped out on the human body on their SSR 12-2p ruling page.
  3. What lab tests did your doctor perform to rule out all other possible causes for your symptoms? This includes drawing blood to rule out hypothyroidism (poor thyroid function) or lupus (ANA or complete blood count test), and a spinal tap or MRI to rule out multiple sclerosis.
  4. Do you experience six or more documented fibro signs, symptoms and related conditions on a repeat basis? These may include things like muscle pain and/or weakness, fatigue, dizziness, memory problems, “fibro fog” and insomnia.

Step 3: Determining Whether Fibro Prevents You From Working 12 Months or Longer

The final step is determining whether your condition(s) forces you to stop working for at least one year. This is how the SSA defines the word “disability,” and a fibromyalgia diagnosis alone isn’t enough. The SSA looks for additional evidence from your doctor that supports your claim. Your rheumatologist, osteopath or any doctor that treats your fibromyalgia should complete a residual functional capacity (RFC) form. Your doctor should give clear examples showing why fibromyalgia limits your ability to work 40 hours per week (a.k.a. your “functionality”). These things may help support your disability claim:

  • You need help picking a pencil back up if you drop it.
  • Prescription drug side effects make you drowsy, unable to follow verbal instructions or operate equipment as required for your job.
  • You require frequent or unscheduled rest breaks during each eight-hour work shift.
  • You’re unable to stoop, lift, or carry objects as required for your job.
  • You must alternate sitting, standing and/or propping your legs up throughout the day.
  • You cannot walk across a flat surface or up/down a few steps without help.

Finally, the SSA will look for other jobs that might hire people with your work experience and educational background. For example: If you quit your construction job, is there a sedentary office position available that pays a similar wage? If not, you’re much more likely to qualify for disability benefits.

What Fibro-Related Health Problems Should You List On Your Claim?

Women are much more likely to develop fibro than men. When it comes to fibromyalgia and getting disability benefits, be sure to list all related health issues on your application. Many people with fibromyalgia experience the following related health problems:

  • Tension headaches
  • Temporomandibular joint (TMJ) disorders
  • Irritable bowel syndrome (IBS)
  • Anxiety
  • Depression
  • Chronic fatigue syndrome
  • Interstitial cystitis (IC)
  • Reflux (GERD)
  • Migraines
  • Restless leg syndrome

These issues are often severe enough on their own to make you stop working. The ability to sit or stand for long periods of time can be painful. Chronic fibromyalgia-related pain issues can sometimes lead to additional health complications. Our best advice is this: List all your health problems, symptoms and current medications on your application. This includes every drug side effect, dosage and how often you take each medication. Don’t expect fibromyalgia alone to make you eligible for disability. But combine all your health issues together, and you’re much more likely qualify for SSD benefits.

You May Qualify for Legal Assistance

If cannot work due to fibromyalgia, you should apply for SSD benefits. While fibro has no known cure, a good attorney knows how to get you the most benefits you deserve paid faster. We can match you with the closest disability attorney in your area who’s available to help you. Most doctors don’t know how to perform a “tender point” medical exam or document your results. But a disability lawyer can provide all the forms you need, give clear instructions to your doctor and file all the required paperwork for you.

All disability lawyers work on contingency. That means unless a lawyer helps you win a lump-sum cash settlement, you owe $0 for legal assistance with your claim. Having a lawyer file your application makes you 2x more likely to get approved for disability benefits on your first try. Only about 1 in 5 first-time disability applicants get approved right away, and most file claims through an attorney.

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