Disability Determination for Fibromyalgia

Although getting Social Security disability benefits for fibromyalgia is difficult, it is not entirely impossible.

Fibromyalgia is a disorder that causes musculoskeletal pain and soft tissue tenderness throughout the body. Common symptoms include numerous tender points, fatigue, stiffness, trouble sleeping, feelings of depression, and problems in thinking and concentration. Fibromyalgia usually affects a higher percentage of women than men. A rheumatologist can evaluate you to determine whether you fit the criteria for fibromyalgia.

The U.S. Food and Drug Administration has approved the prescription drugs Lyrica and Cymbalta for the treatment of fibromyalgia. These medicines may cause side effects such as drowsiness, weight gain or a decreased appetite, and dizziness.

Being Diagnosed with Fibromyalgia

The American College of Rheumatology (ACR) has issued criteria to be used in determining whether you have fibromyalgia. Although the Social Security Administration (SSA) will not give you disability benefits based solely on the ACR's criteria, meeting the criteria means that you do have a "medically determinable impairment" and that Social Security must consider you for  disability.

The ACR has two different ways of diagnosing  fibromyalgia, one based on having 11 out of 18 possible tender points, the other based on your having at least six signs that commonly occur with fibromyalgia, such as fatigue, depression, anxiety, IBS, and cognitive or memory problems. Both methods require a history if widespread pain and your doctor having ruled out other possible causes.

If your  doctor  has diagnosed you with fibromyalgia and stated that you fit one of the ACR's definitions, and your inability to work has lasted or will last at least twelve months, the SSA will continue assessing your claim with its five-step evaluation process. The first step is  determining  whether you meet the requirements of a  disability  listing.

Meeting a Disability Listing

The SSA has created official descriptions of medical conditions that qualify for disability, and one way to qualify for disability benefits it to match one of these descriptions. If your condition meets the requirements of one of these impairment listings, you are automatically found disabled. However, fibromyalgia is not classified as a disability listing. Thus, it can be difficult to be found disabled based on fibromyalgia alone, but you might still be able to qualify based on your having a low functional capacity (see below).

If you've  been diagnosed with other conditions in addition to fibromyalgia, the SSA will determine if you meet any impairment listings based on these other conditions. Common disorders connected with fibromyalgia may include asthma (Impairment Listing 3.03), sleep-related breathing disorders (Impairment  Listing 3.10), inflammatory bowel disease (Impairment  Listing 5.06), and depression (Impairment  Listing 12.04).

Assessing Your Residual Functional Capacity

If the SSA finds your medical condition doesn't meet an impairment listing, the SSA will assess your residual functional capacity (RFC) if it considers your fibromyalgia severe. Your RFC is your maximum ability to perform work; for instance, you might be given a RFC for medium work, light work, or sedentary work.  

Your RFC is based upon your medical records, opinions from doctors and specialists, and statements from you and family members. In assessing your RFC, the SSA will estimate your ability to perform such basic work tasks as sitting, standing, lifting and carrying objects, handling objects, working with coworkers and the general public, using concentration, and understanding and carrying out instructions.  If your RFC is so limited that you are unable to perform your prior work or any other jobs, you will be considered disabled.

Since fibromyalgia is associated with widespread pain, there is a variety of ways in which you might be found disabled based on your RFC. If you have difficulty holding objects or using your fingers for manipulation, then you likely would be restricted from working at a large number of jobs. Similarly, if you have severe fatigue, which prevents the number of days you could work in a month, then you could be found disabled. In addition, if you have problems standing, walking, or sitting for a long period of time, your RFC might be limited to "less than sedentary" work. If so, then you would be found disabled because you would be prevented from performing essentially any work.  

Any medications that you take to treat fibromyalgia and the side effects from those medications should be included in your RFC. If you suffer from serious side effects of medication, such as dizziness or sleepiness that would prevent you from working a full-time job, then the SSA might find that you are disabled.

For more on how your RFC affects your claim, see Your Residual Functional Capacity (RFC).

Controversy Over Disability Benefits for Fibromyalgia

There has been a fair amount of litigation in the federal court system concerning applications for disability benefits based on fibromyalgia. This is because many of the symptoms of fibromyalgia are based on subjective (self-reported) evidence. Most appellate courts have agreed that you have a better chance of supporting your diagnosis of fibromyalgia if all of the following are true.

  • You exhibit the classic symptoms of fibromyalgia (such as fatigue and widespread pain).
  • Your doctor has attempted to rule out other diseases through the use of objective medical clinical testing.
  • You meet the American College of Rheumatology's criteria for fibromyalgia (above), and
  • There is agreement among your doctors that you have fibromyalgia.    

Medical Evidence Required

You will need to provide evidence to the SSA of your medical visits, information regarding the onset and history of your fibromyalgia along with the frequency of your flare-ups, any treatment you have received, the results of that treatment, and any opinions from medical professionals concerning your ability to perform work. The SSA's regulations generally allow more weight to be given to the opinion of a specialist in the field of fibromyalgia, such as a rheumatologist, rather than to the opinion of other medical professionals.

Your credibility could be an important issue in your disability claim for fibromyalgia because your fatigue and pain are usually self-reported. To determine the credibility of your statements, the SSA will consider your entire medical record and evaluate whether your statements are consistent with those of the medical professionals who have treated you and with the objective medical evidence.  If you are  initially  denied benefits and you've appealed until you are at the hearing stage of your disability claim, the administration law judge (ALJ) will assess the credibility of your statements. If the ALJ dismisses any of them as untrue, he or she would need to provide a reason why.

Because you may be up against a judge who is not likely to approve benefits for fibromyalgia, it's worth it to hire a disability lawyer to represent you at the hearing stage. A lawyer will be able to help prove your diagnosis and defend your credibility.

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