Fibromyalgia and Social Security Disability

Strategies and Case Studies

  If you are basing your disability claim on a fibromyalgia diagnosis, there are a number of factors that you should keep in mind as you pursue your claim.

  First, you should be aware that over the past ten years, the number of fibromyalgia disability cases has risen dramatically.  This may be a function of increased awareness about fibromyalgia and chronic fatigues in the general community as well as an increased acceptance of these chronic conditions in the medical community at large.

  Ten years ago, most Social Security judges had never heard of fibromyalgia and any attorney representing a fibromyalgia disability claimant had to educate his judge about this condition (a difficult process given the absence of objective indicators in the medical record in fibromyalgia cases). 

  Now, most Social Security disability judges are familiar with fibromyalgia as a medical condition, even if there is not necessarily consistency regarding how judges approach it.  In my practice, I have seen judges take the position that fibromyalgia is a mental health disorder, that it is a function of depression, that it is a form of a somatoform disorder, or that it is a condition similar to complex regional pain syndrome.

  Unfortunately, along with the increased awareness of fibromyalgia comes an overuse of the diagnosis.  Claimants who don’t really exhibit the classic indicia of the condition claim that they have it.  Physicians who are not trained to diagnose fibromyalgia throw out the term in their medical records and in their discussions with patients.  As such, I regularly see claimants who casually include fibromyalgia as one of their disabling conditions even though the medical record does not support the diagnosis.

  Social Security judges, therefore, have become much more cynical about approving fibromyalgia cases because they are not as willing to accept these casual diagnoses by internists or family doctors who have not carefully evaluated the claimant’s condition using the fibromyalgia guidelines set out by the American College of Rheumatologists.

Fibromyalgia Relies on Subjective Reporting Made by the Patient

  Second, Social Security administrative law judges are generally suspicious about any medical condition that does not lend itself to objective testing.  If a claimant has a herniated disk at L5/S1 with nerve root impingement, it can be seen clearly on an MRI scan.  If a claimant has congestive heart failure, resulting in significantly reduced heart pumping capacity, the heart’s pumping capacity can be measured as an “ejection fraction.”  By contrast, the very diagnosis of fibromyalgia arises from the claimant’s self-reporting to her doctor and the doctor’s acceptance of the veracity of the claimant’s allegations.

  Third, Social Security judges are very concerned about any medical condition that requires long term use of opioid pain medications.  From the judge’s perspective, any claimant they approve may end up receiving disability benefits for twenty, thirty even forty years, along with Medicare.  The last thing a disability judge wants to do is authorize a government giveaway to a person who is a good actor.

Common Features of Winning Fibromyalgia Disability Claimants

  This is not to say that a Social Security judge will not approve a legitimate fibromyalgia based claim.  While every case is different, here are some common attributes that I see in cases involving individuals who truly are dealing with severe and disabling fibromyalgia:

• claimants are typically females 35 to 50 years old
   
• most claimants are type A personalities
   
• often the claimants have been high achievers beyond their educational and work training - in other words, these individuals have taken on and been successful with tasks and duties far beyond their training and education
   
• as the fibromyalgia becomes more symptomatic, the claimants aggressively search for answers, visiting doctor after doctor and trying different medications, therapies and cures
   
• often the claimant have had some sort of trauma in the 10 to 15 years prior to developing fibromyalgia - a serious auto accident, a fall from a horse, an emotional shock

  There is no “listing” for fibromyalgia.  Therefore, the strategy I use to win fibromyalgia disability cases revolves around my client’s functional capacity for work.  I develop a case strategy around the idea that the various limitations arising from my client’s condition would significantly interfere with her ability to perform even simple, unskilled work.  Ideally, I will have a form completed by a treating doctor that identifies these limitations.  Click here to read more about how I develop a winning fibromyalgia SSDI case.

Case Studies:

Social Security Disability and Fibromyalgia Case Study #1 - this case involved a 46 year old female who had previously worked as a business consultant for a large, multinational consulting firm.  She has a college education and previously earned over $100,000 per year.  This case resulted in a favorable decision.

Social Security Disability and Fibromyalgia Case Study #2 - this case involved a 53 year old woman with a high school education who had previously worked as a medical transcriptionist. A favorable decision was issued in this case.