Fibromyalgia, Chronic Pain and Other Medical Conditions Not Objectively Diagnosed – How to Best Prepare Your Case

Posted on Wednesday, January 30th, 2013 by Loyd Bourgeois    

Chronic Pain & SSDI: How to best prepare your case

Chronic Pain & SSDI: How to best prepare your case

I get a lot of questions about fibromyalgia and other medical conditions that rely on subjective reporting by patients.  These cases are more difficult to win due to a lack of objective medical evidence.

A typical question I receive is as follows:

“I’m 44 yrs old and have been suffering for many years with fibromyalgia and chronic pain.  My life is falling apart because of my disabilities. I’ve applied for disability in the past and was denied. I’m applying again and wanting to know how do I prove my disability since its been denied in the past?  What evidence do I need to help win my case?”

Social Security defines disability in terms of your capacity to work a simple, entry-level type of job.  In order to obtain benefits, you have to prove that your medical condition or conditions are so intrusive, that you cannot work at any job, full time.

Generally, in a disability case, you attempt to prove your case by submitting medical records, and, even better, a functional capacity form completed by your doctor that identifies specific activity limitations.  You may also submit third party statements about your functional abilities.

If there is no conflicting medical evidence about the extent of your disability or your limitations and your medical condition is well defined, the judge considering your case is bound by law to accept your doctor’s conclusions about your capacity to work.

However, some medical conditions lend themselves more than others to work capacity limitations.  Specifically medical conditions in which severity can be evaluated with objective testing are more readily approved.  Objective tests include: MRI scans, CT scans, pulmonary function testing, heart pumping capacity testing, liver function testing, and other lab results.

Some medical conditions are progressive, degenerative and debilitating, and can be diagnosed with specific tests. These diseases include multiple sclerosis, muscular dystrophy, lupus, Type I diabetes, and others.

However, there are some conditions that are difficult or impossible to measure, or their diagnoses rely on subjective reporting by the patient.  These diseases include fibromyalgia, chronic pain syndrome, and many mental disorders.

While these conditions can produce symptoms and limitations that substantially interfere with your capacity to perform simple, entry-level work, evaluating the severity is difficult.

The judge can listen to your testimony, but testimony is usually not enough to win the case on its own.

The judge can look at your medical treatment records produced by your doctor, but most medical notes do not focus on work capacity – they focus on your complaints, the doctor’s treatment decisions and whether or not various treatment options have worked.  So, in many cases, the doctor’s notes are not particularly useful except to show that you have gone to the doctor.

Usually, the best evidence you can provide is a functional capacity form (or medical source statement) in which your doctor identifies specific work activity limitations experienced by you.  The doctor’s opinion must be supported by treatment notes and not be contradictory to the notes.  This form is more than a statement from your doctor stating that you are disabled.  It is a detailed form that allows your doctor to identify your ability to perform a variety of activities relevant to work.  These could be physical – such as an how much you can lift or whether you can use foot controls, or non-exertional – such as whether you experience pain at a level that interferes with your capacity to maintain attention and concentration and for how long.  A good functional capacity form is specifically tailored to the type of disability you have.

These cases are usually difficult.  In order to give yourself the best chance at winning, you should provide the following:

  • Records of on-going medical treatment – showing that you are seeking a cure
  • At least one functional capacity form completed by treating doctors, it is best if it is a medical specialists – and these forms must show reliability limitations such as a need for excessive breaks during the workday
  • Clear and specific testimony from you about your limitations – no “I can’t stand very long” and “I can’t lift very much.”  Specifics are needed – “I can only sit for 20-30 minutes at a time before I have to change position.”
  • Evidence of unsuccessful work attempts or decreasing ability to work – when a disability claimant tries and fails to return to work, that work attempt enhances the claimant’s credibility; when a person tries to find lower exertional level jobs or their employer provides accommodations but you are still unable to work, your credibility can be improved.
  • Evidence of a long work history – here, too, a person who has worked continuously for many years will have more credibility than someone with a spotty work record
  • Compliance with the treating doctor’s treatment regimen, or attempts at different treatments without success.

As far as letters of support from friends and family, they do not hurt, but are generally not given much weight.  Your friends and family are not disinterested, objective sources so judges often give these statements minimal credit.

While these cases can be won, evidentiary requirements are strict and the cases are difficult.  If your disability is one that is not objectively defined, it never hurts to talk to an experienced Social Security attorney who can give you intelligent answers that steer you in the right direction and help you properly prepare your case.