Fibromyalgia Case Study #7
Claimant: 43 year old female.
Occupation: My client worked as a head sales clerk for the Kroger grocery store company for almost 20 years. This job involved a great deal of responsibility, as well as heavy lifting of pallets. My client last worked at her job in January, 2007 – this was her onset date.
Education: 9th grade education. No GED
Hearing info: Claimant applied for benefits in August, 2007 alleging an onset date of January 2, 2007. The hearing was held before a judge in the Atlanta downtown hearing office.
Background: As is the case with many of my fibromyalgia cases, this client fit the profile of the high achieving, middle aged female with an extensive medical record and a type A personality. Consistent with the profile of fibromyalgia patients as overachievers, my client had risen to a head sales clerk position at several Kroger stores in the Atlanta area, despite her limited education. As she described it to me, her supervisors would move her to stores with problems in the receiving area because my client was so diligent at her duties. My client reported to me that her job was very stressful because of both the responsibilities thrust upon her as well as the physical demands of the job.
In mid-2006, approximately 6 months prior to leaving her job, my client began experiencing abdominal and pelvic pain, as well as back pain. In November of 2006, she met with an orthopedic surgeon with complaints of numbness and tingling in both arms as well as left shoulder pain. The orthopedist ordered an MRI scan of the cervical spine, which revealed small herniations in the discs at C3/4 and C5/6 as well as degenerative changes elsewhere in the spine.
My client also complained of episodes of mental confusion (these look like episodes of “fibro fog” to me).
In January, 2007, my client took a leave of absence in an effort to regain her heath. She saw many different physicians, all of whom recognized that she had a mild orthopedic condition that was not surgical in nature and that did not explain her extreme pain and fatigue. During 2007 and 2008, my client was diagnosed with a number of conditions, including:
- Sjogren’s syndrome
- Mikulicz’ syndrome
- Raynaud’s syndrome
- pernicious anemia
- atropic gastritis
- sleep apnea
This case was a little unusual in that I did not have any one doctor to “put everything together.” My client saw two neurologists, neither of whom appear to recognize fibromyalgia as a disabling condition. One neurologist noted that the claimant’s condition was not surgical in nature and that she had “multiple somatic complaints and was quite anxious and distraught,” and a second neurologist noted that my client’s MRI was “unimpressive” and that “I do not feel that she is permanently disabled at this time.” The second neurologist refused to complete a functional capacity form at my request.
I was able to get my client’s family doctor to fill out a form in which he said that her primary diagnosis is “myalgia” with a secondary diagnosis of peripheral neuropathy, degenerative joint disease and polyarthritis. The family doctor did assign activity limitations that would result in vocational witness testimony of “no jobs.”
The Hearing: this case was scheduled to be heard by a judge in the Atlanta downtown hearing office who does not rely on vocational witness testimony and who makes quick decisions during the hearing. I have found him to be receptive to well reasoned pre-hearing arguments, so I drafted and submitted a pre-hearing brief in this case. You can read a redacted copy of my brief by clicking on the link.
When my client and I arrived at the hearing room, the judge went through preliminary matters quickly then he noted that I had filed a pre-hearing brief. He announced that based on the argument presented in the brief as well as his review of the record, he was going to approve benefits in this case. My client did not end up having to present any testimony at all.
Analysis: this was a somewhat unusual case that I am classifying as a “fibromyalgia” claim because my client’s symptoms of pain, mental confusion, digestive distress and symptoms of pain that move around her body are much more consistent with a fibromyalgia diagnosis than the patchwork diagnoses that she has received over the years. I think that her family doctor has it right, while the neurologists she saw are missing the big picture.
In any case, the judge was open to my argument that whatever you call my client’s condition, her symptoms are debilitating. Clearly her long work history was a helpful factor here as was her consistency in seeking treatment.