Getting Social Security Disability Benefits for Fibromyalgia

Fibromyalgia is a condition characterized by generalized pain and tenderness. People with fibromyalgia (also known as fibromyalgia syndrome, or FMS) may have chronic aches in their muscles, joints, and tendons, but the source of the pain isn't identifiable on medical imaging, like an X-ray. Doctors aren't yet sure what causes the disorder, but there's some evidence that it's the result of abnormalities in the neural pathways that send pain signals to the brain.

Symptoms of fibromyalgia, such as fatigue, soreness, and memory issues can interfere with your ability to complete daily activities and work tasks. If your fibromyalgia symptoms are severe enough to keep you from working full-time for at least a year, you may qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.

Is Fibromyalgia a Disability?

The Social Security Administration (SSA) awards disability benefits to applicants who have a "medically determinable," severe impairment that prevents them from working at the level of substantial gainful activity. Social Security Ruling SSR 12-2p provides guidance for disability claims examiners and administrative law judges when deciding whether an applicant's fibromyalgia constitutes a medically determinable impairment.

Citing diagnostic criteria used by the American College of Rheumatology, the ruling allows the SSA to consider fibromyalgia as "medically determinable" when the applicant's file contains evidence of all the following:

• a history of widespread pain that has persisted for at least three months
• at least 11 positive tender points on physical examination out of 18 tested areas, on the right and left sides of the body, above and below the waist, and
• objective tests, such as lab results or MRIs, have ruled out other possible conditions.

Another method the SSA may use to establish that fibromyalgia is a medically determinable impairment uses the following criteria:

• a history of widespread pain
• "repeated manifestations" of six or more fibromyalgia symptoms, particularly those relating to fatigue, cognitive or memory problems ("fibro fog"), waking unrefreshed, depression, anxiety, or irritable bowel syndrome, and
• objective tests have ruled out other possible conditions.

Keep in mind that these criteria are used to find out only whether your fibromyalgia is a medically determinable impairment (MDI), not whether you are disabled. Even if you satisfy the above requirements, the SSA will still use the five-step sequential evaluation process to decide whether you can perform your past work or any other jobs in the national economy. (The agency determines whether your fibromyalgia is an MDI at step two of the process.)

Getting Disability for Fibromyalgia With a Reduced Functional Capacity

Because fibromyalgia isn't a listed impairment that can automatically qualify you for disability benefits, Social Security will need to see to what extent your symptoms limit your ability to work. The agency will review your medical records and self-reported activities of daily living to determine your residual functional capacity (RFC).

Your RFC describes what you're still capable of doing, physically and mentally, despite your fibromyalgia symptoms. Social Security uses your RFC to decide whether your limitations prevent you from performing your past jobs or any other full-time work. The worse your symptoms are, the more limitations you'll have in your RFC. Here's an example of how Social Security may evaluate two claims for disability based on fibromyalgia:

Applicants younger than 50 years of age will likely need to show that their fibromyalgia symptoms keep them from performing even the simplest sit-down jobs in order to qualify for benefits. If you're over the age of 50, however, you might have an easier time getting benefits using a special set of rules called the medical-vocational grid.

Documenting Fibromyalgia for Your SSDI or SSI Claim

Disability claims based on fibromyalgia can be difficult to win. Because fibromyalgia can't be seen on a CT scan or from blood tests, claims examiners and judges are often reluctant to approve fibromyalgia claims, even if you've received consistent treatment for your symptoms. However, you can increase your chances of getting benefits by following the tips below.

Get a Proper Diagnosis of Fibromyalgia

Physicians have sometimes used fibromyalgia as a sort of catch-all diagnosis in cases where their patients have chronic pain without any apparent cause. Unfortunately, this can make a fibromyalgia diagnosis more questionable in the eyes of disability examiners. You can avoid this by having your diagnosis made by a rheumatologist (a doctor who specializes in inflammatory joint and muscle diseases) according to medically acceptable diagnostic techniques, such as trigger-point testing.

Make Sure Social Security Has Your Medical Records

Once you've filed your application, Social Security will request your medical records from the past year or so. If you've received treatment for longer than 12 months, you may have to request the medical records on your own and provide them to the agency yourself. Even if your claim has been denied at the initial level—as most fibromyalgia claims are—you should continue to receive treatment and submit your updated medical records to the SSA for as long as your appeal is pending.

Ask Your Doctor to Complete a Medical Source Statement

Social Security values the opinions of doctors who've seen you regularly and can provide special insight into your condition. You can strengthen your case by asking your rheumatologist to provide a medical source statement that includes their opinion on your physical and mental limitations.

The statement should specifically address:

• how long you can sit, stand, and walk (both at one time and in a total 8-hour workday)
• how much weight you can lift and carry
• how frequently you can perform motions such as bending, stooping, and reaching
• what percentage of the day you'll spend "off-task", and
• whether you can maintain punctuality and proper attendance.

Your doctor should also include whether you need to recline, lie down, or elevate your legs at work or require unscheduled breaks due to pain or fatigue.

Keep a Fibromyalgia Journal

Recording your mental and physical symptoms on a daily basis can help your doctor make the correct diagnosis and provide the optimal treatment. It can also help persuade Social Security that your symptoms are persistent, severe, and legitimate. Be sure to record levels and locations of pain as well as any other symptoms you experience, such as exhaustion, insomnia, gastrointestinal issues, or emotional difficulties.

Get Support From Third Parties Familiar With Your Symptoms

Third-party statements from friends, relatives, and former co-workers or employers can bolster your disability case. These reports can help when they come from somebody with first-hand observations of your physical or mental limitations. For example, if a co-worker witnessed you regularly falling asleep on the job, their statement can persuade Social Security to include a need for extra rest breaks in your RFC that could rule out all future work.

How Much Can I Get in SSDI or SSI for Fibromyalgia?

Social Security doesn't pay benefits based on the condition that's causing your disability. Instead, your monthly payment amounts will depend on the type of disability program you're eligible for. For example, SSDI benefits are calculated based on your earnings record, while SSI payments are made by subtracting any countable income you have from the federal benefit rate.

For 2024, the SSI federal benefit rate is $943 per month ($1,415 for couples). Some states offer modest supplemental payments on top of the federal benefit rate. Your SSI award letter should tell you the total amount you can expect to receive every month. The maximum you can receive each month in SSDI is $3,822 in 2024, although the average payment is much smaller, at $1,537.

Do I Need a Lawyer to Get Disability for Fibromyalgia?

You aren't required to have legal representation at any stage of the disability determination process, but it's often a smart idea. An experienced disability attorney will work with you and your doctors to present the strongest possible case to Social Security. Most disability lawyers charge you a fee only if you win your case—collected from any past due benefits you're owed—so there's little risk or up-front costs involved in getting representation.