October 23, 2019

Fibromyalgia Case Study 1

Background

The claimant was a 43-year-old female with a 9th grade education. She had worked the past 20 years as a department manager in a grocery store that was part of a large grocery store chain. She applied for benefits in August 2007 alleging disability as of January 2, 2007, which was her last day physically working at the grocery store. Her earnings record showed earnings after this date, but those earnings reflected accrued vacation. The claimant actually had multiple diagnoses, including a diagnosis of fibromyalgia, and left work due to her worsening symptoms, as further described below.

Hearing strategy

This case involved the claim of a woman with multiple diagnoses, including fibromyalgia, degenerative disc disease, osteoarthritis, hypothyroidism, sleep apnea and multiple other autoimmune conditions including Sjogren’s Syndrome, Mikulicz’ Syndrome, Raynaud’s Syndrome, pernicious anemia, and atrophic gastritis.

I am classifying this case a as a fibromyalgia case because I think that pain, stiffness and discomfort are the underlying issues that keep my client from working. I have seen other cases similar to this one in which the treating doctor used fibromyalgia as the umbrella diagnosis. Also, my client fits the classic profile for fibromyalgia patients: 40+ year old female with a limited education and professional success far beyond what most people with her level of education could expect to achieve.

Plus, fibromyalgia is an auto-immune condition and it is not surprising that it can be frequently complicated by other auto-immune disorders.

After meeting with my client in a pre-hearing conference and after looking at the file, I felt that she was a very credible witness. One does not leave a 20 year career, a solid position, a pension and a good salary to stay at home to wait for a Social Security check.

On the other hand, I did not have a definitive diagnosis. My client had been treated by several doctors, all of whom gave their own spin on her diagnosis. Not every doctor out there believes in the concept of fibromyalgia and I think that is what I had here, although I suspect that a fibromyalgia friendly specialist would have more easily arrived at that diagnosis. I did not want to shortchange the other diagnoses, but I felt that I needed a “big picture” argument to present to the judge. Hence the fibromyalgia argument.

I decided that this was a case that would benefit from a pre-hearing brief, a document I will often draft up for the Judge to review prior to the hearing. If you have read my other pre-hearing briefs you will note that this one is slightly different in that I did not ask for an “on-the-record” decision. I thought that this was a case in which the judge would want to hear testimony, but that it would be helpful to summarize the medical evidence for the judge.

The Hearing

As it turned out, the judge was very receptive to my pre-hearing brief. The judge in our case handles his case calendar differently from all of the other judges in the Atlanta hearing office. He usually does not have a vocational witness present and he tends to make his mind up quickly and avoid long hearings. I have found that spending a few minutes working up a pre-hearing brief and/or preparing a strong opening statement helps when appearing before this judge.

We entered the hearing room and sat down. The judge introduced himself and asked me if I had any objections to the record. Next he announced that he had read my pre-hearing brief and that he was prepared to approve this case without the need for testimony.

I said “thank you” and my client and I left the hearing room without the need for my client to say anything.

Post-hearing Analysis

This was a case that could have easily become very confusing to the judge because of the multiple medical diagnoses and the absence of a consistent diagnosis. Further, I had no functional capacity forms from her doctors. There was also a little contrary evidence in the form of a statement from a treating doctor indicating that he was not prepared to fill out a “permanent disability” form, and radiology reports that were “unimpressive” in terms of objective issues.

I felt that if I could put a label on my client’s condition and make the judge’s life a little easier by summarizing the evidence, then he might be more inclined to think about my client’s long work history and the credibility inherent in the story of a person who would not leave a good job with benefits and future opportunity unless there was no other choice. The claimant ended up winning her claim for disability based on fibromyalgia, and in my opinion the pre-hearing brief describing the big picture of her fibromyalgia was the key to winning.