Understanding the SSA’s Criteria for Disability

The SSA evaluates disability claims using a five-step process. To qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you must prove that your condition prevents you from working and meeting other criteria. These include:

• Step 1: Are you working? If you are earning above a certain threshold (known as Substantial Gainful Activity or SGA), the SSA may determine that you are not eligible for disability benefits.
• Step 2: Is your condition severe? Your condition must significantly limit your ability to perform basic work activities.
• Step 3: Does your condition meet or equal a listed impairment? Although fibromyalgia isn’t specifically listed in the SSA’s Listing of Impairments, it may still meet or equal the criteria for another impairment, such as musculoskeletal disorders or chronic fatigue syndrome, if your symptoms are severe enough.
• Step 4: Can you perform your past work? If you are unable to perform your previous job due to your condition, the SSA will proceed to the next step.
• Step 5: Can you perform any other type of work? The SSA will evaluate whether you can perform other types of work based on your education, work experience, and the severity of your symptoms.

How Fibromyalgia Can Qualify for SSDI

While fibromyalgia is not explicitly listed in the SSA’s impairment listing, it is recognized as a medically determinable impairment. The key to winning a fibromyalgia disability claim lies in providing substantial medical evidence of the severity of the condition and how it limits your ability to work. To qualify for SSDI with fibromyalgia, you must meet the following criteria:

• Documented Diagnosis: You must have a documented diagnosis of fibromyalgia from a qualified physician. The SSA will require medical evidence such as doctor’s notes, test results, and any physical examinations that confirm the presence of fibromyalgia.
• Ongoing Treatment: The SSA will want to see that you are receiving regular and consistent treatment for your fibromyalgia. This can include medications, physical therapy, or visits to pain specialists.
• Severe Symptoms: You must demonstrate that your symptoms are severe enough to prevent you from engaging in work for at least 12 months or result in death. This includes documenting symptoms such as chronic pain, fatigue, sleep disturbances, memory problems, and difficulty concentrating.
• Functional Limitations: To qualify for SSDI, you must provide evidence that your fibromyalgia causes severe functional limitations that prevent you from performing routine work tasks. This can include difficulty sitting, standing, walking, lifting, or concentrating for extended periods.

Proving Your Disability for Fibromyalgia

Because fibromyalgia does not have specific diagnostic tests that can conclusively prove its severity, the SSA requires a comprehensive medical record that includes:

• Medical History: Detailed documentation from your treating physician regarding the history of your fibromyalgia and the symptoms you experience.
• Physical Examinations: Records from physical examinations that demonstrate your physical limitations.
• Objective Evidence: While there are no specific lab tests for fibromyalgia, any tests that show evidence of inflammation, joint issues, or other related conditions may help support your claim.
• Work Limitations: Statements from your employer, if applicable, regarding how your symptoms have affected your ability to work or perform tasks.
• Residual Functional Capacity (RFC): The SSA will assess your Residual Functional Capacity, which is an evaluation of your ability to perform work-related tasks despite your condition. This is often documented by a physician and includes an evaluation of your ability to sit, stand, walk, lift, carry, and perform other basic tasks.

The Importance of Medical Evidence

To increase your chances of success in securing Social Security Disability benefits for fibromyalgia, it’s essential to have strong, detailed medical evidence. The SSA will carefully evaluate the severity and persistence of your symptoms. Here’s what you can do:

• See a Specialist: A rheumatologist or pain management specialist can help provide a more detailed assessment of your condition.
• Follow a Treatment Plan: Be sure to follow any treatment plans prescribed by your doctor, and document these visits as part of your medical records.
• Keep Detailed Records: Maintain a symptom journal that documents the frequency and severity of your fibromyalgia symptoms. This can help build a case for how the condition impacts your daily life.

What to Do if Your Claim Is Denied

It’s not uncommon for Social Security Disability claims to be denied, especially for conditions like fibromyalgia that rely on subjective symptoms rather than objective tests. However, you have the right to appeal the decision. If your claim is denied, here are your options:

• Request Reconsideration: If your claim is denied, you can request a reconsideration by the SSA to review your application again.
• Request a Hearing: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ), where you’ll have the opportunity to present your case in person.
• Appeals Council: If your hearing is unsuccessful, you can appeal to the SSA’s Appeals Council for further review.