Presenting Social Security Disability claims based exclusively or in part on the basis of fibromyalgia can be challenging. We assure you that we believe in this diagnosis. We have presented many cases (perhaps as high as 1,000 cases) in which Fibromyalgia was the basis for our clients’ claims that they were disabled. The following article offers some helpful information and tips regarding the presentation of such cases.
According to the American College of Rheumatology, Fibromyalgia is a real medical condition that can be diagnosed and proven according to specific criteria. Although it often occurs along with other medical conditions such as Lupus or various forms of Arthritis, it is distinct from these medical conditions. For instance, curing or alleviating the symptoms of Lupus or Arthritis does not necessarily cure Fibromyalgia.
The diagnostic criteria for Fibromyalgia, according to the American College of Rheumatology, is: 1.) a history of widespread pain that has been present for at least three months. Pain is considered to be “widespread” when all of the following are present: pain in both sides of the body, pain above and below the waist, 2.) “axial” skeletal pain (pain of the cervical spine, anterior chest, thoracic spine, or low back), and 3.) pain present in 11 of 18 “tender point sites”, identified by the physician’s palpation (light pressing with the hands).
Synopsis of Social Security Disability evaluation and Fibromyalgia
Social Security evaluates disability cases essentially in one of two ways: either by comparing the claimant’s medical condition to a medical condition described in the “medical listing of impairments”, or in the commonsense way of evaluating the overall effect of the claimant’s symptoms on their ability to work. Social Security currently does not have a “medical listing” for Fibromyalgia, but disability claims based on Fibromyalgia may be successfully presented by showing that the claimant is not able to work “on a regular and continuous basis” due to their impairments.
Social Security defines “work” as an eight hour a day, five-day week endeavor. As in most Social Security Disability claims, the judge’s (referred to as “ALJs”) decision really boils down to whether or not he or she believes that you can perform the basic functions of work (sitting, standing, walking, lifting, concentrating, interacting appropriately with people encountered in the workplace, etc.). The fact that a claimant can only perform these basic functions sporadically, but not consistently, is the basis for the large majority of successful Social Security Disability claims. A claimant experiencing severe Fibromyalgia can refer to many aspects of their illness to show that they would not be able to meet the basic demands of even nonphysical, low stress jobs.
Having said this, Fibromyalgia cases are sometimes made more difficult by several factors, some of which can be controlled and others which cannot. It is, sadly, still the case that there is a certain amount of prejudice toward the diagnosis itself among Social Security ALJs and some physicians (and even some Social Security Disability attorneys!). With respect to a hearing before ALJs, our approach is that even if we are presenting a Fibromyalgia disability claim to a skeptical ALJ (and maybe even especially when we are), our job is to document the impairments as thoroughly as possible. Obviously, we hope that this will convince even a skeptical ALJ. If we cannot, our chances of success on appeal are much better when the medical condition has been thoroughly presented. Regardless of the opinions of the few “rogue ALJs”, the fact is that the Appeals Council and especially the federal district courts have clearly acknowledged that this is a valid medical condition and will force the ALJ to reconsider his decision if the medical evidence is not dealt with in a fair and evenhanded manner.
To see a summary of the types of cases we have been bale to win in Federal District Court, please go to the Federal Court Appeals Center.
Another problem in the presentation of Fibromyalgia cases is the fact that the diagnosis has, to a certain extent, become mis-used. Specifically, it does seem as though “Fibromyalgia” sometimes becomes the diagnosis when doctors have not been able to identify the source of a person’s complaints of pain, a sort of “catch-all” diagnosis. This behavior has had the effect of increasing the amount of skepticism that Social Security Disability claims based on Fibromyalgia are sometimes met with. Fortunately, there are some very simple ways of making sure, if you really have Fibromyalgia, that this condition is well documented and presented to the ALJ in such a way that it cannot be simply dismissed.
“Must-do” tips for developing Social Security Disability claims based on Fibromyalgia
1. Describe all your symptoms: Many Social Security Disability claimants with Fibromyalgia make the mistake of describing their medical condition exclusively in terms of their pain. While, obviously, people with Fibromyalgia have significant complaints of pain, and these complaints must be described extensively, it is well known that many other types of symptoms and medical problems are often present along with the chronic pain. It is crucial that these additional symptoms and complaints be described in their entirety.
A medical study underwritten by the American College of Rheumatology showed that 100% of people with Fibromyalgia complained of muscle pain. However, a significant percentage of these same people described numerous other medical symptoms in addition to pain. Among these additional symptoms were:
difficulty sleeping (86%),
pain in the joints (72%),
restless legs (56%),
numbness and tingling in the extremities (52%),
impaired memory (46%),
leg cramps (42%),
decreased concentration (41%),
nervousness (32%), and
“major” depression (20%).
Arthritis and Rheumatism, Vol. 33, No. 2, Feb. 1990, F. Wolfe, et. al. We might add with respect to the last two items, nervousness and “major” depression, that in our experience a significant percentage of clients we have represented with Fibromyalgia have complained of some degree of depression and anxiety (even if not “major”).
It is absolutely crucial that you describe thoroughly any symptoms you have in addition to your pain. You will, for instance be asked to describe your major symptoms on various forms sent to you by Social Security (the most common being the “pain questionnaire” in the “daily activities questionnaire”), and at your hearing before the ALJ you’ll be asked a number of questions designed to elicit testimony concerning all of your severe medical symptoms. It may be that you have grown used to symptoms such as fatigue, headaches, or depression and think of them, in a way, as your “normal” condition. However, these additional symptoms may be related to your Fibromyalgia.
2. If possible, treat with all the medical specialists appropriate to the treatment of Fibromyalgia: Part of the problem in presenting Social Security Disability claims based in Fibromyalgia is that in many cases a claimant has seen only their primary care physician, received a diagnosis of Fibromyalgia, and stopped there. While it is possible to be successful in the claim where the only diagnosis of Fibromyalgia comes from the PCP, the claim is far more likely to be successful (and you are far more likely to get state-of-the-art medical treatment) if you see an appropriate medical specialist, in addition to senior PCP.
In the treatment of Fibromyalgia, the appropriate medical specialist is usually a Rheumatologist, a Physiatrist, or a Pain Specialist. If at all possible, have your PCP refer you (if your medical insurance requires a referral) or see such a specialist on your own (if your medical insurance does not require a referral to see a new doctor). A medical specialist who is experienced in treating Fibromyalgia will not only be able to offer a diagnosis based upon accepted standards of the American College of Rheumatology, they are much more likely to be aware of the most recent advances in the treatment of this disorder. And, quite frankly, the report of such a specialist is much more likely to carry significant weight in a Social Security ALJ’s eyes.
With respect to the depression, anxiety and nervousness, we believe it is extremely important that you receive appropriate treatment for this condition also. If you are significantly depressed, anxious or nervous, then you may need to be treated by a mental-health professional such as a counselor, therapist, or psychiatrist. Many clients, when we first offer this advice, believe that we are asking them to consider seeing a psychiatrist or mental-health professional because we do not believe them. To the contrary, we have learned through experience and through the medical research necessary to do our jobs that depression etc. is simply one of the many problems a person with Fibromyalgia will often experience. Our attempt is not to disprove your Fibromyalgia, but rather to make sure that all your medical problems are adequately documented, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
It is not possible in a short article (or maybe even in a long one) to discuss in detail all of the medical, legal, and personal aspects of a Social Security Disability claim based on Fibromyalgia, but we hope this article has accomplished at least two things: first, assure you that Social Security Disability claims based on Fibromyalgia are winnable cases and, second, that you will see the wisdom of contacting our law firm or some other qualified representative to guide you through this complex process.
For additional information about Social Security Disability law or to discuss your claim, please to schedule a free confidential consultation by calling us at 412-794-8003 (locally in the Pittsburgh area) or toll free at 1-866-438-8773 (outside the Pittsburgh calling area). If you prefer, you can fill out our intake form, and an experienced lawyer will contact you to schedule an appointment.