Winning a Fibromyalgia Disability Case (Part 2)

There is a perception that Social Security disability cases based on fibromyalgia are difficult to win.  It is not surprising that some judges have a problem acknowledging a medical syndrome that cannot be detected by a blood test and that can have a wide range of generalized symptoms.  Until fairly recently, in fact, physicians did not have a way to specifically “code” a fibromyalgia diagnosis on insurance claim forms, and there were no medications approved by the FDA to treat it.  Every once in a while, you will find a judge who does not believe that fibromyalgia exists.  But even these non-believers will still approve your case if you can show that your symptoms are chronic and severe, that you have sought medical treatment, and that your condition prevents you from performing any kind of work at all.

In fibromyalgia cases, there is no “one size fits all” strategy – just as the condition’s symptom cluster can impact each individual differently, each case must focus on the individual claimant’s symptoms and their impact on function.  Over the years, I have won favorable decisions for many fibromyalgia Social Security claimants.  In one case, the Judge called a psychiatrist as an expert witness.  The Judge granted benefits on the ground that my client’s “fibro fog” was equivalent to a chronic state of anxiety – a psychiatric condition.

A short time later, I represented another fibromyalgia client before another Judge in the same hearing office – this Judge awarded benefits (correctly, I believe) on the basis of a combined impairment.  This is significant in that it demonstrates the potential importance of convincing the judge to recognize the combined effect of fibromyalgia’s impact on the claimant’s physical and mental condition, and the potential that the combined effect is sufficiently disabling.

Within a few months, another client with fibromyalgia sought disability benefits due to severe, chronic pain associated with fibromyalgia.  In this case, a different judge granted disability benefits based on the determination that the client’s condition was equivalent in impact to severe arthritis.

I recently wrote about the recent exciting news for fibromyalgia sufferers – identification of a potential viral cause or precipitator for the condition.  As increased research on causes and treatments emerge, I expect that it will eventually become quite rare to encounter a judge who is completely resistant to considering a fibromyalgia basis for disability.  In the meantime, though, even if judges don’t understand the condition, many will honor the opinion of your treating physician, especially if you have a long and continuous treatment record (the legal term for a thorough medical history is a “longitudinal treatment record”).