Fatigue damage is one of the primary safety concerns for steel bridges reaching the end of their design life. Currently, US federal requirements mandate regular inspection of steel bridges for fatigue cracks; however, these inspections rely on visual inspection, which is subjective to the inspector’s physically inherent limitations. Structural health monitoring (SHM) can be implemented on bridges to collect data between inspection intervals and gather supplementary information on the bridges’ response to loads. Combining SHM with finite element analyses, this paper integrates two analysis methods to assess fatigue damage in the crack initiation and crack propagation periods of fatigue life. The crack initiation period is evaluated using S-N curves, a process that is currently used by the FHWA and AASHTO to assess fatigue damage. The crack propagation period is evaluated with linear elastic fracture mechanic-based finite element models, which have been widely used to predict steady-state crack growth behavior. Ultimately, the presented approach will determine the fatigue damage prognoses of steel bridge elements and damage prognoses are integrated with current condition state classifications used in bridge management systems. A case study is presented to demonstrate how this approach can be used to assess fatigue damage on an existing steel bridge.