Over the course of more than twenty-six (26) years of assisting those applying for Social Security disability throughout Maine, Massachusetts and New Hampshire, we have come across a number of recurring problems for those who contact our office claiming disability benefits for the condition “Fibromyalgia.” With that in mind, here is the most common themes that seem to arrive and how they might be resolved.
First and foremost, it’s important to recognize that the Social Security regulations require one to prove that they are suffering from a severe medical impairment that despite prescribed treatment remains severe and disabling such that the claimant remains incapable of performing any manner of gainful employment. We have addressed these complex classification and diagnostic criteria for Fibromyalgia set forth by the American College of Rheumatology and Social Security Ruling 2012-2P on a separate page of our website as it remains too extensive to detail here. What becomes clear from a review of the criteria, however, is that a very targeted examination and history need to be undertaken, with additional testing to exclude potential other causes for one’s symptoms. Too many times, individuals hear their primary care physician conclude that they have Fibromyalgia without undertaking the various blood tests or trigger point examination that are deemed necessary for an appropriate diagnosis of the condition. This can result in a determination that the individual does not have a “severe medical impairment,” such that the Social Security Administration (SSA) does not feel it necessary to undertake an analysis as to how the condition impacts one’s ability to work.
Another, very common mistake made by claimants is that they believe a one time evaluation earlier on by a rheumatologist, establishing at the time that they did have Fibromyalgia would serve as the basis years later to esablish that the condition is the generator of the fatigue or pain symptoms that they suffer from latter in life. Unless other possible conditions can be excluded as potential sources of one’s continued current symptomatology, such assumption based on one’s symptoms alone can cannot be made by either the claimant. It is wise to reestablish with a rheumatologist to confirm whether the current constellation of symptoms remains related to Fibromyalgia.
Moreover, once the severe medical impairment of Fibromyalgia has been established, it is then important to show that the individual claimant is doing everything possible to address the types of treatment available to treat the condition. Many primary care physicians, as a matter of course, will make the referral not only to confirm their suspicion that Fibromyalgia is the correct diagnosis, but also to confirm that the treatment being provided is optimal. Many primary care physicians will improperly prescribe narcotics, failing to realize that perhaps anti-depressant medications (such as tricyclics) can help address chemical imbalances in the brain and, thereby, assist with some of the associated symptoms that can include anxiety, depression, sleep difficulties along with the pain associated with the condition. Amitriptyline and Nortriptyline are common antidepressant medications that are seen prescribed to assist with the condition. Likewise, seen as a first line of defense in the event of a diagnosis of Fibromyalgia, is an anticonvulstant drug that has been used as to treat neuropathic pain, called Gabapentin (name brand, Neurontin). Many primary care physicians remain unaware of how to titrate up and down this medication in a manner best suited to treated the condition, and, many times, we see that a referral to a rheumatologist will result in either initiation of the drug for the first time or a titration of the drug to a much higher dosage. Finally, assuming the other medications are not proving helpful, medical professionals who are expert in the treatment of Fibromyalgia will then move on to other anticonvulsant options such as Cymbalta or, if not effective, one of the newer drugs, Savella.
Because Fibromyalgia remains primarily a diagnosis through history taking, exclusion through testing and examination (versus objective lab or diagnostic testing that affirmatively proves the objective basis for believing the condition exists), having a rheumatologist involved early on in one’s care can be quite helpful to ensure 1) you have been properly diagnosed and 2) you are receiving the zealous treatment for your condition that might make you better (and might resolve the need for you to apply in the first place). Treatment should be exhausted prior to applying for disability as the Social Security regulations require you to show that have remained or you are likely to remain totally disabled from all forms of gainful employment for what has been (or is expected to be) a year or longer as a result of a severe medically determinable impairment despite prescribed treatment. Thus, one should be showing SSA that an application is being undertaken as a last resort rather than a first resort.
If you or someone you care about is suffering from medical problems that are impacting their ability to work, you would be well advised to contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 or on line to see whether appropriate diagnosis and treatment of the conditions have taken place prior to proceeding further with a claim or appeal. We’ll be happy to undertake such an analysis for you or your loved one for no charge, and perhaps assist with moving forward with your claim should that be appropriate.