Despite a general acceptance in the medical literature that fibromyalgia is a real illness that can be disabling, there are still judges out there who refuse to accept that this chronic pain condition exists. There are no "objective" tests that can be run for fibromyalgia – its existence can be inferred by symptoms such as generalized body pain, tender points, poor sleep, fatigue, digestive issues, balance problems, anxiety and depression.
Social Security judges are often cynical since every person they see claims to be disabled. For this reason, some Social Security judges have decided that fibromyalgia is not a real condition and they will deny fibromyalgia claims based on the absence of objective evidence in the form of diagnostic reports like MRI’s, CT scans and x-rays and the absence of organ damage.
Recently a fibromyalgia claimant in Cleveland, Ohio appealed a denial and won at the federal district court level. You can read this opinion – Rogers v. Commissioner of Social Security, 486 F.3d 234 (6th Cir. 2007). This decision is interesting at several levels. First, look at the amount of time involved in appeals. The claimant first applied for SSI benefits on May 21, 1998. A hearing was held in December, 1999 and she was denied by the ALJ in January, 2000. The claimant appealed to the Appeals Council and won – the case was sent back to the same judge for a second hearing.
The second hearing was held on November 15, 2002. On November 23, 2003 (a full year after the hearing) the ALJ again denied the case on the grounds that there was no objective evidence to support the fibromyalgia claim.
The claimant appealed to Appeals Council again, but was denied. She then appealed to the district court where the ALJ’s decision was affirmed by a federal Magistrate Judge on August 30, 2005. The claimant then appealed to the 6th Circuit Court of Appeals.
The 6th Circuit decision was issued on May 24, 2007 reversing the ALJ and remanding back to the ALJ level for yet another hearing, but with guidance that the claimant’s fibromyalgia complaints ought to be given credence, despite the absence of objective evidence. Presumably Ms. Rogers has or will have a third hearing soon – perhaps after 10 years she will get her SSI.
The Rogers case can serve as a useful blueprint for lawyers and claimants who face judges who are unable or unwilling to recognize the functional limitations caused by fibromyalgia. When reading this decision I was struck by the overwhelming nature of the evidence that supported Ms. Rogers’ claim. She had extensive medical records from treating doctors. She had functional capacity forms completed by treating doctors. The symptoms she described are entirely consistent with fibromyalgia. Yet, she was denied because the judge could not see any problems on an x-ray.
Hopefully, you will not face a 10 year battle in an effort to prove that your fibromyalgia is real. Hopefully an understanding of why some judges deny these cases and a reference to cases like the Rogers case will help you avoid delay and get your benefits at your initial hearing.