Fibromyalgia Diagnosis? Applying for Social Security Disability Benefits

High Swartz LLP

If you have been diagnosed with fibromyalgia and have been unable to work for the last year or longer due to the severity of your condition, you may be considering whether or not you should apply for Social Security Disability Benefits.

Before applying for SSD benefits, you should be aware of how fibromyalgia is viewed by the Social Security Administration. The SSA requires strict evidence that you will need to provide to be considered disabled under the administration’s guidelines.

Can I get Social Security Disability Benefits for Fibromyalgia?

First, let’s start with a breakdown of Fibromyalgia, its symptoms, and how covid can impact its severity.
According to the Social Security Administration (SSA), Fibromyalgia (FM) is a complex medical condition characterized by widespread pain in the joints, muscles, tendons, or nearby soft tissues that persists for at least 3 months. In addition to chronic pain, fibromyalgia is also associated with difficulty sleeping, memory and cognitive problems otherwise known as “fibro fog”, chronic fatigue, depression, recurring migraine headaches, irritable bowel problems, muscle fatigue causing twitching and spasms, and temperature sensitivity.

For those suffering with fibromyalgia, COVID-19 may have a significant impact on your health. The effects of COVID-19 on our everyday life has resulted in increased stress, depression, reduced physical activity and weight gain for many people. While these changes are not good for anyone’s health, they are particularly concerning for those with fibromyalgia as they can result in painful and debilitating flare-ups of their condition.

What do I need to know before I apply for benefits?

  • Establish diagnosis and treatment. First, it must be established that you have been diagnosed and treated for fibromyalgia by a medical or osteopathic doctor. The Social Security Administration (SSA) will review the doctor’s treatment notes, findings on physical examination, and the diagnostic studies that have been performed. Then, the SSA will evaluate whether the doctor’s records are consistent with a diagnosis of fibromyalgia and whether your reported symptoms over time have been severe enough under the Social Security Administration’s requirements to find you disabled.
  • A Rheumatologist is key. Social Security Administration evaluates fibromyalgia through the criteria established by the American College of Rheumatology. If you have been diagnosed with fibromyalgia by a physician that is not a rheumatologist, the doctor’s diagnosis and documentation may not be sufficient to meet the requirements that the SSA is using to evaluate claims.
  • Evidence. There are three key pieces of evidence that the Social Security Administration will look for in your medical records to establish the diagnosis of fibromyalgia.
  1. Your Records. Records must establish that you have had widespread pain that has persisted for at least three months. Widespread pain is defined as experiencing pain on both sides of the body, and in both upper and lower halves of the body.
  2. Tender points. There are 18 tender points identified on the body that are addressed in evaluating fibromyalgia. Of the 18 tender points, you must have pain in at least 11 of them. If your doctor is not documenting tender point testing, meeting this criteria will be difficult.
  3. Ruling out other diagnoses. There must be documented evidence in the documentation that other disorders likely to cause the same symptoms have been ruled out.
  • Symptoms. In considering the severity of fibromyalgia, the Social Security Administration is looking for evidence of having repeated manifestations of six or more fibromyalgia symptoms, or co-occurring conditions such as: fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression, anxiety and irritable bowel syndrome.

Is it difficult to get SSD benefits if you have Fibromyalgia?

Obtaining Social Security benefits based on a fibromyalgia diagnosis can be extremely difficult for several reasons. First and foremost, the condition is usually diagnosed between the ages of 35 to 45. At that age, the Social Security Administration considers you to be a younger individual and presumes that you are not disabled based upon their regulatory guidelines. The diagnoses of fibromyalgia is based upon a combination of subjective symptoms which cannot easily be established and are not always well documented. The SSA relies heavily on medical records when making disability determinations. If your complaints are not substantiated by the medical records, your claim will most likely be disapproved.

While you are not required to utilize the services of an SSDI lawyer during the benefit application process, it is crucial to put your best case forward from the very beginning. If Fibromyalgia is your primary disabling condition, you should consider consulting with an experienced Social Security Disability attorney before entering your claim. If you are denied benefits at the initial stage, it then takes a significant period of time to get a hearing date before an Administrative Law Judge (ALJ), with some offices reporting a wait of 18-months.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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