Fibromyalgia and Social Security Disability Benefits - Smith v. Commissioner of Social Security

February 14,2012
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Fibromyalgia is a musculoskeletal disorder characterized by chronic widespread pain and a heightened and painful response to pressure. Anyone who suffers from this serious impairment knows that it’s very painful and can make it hard to perform a wide variety of jobs on a daily basis. Social Security Ruling 12-02p makes it clear that people who are unable to work due to fibromyalgia may be eligible for Social Security Disability benefits. The U.S. District Court for the Northern District of New York takes on one such case in Smith v. Commissioner of Social Security.

Mr. Smith filed a Social Security Disability benefits claim in June 2009, alleging disability because of a number of physical and mental impairments, including fibromyalgia, degenerative disc disease in his spine, degenerative joint disease in his knee, carpal tunnel syndrome, obstructive sleep apnea, diabetes and depression.

After an initial denial, the Administrative Law Judge (ALJ), determined that Smith wasn’t disabled. Although the ALJ found that Smith suffered from a handful of severe impairments – the joint and disc diseases, carpal tunnel syndrome and depression – the judge ultimately concluded that he retained the residual functional capacity to perform a full range of sedentary work. The judge acknowledged that Smith could not, however, return to his previous work as a sanitation truck driver because of his impairments. The SSA’s Appeals Council upheld the ALJ’s decision.

Nevertheless, a federal magistrate judge recommended that the ALJ’s decision be remanded after further appeal. The magistrate found that the decision may have been improperly impacted by the judge’s misunderstanding of Smith’s fibromyalgia and its effect on his ability to work.

Smith argued that he wasn’t able to hold a sedentary job because he couldn’t stay seated long enough and because his fibromyalgia and other impairments required him to have the ability to change positions and go from sitting to standing freely. While Smith’s treating physician – Dr. Fang – diagnosed him with fibromyalgia, the ALJ discarded the diagnosis, concluding that it wasn’t made in accordance with the criteria set forth by the American College of Rheumatology (one of two bases for diagnosing the condition that are acceptable under SSR 12-02p). That criteria “requires a history of widespread pain and pain that is present in 11 of 18 tender point sites on digital palpation,” according to the ALJ.

Despite this conclusion, the magistrate noted that Dr. Fang clearly stated in a deposition provided to the Appeals Council after the ALJ’s decision that she had made to diagnosis in consideration of the ACR criteria.

“Thus, the ALJ’s assumption, based on what may have been a misunderstanding of, or vague language in, Dr. Fang’s report, was incorrect,” the magistrate found. “If the diagnosis had been stated properly in Dr. Fang’s reports, the ALJ may have changed his opinion about whether fibromyalgia was a severe impairment, and it may have changed the ALJ’s opinion regarding the effect of this impairment.” As a result, the magistrate recommended that the ALJ’s decision be reversed and that the case be remanded for further proceedings.

As this case shows, the success or failure of a Disability claim can come down to the proper preparation of an application and strong presentation of medical evidence of disability. In cases like this we would ask the treating physician to complete a Functional Capacity Assessment that includes the information that is required under various Social Security Rulings and Regulations. A competent Social Security Disability attorney will do this by listening carefully to a client’s medical problems, educational background and job history in order to present the most compelling possible claim.