Fibromyalgia and Qualifying for Disability Benefits
512-454-4000Author: Attorney Greg Reed
Updated: 5/16/2025
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.
Navigating Disability Benefits for Fibromyalgia: A Comprehensive Guide
Living with fibromyalgia can be an overwhelming challenge, affecting nearly every aspect of daily life.
For many who suffer from this complex condition, there comes a point when working becomes impossible due to persistent pain, fatigue, and cognitive difficulties. When your ability to maintain employment is compromised, disability benefits may provide essential financial support. However, navigating the disability benefits system for fibromyalgia can be particularly challenging due to the invisible nature of the condition and its complex diagnostic criteria.
Table of Contents:
This guide aims to provide a comprehensive overview of qualifying for disability benefits with fibromyalgia, including both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), as well as options through private long-term disability insurance.
1. Functional Challenges Related to Fibromyalgia
Fibromyalgia presents numerous functional challenges that can severely impact a person’s ability to work:
Pain and Physical Limitations:
- Widespread chronic pain affecting multiple body areas
- Tender points that can be severely painful when touched
- Morning stiffness and muscle spasms
- Decreased physical stamina and exercise tolerance
- Difficulty sitting, standing, or maintaining positions for extended periods
Cognitive Difficulties (Often Called “Fibro Fog”):
- Impaired concentration and attention span
- Short-term memory problems
- Difficulty multitasking
These functional challenges collectively impact a person’s ability to reliably perform work duties on a sustained basis, which is a critical factor in disability determinations.
2. Fibromyalgia in the Social Security Administration’s Blue Book
Fibromyalgia is not specifically listed as a separate impairment in the Social Security Administration’s (SSA) Blue Book (Listing of Impairments). However, the SSA officially recognizes fibromyalgia as a potentially disabling condition through SSR 12-2p, a ruling that provides specific guidance on evaluating fibromyalgia in disability claims.
While not having a specific listing, fibromyalgia cases are typically evaluated under:
- Section 14.00 – Immune System Disorders
- Section 1.00 – Musculoskeletal System
- Section 12.00 – Mental Disorders (when significant cognitive or psychological symptoms are present)
The lack of a specific listing doesn’t mean you can’t qualify for benefits; it simply means the SSA evaluates fibromyalgia cases using alternative criteria.
3. Medical Requirements to Qualify for Disability with Fibromyalgia
The SSA requires the following medical evidence to establish fibromyalgia as a medically determinable impairment (MDI):
Option 1:
- A history of widespread pain in all four quadrants of the body and axial skeletal pain lasting at least three months
- At least 11 of 18 specific tender points on physical examination
- Evidence that other disorders such as lupus, hypothyroidism, or multiple sclerosis that could cause these symptoms have been excluded
Option 2:
- A history of widespread pain lasting at least three months
- Repeated manifestations of six or more fibromyalgia symptoms, signs, or co-occurring conditions, especially fatigue, cognitive or memory problems (“fibro fog”), waking unrefreshed, depression, anxiety, or irritable bowel syndrome
- Evidence that other disorders such as lupus, hypothyroidism, or multiple sclerosis that could cause these symptoms have been excluded
Documentation Requirements:
- Medical records from acceptable medical sources (primarily physicians)
- Detailed description of physical examinations
- Laboratory test results ruling out other conditions
- Treatment history and response to treatments
- Longitudinal records showing persistent symptoms
4. Qualifying Without Meeting Specific Listings
Many fibromyalgia patients don’t qualify under specific medical listings but can still receive disability benefits through what’s called a “medical-vocational allowance.”
This approach considers how your symptoms affect your Residual Functional Capacity (RFC) – what you’re still able to do despite your limitations.
To qualify through this pathway the SSA will assess:
- Your functional limitations due to fibromyalgia. The SSA will assess your ability to perform physical activities (sitting, standing, walking, lifting) and mental activities (concentration, following instructions, handling stress).
- They will examine your ability perform your previous job or past relevant work by determining whether your Residual Functional Capacity (RFC) allows you to carry out these former duties.
- Transferable Skills Analysis: If you cannot perform your previous work, the SSA will examine whether you could adjust to other types of work given your age, education, work experience, and RFC.
For fibromyalgia cases, focus on documenting:
- Specific functional limitations
- Frequency and severity of flare-ups
- Need for unscheduled breaks
- Inconsistent attendance due to symptoms
- Side effects of medications
- Combined impact of all symptoms on work ability
The SSA will hire a vocational expert to help determine whether there are any jobs in the national economy that you could perform given your limitations.
If they conclude that fibromyalgia symptoms prevent you from performing even the most basic unskilled work on a regular and continuing basis, you may be approved for disability benefits despite not meeting the specific listing requirements.
Of note: 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.
Medical-vocational allowances account for most approved fibromyalgia disability claims, making thorough documentation of functional limitations crucial to your case.
“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.”
5. Multiple Medical Conditions With Fibromyalgia
Having multiple medical conditions alongside fibromyalgia often strengthens a disability claim. The SSA is required to consider the combined effect of all your medical conditions on your ability to work, rather than evaluating each condition in isolation.
Common co-occurring conditions with fibromyalgia include:
- Chronic fatigue syndrome
- Irritable bowel syndrome
- Migraines or chronic headaches
- Depression and anxiety disorders
- Autoimmune disorders like rheumatoid arthritis or lupus
- Sleep disorders like sleep apnea or restless leg syndrome
- Degenerative disc disease or other spinal conditions
When multiple conditions are present:
- Each condition should be separately documented with proper medical evidence
- Medical records should note how conditions interact and compound limitations
- Your RFC assessment should address the combined impact of all conditions
- Treatment history should show consistent efforts to address all conditions
While having multiple conditions doesn’t guarantee approval, it often presents a more complete picture of your limitations and can significantly strengthen your case for disability benefits.
Disability for Multiple Impairments –>
6. Basic Financial Requirements for Social Security Disability Benefits
In order to qualify for disability benefits you must first meet the SSA’s financial requirements:
- You must have sufficient work credits earned through paying Social Security taxes. Generally, individuals 31 years and older need at least 20 work credits earned in the 10 years immediately before their disability began. Younger workers may qualify with fewer credits. Work credits are based on annual income; in 2025, you earn one credit for each $1,810 in covered earnings, up to four credits per year
- The SSA also requires that you cannot engage in “substantial gainful activity” (SGA) which they define as earning more than $1,620 per month (in 2025) for non-blind individuals and $2,700 for blind individuals. If you can earn more than $1,620 per month you will be denied benefits.
In order to qualify, your disability must be expected to last at least 12 months or result in death, and you must be unable to engage in substantial gainful activity.
SSDI Financial Requirements –>
7. Qualifying for Disability Benefits Over Age 50
The SSA recognizes that older workers may have more difficulty transitioning to new occupations through what are called the “Medical-Vocational Guidelines” or “Grid Rules.” These rules make it progressively easier to qualify for disability benefits as you age, particularly from age 50 onward.
For fibromyalgia claimants over 50:
- Physical limitations are given more weight than for younger claimants
- Limited education or lack of transferable skills becomes more significant
- The SSA may not expect you to learn entirely new skills or adapt to new work environments
This doesn’t mean approval is automatic, but the standards become more lenient, recognizing the challenges older workers face in adapting to new types of employment when their health is compromised.
Disability for those over 50 –>
8. SSI as an Alternative to SSDI
If you don’t qualify for SSDI due to insufficient work credits, Supplemental Security Income (SSI) provides an alternative pathway to disability benefits for those with financial need.
Key considerations for fibromyalgia patients seeking SSI:
- The medical criteria for proving disability are identical to SSDI
- Financial need, not work history, determines eligibility
- Living arrangements can affect benefit amounts (living rent-free reduces benefits)
- Resource limits are strictly enforced and regularly reviewed
- In-kind support (food, shelter provided by others) may reduce benefit amounts
For those who have never worked or who left the workforce many years ago due to fibromyalgia, SSI may be the only option for disability benefits through the Social Security Administration.
9. Long-Term Disability Insurance Policies
Private long-term disability (LTD) insurance, whether employer-provided or individually purchased, offers an additional potential source of income for fibromyalgia patients unable to work.
Important considerations:
- Most policies require applying for Social Security benefits
- Benefits are often offset by any SSDI payments received
- Definitions of disability typically change after 24 months from “own occupation” to “any occupation”
- Fibromyalgia claims face particular scrutiny due to subjective symptoms
- Medical documentation requirements are similar to Social Security’s
- Some policies limit benefits for “self-reported” conditions like fibromyalgia
If you have an LTD policy, review your policy documents carefully to understand how it defines disability and any specific limitations for conditions like fibromyalgia.
The Long-Term Disability Appeal Process –>
10. The Importance of Legal Representation
Having an experienced disability attorney represent you can significantly improve your chances of approval for fibromyalgia-related disability claims:
Statistical advantage: Represented claimants are approximately three times more likely to be approved at hearing level than unrepresented claimants.
Why legal representation is crucial:
- Fibromyalgia cases are inherently complex due to subjective symptoms
- Attorneys understand how to properly document “invisible” disabilities
- They can identify and address potential weaknesses in your case
- They know how to effectively cross-examine medical and vocational experts
- They understand the specific requirements of SSR 12-2p for fibromyalgia
- They can help obtain proper medical documentation from your doctors
- They can prepare you for questions you’ll face during hearings
Financial considerations:
- Disability attorneys work on contingency (no upfront fees)
- Fees are capped at 25% of past-due benefits, with a maximum of $9,200
- No fee is charged if your case is unsuccessful
- The potential increase in approval chances often justifies the cost
The complexity of fibromyalgia cases and the elevated denial rates make professional representation particularly valuable for those with this condition.
11. Conclusion
Navigating the disability benefits system with fibromyalgia presents unique challenges, but it is certainly possible with proper documentation, persistence, and appropriate support.
The invisible nature of fibromyalgia symptoms makes thorough medical documentation and clear articulation of functional limitations absolutely essential to a successful claim.
Remember that most claims are initially denied, making the appeals process a normal part of the journey rather than an indication that your condition isn’t legitimate or severe.
Many successful claims are approved only after reaching the hearing level, where you can personally testify about your limitations and challenges.
While securing disability benefits for fibromyalgia may require significant effort and patience, these benefits can provide crucial financial support, allowing you to focus on managing your health rather than struggling to maintain employment that exacerbates your symptoms. With proper medical care, appropriate documentation, and experienced legal representation, those disabled by fibromyalgia can successfully navigate the complex disability benefits system and secure the support they need.
If you’re considering applying for disability benefits due to fibromyalgia, start by assembling a comprehensive medical record, consulting with a disability attorney familiar with fibromyalgia cases, and preparing yourself for what might be a lengthy but ultimately worthwhile process.
Bemis, Roach & Reed Fibromyalgia Case Example
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.
Citations:
SSA Fibromyalgia Listing
Fibromyalgia Mayo Clinic
SSA Age Grid Rules
SSA Disability Financial rules
SSI Qualifications – The SSA
SSA – Residual Functional Capacity
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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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