Fibromyalgia case study #1
Claimant: 44 year old female.
Occupation: Business consultant – pre-disability income of $90,000+
Education: college degree and post-graduate degrees
Hearing info: Claimant applied for benefits in October, 2003, alleging an onset date in August, 2003 (date she stopped working). Hearing held in May, 2007 before an out of state judge appearing via video in the Atlanta North hearing office
Background: My client is a 44 year old female with post graduate education and past work as a business consultant. Her past work included a significant amount of travel and interaction with high level executives of large corporations. She had been involved in a severe car accident in the early 1990’s and underwent fusion surgery in mid-1990’s.
In late 1990’s, the claimant began to experience recurring sinus infection and episodes of unexplained fatigue. She continued to work despite the increasing frequency of the infections and increasing fatigue. In addition, she began experiencing significant levels of pain in her joints and in her upper back.
By late 2002, my client’s sinus infections were not responding to oral antibiotics and she began a regimen of intravenous antibiotics. At around this time, my client found that she was unable to meet the physical and concentration demands of her job and, for the first time in her career, a consulting client asked that she be removed from her current project.
My client then went to her employer and asked if she could work from home, which she did (primarily from her bed) for the next few months. By June, 2003, my client was experiencing extreme headaches, chronic fatigue and generalized body pain. On the advice of her primary physician she asked her employer to put her on indefinite leave.
Since stopping work, my client has sought medical treatment from a variety of sources. She has been seen by allergists, neurologists, psychiatrists, and pain management physicians. She remains extremely susceptible to colds and infections and continues to experience body and joint pain, headaches with occasional migraines and chronic fatigue.
She did attempt to volunteer at an animal shelter in 2004, but was unable to stay more than a few hours. My client’s mother moved to Atlanta from out of State and has been here to care for her daughter for over 2 and a half years.
Hearing strategy: When I reviewed my client’s record, I saw this as a classic fibromyalgia/chronic fatigue case. My client is a well educated, highly motivated female who had been a high achiever her entire life. Over the last eight to ten years, her body has been betraying her and she has been struggling to find a physician who can offer some degree of hope. Like many of my fibromyalgia clients, this client has a voluminous medical chart detailing visits to numerous doctors and specialists. Like many of my fibromyalgia clients, this client organized and tabbed her medical file and obtained copies of her entire medical record.
Since fibromyalgia and chronic fatigue are not “listing level” impairments, I knew that this case would be decided on (a) functional capacity and (b) credibility. The medical record contained several letters from treating doctors that were very supportive of my client’s claim. One physician, who specializes in fibromyalgia patients, offered the opinion that of the 700 fibromyalgia patients he has seen, this patient’s (my client) symptoms were worse than 95% of fibromyalgia patients. He also indicated that he so no way that my client could sustain competitive employment because of her fatigue and pain levels.
Because the Atlanta North hearing office is so backed up, this case was assigned to a judge based in California. He was present via a videoconference setup so he could see us and we could see him. A local vocational witness appeared live in the courtroom and the judge also called a medical expert. The medical expert was not present in the California courtroom. Instead, he appeared by phone. For whatever reason, the medical expert could barely hear me, much less my client, who is somewhat soft spoken. As a result, the judge would end up summarizing my client’s testimony every few minutes for the benefit of the medical expert (in my opinion, the inability of the medical expert to actually hear the testimony would be grounds for appeal if we had been denied).
The judge opened the hearing and then turned the questioning over to me. I started by asking some background questions about where my client lived, her education background and her work background. I then noted that she had applied for benefits using a August, 2003 onset date and asked why she felt that she was not able to work after that date.
My client testified clearly about her history of chronic sinus infections, her growing fatigue, her inability to get any restorative sleep, her headaches and her body pain. We went though my list of medical problems and activity limitations. I also elicited testimony about my client’s specific physical limitations – that she could not stand for more than 10 minutes, that walking was limited to 20 minutes, that sitting was limited to an hour, that she could not climb ladders, ropes or scaffolds, that bending and kneeling were extremely painful. I also asked her about non-exertional limitations including pain, fatigue, poor concentration and decreased memory. Her testimony lasted about 30 minutes and we covered her various complaints thoroughly.
Next, the judge turned to the medical expert and asked for his summary of the evidence. The medical expert read his notes from his review of the file and was not particularly impressive. For example, he would say things like “someone noted that the claimant has an impaired immune system,” and “someone decided to try ECT.” The medical expert concluded by stating that chronic fatigue “and its cousin” fibromyalgia appeared to be the primary diagnosis.
The judge then asked the medical expert to address the relative severity of this case. At that point the medical expert began to ramble on about his theories regarding fibromyalgia and chronic fatigue. He stated that in his view, fibromyalgia and chronic fatigue were elements of depression and that some people relied on the diagnosis for “secondary gain.” At that point the judge interrupted to say that he would eliminate “secondary gain” from consideration as the claimant had been earning over $100,000 a year and there was not reason she would stop working to collect less than $2,000 per month from Social Security.
The medical expert concluded by saying that the diagnosis was chronic fatigue and fibromyalgia but that he had no way of knowing if the claimant actually experienced anything or at what level.
I was then given the opportunity to cross examine the medical expert. I first asked the medical expert if anything in this claimant’s record suggested any malingering or desire for secondary gain. His response – “no.” I then pulled a narrative letter from the treating doctor which spoke about this case being one of the worst fibromyalgia cases ever seen. I asked the medical expert if he would agree that the treating doctor felt that this case was debilitating. The medical expert hemmed and hawed, and finally acknowledged that the treating doctor obviously believed his patient.
The judge then excused the medical expert and asked the vocational witness only to identify my client’s past work. He announced that he had no more questions and closed the hearing.
As is typical in Social Security hearings, the judge did not announce his decision but I explained to my client that I am about 95% positive that the decision will be favorable. There was no contradictory evidence and the claimant was 100% supported by her treating doctors. Further she testified in a credible manner and, as the judge himself pointed out, there is no reason why a healthy, upwardly mobile, high earner would trade her career for a small Social Security check.