Flawed Denial Of Disability Benefits For Fibromyalgia

By Author: Steven Johnson
Total Articles: 494
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The law is often considered difficult to understand — a myth put about by attorneys who want to keep the profitable business for themselves. Yet, when the judges are in full stream, even the simplest of legal principles can come out sounding complicated. That makes this another of those conspiracies we love to moan about as the system stacks the deck against all the players. To illustrate the point, let's take a quick look at an appeal case heard this February. It's really a very simple point, but you might not think so after staggering through the judgment. At issue is whether an Administrative Law Judge properly denied disability benefits to a woman suffering from fibromyalgia, restless leg syndrome and other disorders. The evidence seemed to show a natural progression of the disorder starting in 1986 with minor paralysis of her fingers and muscle weakness. She reported flu-like symptoms and increasing pain everywhere. This steadily worsened over the years and made it impossible for her to continue working after 2002. Needless to say, she has seen many doctors, with one regular general practitioner from 2000 who has ...
... referred the patient to a rheumatologist and neurologist for treatment. Yet, the Judge denied her disability benefits.

Underlying this refusal is an obvious skepticism that fibromyalgia is a real disorder that prevents people from doing some paid work. The judge accepted there was some evidence of fibromyalgia, restless leg syndrome, lumbar scoliosis and degenerative disc disease, but found the evidence that the claimant was suffering intense pain and limitations on movement not entirely credible. The judge was of the view that the pain suffered by those with fibromyalgia is subjective, i.e. there is no evidence of it. Since there were no intellectual difficulties and some mobility, the claimant was therefore able to earn a living wage.

The appeal was dismissed and it took a reference to the Eleventh Circuit Court of Appeals to overturn this Judge's dismissal of the contemporary medical evidence from three doctors. Ignoring all the detail of the Court of Appeals' ruling, it comes down to a simple rule. It's always open to a judge to ignore medical evidence, but there has to be a good reason for doing so and that reason must be carefully explained in the judgment. In this case, the patient had been through substantial diagnostic testing and, among other drugs, she had been prescribed flexeril and physical therapy to treat both the weakness in her hips and knees caused by the fibromyalgia and the restless leg syndrome. A specialist rheumatologist is not going to prescribe a drug like flexeril if he is not satisfied there is a patient with a real need. More importantly, if that specialist and two other doctors of experience write reports to a court considering an application for disability benefits, their evidence cannot simply be ignored. No matter what the judge's private views may be, a proper legally acceptable reason for discrediting the medical evidence must be identified. This decision is good news for the many who suffer from fibromyalgia. The Administrative Law Judges have been generally reluctant to support applications for disability benefits. Unlike a broken bone, fibromyalgia is not easily diagnosed. To some extent, it must always depend on the patient to describe how he or she feels. Despite this lack of an obvious cause for the pain and fatigue, the Court of Appeals has now affirmed the need for judges to show some deference to the medical profession. If eminent specialists confirm the existence of disability, the Judge is now more likely to agree and allow benefits.