Fibromyalgia and Qualifying for Disability Benefits
Author: Attorney Greg Reed
Updated: 7/25/2024
Can I get disability benefits if I am suffering from the effects of Fibromyalgia?
To qualify for Social Security Disability Income (SSDI) with fibromyalgia, you must prove that your symptoms and limitations are so severe that you cannot work. This includes experiencing widespread pain, ruling out other diseases, and meeting specific criteria for fibromyalgia symptoms. Your medical records will be reviewed, focusing on your doctors’ notes and complaints of pain, fatigue, cognitive difficulties, and memory loss. It’s important to keep a journal of your symptoms and side effects to demonstrate the pattern and frequency of your symptoms. Social Security will assess whether a person with your limitations is employable.
Can I get disability benefits if I am suffering from the effects of a Fibromyalgia?
Approximately four million adults in the U.S. are affected by fibromyalgia (FM), a condition characterized by extensive musculoskeletal pain and fatigue. Women are more likely to have fibromyalgia and most people are diagnosed during middle age, but the disorder affects people of any age, including children. If you are suffering from the effects of Fibromyalgia you may qualify for disability benefits.
There are three main symptoms of fibromyalgia:
- Widespread pain, often described as a dull ache that has lasted at least three months; the pain must occur on both sides of the body and above and below the waist
- Fatigue, even after sleeping a long period of time. An affected individual’s sleep may be disrupted by pain and other sleeping disorders such as sleep apnea or restless legs.
- Cognitive difficulties that impair an individual’s ability to focus, pay attention, and concentrate.
Fibromyalgia often co-exists with other medical conditions, including:
- Chronic fatigue syndrome
- Migraine and other headaches
- Irritable bowel syndrome
- Interstitial cystitis
- Postural tachycardia syndrome
- TMJ
- Depression
- Anxiety
These conditions and accompanying symptoms can cause you to miss work, possibly jeopardizing your ability to maintain employment.
Treatment for fibromyalgia involves medication and self-care strategies to reduce symptoms and enhance general health.
There is no cure for fibromyalgia currently, and no single treatment works for all symptoms, but a combination of medications and therapies can have a positive impact on an individual’s well-being. Demonstrating that you are following your doctor’s treatment plan is an important part of qualifying for disability benefits.
Can I qualify for SSDI if I have fibromyalgia?
Social Security considers any “medically determinable” disorder that prevents you from working full-time for at least 12 months a disability.
Fibromyalgia is not listed as a disabling impairment in Social Security’s Blue Book, but the Administration has offered guidance for assessing the condition in a special ruling which has improved applicants’ chances for approval. To qualify for Social Security Disability Income, you must be able to prove that your symptoms and limitations are so severe you cannot work and provide complete medical records supporting a diagnosis of fibromyalgia.
Specifically, you must show:
- You experience widespread pain, including pain in the neck, back or chest; AND
- Tests and imaging used by your doctor to rule out other diseases such as lupus, hypothyroidism, or multiple sclerosis; AND
- Either:
- Repeated occurrences of at least six symptoms of fibromyalgia. This includes mental fog, fatigue, poor sleep, IBS, depression or anxiety; OR
- At least 11 out of 18 positive tender points on physical examination. The positive tender points must be found on the left and right sides of the body and above and below the waist.
A claims examiner will review your medical records, focusing on your doctors’ notes and look for complaints of pain, fatigue, cognitive difficulties, and memory loss.
The further back your medical record shows evidence of fibromyalgia symptoms and treatment, the better. Social Security will want to see how long you’ve been treated for fibromyalgia, how well you function, what treatments and medications you’ve taken and your response, and how long your doctor expects your functional limitations to last.
You must also show how fibromyalgia prevents you from working at any job.
Ask your doctor to fill out a Residual Functional Capacity form (RFC), an assessment that evaluates your physical and mental capabilities.
A person with fibromyalgia is typically limited in the following functions:
- How long you can sit, stand, and walk during an 8-hour day
- How much weight you can lift
- Whether you can crouch, stoop, kneel and bend
- How well you can focus and remember instructions
- Whether you miss time at work each month
Social Security will use an RFC to determine if you are able to return to your old job or are able to do another job, so it’s important to document all your functional limitations.
- Review your medical records yourself and make sure they include a diagnosis of fibromyalgia and any other medical conditions you are being treated for. Make sure your doctor has included comprehensive notes, knows you are applying for disability, and is willing to support your claim.
- Get a referral from a specialist. Social Security will take your claim of fibromyalgia more seriously if you have a diagnosis from a doctor who treats bone or tissue conditions or disorders involving pain and fatigue. Avoid a diagnosis of fibromyalgia by a mental health professional as it will carry less weight with Social Security. Instead, any diagnosis of depression or anxiety should be separate.
- Keep a journal of your symptoms and side effects so that Social Security can see your symptoms are real and have a pattern. It will be helpful if you can state how often you experience pain, fatigue, sleep disturbances, memory problems, or digestive issues and how many days you have to avoid certain activities.
- Provide statements from your family, friends and co-workers regarding your fibromyalgia symptoms and limitations.
Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable.
“Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable. Most vocational experts will find a person to be unemployable if their condition or the treatment rendered for the condition causes the person to regularly be absent two or more days a month or be “off-task” 15% or more of the workday.”
A college professor suffering from fibromyalgia in north Texas contacted Bemis, Roach & Reed to assist in challenging the denial of long term disability (LTD) benefits through Fort Dearborn Life Insurance Company.
At the time we were contacted, the client had already initiated an appeal of the Fort Dearborn denial by requesting a review from the Employee Retirement System of Texas (ERS). The claim was set for hearing before an administrative law judge (ALJ) with the State Office of Administrative Hearings in Austin, Texas. The disease had progressed to the point that work was no longer possible due to constant pain and fatigue. Fort Dearborn denied the claim when it was filed.
Bemis, Roach & Reed accepted the representation and began to litigate the case.
We arranged for our client to attend a functional capacity evaluation (FCE). The FCE supported our contention that our client could no longer work as a college professor. We also developed medical testimony from the client’s treating physicians. The case resolved to the satisfaction of all parties by confidential settlement prior to the ALJ hearing.
A Floresville client had been found totally disabled by the Social Security Administration (SSA).
The SSA found that she had a medically determinable impairment, fibromyalgia, which met the criteria set out in Social Security’s Guidelines.
She was presumptively disabled due to fibromyalgia under Social Security’s standards, but Liberty Mutual denied her. Mr. Roach challenged the denial and got her a settlement.
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Disability Benefits FAQs
Social Security has some basic financial requirements.
Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements. You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,620 per month in 2025 for nonblind applicants and $2,700 per month for blind applicants.
Basic SSDI Requirements –>
You may also be eligible for Social Security Disability benefits if you have another medical condition.
One disorder alone may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.
Disability for Multiple Impairments –>
If you are 55 or older or have another medical condition you may get approval.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job.
Disability for those over 55 –>
You may also be eligible for Social Security Disability benefits if you have another medical condition.
One disorder alone may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.
Disability for Multiple Impairments –>
Should you file a claim?
If you believe that you meet Social Security’s medical and financial requirements, you should apply for benefits. If you are still unsure or would like to talk to someone, please contact us at 512-454-4000. We are always ready to take your call and discuss your options with you free of charge. We are happy to help folks just like you find the best solution for their personal situation.
How do I file for Social Security Disability benefits?
Once you have decided to file a claim, you can take the first step and apply for Social Security Disability benefits in person at your local Social Security Administration office, online, or over the phone.
How to Apply for SSDI –>
Appealing denied benefits
Most who file are denied initially. That doesn’t mean you won’t qualify; you just need to file an appeal.
There are four steps to the Social Security appeal process.
SSDI Appeals Process –>
Do I need a disability attorney for SSDI?
You may certainly file a claim on your own, but evidence shows that your chances for approval are increased significantly if you have legal representation.
Do I need an SSDI attorney–>
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.
What is Supplemental Security Income or SSI?–>
I have long-term disability insurance – should I file a claim?
Absolutely – you should file a claim as soon as you become disabled.
LTD Disability Appeals Process–>
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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