Understanding the SSA’s Criteria for Disability

The SSA has a specific set of criteria for qualifying for Social Security Disability benefits. To qualify for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income), you must meet certain medical and work history requirements. For fibromyalgia, the SSA evaluates the severity of your symptoms and the impact they have on your ability to work. Here’s how the SSA typically assesses fibromyalgia claims:

Medical Evidence is Key

One of the most important aspects of applying for SSD benefits with fibromyalgia is providing detailed medical evidence. The SSA will need proof that your fibromyalgia is severe enough to prevent you from maintaining a substantial gainful activity (SGA). Here’s what you’ll need:

• Diagnosis from a doctor: You must have a documented diagnosis of fibromyalgia from a licensed healthcare professional.
• Medical records: The SSA will look for medical records that document the severity of your symptoms, treatments you have received, and how the condition affects your daily activities.
• Laboratory tests and physical exams: While there are no specific tests for fibromyalgia, the SSA will review any tests that may help rule out other conditions with similar symptoms. Additionally, a physical examination can provide important documentation of the limitations caused by fibromyalgia.

Proving Your Limitations

The SSA uses a 5-step process to evaluate disability claims, and it’s crucial that you demonstrate how your fibromyalgia limits your ability to perform basic work tasks. Fibromyalgia can affect various parts of the body and lead to:

• Fatigue: Severe tiredness that impacts your ability to concentrate or perform tasks.
• Musculoskeletal pain: Pain that makes it difficult to stand, sit, or move without discomfort.
• Cognitive difficulties: Issues with memory, concentration, or thinking clearly (often referred to as “fibro fog”).

You will need to show how these symptoms interfere with your ability to perform the physical, mental, and social demands of work.

SSA’s Evaluation of Fibromyalgia Claims

The SSA does not have a listing specifically for fibromyalgia in its Listing of Impairments, which means that you cannot automatically qualify for SSD benefits based on fibromyalgia alone. However, it is possible to be approved under the SSA’s musculoskeletal or neurological impairment listings if you can demonstrate that your condition is equal in severity to those listings.

The SSA will use a residual functional capacity (RFC) assessment to determine what kind of work you are still capable of doing. If your RFC shows that you are unable to perform the physical or mental tasks required for most jobs, you may qualify for SSD benefits.

What to Do if Your Initial Claim is Denied

It’s common for SSD claims to be denied initially, even if you have fibromyalgia. If this happens, you have the right to appeal the decision. Here’s what you can do:

• Request Reconsideration: The first step in the appeals process is asking for a reconsideration of your claim.
• Request a Hearing: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is an important stage where you can present your case in person.
• Provide Additional Evidence: Be prepared to provide any new medical records or additional evidence that may help your case.