Understanding Fibromyalgia and Social Security Disability

Fibromyalgia is a condition that affects the muscles and soft tissues, causing pain, stiffness, sleep disturbances, fatigue, and difficulty concentrating, which are often referred to as “fibro fog.” Although fibromyalgia itself is not listed in the Social Security Administration’s (SSA) official Listing of Impairments, you may still qualify for Social Security Disability benefits if your fibromyalgia severely limits your ability to work.

The SSA will evaluate your claim based on how fibromyalgia affects your ability to perform substantial gainful activity (SGA), which is the ability to earn a certain income each month through work. If your symptoms are debilitating enough to prevent you from working, you may qualify for benefits.

How the SSA Evaluates Fibromyalgia Claims

While fibromyalgia is not a listed impairment, the SSA evaluates claims involving conditions like fibromyalgia based on the severity of your symptoms and their impact on your ability to function in a work setting. Here’s how the SSA assesses fibromyalgia claims:

• Step 1: Severe Condition – The SSA evaluates whether your fibromyalgia is severe enough to limit your ability to perform basic work tasks. This includes examining your medical records, including doctor visits, physical exams, and lab results. The more documentation you provide, the stronger your case will be.
• Step 2: Meet the SSA’s Definition of Disability – Your disability must prevent you from working for at least 12 months or be expected to result in death. Fibromyalgia often causes chronic pain and fatigue, which may qualify as a disabling condition if they severely limit your ability to maintain full-time employment.
• Step 3: Medical Evidence – The SSA will look at the medical evidence to determine whether your fibromyalgia meets their criteria for disability. This may include physical limitations, cognitive issues (such as memory problems), and other symptoms that prevent you from working. Fibromyalgia can affect multiple body systems, so it’s important to provide a comprehensive medical history from multiple specialists who have treated you.
• Step 4: Residual Functional Capacity (RFC) – If your condition doesn’t meet the SSA’s listed impairments, the SSA will assess your Residual Functional Capacity (RFC). This means determining what work tasks you can still perform despite your condition. If fibromyalgia limits your physical abilities (standing, walking, lifting, etc.) or mental abilities (concentrating, following instructions), your RFC may be restricted, which could make you eligible for benefits.

Gathering Medical Evidence for Your Claim

To increase your chances of approval, it’s critical to provide solid medical evidence that documents the severity of your fibromyalgia and its impact on your life. Here are a few steps to take:

• See Your Doctor Regularly: Regular visits to your doctor will ensure that your medical records accurately reflect the ongoing nature of your condition. Your doctor should document the severity of your symptoms and how they limit your functioning.
• Get Detailed Medical Records: Request comprehensive records from your healthcare providers that detail your diagnosis, treatment, medications, and response to treatment. You should also keep a record of any hospital visits, therapy sessions, and specialist consultations.
• Have Your Doctor’s Opinion: A statement from your treating physician that explains how your fibromyalgia affects your ability to work can significantly strengthen your claim. This should include details on your symptoms, limitations, and how they prevent you from engaging in any gainful activity.
• Include Evidence of Functional Limitations: The SSA looks at your ability to perform basic work functions such as standing, walking, sitting, lifting, and concentrating. You should document how your fibromyalgia affects your ability to perform these tasks.

Applying for Social Security Disability Benefits

Once you have your medical evidence in order, you can begin the process of applying for Social Security Disability benefits:

• Online: The easiest way to apply for benefits is to use the Social Security Administration’s online portal at www.ssa.gov.
• Phone: You can also apply over the phone by calling the SSA at 1-800-772-1213.
• In Person: If you prefer to apply in person, you can visit a local Social Security office in North Carolina. To find the nearest office, use the SSA’s office locator tool.

The Disability Determination Process

After you submit your application, the Disability Determination Services (DDS) office in North Carolina will evaluate your claim. They will review the medical evidence and assess your ability to work based on your fibromyalgia symptoms. This process typically takes 3 to 5 months. However, if additional information is needed or a consultative exam is required, the process may take longer.

The DDS will follow a five-step process to determine whether you meet the SSA’s definition of disability:

• Step 1: Substantial Gainful Activity – If you are working and earning above the SGA threshold ($1,470 per month in 2025), you may be disqualified.
• Step 2: Severe Condition – Your condition must be severe enough to limit your ability to do basic work tasks.
• Step 3: Meet a Listed Impairment – The SSA will check if your condition meets one of their listed impairments, which fibromyalgia typically doesn’t. However, if your condition is severe enough, you may still qualify.
• Step 4: Past Work – The SSA will evaluate whether you can do your past work. If not, they will move to the next step.
• Step 5: Other Work – If you cannot perform your past work, the SSA will check whether you can do any other type of work.

If your claim is denied, you can appeal the decision and request a hearing before an Administrative Law Judge (ALJ).