Can you get Social Security disability for Fibromyalgia?

The short answer is yes, you can receive Social Security disability benefits if you have fibromyalgia. In my experience, though, you may face some obstacles along the way, and knowing where they are makes a real difference.

I have seen an increasing number of Indiana disability claims for fibromyalgia. Residents across the state find themselves unable to work because of chronic pain in different areas of the body, and while research into causes and treatment has grown, a great many people are still living with it every day.

What fibromyalgia is

Fibromyalgia is a condition involving widespread pain and painful responses to pressure. It is frequently associated with depression, anxiety, and other stress-related disorders.

While the cause is not yet established, many of my clients describe very similar symptoms:

• Muscle pain. Widespread and tender to the touch.
• Fatigue. Even with adequate sleep, many people feel exhausted.
• Focus, concentration, and memory problems. Sometimes called fibro fog.
• Sleep disturbances and waking unrefreshed
• Joint stiffness
• Bowel or bladder problems
• Numbness and tingling
• Difficulty swallowing

Many of my clients also have other conditions alongside it, commonly migraine headaches, irritable bowel syndrome, arthritis, and depression. That combination matters more than people expect, and I come back to it below.

The cause is unknown, though current thinking involves a combination of genetic, environmental, psychological, and neurobiological factors. Stress appears to play a role, and factors such as smoking, weight, and physical inactivity may increase risk. Fibromyalgia is not degenerative or fatal, but the chronic pain is persistent, and most people report that it does not improve over time. There is no universally accepted cure, though psychological therapy, medication, and graded exercise are commonly recommended for symptom management.

How Social Security evaluates fibromyalgia

Social Security does not have a listing for fibromyalgia. That does not mean you are ineligible for benefits. It means the analysis runs through a policy ruling instead.

Although doctors have been diagnosing fibromyalgia for many years, it was not until 2012 that Social Security issued guidance addressing it as a disabling condition, in policy ruling SSR 12-2p. That ruling is what your claim will be measured against.

SSR 12-2p makes one thing plain at the outset: a diagnosis of fibromyalgia alone is not sufficient proof of a disabling condition. Social Security will review your doctor’s treatment notes to see whether the clinical findings over time show that your functional abilities are limited enough to be disabling.

Who has to make the diagnosis

SSR 12-2p requires that the diagnosis come from a licensed physician, meaning a medical doctor or a doctor of osteopathy, who has reviewed your medical history and examined you. The diagnosis also has to be consistent with the other evidence in your file.

While many primary care providers diagnose fibromyalgia and prescribe medication for it, a diagnosis from a rheumatologist substantially improves the likelihood that Social Security accepts it. A specialist’s findings tend to be better supported and more detailed, and both of those things count.

Two ways to establish fibromyalgia, not one

This is the part most sources get wrong, and it is worth reading carefully.

SSR 12-2p provides two alternative sets of criteria. You need to satisfy one of them, not both.

The 1990 ACR criteria. All three of the following:

• A history of widespread pain, meaning pain in all four quadrants of the body and axial skeletal pain in the cervical spine, anterior chest, thoracic spine, or low back, that has persisted for at least three months
• At least 11 positive tender points out of 18 specified sites, found bilaterally and both above and below the waist, with the physician documenting the findings and the use of approximately nine pounds of force
• Evidence that other disorders which could cause the symptoms were excluded

The 2010 ACR preliminary criteria. All three of the following:

• A history of widespread pain
• Repeated manifestations of six or more fibromyalgia symptoms, signs, or co-occurring conditions, especially fatigue, cognitive or memory problems, waking unrefreshed, depression, anxiety disorder, or irritable bowel syndrome
• Evidence that other disorders which could cause these repeated manifestations were excluded

Notice that the second route does not involve tender points at all.

This matters practically. The tender point examination fell out of routine clinical use after 2010, and many rheumatologists no longer perform it. If your records contain no tender point count, that does not sink your claim, because the 2010 criteria exist precisely for that situation. What those criteria need instead is documentation of your co-occurring conditions and symptoms across your record, which is often already there and simply needs to be pulled together.

If you are being examined and the 1990 route is the one your evidence fits, it is worth knowing that Social Security expects the physician to document the tender point findings, including the approximate force used.

Ruling out other conditions

Both routes require evidence that other disorders were excluded. This is a step people frequently overlook, and it is one of the reasons laboratory testing matters in a condition with no confirmatory test. Results ruling out lupus, rheumatoid arthritis, thyroid disease, and similar conditions are not incidental to your claim; they are part of establishing it.

Fibromyalgia can medically equal a listing

Because fibromyalgia is not a listed impairment, it cannot meet a listing. It can, however, medically equal one, and SSR 12-2p names listing 14.09D for inflammatory arthritis as the example. It can also equal a listing in combination with another impairment.

This is worth raising with a treating rheumatologist, because it takes a physician’s opinion to make the argument properly.

Winning on residual functional capacity

Most fibromyalgia claims are decided at this stage rather than through equivalence. I have to show that your residual functional capacity is low enough that you cannot work a job eight hours a day, five days a week. As with any claim, your condition also has to have lasted, or be expected to last, at least twelve months.

Social Security will consider your inability to physically perform a job, including how pain and weakness affect your ability to:

• Sit, stand, and walk
• Lift and carry
• Bend, stoop, crouch, and climb
• Use your hands for repetitive tasks

It will also consider non-exertional limitations. Fibro fog can limit your ability to concentrate, remember tasks, and stay alert, and where cognitive symptoms are severe they may be evaluated as a separate mental impairment as well as a fibromyalgia symptom.

Your age, education, and work history matter at this stage too. A claimant of 50 or older with no transferable skills is in a considerably stronger position than a younger claimant with identical limitations, and at 55 the vocational rules shift again in the claimant’s favor. Since June 22, 2024, Social Security also looks only at work performed in the previous five years rather than fifteen.

Two points deserve particular emphasis.

Good days and bad days. SSR 12-2p specifically directs Social Security to consider a longitudinal record wherever possible, because fibromyalgia symptoms wax and wane and a person may have good days and bad days. A single examination on a better day says very little. What matters is whether you could sustain work on a regular and continuing basis, and how many days a month you would miss.

Evidence from people who are not doctors. SSR 12-2p allows Social Security to consider statements from non-medical sources, including family, friends, neighbors, and former employers, about how your symptoms affect your daily functioning. In a condition with no confirmatory test, these statements can count for a great deal and are often overlooked entirely.

If a judge seems skeptical

I have at times encountered Administrative Law Judges who discount fibromyalgia claims. A solid, detailed medical history is the best answer to a skeptical judge.

It is also worth knowing that the rules changed in your favor in 2016. Social Security replaced its older guidance on evaluating symptoms with SSR 16-3p and deliberately removed the concept of assessing a claimant’s credibility. Adjudicators are now directed to evaluate whether your statements are consistent with the evidence, not to judge your character or truthfulness. If you have felt that your account of your own symptoms was being treated as suspect, that is not the standard.

The medical evidence your claim needs

Fibromyalgia can be hard to prove without the right supporting evidence. Useful records include:

• Rheumatology treatment records covering an extended period
• Documentation of either the 1990 or the 2010 criteria, whichever fits your evidence
• Laboratory results excluding other conditions
• A record of treatments tried, including medications that did not work
• Notes describing cognitive symptoms, not only physical ones
• Records of co-occurring conditions

A medical source statement from a treating provider, setting out the diagnosis, duration, symptoms, and specific work-related limitations, can help persuade Social Security or an ALJ. A statement that addresses how many days a month you would be absent is more useful than one describing your condition in general terms.

Remember that fibromyalgia may not be the only thing keeping you from working. Social Security is required to consider all of your conditions in combination, and the combination is frequently what carries a claim that fibromyalgia alone would not.

Talk with an Indiana disability attorney about your fibromyalgia claim

With any Social Security disability case, time matters. File your claim promptly, and if you are denied, appeal rather than starting a new application. Appealing protects your original filing date and the back pay attached to it, and you generally have sixty days from the date on the notice. The application and appeals process can be confusing and frustrating, but in my experience continuing to move forward in a timely way improves your chances.

My office has handled thousands of disability claims, many involving fibromyalgia. If you would like to talk through where your claim stands and what your records still need, contact my office for a free consultation.