Can You Get SSI for a Fibromyalgia Diagnosis?

Have you been diagnosed with Fibromyalgia and unable to work owing to the severity of your condition? If so, you may be wondering if you can get SSI for Fibromyalgia.

Before applying for SSD benefits, you should be aware of how the Social Security Administration views Fibromyalgia. The SSA requires rigorous evidence that you will need to provide to be considered disabled under the administration's guidelines. It may be helpful to have an SSDI attorney available to support your claim.

Can I get Social Security Disability Benefits for Fibromyalgia?

First, let's start with a breakdown of Fibromyalgia, its symptoms, and how covid can impact its severity.

According to the Social Security Administration (SSA), Fibromyalgia (FM) is a complex medical condition characterized by widespread pain in the joints, muscles, tendons, or nearby soft tissues that persists for at least three months. In addition to chronic pain, Fibromyalgia presents other conditions like difficulty sleeping, memory, and cognitive problems otherwise known as "fibro fog," chronic fatigue, depression, recurring migraine headaches, irritable bowel problems, muscle fatigue causing twitching and spasms, and temperature sensitivity.

For those who have Fibromyalgia, COVID-19 may have a significant impact on their health. The effects of COVID-19 on our everyday life have increased stress, depression, reduced physical activity, and weight gain for many people. While these changes are not unwanted for anyone's health, they are particularly concerning for those with Fibromyalgia as they can result in painful and debilitating flare-ups of their condition.

What do I need to know before I apply for SSI benefits?

• Establish diagnosis and treatment. First, you must establish the diagnosis and treatment for Fibromyalgia by a medical or osteopathic doctor. The Social Security Administration (SSA) will review the doctor's treatment notes, findings on physical examination, and the diagnostic studies. Then, the SSA will evaluate whether the doctor's records are consistent with a diagnosis of Fibromyalgia and whether your reported symptoms over time have been severe enough under the Social Security Administration's requirements to find you disabled.
• A Rheumatologist is vital. Social Security Administration evaluates Fibromyalgia through the criteria established by the American College of Rheumatology. If you have been diagnosed with Fibromyalgia by a physician and not a rheumatologist, documentation may be insufficient to meet the requirements the SSA uses to evaluate claims.
• Evidence. There are three critical pieces of evidence that the Social Security Administration will look for in your medical records to establish the diagnosis of Fibromyalgia. An SSDI attorney can help support you during the process.

1. Your Records. Records must establish that you have had widespread pain that has persisted for at least three months. Widespread pain involves pain on both sides of the body and in both upper and lower halves of the body.
2. Tender points. There are 18 tender points identified on the body and addressed in evaluating Fibromyalgia. Of the 18 tender points, you must have pain in at least 11 of them. If your doctor is not documenting delicate point testing, meeting this criterion will be difficult.
3. Ruling out other diagnoses. There must be documented evidence ruling out other disorders likely to cause the same symptoms.

Symptoms. Considering the severity of Fibromyalgia, the Social Security Administration looks for evidence of having repeated manifestations of six or more fibromyalgia symptoms or co-occurring conditions such as fatigue, cognitive or memory problems ("fibro fog"), waking unrefreshed, depression, anxiety, and irritable bowel syndrome.

Is it challenging to get SSD benefits if you have Fibromyalgia?

Obtaining Social Security benefits based on a fibromyalgia diagnosis can be extremely difficult for several reasons. First and foremost, diagnosis typically occurs between the ages of 35 to 45. At that age, the Social Security Administration considers you to be a younger individual and presumes that you are not disabled based upon their regulatory guidelines. Fibromyalgia diagnosis relies on a combination of subjective symptoms which cannot quickly be established and are not always well documented. The SSA relies heavily on medical records when making disability determinations. If the medical records do not substantiate your complaints, the SSA will most likely disapprove the claim.

Should I Work with an SSDI Attorney?

While you are not required to utilize the services of an SSDI attorney during the benefits application process, it is crucial to put your best case forward from the very beginning. If Fibromyalgia is your primary disabling condition, you should consider consulting with an experienced SSDI attorney near you before entering your claim. If you are denied benefits at the initial stage, it then takes a significant time to get a hearing date before an Administrative Law Judge (ALJ), with some offices reporting a wait of 18-months.

Talk to the attorneys at our law offices in Doylestown for advice. They'll make sure you the best advantage of winning your claim.