November 13, 2019

Finding the Right Fibromyalgia Doctor

I recently ran across an interesting article on a blog published by the North Carolina disability law firm Hardison & Associates called “Fibromyalgia: Searching for the Right Doctor.”   This article raises several issues that I regularly face in my own disability practice – many physicians do not understand how to diagnose fibromyalgia and can damage your disability case by offhand comments in your medical record.

Some doctors incorrectly see fibromyalgia as a “garbage can” diagnosis, meaning that any pain symptoms that cannot otherwise be explained end up with the fibro label.  The problem with this approach is that Social Security judges are increasingly familiar with the American College of Rheumatology’s diagnostic classifications for the disease and judges will discount or ignore a physician diagnosis that does not refer to the American College diagnostic criteria.

Some doctors – thankfully fewer and fewer – do not accept that fibromyalgia exists at all.  Often the medical records from these doctors will contain suggestions that the patient has psychiatric problems, or worse, that the patient is a malingerer or drug seeker. [Read more…]

What Constitutes a Losing Fibromyalgia Claim

We spend a lot of time on this site and others talking about the elements of a winning Social Security disability claim arising from fibromyalgia.   Because there are no objective tests currently available, Social Security judges have to rely on medical records and testimony from the claimant.

Successful claimants need treating doctors who fully support the claim.  The “classic” fibromyalgia treatment record is usually voluminous as the suffering patient goes from one doctor to another seeking relief.  The symptoms that the patient suffers also change over time.  A good record will contain discussions from either a primary care doctor or a pain doctor that explains how the claimant is seeking relief and that her symptoms are changing and resistant to treatment.

Less compelling cases, by contrast, usually contain a medical record that is conspicuous for what it does not say.  The treating doctor may talk about the claimant’s complaints and how those complaints do not seem consistent with any particular diagnosis.  Hints of drug seeking behavior may appear in the record.   The treating doctor will report the symptoms but make it clear that these symptoms are self reported, with nothing said about whether the doctor believes his patient.

Judges reading these records will “read between the lines” and will recognize that the doctor has come to the conclusion that his patient has multiple complaints but that no medical treatment of any type is going to help.  Judges often translate this resignation on the part of both the doctor and the patient as the dreaded “attitude of entitlement.”

I recently posted a case study on my Georgia Social Security disability web site describing a hearing in a fibro case I tried that the judge will likely deny.  My client is a pleasant person and she undoubtedly experiences fatigue and discomfort but the record in her case will not support a claim for disability.  Compare this case study to the case studies on this web site that describe winning cases.

Living with Fibromyalgia

A Cypress Times article reports that Fibromyalgia occurs in about 2% of the population in the United States. It explains that the disease mostly affects women and that the risk of fibromyalgia increases with age.

What is Fibromyalgia?

Fibromyalgia is a chronic condition characterized by widespread pain in your muscles, ligaments and tendons. The symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event. Symptoms include widespread and localized pain, fatigue, sleep problems, and mood disturbances such as depression. These symptoms vary in intensity and come and go over time. Certain conditions such as poor sleep, physical activity, and anxiety may aggravate the symptoms.  In addition to the above-noted symptoms, other conditions including migraines, irritable bowel syndrome, TMJ disorder, or restless leg syndrome may also result from one’s fibromyalgia.

Fibromyalgia and Social Security Disability

Though fibromyalgia is not a life-threatening condition, it does impair ones quality of life. It might also affect your ability to work a full-time job, in which case it may be a good idea to file for Social Security Disability benefits. If you are able to win your fibromyalgia claim for disability benefits, you will be entitled to monthly payments from the Social Security Administration which will make paying for living expenses a bit easier. Remember, though – you cannot win a Social Security Disability case based on fibromyalgia unless you can prove that you cannot work. You must be able to prove that your fibromyalgia symptoms impair your ability to work.

Living with Fibromyalgia

Fibromyalgia can make everyday tasks difficult. While there is no cure for fibromyalgia, learning how to manage your pain and fatigue is the key to living a full and active life. The symptoms of fibromyalgia can be treated. In fact, he U.S. Food and Drug Administration has approved one medication, an anti-convulsant, specifically to treat fibromyalgia. Additionally, antidepressants and analgesics may also relieve symptoms. Nutrition, exercise and sleep therapy can also help, as well as massage, acupuncture, relaxation techniques, or biofeedback.

Winning a Fibromyalgia Disability Case (Part 1)

In a fibromyalgia disability case, you need to prove one thing – that you are not able to work. If you remember nothing else about Social Security disability, you should remember that your capacity for performing work is the only thing that matters to a Social Security judge.  Your underlying medical condition – fibromyalgia, chronic fatigue syndrome, or any other medical problem, is only important to the Social Security Judge if your symptoms limit you from performing a job 8 hours a day, 5 days a week.

In most cases, the judge’s decision really boils down to a judgment call about whether you could hold down a simple, sit-down type of job that requires no training; that allows you to sit, stand, and adjust your position; and that is not production oriented.  In fact, in most hearings, the Judge will call a ‘vocational expert’ to testify about work you have done in the past and about simple, minimally demanding jobs that exist in the national economy.

As a claimant’s lawyer, my job is to identify medical records that suggest work limitations.  In many cases this means I need to review all of the medical records, then create a functional capacity checklist that includes both the limitations associated with your fibromyalgia case and the impairment categories used in Social Security cases.

We then ask your doctor to complete the checklist for submission to the Judge.  We do not ask the doctor to decide if you are ‘disabled’ – that is a legal decision for the Judge.  Instead, we ask your doctor to help ‘translate’ medical conclusions into specific work limitations.

Many fibromyalgia patients get used to living with their symptoms and fail to mention all of them to their doctors or to the judge.  It may be helpful to use a calendar to keep diary notes about how you feel, what symptoms you experience each day, and the impact on your performance.  Make lists.  Ask for your spouse’s or children’s observations.

If you are considering or currently pursuing a disability case based on fibromyalgia, I invite you to get a free evaluation of your case by filling out the simple online form on the right side of this page.