Are you struggling to get your SSDI claim approved for fibromyalgia? The Social Security Administration requires more than just a diagnosis to approve your case. In this video, I explain how SSA evaluates fibromyalgia and the exact documentation they expect to see. You’ll learn what criteria your records must meet and why some claims are denied despite valid symptoms. If you want to learn how to prepare a stronger, more credible case, just check out this video.
SSA uses strict diagnostic criteria and expects clear medical documentation when evaluating fibromyalgia disability claims.
What is Fibromyalgia
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and sleep disturbances. It’s often accompanied by other symptoms like cognitive dysfunction and mood problems. While there’s no cure, treatments focus on managing symptoms and improving quality of life. Fibromyalgia is a condition that continues to face skepticism in Social Security disability evaluations. While it affects many people, the Social Security Administration (SSA) does not always accept a diagnosis at face value. This is largely due to an increase in cases where fibromyalgia is diagnosed without meeting the formal medical criteria recognized by SSA.
The SSA relies on diagnostic standards set by the American College of Rheumatology. These standards define how fibromyalgia should be diagnosed and are used by the administration to assess disability claims. There are two sets of criteria: one from 1990 and an updated version from 2012. The SSA will consider either set when reviewing a case.
Diagnosis of exclusion
The first major requirement is that fibromyalgia must be a diagnosis of exclusion. This means other potential causes for the symptoms must be ruled out. For example, if a person reports wrist pain, SSA expects to see imaging, such as an X-ray, confirming that there is no underlying issue causing the pain. If a claimant experiences migraine headaches, the medical file should show that other conditions, such as brain tumors, have been ruled out. For fatigue, bloodwork may need to rule out conditions like Epstein-Barr virus.
1990 criteria
The 1990 criteria require documented evidence of 11 out of 18 specific tender points in the body. If that is not present, SSA looks for documentation of at least six fibromyalgia-related symptoms. These may include chronic fatigue, brain fog, and other related conditions. Without meeting one of these two sets of criteria, it becomes difficult for the claimant to demonstrate disability due to fibromyalgia alone.
Strong medical records are the key to fibromyalgia-related SSDI approval.
In one recent case, a claim based solely on fibromyalgia was approved, but only after providing detailed medical documentation. The individual had undergone extensive testing to rule out all other possible conditions, and the severity of the fibromyalgia was well established, including the fact that she required a wheelchair. This level of documentation is not common. Due to an increase in fibromyalgia diagnoses that do not meet formal criteria, the SSA has become more cautious in how it evaluates these claims. As a result, it is now more difficult for applicants to prove disability based on fibromyalgia alone.
Contact The Good Law Group
Understanding how SSA evaluates fibromyalgia is critical for those filing for disability benefits. Accurate documentation and medical support remain key to a successful claim. If you need help understanding how this applies to your situation or navigating your SSDI case, you can contact us at (800) 419-7606. We’re here to help.
