Does Fibromyalgia Qualify for Social Security Disability?
April 25, 2023 · 4 min read
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Fibromyalgia can qualify you for disability benefits as long as your condition leaves you unable to hold a job. According to the Social Security Administration (SSA), fibromyalgia falls somewhere between an immune system and musculoskeletal condition. The good news here is that of people receiving disability benefits, more than 36% have musculoskeletal disorders, making it the most common type of condition.
Still, qualifying for Social Security disability benefits is a challenging process. We'll walk you through how the SSA defines fibromyalgia, how your fibromyalgia could allow you to qualify for disability, and what steps you should consider taking next.
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Is Fibromyalgia a disability?
Fibromyalgia is considered a disability by the SSA and it could qualify you for Social Security disability if it's preventing you from working. However, not all forms of fibromyalgia qualify for benefits, so it’s important to understand the SSA requirements for eligibility.
How the SSA defines Fibromyalgia
Fibromyalgia is a condition that leads to widespread pain and tenderness throughout the body, among other symptoms. The cause of this disorder remains unknown and there is no cure, though there are effective options for treatment and management. Fibromyalgia isn’t listed in the Blue Book, but the SSA treats it as a condition that falls between a musculoskeletal disorder and an immune system disorder.
The most common symptoms of fibromyalgia include:
Pain all over your body
Anxiety and depression
Headaches, including migraines
Can you get disability for Fibromyalgia?
You can get disability benefits for fibromyalgia if your symptoms are severe enough that you’re unable to work. However, even if your condition does technically qualify, it's worth noting that the process of securing benefits can still be challenging. There are strict criteria that applicants must meet in order to receive disability benefits and the application process can take months or years.
Even if your fibromyalgia seriously affects your ability to work, it’s easier to get benefits if you have another qualifying condition alongside it. Here are some common health conditions you may experience alongside fibromyalgia:
For your fibromyalgia to qualify for Social Security disability benefits, you'll need to provide medical records demonstrating that while you’re receiving treatment for your condition, you’re still unable to work or perform daily functions because of it.
Here are some criteria the SSA will look for when determining whether you qualify for disability with fibromyalgia:
You’ve done a trigger point test and had a high score. The SSA will look for medical test results that confirm you have fibromyalgia. One common test is the trigger point test. A high score, like 14 or higher, is more likely to help you qualify for benefits. Another similar option is the tender point test, though it’s less common than in the past.
Your flare-ups are consistent. Fibromyalgia symptoms are often cyclical, meaning they get better and then worse again. The SSA will try to understand whether you consistently experience severe flare-ups and how those interfere with your ability to work. As you go through the application, it’s helpful to give evidence of how your fibromyalgia interferes with basic tasks of living like walking, sitting, standing for long periods, cooking for yourself, and getting dressed on your own.
You have chronic fatigue. Alongside widespread pain, a common symptom of fibromyalgia is fatigue. You'll need to demonstrate chronic fatigue despite sleeping for long periods of time, often 18+ hours. Try to provide physical documentation of your fatigue. For example, make sure you mention it to your doctors so that their notes include mentions of it and so it factors into their diagnoses. The SSA will ask about the hours you're usually sleeping and sleep disturbances you deal with, and having medical documents to back up your claims is always helpful.
You have another condition that appears in the Blue Book. The SSA does not list fibromyalgia as an official condition in the Blue Book. It can absolutely qualify for benefits on its own, though fibromyalgia commonly coincides with other conditions that are also considered qualifying conditions, such depression, IBD, or POTS. Even if the SSA doesn’t consider your fibromyalgia severe enough on its own, you can qualify with these secondary conditions.
Questions to ask yourself before applying
Before applying for Social Security disability, consider asking yourself the following questions. If you can answer “yes” to most of them, there is a better chance your condition will qualify.
Do I have consistent flare-ups?
Do I have any other conditions, such as depression or another mental illness?
Have I undergone a trigger point or tender point test and received a score of 14 or higher?
Am I experiencing chronic fatigue and sleeping 18+ hours in a day?
Have I met with a rheumatologist or specialist doctor multiple times, in addition to my primary care provider (PCP)?
My Fibromyalgia meets the criteria. Now what?
If you believe your fibromyalgia meets the criteria to receive Social Security disability, your next step is to apply for benefits. The application process is long, so it’s best to start as soon as possible.
If you're still on the fence, here's some advice that can help you decide if you should move forward with the application process:
Apply now if:
You've been diagnosed with and treated for fibromyalgia.
Your symptoms make it impossible to work and persist even though you’re getting treatment.
To save yourself some time and get advice for your situation, consider taking Atticus’ disability benefits quiz. If it looks like you could qualify for Social Security disability, a member of our team will reach out to learn more about our situation. We can also match you with a qualified disability lawyer if you want one. (Getting matched is free, you don’t need to work with our lawyers if you don’t want to, and you’ll never need to pay anything until after you win benefits.)
Both are government programs that offer support to those who are unable to work because of a medical condition. They also both provide health insurance — Medicare for SSDI and Medicaid for SSI.
However, SSDI is for those who have worked and paid taxes for years, including at least five of the past 10 years. SSI is intended for people with few assets and little income. To be eligible for SSI, a single individual would need to earn less than about $900 of income per month and have less than $2,000 of other savings and assets.
To learn more about the differences and who can qualify for each, here's a more in-depth breakdown of SSDI vs. SSI.
How much is a disability check for Fibromyalgia?
On average, the disability benefit check for fibromyalgia ranges from $1,450.61 to $1,477.68 per month. That said, the maximum possible amount that someone with fibromyalgia can receive in 2023 is $3,627 per month for SSDI and $914 per month for SSI.
These upper limits apply regardless of which condition you have, how severe it is, or how many qualifying conditions you have. The exact amount of your monthly benefit will depend on your work history if you’re applying for SSDI and your other sources of income if applying for SSI.
What if my Fibromyalgia doesn’t meet the criteria?
If your condition doesn't quite meet the criteria outlined in this article, know that it's still an option to apply for disability benefits. When applying, it’s crucial that you can demonstrate through medical records that you're unable to work due to your fibromyalgia.
Even for those with serious fibromyalgia, it's likely that your application will get denied the first time. In fact, only about 20% of people who apply for disability benefits receive them on their first application. Though the process of qualifying is difficult, it pays off to keep trying. You can appeal the initial denial and after a couple of rounds of appeal, your odds of approval increase significantly. Learn more about the chances of winning a disability appeal.
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