Understand the Eligibility Requirements for Disability

To qualify for Social Security Disability benefits, you need to meet the Social Security Administration's (SSA) eligibility criteria. The key factors are:

• Work History (for SSDI): To qualify for SSDI, you need to have worked for a certain number of years and paid into the Social Security system. Generally, you must have at least 20 work credits earned over the last 10 years to qualify.
• Income and Resources (for SSI): If you have limited work history or resources, you may qualify for Supplemental Security Income (SSI). SSI benefits are based on financial need, rather than work history.
• Severe Disability: Your condition must be severe enough to prevent you from engaging in substantial gainful activity (SGA) for at least 12 months or result in death.

The SSA requires medical evidence that your fibromyalgia is so severe that it prevents you from working or engaging in other significant activities.

Prove That Fibromyalgia Is a Severe Condition

While fibromyalgia is recognized by the SSA as a valid disability, it is often difficult to prove because there are no specific laboratory tests to confirm the diagnosis. Therefore, it’s important to provide detailed medical evidence to show that the condition significantly limits your ability to work. The SSA considers fibromyalgia under the musculoskeletal and connective tissue disorders category, but it’s necessary to provide the following:

• Medical Documentation: Your medical records should include documentation from treating physicians (rheumatologists, pain specialists, or primary care doctors) who confirm the diagnosis of fibromyalgia and the severity of your symptoms.
• Consistent Symptoms: You must show a consistent history of symptoms that align with fibromyalgia, such as widespread pain, sleep disturbances, cognitive difficulties (often called "fibro fog"), and fatigue.
• Limitations on Functioning: The SSA requires evidence that fibromyalgia significantly limits your ability to perform basic work activities. This can include limitations in walking, standing, sitting, lifting, or concentrating.

The more detailed and consistent your medical records are, the better your chances of approval.

Submit Comprehensive Medical Evidence

Medical evidence is one of the most important factors in proving your disability claim for fibromyalgia. Here’s what you need to gather:

• Doctor’s Statements: A letter from your primary doctor or specialist outlining how fibromyalgia affects your ability to function and perform basic work tasks is essential. The doctor should explain how your symptoms impair your ability to work, especially considering things like fatigue and pain.
• Medical History: Provide a comprehensive history of your fibromyalgia, including dates of diagnosis, treatments, and ongoing symptoms.
• Test Results: While fibromyalgia does not have specific diagnostic tests, any test results showing associated conditions (such as sleep studies, blood tests, or MRI results) can strengthen your case.
• Functional Limitations: Your doctor should explain the limitations you face in everyday activities, including your ability to handle work demands, such as interacting with others, maintaining attention and concentration, and performing physical tasks.

Ensure that your doctor is aware of the SSA’s requirements and provides as much detail as possible about how your condition affects your life.

Meet the SSA’s Criteria for Disability

To meet the SSA’s criteria for disability with fibromyalgia, you must meet one of the following:

• Medical Vocational Guidelines: These guidelines take into account your age, education, and work experience to determine whether you can perform any type of work. The SSA evaluates whether your disability prevents you from doing your past job or any other job that fits your skill set.
• Listing of Impairments: The SSA has a Listing of Impairments, which includes conditions that automatically qualify you for disability if certain criteria are met. Fibromyalgia itself is not listed, but it is evaluated under musculoskeletal and connective tissue disorders. To meet the SSA’s criteria, you must show that your condition is severe enough to limit your ability to perform daily work tasks.

In addition, if your fibromyalgia is accompanied by severe cognitive dysfunction, severe fatigue, or sleep disturbances, the SSA may also consider these factors as contributing to the severity of your condition.

Be Prepared for a Possible Denial

It’s important to be aware that fibromyalgia claims are often denied initially. The subjective nature of the symptoms makes it harder for the SSA to evaluate the severity of the condition. If your claim is denied, don’t be discouraged. You have the right to appeal the decision.

The appeals process typically involves:

• Requesting a Reconsideration: If your initial claim is denied, you can request that the SSA reconsider your case with additional evidence.
• Requesting a Hearing: If your reconsideration is also denied, you can request a hearing in front of an Administrative Law Judge (ALJ). At this stage, you can present more evidence, including testimony about how your fibromyalgia affects your ability to work.
• Hiring an Attorney: If you’re going through the appeals process, hiring an experienced Social Security Disability attorney can improve your chances of success.