Are you working on getting an SSDI-approved fibromyalgia claim? The Social Security Bureau requires more than just diagnosis to approve your case. In this video, I explain how SSAs evaluate fibromyalgia and the exact documentation they expect to see. You will understand the criteria your record must meet and why some claims are rejected despite valid symptoms. If you want to learn how to prepare for a stronger and more reliable case, check out this video.
SSA uses strict diagnostic criteria and expects a clear medical literature when evaluating claims for fibromyalgia.
What is fibromyalgia
Fibromyalgia is a chronic disease characterized by musculoskeletal pain, fatigue, and sleep disorders. It is often accompanied by other symptoms such as cognitive dysfunction and emotional problems. Although it is not curable, the therapy focuses on managing symptoms and improving quality of life. Fibromyalgia is a condition that continues to face doubt in the assessment of social security disorders. Although it affects many people, the Social Security Agency (SSA) does not always receive diagnosis at face value. This is largely due to the increase in the diagnosis of fibromyalgia without meeting the formal medical standards recognized by SSA.
SSA relies on diagnostic criteria set by the American College of Rheumatology. These criteria define how fibromyalgia should be diagnosed and used by the government to assess claims for persons with disabilities. There are two sets of standards: one: the first set in 1990 and the updated version in 2012. SSA considers a set when reviewing cases.
Diagnostic exclusion
The first major requirement is that fibromyalgia must be an excuse diagnosis. This means that other potential causes of symptoms must be ruled out. For example, if a person reports wrist pain, SSA would like to see imaging, such as X-rays, confirming that there is no underlying problem causing the pain. If the claimant suffers migraine, the medical file should indicate that other conditions (such as brain tumors) have been excluded. For fatigue, blood investigations may need to rule out diseases like Epstein-Barr virus.
1990 Standard
The 1990 standard requires evidence recorded in 11 of the 18 specific bidding points in the body. If not, SSA will look for at least six literature on symptoms associated with fibromyalgia. These may include chronic fatigue, brain fog and other related conditions. If one of these two sets of criteria is not met, it is difficult for the claimant to show disability due to fibromyalgia alone.
Strong medical records are key to SSDI approvals associated with fibromyalgia.
In a recent case, only fibromyalgia-based claims were approved, but only after detailed medical documentation was provided. The person had extensive testing to rule out all other possible conditions and the severity of fibromyalgia was well established, including the fact that she needed a wheelchair. This level of documentation is not common. SSA has become more cautious in evaluating these claims due to the increase in fibromyalgia diagnosis that does not meet formal criteria. As a result, it is difficult for applicants to prove disability based solely on fibromyalgia.
Contact the legal team
Understanding how SSA evaluates fibromyalgia is critical for those who apply for disability benefits. Accurate documentation and medical support remain key to successful claims. If you need help understanding the application of this for your situation or navigating your SSDI case, you can Please call us at (800) 419-7606. We are here to help you.
