Fibromyalgia is a chronic and debilitating condition that disrupts the lives of people it afflicts. It causes extreme pain, fatigue, and cognitive impairment, frequently interfering with a person’s ability to work, perform day-to-day activities, and enjoy life.
The disability professionals at Liner Legal Disability Lawyers frequently get asked the question: Is fibromyalgia a disability? The simple answer is yes, but it depends on the extent and severity of the symptoms experienced by a person suffering from the disorder.
Social Security has strict criteria for evaluating fibromyalgia claims, and more than two-thirds of applications for disability benefits filed with the Social Security Administration are not approved. That’s one of the reasons this blog post explains the disability determination process and the evidence you need to prove that you have fibromyalgia and cannot work because of it.
Disability Benefits Available For Fibromyalgia
The Social Security Administration has two programs, Supplemental Security Income and Social Security Disability Insurance, paying benefits to people who are disabled. SSI is a needs-based program for disabled adults and children, requiring applicants to have only limited income with financial resources that do not exceed a total value above $2,000 for individuals and $3,000 for couples.
SSDI does not have income or resource restrictions because eligibility is not based on need. Instead, you must have a work history with payment of Social Security taxes on your earnings.
If you meet these non-medical criteria for eligibility for either SSI or SSDI, your application for disability benefits moves on in the review process. The next stage in the process for someone with fibromyalgia is to determine if your condition meets the definition of disability used by Social Security.
Determining If Fibromyalgia Qualifies For Disability
To determine whether your fibromyalgia qualifies for disability, you must meet the following requirements:
- You have a medically determinable physical or mental impairment;
- The impairment or impairments are expected to last for at least 12 months or result in death and
- The impairments prevent you from doing any substantial gainful activity.
Substantial gainful activity or SGA refers to work-related activities, but Social Security measures your ability to engage in it by your monthly earnings. A person capable of earning more than $2,460 for someone who is blind and $1,470 for all others with a disability. The SGA changes in 2024 to $2,590 for people applying because of being blind and $1,550 for all others.
Evidence Needed To Prove Is Fibromyalgia A Disability.
Fibromyalgia is a complex condition that is not well understood. It does not have a specific test or imaging to confirm its diagnosis. Therefore, you need to provide medical evidence to support a claim.
The Social Security disability determination process must decide whether your medical evidence establishes that fibromyalgia qualifies as a disability. The evidence must show the following:
- A diagnosis of fibromyalgia from a physician who is a rheumatologist or specializes in chronic pain disorders.
- Medical records documenting chronic, widespread pain in your body’s upper right, upper left, lower right, and lower left parts for at least three months.
- Medical records, including blood tests, X-rays, MRIs, and other diagnostic testing, that rule out other causes of your symptoms.
Medical evidence must also establish the presence of at least six of the following symptoms common to fibromyalgia:
- Fatigue
- Cognitive impairment.
- Sleep disturbance
- Depression
- Anxiety
- Irritable bowel syndrome
- Headaches
- Numbness or tingling arms or legs
If your medical records do not prove six of the symptoms listed above, you have the option of submitting the results of a physical examination conducted by your doctor where at least 11 out of 18 tender points were confirmed. Tender points are specific areas of the body that are painful when pressure is applied during an examination.
Statements from friends, family, and people at work can help prove how the symptoms of your medical condition affect you. A disability lawyer at Liner Legal can help you gather evidence proving that you cannot work because of fibromyalgia symptoms.
Medical Treatment Is Essential To Qualify For Disability
Your medical records must show that you have a regular and ongoing relationship with the physicians who diagnosed and treated you for fibromyalgia. Filling prescriptions and taking the medication your doctors prescribe is essential to the success of your claim for benefits. The same is true of physical therapy, counseling, and occupational therapy. If your doctor recommends that you participate, Social Security may deny a claim for benefits of someone who fails to follow the treatment plan prescribed by their physician.
Consult A Disability Lawyer
It’s not easy to prove fibromyalgia qualifies for disability, but the information about the disorder explained in this blog, along with the assistance of a skilled and experienced disability lawyer, can improve your chances of success. Learn more about what Liner Legal Disability Lawyers can do for you. Call us today for a free consultation.
