Fibromyalgia claims are challenging because the condition is hard to prove objectively. But thousands of people with fibromyalgia receive disability benefits. Here's how to approach your claim.
In this article, we'll cover:
- Can fibromyalgia qualify?
- How SSA evaluates fibromyalgia
- Evidence you need
- Tips for approval
1. Can Fibromyalgia Qualify?
Yes, fibromyalgia can qualify:
- SSA recognizes it as a legitimate impairment
- Published ruling SSR 12-2p provides guidance
- Can be basis for disability
- If severe enough
The challenge:
- No definitive lab test
- Subjective symptoms
- Invisible disability
- Must prove severity
When it qualifies:
- Symptoms are severe
- Despite treatment
- Significantly limits function
- Can't maintain employment
2. How SSA Evaluates Fibromyalgia
SSA's fibromyalgia criteria (SSR 12-2p):
Option 1: Evidence of:
- History of widespread pain
- At least 11 positive tender points
- Evidence other disorders ruled out
Option 2: Evidence of:
- History of widespread pain
- Repeated manifestations of 6+ symptoms:
- Fatigue
- Cognitive problems
- Waking unrefreshed
- Depression
- Anxiety
- IBS
- Evidence other disorders ruled out
After establishing fibromyalgia:
- SSA evaluates functional limitations
- Creates RFC
- Determines what work possible
- Considers all symptoms
No specific listing:
- Fibromyalgia has no numbered listing
- Evaluated under RFC
- May meet related listings (depression, etc.)
- Combined with other conditions
Important: Establishing you have fibromyalgia is step one. Then you must prove it prevents work.
3. Evidence You Need
Medical records:
- Consistent treatment history
- Rheumatologist or pain specialist
- Physical exam findings
- Tender point examination
Rule out other conditions:
- Lab work showing no other cause
- Tests ruling out RA, lupus, etc.
- Negative for other explanations
- Important for SSA
Treatment history:
- Medications tried and results
- Physical therapy
- Pain management
- Alternative treatments
Doctor's opinion:
- Detailed RFC assessment
- Specific limitations
- How symptoms affect function
- Work-related restrictions
Symptom documentation:
- Fatigue level and pattern
- Pain location and severity
- Cognitive issues ("fibro fog")
- Sleep problems
- Good days vs. bad days
Functional limitations:
- Can't sit/stand for how long
- Need to lie down during day
- Can't lift certain weights
- Concentration problems
4. Tips for Approval
Consistent treatment:
- See doctors regularly
- Follow treatment plans
- Document responses to treatment
- Shows ongoing severity
Specialist involvement:
- Rheumatologist preferred
- Pain management specialist
- Not just primary care
- Specialists carry more weight
Document symptoms:
- Keep a symptom diary
- Note triggers
- Track flares
- Record daily limitations
Describe functional impact:
- Not just "I hurt"
- "I can only stand 10 minutes"
- "I must lie down 3 times daily"
- "I can't concentrate for tasks"
Include co-occurring conditions:
- Depression (very common)
- Anxiety
- Chronic fatigue
- IBS
- These add to limitations
Explain work history:
- Why you stopped working
- How fibromyalgia affected jobs
- Accommodations tried
- Why work isn't possible
Common Challenges
Subjective symptoms:
- No blood test for fibromyalgia
- Must rely on clinical findings
- Get thorough examinations
- Document tender points
"Good days" problem:
- Some days are better
- Doesn't mean you can work
- Inconsistency IS the disability
- Can't predict or maintain schedule
Credibility concerns:
- SSA may question severity
- Consistent records help
- Multiple doctors confirming
- Daily life descriptions
Medication complications:
- Side effects limit function
- Document all side effects
- Explain why some meds stopped
- This supports severity
How Purple Helps
Purple supports those with chronic pain:
- Track benefit deposits
- Manage finances easily
- Reduce stress
- Simple interface
- No complicated banking