Getting Disability Coverage for Fibromyalgia

A great deal of disability claims are made each year because of fibromyalgia, a disease whose causes are not well understood and whose symptoms are wide ranging. My clients with fibromyalgia usually tell me about joint stiffness and muscle soreness, trouble sleeping, and extreme fatigue.  Often there are all sorts of other symptoms as well, and many clients tell me that they feel like their doctors have decided to call whatever they have "fibromyalgia" for no other reason than they do not know what else to call it.  

Disability Listings

Social Security has "listings" that are descriptions of impairments and diseases that the claims examiners at Disability Determination Services (the state agencies that make the initial disability determination for Social Security) can recognize and go down a checklist of symptoms to decide if a person is disabled. Presently there is no listing for fibromyalgia, which makes it more difficult for disability claimants to get approved.  To get approved, most fibromyalgia claims will have to go through the appeals process of reconsideration and on then to a hearing with an Administrative Law Judge (ALJ).

Social Security Ruling on Fibromyalgia

The Social Security Administration (SSA) recently published a ruling on evaluating fibromyalgia. The ruling says that claims examiners should use the criteria issued by the American College of Rheumatology (ACR) to determine whether an applicant has fibromyalgia and whether it is a "medically determinable impairment," one of Social Security's requirements for receiving disability benefits. The ACR has two different ways of diagnosing fibromyalgia, one based on tender points, the other based on symptoms that often occur with fibromyalgia. 

After the SSA decides you have a medically determinable impairment, the agency will develop a residual functional capacity (RFC) assessment for you to determine if there is any work you can do. The RFC will contain your limitations, such as not being able to stand for more than one hour at a time or not being able to work an eight-hour day due to fatigue. Social Security will then use your RFC to determine if there are any jobs that you can do.

The Importance of Seeing Your Doctor 

It important while navigating the disability process to see your doctor as often as you can afford, and to tell your doctor about all of your problems. Most people who have to leave work and who experience the pain of fibromyalgia also experience depression and anxiety, and many experience other pain like degenerative joint or degenerative disc disease. It is important to make sure your doctors know about these other symptoms as they will be instrumental in helping your attorney get your claim approved.


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