Written by Kristeen Cherney
Medically reviewed by Brenda B. Spriggs, MD, FACP
Fibromyalgia (FM) is one of the harder conditions to get approved for as a disability. Because the symptoms are often self-reported, you’ll need medical documents and a doctor to support your case. But it’s possible to have a successful claim for FM.
How is fibromyalgia diagnosed? »
Keep in mind that your best chance of getting approved for disability is to have:
- relevant medical records
- laboratory testing
- doctors’ opinions
- statements from friends, family, and coworkers
Read on to learn what the Social Security Administration (SSA) requires and how you can build your case for fibromyalgia disability.
The SSA is responsible for evaluating all disability applications. When reviewing your case, the SSA will determine if you have a medically determinable impairment (MDI) of FM.
The criteria and requirements for claiming disability due to FM are extensive. They include:
- symptoms that must be severe and present for at least three months
- documented evidence that rules out other conditions
- statements from you and others about any restrictions or inabilities on your daily activities
- whether FM prevents you from working
You must also have at least 11 of the 18 tender points above and below the waist, and on both sides of the body, or at least six ongoing symptoms of FM.
These symptoms include:
- memory or problems with thoughts, also known as fibro fog
- irritable bowel syndrome
- waking up exhausted
What are the complications of fibromyalgia? »
While the SSA requires a doctor’s diagnosis, cases are often won or lost based on symptoms and limitations, according to The National Fibromyalgia Association. Even if you have a diagnosis for FM, the SSA will look at whether you’re capable of work.
Documentation is the key to a successful disability case. This means more than supplying the SSA with your medical records. If your symptoms result in missed workdays, your employer may need to provide a statement saying so.
Overall, your application should contain:
- a confirmed diagnosis from a rheumatologist
- dates and contact information of your doctors, caseworkers, and hospitals
- your current and relevant medical records such as medications, lab tests, or psychologist visits
- a Residual Functional Capacity (RFC) about your impairments filled out by your physician
- a summary of your previous jobs
It’s also helpful to keep a fibromyalgia diary. This can help you track all the days you experience pain, and how it interferes with your normal daily routine. You can take into account migraines, painful periods, and chronic exhaustion.
Your rheumatologist can also give a professional opinion on your limitations. This includes an assessment of your ability to:
- sit, stand, and walk in an eight-hour workday
- lift and carry heavy loads
- conduct fluid movements like bend, balance, or crawl
- maintain punctuality and attendance at work
The SSA takes all documentation into consideration before making a decision on your disability application. Once you submit your application, a team of doctors that work with the SSA will evaluate all of its components. The team of doctors will also include a psychologist to see if FM has resulted in any mental impairment.
These impairments are based on:
- speed of information processing
The team interprets your medical information and predicts how long your condition is likely to last.
When you are ready to apply for disability benefits, you can apply:
- by phone at 1-800-722-1213, or TTY 1-800-325-0778, if you’re hard of hearing
- at your local social security office
You’ll want to call ahead and make an appointment, if you plan to apply in person.
The SSA says you can apply for benefits as soon as you receive a fibromyalgia disability diagnosis.
The SSA estimates an average wait time of three to five months for disability benefit claims. It’s best to apply for this once you become disabled.
In some cases, the SSA will request additional documents to process your disability claim. Providing everything you need in advance may help shorten the waiting period.
Disability benefits can help if FM prevents you from working at least one year. The average cost for annual fibromyalgia treatment can add up to $5,945 per person. This amount may be even more if your health insurance doesn’t cover all your treatments. Disability can help with the costs, especially if you are unable to work.
Check out the SSA’s Disability Starter Kit when you are ready to apply.