How to Get Disability Benefits for Fibromyalgia

You can get disability benefits for fibromyalgia by working with an attorney to show that you have the condition and that the symptoms of the condition prevent you from working. Due to the nature of fibromyalgia, it’s often very challenging to establish these facts.

A fibromyalgia Long Term Disability lawyer can walk you through each step you need to take to secure disability benefits. You do not have to try to complete this process on your own. Instead, you can get the professional support you need right now.

What You Need to Know About How to Get Disability Benefits for Fibromyalgia

Getting Long Term Disability benefits for fibromyalgia (FM) can be particularly frustrating. Besides widespread pain and physical limitations, victims of FM must overcome credibility problems that go hand in hand with “invisible diseases.” Here’s what you need to know:

• You may qualify for Social Security Disability benefits for fibromyalgia.
• You may also be able to claim Long Term Disability benefits if you have disability insurance coverage through your employer or a private insurance policy.
• For disabled veterans, the VA follows a fibromyalgia rating scale ranging from 10% to 40%. For Gulf War veterans, fibromyalgia is a presumptive condition. Additionally, the VA now accepts “pain alone” as a basis of disability. These rules may improve a veteran’s chance of obtaining disability benefits for fibromyalgia.

An attorney can tell you more about this condition and how to get disability benefits for fibromyalgia.

For a free legal consultation, call (800) 562-9830

What is Fibromyalgia?

Fibromyalgia is a complex disorder that causes persistent, body-wide pain, often accompanied by numbness and tingling in the extremities and muscle and joint stiffness. Pain fluctuates in intensity and may not always be present.

Symptoms include: 

• Fatigue
• Sleep problems
• Waking unrefreshed
• Headaches
• Memory problems (“fibro fog”)
• Depression
• Anxiety disorder
• Irritable bowel syndrome

If you live with fibromyalgia, the multitude of symptoms caused by this condition may disrupt your life so much that you can no longer work.

Challenges Associated with Diagnosing Fibromyalgia

The symptoms of FM are notoriously difficult to diagnose. Symptoms resemble those of other diseases, and doctors do not always do proper diagnostic testing for fibromyalgia. Self-reported, “invisible” conditions are sometimes viewed with suspicion and doubt by insurance companies and federal disability programs.

You deserve help from a law firm that knows FM is very real. A lawyer can represent individuals who can’t work due to fibromyalgia, helping them apply for and win their rightful disability benefits. If you faced a claim denial, an attorney can help you appeal the denial and pursue the benefits you deserve.

In all cases, you need to know how each disability program or insurance company views and determines claims based on fibromyalgia. Although obstacles may abound, they simply mean you need a strategy that will craft the most competent claim for your situation.

How to Get Social Security Disability Benefits for Fibromyalgia

The Social Security Administration (SSA) does not include fibromyalgia in its published Listing of Impairments. Even so, you may still qualify for Social Security Disability Insurance (SSDI).

The SSA will evaluate your medical conditions to see if they “meet or equal” one of the listings. Even beyond that, you may qualify for disability benefits based on vocational standards.

Evidence to Support Your SSA Claim

SSA will want to know whether you: 

1. Have a medically determinable impairment, and
2. Your condition so limits your functional abilities that it keeps you from working, which the SSA refers to as performing any “substantial gainful activity”

The SSA looks for the following when evaluating your claim:

Objective, Diagnostic Medical Evidence

In cases of fibromyalgia disability, SSA wants to establish the presence of a medically determinable impairment of fibromyalgia. SSA will consider one of two sets of criteria for diagnosing fibromyalgia.

Criteria generally include a history of widespread pain throughout your body for at least three months, the “18 tender points” test, and evidence excluding other disorders that could cause the symptoms or signs.

Your medical records may establish that you have this condition, which means you can proceed with a disability claim.

Diagnosis from a Specialist

Because the symptoms are often self-reported, you’ll need a thorough medical history and treatment from a specialist, such as a rheumatologist, who can be pivotal in your case. You must maintain your medical records to establish your symptoms.

Longitudinal Records

Longitudinal records become extremely important because the symptoms of fibromyalgia can wax and wane. Longitudinal records are medical histories that demonstrate you’ve undergone ongoing evaluations and treatment from reputable medical sources.

To claim disability based on FM, longitudinal medical records, such as from a rheumatologist with expertise in fibromyalgia, are very helpful in substantiating both the existence and severity of your impairment. The SSA generally will want to see evidence from the 12 months before the date of your disability application.

Supporting Medical Evidence

Getting disability benefits for fibromyalgia involves developing your case further with supporting medical evidence. For example, lawyers help clients keep a fibromyalgia journal to document pain and other symptoms suffered.

An attorney may advise getting a psychological assessment to assess the severity of your FM and how it affects your ability to function on a day-to-day basis and over the long term.

Relevant Non-Medical Evidence

Supporting statements from family, friends, employers, clergy, and others help document the impact of fibromyalgia on your daily activities and reinforce the credibility of your allegations of pain and suffering.

The Sequential Evaluation Process Used by the Social Security Administration

The Social Security Administration reviews your case file using the following process:

Step 1

The SSA checks to see if you’re engaged in substantial, gainful employment. If you are, the SSA will say you are not disabled. If not, the SSA proceeds to Step 2.

Step 2

The SSA will check whether you have a severe impairment. If it finds that your pain (or other fibromyalgia symptoms) limits you more than “minimally” in your ability to do work activities, the SSA will determine that your impairment is severe. You go to Step 3.

Step 3

The SSA will determine if your impairment meets or equals the medical criteria of any of its listings. Because fibromyalgia is not a listed impairment, it cannot meet a listing. The SSA will look at whether your fibromyalgia medically equals any listing or if it equals a listing in combination with at least one other impairment.

If the SSA finds that your FM satisfies the criteria of another listing at Step 3, you will be considered disabled. If not, your claim is still alive and proceeds to Steps Four and Five. Before proceeding, you’ll need to complete a Residual Functional Capacity (RFC) Assessment. RFCs examine the effects of all your medically determinable impairments.

Longitudinal records may be especially important to winning disability benefits for fibromyalgia at Steps 4 and 5 of the evaluation process. Your fibromyalgia symptoms may come and go, and you will need continuing documentation showing, over time, how you have both good days and bad days that cumulatively support a disability finding.

Step 4

The SSA looks at your RFC assessment to determine whether you can do any past relevant work or if you cannot.

Step 5

SSA considers your RFC, age, education, and work experience to determine whether you can adjust to any other work. If you cannot pass both the requirements of Steps 4 and 5, the SSA will find you to be “disabled” and grant you disability benefits for fibromyalgia.

What Does the SSA Look for in Steps Four and Five of the Evaluation Process?

While reviewing your request for benefits, the SSA should look for:

• Exertional Limitations: Extensive pain, exhaustion, and other symptoms of fibromyalgia often result in exertional limitations that may keep you from being able to do many kinds of unskilled work.
• Non-Exertional Limitations: Pain, fatigue, and other symptoms may burden you with non-exertional physical or cognitive limitations, or cause you to need environmental restrictions in possible workplaces.

Don’t file your initial claim or appeal a denied claim automatically. When you need help with your initial application, Social Security Disability attorneys can help you build a compelling case for benefits. 

If the SSA denies your claim, an experienced attorney becomes even more essential to your success by working to prove that fibromyalgia can cause permanent disability.

How to Get Long Term Disability Benefits for Fibromyalgia

You can apply for Long Term Disability benefits if you have insurance coverage and your fibromyalgia prevents you from working. You’ll need to establish the severity of the condition and submit all the correct paperwork.

To meet the insurance company’s threshold of evidence for FM, it is essential to prepare your LTD claim with the same level and strength of medical and vocational evidence used to win Social Security Disability benefits for fibromyalgia. If denial occurs, you will have a well-developed case that will hold up in court.

Insurers often deny disability claims based on fibromyalgia and other chronic pain diagnoses. Most insurers will look for weaknesses in a claim that allow them to avoid paying benefits. Unfortunately, the subjective nature of this disease creates further incentives to deny.

A Lawyer Can Develop a Strategy to Handle a Denial

One aspect of dealing with insurance companies is preparing for any tactics a disability carrier may use to deny benefits and holding the company accountable for wrongful denials.

For instance, the disability company may try to claim that:

• A doctor misdiagnosed you.
• There is no objective basis for the restrictions and limitations assigned by your doctor.
• You can still work in a sedentary capacity.
• A doctor isn’t properly treating you.
• Insurers often use biased independent medical examination (IME) doctors to review and deny fibromyalgia claims.

For every “reason” the carrier uses to deny a valid claim, disability insurance lawyers work to reverse the denial with multiple arguments in your favor to help you get the disability benefits for fibromyalgia you deserve. You can get help with fighting fibromyalgia disability benefit denials today.

How to Get Veterans Disability Benefits for Fibromyalgia

You can apply for Veterans Disability benefits if you have fibromyalgia by working with a lawyer to file the appropriate paperwork. You need to show that you have the condition, that it impairs you, and, in most cases, that it’s connected to your military service.

If the VA denied your claim for disability compensation for fibromyalgia, or you are not satisfied with the disability pay you were awarded, you may want to work with an accredited veteran’s claims attorney.

A lawyer can explain the diagnostic criteria used by the VA and focus on helping with all aspects of your fibromyalgia disability claim. You deserve help from someone who understands the pains of proving fibromyalgia.

The VA Uses a Range of Ratings for Fibromyalgia Symptoms

The VA describes fibromyalgia symptoms as widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesia, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms.

Depending on the severity of your symptoms, the VA will give you different disability ratings for this condition. These ratings can include:

Getting an official fibromyalgia diagnosis can help with your Veterans Disability benefits application.

Fibromyalgia is a Presumptive Condition for Gulf War Veterans

If you served in the Gulf War and have been diagnosed with fibromyalgia, the VA already understands that there is a connection between your service and that condition. Thus, there’s no need for you to make that correlation yourself. Instead, you may qualify for presumptive disability benefits.

If you’ve been having symptoms of certain conditions, including fibromyalgia, for at least six months, the VA presumes that they are related to Gulf War service. The illness must have also appeared during active duty in the Southwest Asia theater of military operations by December 21, 2021, and be at least 10% disabling.

Here are some of the eligible theaters of operation:

• Saudi Arabia
• Oman
• Iraq
• Kuwait
• Qatar
• The Persian Gulf
• The Gulf of Aden
• Neutral zone between Iraq and Saudi Arabia
• The Red Sea
• The Arabian Sea
• Bahrain

An attorney can give you more information about VA benefits and presumptive conditions.

You May Get Veterans’ Disability Benefits for Fibromyalgia Based on “Pain Alone”

For purposes of VA disability compensation, pain alone can serve as a functional impairment, no matter the underlying cause. The court held that a veteran’s pain is a functional impairment that affects a veteran’s earning capacity, regardless of the disease causing the pain or lack of any formal diagnosis.

To establish the presence of a disability such as fibromyalgia, a veteran will need to show that their pain reaches the level of functional impairment of earning capacity. If your ability to earn a living is impaired as a result of your military service, a lawyer can fight for your benefits.

Make Sure You Get the Disability Benefits for Fibromyalgia You Are Due

Are you wondering how to get disability benefits for fibromyalgia? Our team at Marc Whitehead & Associates can step in to help you get the benefits you deserve. We understand that the key to winning disability benefits for fibromyalgia is in how you develop and present your claim.

Our disability attorneys have an extensive understanding of the restrictions and limitations that people who suffer from fibromyalgia endure. We will help you take action swiftly, as timing can be critical to your case.

Don’t wait to get help; contact us now so we can start fighting for you. We can focus on winning disability benefits for fibromyalgia when we take on your case.

Call or text (800) 562-9830 or complete a Free Case Evaluation form