Fibromyalgia is one of the more difficult medical conditions to address in the context of applying for Social Security disability insurance. The medical definition of fibromyalgia, according to the U.S. Centers for Disease Control and Prevention, is a “condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress.” While fibromyalgia can manifest itself through these symptoms, there is no simple medical “test” that can diagnose a patient with the condition.

As a result, Social Security administrative law judges (ALJs) tend to discount subjective complaints of pain by disability applicants as insufficient to prove their fibromyalgia prevents them from working. Illinois courts have repeatedly told Social Security, however, that ALJs cannot require such “objective” tests to confirm a fibromyalgia diagnosis.

Appeals Court Rejects Widower's Appeal of Social Security Decision

At the same time, an ALJ may consider additional objective evidence when evaluating the “severity” of fibromyalgia under the Social Security Administration's disability listings. A recent decision from the U.S. Seventh Circuit Court of Appeals here in Chicago, Gebauer v. Saul, illustrates this principle in greater detail. This sad case actually involved the widower of a woman (the decedent) who died suddenly while her application for disability benefits was still pending.

There is a tendency among Social Security officials to take claims involving psychological impairments less seriously than those involving physical impairments. Legally, this should not matter. If a person is unable to work due to a documented mental disorder, they are just as entitled to disability benefits as someone with a physical impairment. Unfortunately, that is not always the reality.

Illinois Magistrate Orders a New Hearing, Criticizes ALJ for “Playing Doctor”

Take this recent decision from an Illinois federal magistrate judge, Anthony S. v. Saul. In this case, a 55-year-old man (the plaintiff) applied for disability benefits, citing a number of psychological impairments, including post-traumatic stress disorder and bipolar disorder. After a hearing, a Social Security administrative law judge (ALJ) determined these impairments did not prevent the plaintiff from performing some types of “light work” and denied his disability claim.

The magistrate, who reviewed the case after the plaintiff sued the Social Security Administration, noted the ALJ failed to “explicitly” state a “single theory” to explain the decision to deny benefits. Based on the content of the ALJ's decision, however, the magistrate interpreted rationale as that the plaintiff was “malingering,” i.e., the “intentional production of false or grossly exaggerated [] psychological symptoms.”

Even if you have a physical or mental impairment that qualifies you for Social Security disability, the government will cease paying those benefits if you reach “medical improvement.” In other words, if a doctor determines your impairments no longer prevent you from working, Social Security will find you no longer qualify as legally disabled. In some cases, Social Security may even determine you have already reached medical improvement by the time it considers your disability benefits application.

Federal Court Finds Social Security Officials Improper “Playing Doctor” Once Again

But as with all such determinations, Social Security must rely on the actual medical evidence presented. Agency officials are not supposed to engage in conjecture or render their own non-expert medical findings. Yet we continue to see cases where Social Security administrative law judges improperly “play doctor,” particularly in situations where a disability applicant has a difficult-to-diagnose impairment.

Consider this recent case, Brown v. Saul. The plaintiff in this case suffers from hand tremors. In part due to this impairment, the plaintiff applied for disability benefits in 2014. Following a hearing in 2016, an ALJ determined the plaintiff was disabled–but only for the period between March 2014 and July 2015. After July 2015, the ALJ found the plaintiff achieved medical improvement because he “did not suffer from tremors after that point.”