Social Security Disability Benefits for Fibromyalgia

by Aug 24, 2014

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There are a range of medical conditions that can qualify a person to receive disability benefits from the Social Security Administration. Fibromyalgia is one such condition. However, in order to receive social security disability benefits for illness, there are strict evidentiary requirements that each applicant must satisfy. It is not enough to simply assert that one is disabled. Failure to provide sufficient evidence can result in a denied claim.

It can be difficult to prove a fibromyalgia-related disability because the disease is lesser understood than many others and is primarily related to pain. As a medical condition, it is hard to define but medical professionals describe it as a condition that causes widespread pain, for at least three months, in a person’s tendons, muscles, joints and soft tissues. Because many people suffer from fibromyalgia but not all of them become disabled, the SSA has strict guidelines to determine whether or not a person has a “medically determinable impairment” due to fibromyalgia.

First and foremost, a person cannot establish a fibromyalgia-related disability without providing medical evidence from a licensed physician. The physician must provide not only a diagnosis but also substantial documentation of showing that the physician carefully examined the applicant and reviewed his or her medical history in detail. The SSA will also analyze treatment notes from the doctor to assses whether the applicant is receiving an accepted form of fibromyalgia treatment and determine whether symptoms have improved or worsened over time.

There are two different sets of evidence that an applicant for disability benefits can provide in order to show a disability from fibromyalgia. The first set requires evidence that a person has suffered widespread pain (on both sides of the body and above and below the waist) for at least three months, that at least 11 of 18 tender points on the body are classifed as positive and that other disorders which could potentially cause the pain are excluded from being the cause. The second set of evidence requires showing a history of widespread pain, the presence of at least six or more fibromyalgia-related symptoms, signs or co-occurring conditions and the exclusion of other potential causes.

Source: Social Security Administration, “Policy Interpretation Ruling: SSR 12-2p: Titles II and XVI: Evaluation of Fibromyalgia,” Accessed on Nov. 5