Is Your Fibromyalgia Covered By Social Security?

If you are suffering from the debilitating disease of fibromyalgia (FM) and are unable to work, you might consider applying for Social Security benefits. Unfortunately, the Social Security Administration (SSA) does not readily accept a diagnosis of FM, and this disorder is not listed on the SSA list of covered illnesses. With this illness affecting so many workers, the SSA has instituted an evaluation method to deal with FM. While it is still a challenge to be approved for benefits based on an FM diagnosis, it is now possible to be approved if you meet the guidelines. Read on to learn more.

The Hidden Disease

Part of the problem for sufferers of FM is that some of the worst effects of it seldom show up in diagnostic tests like x-rays and blood tests. This disease can cause joint and muscle pain, overall fatigue, and "fibro fog". Fibromyalgia can often go on to cause additional medical conditions that are covered by the SSA, such as spinal stenosis and rheumatoid arthritis. In the past, citing conditions that go along with FM was the only way to be approved for Social Security benefits. The 2012 SSA ruling, however, makes it possible for those who suffer from FM to prove their disease using guidelines developed by the American College of Rheumatology (ACR).

Meeting the Guidelines

Under the guidance of the ACR, Social Security claims examiners and administrative law judges (SSA appeals hearing judges) are to use the following evaluation of a claim for FM:

1. Other diseases must have been ruled out by your doctor. Lupus, multiple sclerosis, hypothyroidism, and other illnesses can parody FM. Once ruled out, you must demonstrate at least one of the below:

2. Common FM symptoms, such as fatigue, fibro fog, sleeping problems, pain, depression, headaches, and many more should be present, and you must suffer from repeat occurrences of those symptoms.


3. Tender points numbering at least 11 of the 18 points. These tender points must be on both sides of the body and both below and above your waist.


4. Information from your doctor (preferably, a rheumatoid arthritis specialist) that shows how long you have suffered from pain, cognitive difficulties, fatigue, and more. The information gathered from your doctor will include your visits, your complaints, what treatments have been tried, their opinion as to the level of impairment, how well you can function in day-to-day life, and more. The more information your doctor can provide about your illness and treatment, the more likely it is you will be approved for benefits.

The Final Evaluation

If you qualify by meeting the above guidelines, you will be evaluated using what is known as a residual functioning capacity (RFC). This assessment determines your level of impairment in regard to the specific tasks of your job. If you are found to be able to not only not do your most recent job but to do any job at all, you will be qualified for benefits.

As you can see, the SSA places many challenges in the path of those suffering from FM. If you get denied, you will need the help of a Social Security attorney familiar with FM and that knows how to handle your case at the appeal hearing.