Is Fibromyalgia a Disability?
Fibromyalgia is a chronic condition that causes widespread pain as well as a range of other debilitating symptoms. Therefore, people with fibromyalgia may find it hard to work, and might wonder whether their condition is classed as a disability.
In this article, we take a look at whether you are entitled to disability benefits with fibromyalgia, and what you need to know before you apply.
Can You Apply for Disability Benefits with Fibromyalgia?
Although the symptoms of fibromyalgia can make it impossible to work, people with this condition may find it challenging to apply for disability benefits. This is because the severity and frequency of fibromyalgia symptoms can vary so much between patients, and because it is such a difficult condition to diagnose.
However, the Social Security Administration defines a disability as a condition which prevents you from performing any “gainful activity” and is expected to last at least 12 months, or result in death. Since fibromyalgia is a chronic condition for which there is no known cure, it should be covered by this definition. Therefore, it may be possible to successfully apply for disability benefits with fibromyalgia in some cases. You just need to know how.
Fibromyalgia Disability Criteria
The SSA states that fibromyalgia may be classed as a “medically determinable impairment” (disability) under certain conditions. They require evidence that a person with fibromyalgia is unable to perform any gainful activity. You must fulfill the following criteria to qualify:
- A history of widespread pain for at least three months
- Tenderness at 11 or more of the 18 "tender spots" associated with fibromyalgia
- Evidence that your symptoms are not due to any other medical condition
Alternative fibromyalgia disability criteria includes:
- A history of widespread pain for at least three months
- Repeated occurrence of at least six other fibromyalgia symptoms including fatigue, cognitive or memory impairment, waking unrefreshed, depression, anxiety or irritable bowel syndrome
- Evidence that your symptoms are not due to any other medical condition
If you fulfill all three categories of either set of criteria, you may be entitled to apply for disability benefits.
Fibromyalgia Disability Living Allowance
There are two types of disability benefits that you may be entitled to with fibromyalgia.
Social Security Disability Insurance is paid to people who have previously worked and paid sufficient social security taxes. SSDI may entitle you, your spouse, or other family members to benefits, providing you have built up enough "work credits" in the past. The number of work credits required depends on your age and when you became unable to work.
Supplemental Security Income provides benefits to disabled people based on their individual financial needs. In some cases, people who are receiving SSDI may also be eligible for SSI.
There are both short-term and long-term disability policies, with short-term policies being valid for up to two years, and long-term policies being valid for several years or until your disability ends.
What Disability Benefits Am I Entitled to with Fibromyalgia?
If your application for SSDI is approved, your payment will begin six months from the date your disability began. The amount you receive will depend on your lifetime earnings and how many work credits you have accrued. You can use the SSA’s online benefits calculator to find out how much you are entitled to claim.
Once you have been receiving disability benefits for two years, you will also be automatically enrolled in Medicare parts A and B. This will entitle you to help with paying for inpatient treatment, follow-up treatment, doctor fees and other medical services.
While hospital care and certain follow-up treatments could be provided free of charge, you will need to pay a monthly premium in order to cover other services.
While the exact cause of fibromyalgia is still unknown, scientists and researchers have discovered some possible fibromyalgia causes.
How to Apply for Disability with Fibromyalgia
You can apply for disability with fibromyalgia online by visiting the SSA official website. However, you may only apply online providing you fulfill the following criteria:
- You are over 18 years of age
- You are not currently receiving any benefits on your own social security account
- You cannot work due to a medical condition that is expected to last longer than 12 months or that will result in death
- You have not been refused disability benefits within the last 60 days
Alternatively, you can apply by calling 1-800-772-1213 (TTY 1-800-325-0778) or scheduling an appointment at you local social security office. You may wish to use the SSA’s Checklist for Online Adult Disability Application to ensure you have prepared all the information you need. For example, you will need to provide employer details, direct deposit information, medical records, information about health care professionals and more.
How to Prove Fibromyalgia Disability
The SSA will want to see objective proof of your disability in the form of a physician’s letter. This could be from a medical doctor or osteopath, although you may stand a better chance of being approved if you see a specialized rheumatologist.
In addition to a confirmed diagnosis of fibromyalgia, you will need to provide your medical history for the previous 12 months. This should include records of physical examinations, lab tests, scans, prescribed medications and an assessment of whether your symptoms have improved, worsened or remained the same.
You should also include details of any psychiatric assessments or other treatments you have received. Your physician will need to fill in a Physical Residual Functional Capacity Assessment to prove that you are unable to work due to your disability.
In addition to doctor’s records, the SSA may request information from non-medical sources and this may include previous employers, teachers, neighbors, relatives or friends.
Other Chronic Conditions Covered by the SSA
Although fibromyalgia is not specifically listed as a disability by the SSA, there are a number of other chronic conditions that are. You may be more likely to be approved for disability benefits if you suffer from any of the following in addition to fibromyalgia:
- Cardiovascular disease
- Digestive disorders
- Endocrine disorders
- Gentitourinary impairment
- Hematologic disorders
- Immune system disorders
- Malignant neoplastic disease
- Mental disorders
- Multiple body system impairments
- Musculoskeletal disorders
- Neurological disorders
- Respiratory disorders
- Skin disorders
- Speech or sensory disorders
For more information, visit the SSA website.
