Is Fibromyalgia Covered Under Social Security Disability?

June 12, 2017

Fibromyalgia is a chronic pain disorder affecting approximately 10 million Americans. Unfortunately, it is also a greatly misunderstood condition and difficult to prove its debilitating effects on an individual’s ability to work. Although you may be able to qualify for Social Security disability insurance (SSDI) if you suffer from fibromyalgia, it will likely be a tough fight. It’s important to understand why.

What Is a Medically Determinable Impairment?

Of course, your medical conditions are not the only thing that the Social Security Administration (SSA) takes into account when deciding whether or not you qualify for SSDI. Depending on whether you’re applying for disability insurance benefits (DIB) or supplemental security income (SSI), you will also need to show that you either have enough work credits to qualify for DIB or you earn below a certain level of household income to qualify for SSI.

However, let’s say that, beyond your medical conditions, your case is solid. One question remains: does the SSA consider fibromyalgia to be a medically determinable impairment?

A medically determinable impairment is a disabling condition that is proven by objective medical evidence such as lab tests or blood work. In the case of fibromyalgia, this presents a challenge. Since fibromyalgia is a chronic pain disorder that affects many parts of the body and tends to decrease and increase in severity over time, it can be difficult to determine whether or not a person’s symptoms are the result of fibromyalgia or the result of another disease or condition.

The problem also remains that there are no lab tests that can prove that you have fibromyalgia. However, lab tests can be used to rule out other conditions such as lupus or arthritis that cause similar symptoms to fibromyalgia.

In order to assert that your case of fibromyalgia is a medically determinable impairment, it is vital that you seek regular medical treatment from a physician. When it comes to fibromyalgia, a licensed medical doctor must make the diagnosis. Your medical records must document your symptoms as well as all attempts to alleviate your pain and the steps your doctor took to rule out other medical conditions that may be causing your pain.

The SSA’s Criteria for Fibromyalgia

In 2012, the SSA released their criteria for determining that a person’s fibromyalgia was a medically determinable impairment:

1. History of Widespread Pain: The patient has experienced pain in all quadrants of the body as well as axial skeletal pain (pain in the cervical spine, anterior chest, thoracic spine, or lower back). This pain must have continued for at least three months.

2. Eleven Tender Points: The patient has 11 positive tender points found in all four quadrants of the body (right and left sides of the body as well as above and below the waist). These points can be tested upon physical examination.

3. Exclusion of Other Possible Disorders: The patient’s doctor has taken into account and tested for other disorders that cause similar symptoms. The results of these tests have excluded these other possible disorders from causing these symptoms.

4. Six or More Fibromyalgia Symptoms: The patient experiences at least six symptoms commonly associated with fibromyalgia, such as fatigue, cognitive problems (known as “fibro fog”), waking unrefreshed, depression, anxiety, or irritable bowel syndrome.

Social Security’s 5 Steps for Determining Disability

Proving that your fibromyalgia is a medically determinable impairment, however, is just one of the steps necessary to prove that your condition is disabling and preventing you from returning to work. The SSA has five criteria you must meet in order to be approved for disability:

1. Financial Eligibility: This is where the SSA looks at your work history if you are applying for DIB or your household income level if you are applying for SSI. Even if you have a disabling condition, if you do not meet these work history or financial requirements, you will be denied.

2. Medically Determinable Impairment: Here is where the SSA will apply their criteria for determining whether your fibromyalgia is a medically determinable impairment.

3. Meets or Equals Condition on Listing of Impairments: The SSA’s Listing of Impairments includes various medical conditions, disorders, and diseases that the SSA considers to be disabling. Unfortunately, fibromyalgia is not included on this list. That means patients suffering from fibromyalgia will likely need to have other disorders or diseases to have their condition equal one on the Listing of Impairments.

4. No Capacity for Past Work: The SSA will review your disabling conditions and determine whether or not they are preventing you from working in your current or past jobs.

5. No Capacity for Any Work: The SSA will determine whether your conditions are preventing you from doing any work, not just the work you were trained for. For example: you may not be able to return to your former job if you were a construction worker and your disability prevents you from lifting heavy objects, but you may still be able to work a desk job.

Help from an Indiana Social Security Disability Attorney

If you’re suffering from fibromyalgia, you may be eligible for Social Security disability benefits. However, because of the way the SSA evaluates the disorder, it will be even more difficult for you to prove your disabling condition than it is for people with other conditions. An Indiana disability attorney can help you navigate the complex approval process and make sure you’re completing your medical treatments as the SSA evaluates your claim. A disability attorney knows what the SSA is looking for and can gather all of the evidence to prove that your fibromyalgia is a medically determinable impairment. Call Hensley Legal Group today or contact us online for a free consultation, and be sure to download our free eBook, Eight Mistakes to Avoid When Applying for Social Security Disability Benefits.