In mild cases, lupus may cause achy or swollen joints, rashes, fatigue and sensitivity to sunlight. In more severe cases, lupus patients may experience problems with kidney function, anemia, blood clotting problems, Raynaud’s syndrome (cold fingers and toes) or seizures.
Fibromyalgia (FM) is one of the harder conditions to get approved for as a disability. Because the symptoms are often self-reported, you’ll need medical documents and a doctor to support your case. But it’s possible to have a successful claim for FM.
Keep in mind that your best chance of getting approved for disability is to have:
relevant medical records
laboratory testing
doctors’ opinions
statements from friends, family, and coworkers
Read on to learn what the Social Security Administration (SSA) requires and how you can build your case for fibromyalgia disability.
The SSA is responsible for evaluating all disability applications. When reviewing your case, the SSA will determine if you have a medically determinable impairment (MDI) of FM.
The criteria and requirements for claiming disability due to FM are extensive. They include:
symptoms that must be severe and present for at least three months
documented evidence that rules out other conditions
statements from you and others about any restrictions or inabilities on your daily activities
whether FM prevents you from working
You must also have at least 11 of the 18 tender points above and below the waist, and on both sides of the body, or at least six ongoing symptoms of FM.
These symptoms include:
fatigue
memory or problems with thoughts, also known as fibro fog
irritable bowel syndrome
depression
anxiety
waking up exhausted
While the SSA requires a doctor’s diagnosis, cases are often won or lost based on symptoms and limitations, according to The National Fibromyalgia Association. Even if you have a diagnosis for FM, the SSA will look at whether you’re capable of work.
Documentation is the key to a successful disability case. This means more than supplying the SSA with your medical records. If your symptoms result in missed workdays, your employer may need to provide a statement saying so.
Overall, your application should contain:
a confirmed diagnosis from a rheumatologist
dates and contact information of your doctors, caseworkers, and hospitals
your current and relevant medical records such as medications, lab tests, or psychologist visits
a Residual Functional Capacity (RFC) about your impairments filled out by your physician
a summary of your previous jobs
It’s also helpful to keep a fibromyalgia diary. This can help you track all the days you experience pain, and how it interferes with your normal daily routine. You can take into account migraines, painful periods, and chronic exhaustion.
Your rheumatologist can also give a professional opinion on your limitations. This includes an assessment of your ability to:
sit, stand, and walk in an eight-hour workday
lift and carry heavy loads
conduct fluid movements like bend, balance, or crawl
maintain punctuality and attendance at work
The SSA takes all documentation into consideration before making a decision on your disability application. Once you submit your application, a team of doctors that work with the SSA will evaluate all of its components. The team of doctors will also include a psychologist to see if FM has resulted in any mental impairment.
These impairments are based on:
memory
speed of information processing
concentration
calculation
speech
word-finding
The team interprets your medical information and predicts how long your condition is likely to last.
When you are ready to apply for disability benefits, you can apply:
by phone at 1-800-722-1213, or TTY 1-800-325-0778, if you’re hard of hearing
at your local social security office
You’ll want to call ahead and make an appointment, if you plan to apply in person.
The SSA says you can apply for benefits as soon as you receive a fibromyalgia disability diagnosis.
The SSA estimates an average wait time of three to five months for disability benefit claims. It’s best to apply for this once you become disabled.
In some cases, the SSA will request additional documents to process your disability claim. Providing everything you need in advance may help shorten the waiting period.
Disability benefits can help if FM prevents you from working at least one year. The average cost for annual fibromyalgia treatment can add up to $5,945 per person. This amount may be even more if your health insurance doesn’t cover all your treatments. Disability can help with the costs, especially if you are unable to work.
Check out the SSA’s Disability Starter Kit when you are ready to apply.
Wait for a decision. An SSA analyst will review your disability benefit application and evaluate whether you have a 'medically determinable impairment.' The SSA will notify you by mail of their decision on your claim. The medical documentation that you collected will be used in making this determination. The SSA uses the following five-step process to evaluate a claim:
determine whether you are working and if you average earnings exceed a certain amount they will consider you disabled
determine whether your medical condition is severe enough to limit basic work activities, such as sitting, walking or remembering, for at least 12 months
determine whether your medical condition is one of their listed impairments that prevents you from working. While fibromyalgia is not one of the officially listed impairments, the SSA has issued guidance on how to evaluate whether fibromyalgia meets the criteria for a “medical determinable impairment” that prevents employment[11]
determines whether you can perform the work you performed before the onset of your condition
determines if there is any type of work that you can perform with your medical condition[12]