Qualifying for Social Security Disability Benefits with Fibromyalgia

Fibromyalgia may be difficult to diagnose, but this disease is very real and the impact it can have on an individual can be truly debilitating. For those suffering from fibromyalgia, maintaining steady, gainful employment may not be possible. These individuals may seek financial support in the form of Social Security disability benefits. With fibromyalgia proving so difficult to diagnose, however, qualifying for benefits may be an uphill, but not impossible, battle.

What Is Fibromyalgia?

Those who suffer from fibromyalgia generally experience tenderness and muscle pain throughout the body. This is also commonly accompanied by other issues with memory, mood, fatigue, sleep issues, restless leg syndrome, sensitivity to light, noise, and temperature, issues with bladder or bowel control, and numbness and tingling in the arms and legs.

Additionally, while a physical condition, fibromyalgia is commonly associated with mental illnesses such as anxiety, depression, and post-traumatic stress disorder (PTSD). Although fibromyalgia is a very real disease, it is often diagnosed after ruling out other causes of one’s pain. Currently, the causes of fibromyalgia remain unknown, though many believe there are both environmental and genetic components.

If you suffer from fibromyalgia it can be debilitating and prevent you from being able to work. But luckily, it may also qualify you for Social Security Disability (SSD) benefits.

Qualifying for SSD Benefits

Despite the significant impact that fibromyalgia can have on your life, it’s important to understand that being diagnosed with the disease doesn’t mean you will automatically receive SSD benefits. Rather, it’s the decision of the Social Security Administration (SSA). The SSA will look at its “Blue Book” requirements when making this determination.

Blue Book Requirements

The SSA will look at the Blue Book to see if the applicant meets the following criteria:

1. A history of widespread pain that has persisted for a minimum of three months. This does not require that pain be constantly present or to the same degree. Widespread pain includes pain in all quadrants of the body.
2. A minimum of 11 positive tender points on a physical examination. These points must be located on both the left and the right sides of the body, above and below the waist. (The physician must test the tender-point sites per the requirements of the Blue Book).

Qualifying for Social Security Disability Benefits with Fibromyalgia

Fibromyalgia symptoms can closely mirror those of other diseases. Additionally, proper diagnostic testing for fibromyalgia is not always conducted. To compound the difficulty of diagnosing fibromyalgia, there are many self-reported symptoms that are not always visible to those other than the individual suffering from the condition. All of this is to say that insurance companies and those government agencies tasked with distributing disability benefits can view claimants suffering from fibromyalgia with great trepidation.

While difficult, it is still possible to qualify for Social Security disability benefits if you have fibromyalgia. The Social Security Administration (SSA) will want to evaluate your medical condition to see if it equals one of its listings of qualifying medical impairments. If you have a medically determinable impairment and your medical condition prevents you from working in a substantial gainful activity job, you may qualify for benefits.

Because fibromyalgia can be so commonly misunderstood by those in the Disability Adjudication Services office as well as administrative law judges in the Office of Disability Adjudication and Review, the SSA issued Social Security Ruling (SSR) 12-2p to shed light on fibromyalgia as a disabling condition. The ruling defines fibromyalgia as pain in the joints, muscles, tendons, or nearby soft tissue that has persisted for a minimum of 3 months. The ruling requires that for fibromyalgia to be considered a medically determinable impairment, there must be evidence of diffuse chronic muscle pain impacting four quadrants of the body in addition to the spine.

In order to test for fibromyalgia, medical professionals may apply standard pressure to 18 tender points on the body. Should 11 or more tender points to both the right and left side of the body in addition to above the waist yield pain when standard pressure is applied, then a fibromyalgia diagnosis can be issued. SSR 12-2p states that a claimant must not only have a history of diffuse chronic pain but also exhibit six or more repeated fibromyalgia symptoms which may include:

• Chronic fatigue syndrome
• Poor restorative sleep
• Difficulty concentrating
• Anxiety
• Depression
• Temporal-mandibular joint dysfunction (TMD)
• Chronic migraines or tension headaches
• Chest pain
• Nausea
• Loss or change in taste
• Irritable bowel syndrome
• Irritable bladder

Furthermore, SSR 12-2p requires other disorders which may lead to similar symptoms manifesting themselves to be excluded. Adjudicators must take into account the opinions of treating doctors of the claimant as well as other acceptable medical sources including psychologists and psychologists. Additionally, family members and others who know the claimant may make statements that could be informative regarding the establishment of a claimant’s fibromyalgia diagnosis.

If you suffer from fibromyalgia and wish to apply for Social Security disability benefits, do not delay in reaching out to Roeschke Law for assistance. We can help you navigate the process, comply with application requirements, and help present the strongest possible case for benefits. Contact us today.