November 13, 2019

Tips on Winning a Fibromyalgia Disability Case

The importance of work background in a fibromyalgia disability case

In a previous fibromyalgia disability case I tried in court, my client had a very insufficient work record. In addition, what was stated in her medical records about her condition did not match with what she claimed about her condition; she seemed to very much exaggerate her fibromyalgia pain during the hearing, but when the Judge reviewed the records, he could not find any evidence that she suffered from severe pain. This may not have been a deal breaker for her case, but combined with her lackluster work background, it was enough for her to lose the case. I sometimes feel that if a client has a strong work background and appears to want to work, then that client may have a better chance of winning even despite discrepancies in the medical record.

For example, I had a client once who had a managerial level position within her company and made over $100,000 at the time when her fibromyalgia took her out of work. Well, she won her case without even having to make too much of a compelling argument, since the Judge trying the case likely thought that a person who earns a good salary is less likely to want to stop working and earn a $2,000 Social Security pay check. Seems logical, right? In essence, I believe that this client’s work background helped her win her case even though her medical records weren’t all that comprehensive.

In yet another fibromyalgia case, a client of mine had an excellent testimony which again focused on her past work and desire to keep working even though she couldn’t. In this particular case, the woman testified about her pain, her problem with adjusting to a great decrease in her monthly income after being forced out of work by her condition, and about her feelings of unimportance now that she no longer had a job. This great testimony helped her win the case.

So, in conclusion, if you are suffering from fibromyalgia and want to make the most of your case, focus on what work you have done, communicate that you wish you could still be working if you were healthy enough, and make the Judge understand that getting on Social Security is a necessary evil and not something you actually want. Then, your chances of winning at the hearing are that much better.

One last note: It always helps, of course, to have good medical records to back up your claim or what we call a functional capacity form that is filled out by your physician. If your physician is willing to assist, you will be that much more ahead of the game when it comes to winning your fibromyalgia disability claim.

Can a fibromyalgia disability case be won at the early stages of the claims process?

I am asked this question by fibromyalgia clients often, and the answer is yes, but there’s a big asterisk there. You see, to win your fibromyalgia disability case early on, you need to meet certain criteria which may be hard to achieve.

First of all, you will need to obtain strong support from your treating physician. You will have to submit solid medical records along with your claim for benefits, and these medical records must clearly show that you have a firm fibromyalgia diagnosis and that it interferes with your ability to perform work in major ways. Things like discussions of pain levels and extent of fatigue are the types of things that will need to be present in such records in order for you to even have a chance at winning early.

Another way of possibly winning early is if your condition meets a Listing – which is essentially the SSA’s definition of severe/disabling fibromyalgia. Anything that falls short of meeting that definition/description will fail to meet the listing. Here, again, your medical treatment records must be extensive and consistent. Also, a form completed by your physician which tracks the listing can help. Such a form, which is structured as an easy to read checkbox type of document, will ideally make the adjudicator reviewing your case recognize that your condition meets a listing. This will increase your chances at an early approval.

There is one final way to possibly win a fibromyalgia claim early, and that is to Meet a Grid Rule. Like meeting a listing, this may sound mysterious, but it’s really quite simple (especially if you are over the age of 50). Here’s an example: Let’s say that you don’t meet a listing. Well, you can still win if you have a physical impairment like fibromyalgia, you have limited work and educational history, and you are 50 years old or older. If you meet these criteria, consider taking a look at the “grid rules.” You may fall under a certain grid rule and therefore automatically qualify. The grid rules, however, can sometimes be difficult to understand, so that is why it is a great idea to talk to a disability attorney about winning disability benefits based on the grids.

State Agency adjudicators are known to issue positive decisions in grid cases. That’s why it is imperative that you stress that your case is a grid case and point out the specific grid. Like I said, an attorney can help.

Finally, it is also important to note that State Agency adjudicators are usually underpaid and overworked. They are often given very limited authority, and they are quick to deny cases, even if they are deserving. Consider asking the adjudicator to give your file to a medical consultant or even a supervisor in the State Agency office. That may be your last chance at winning your fibromyalgia disability case early.