For a Social Security Disability advocate or decision maker, somatic symptom disorders can be particularly challenging. These are considered under Social Security’s Listing 12.07 and involve symptoms which are not “faked” or fabricated by a patient but are not fully explained by a medical condition. For example, someone may complain of widespread pain, but x-rays do not show any arthritis, blood work does not show any inflammatory process, and doctors have otherwise ruled out any other organic explanation for the pain. In these situations, the pain may be associated with psychological distress. Social Security’s definition of somatic symptom disorders acknowledges that other symptoms can arise like this, as well, such as: “abnormalities of sensation, gastrointestinal symptoms, fatigue, a high level of anxiety about personal health status, abnormal motor movement, pseudoseizures, and pseudoneurological symptoms, such as blindness or deafness.”
I’ve never actually seen a case where blindness or deafness were associated with a somatic symptom disorder, but otherwise the issues Social Security identifies here are very common. If someone has chronic widespread pain and other symptoms which have been evaluated by doctors and the doctors have ruled out organic causes of the symptoms, this person can be diagnosed with fibromyalgia, which we see very frequently. Chronic fatigue syndrome may be diagnosed in a similar way. Those suffering with these disorders are likely to experience co-morbid headaches, GI problems (abdominal pain, constipation, diarrhea) and are also very likely to carry some kind of anxiety or depression diagnosis. Sometimes someone will be diagnosed with a “functional neurological disorder” when they experience the “abnormal motor movement” described by Social Security and doctors cannot determine a specific organic etiology. Pseudoseizures are common and often difficult to distinguish from true epileptic episodes. Pseudoseizures do not happen when someone “fakes” a seizure; instead, they occur when someone has an episode that mimics an epileptic seizure but without the brain’s abnormal electrical discharge that occurs with an epileptic seizure. A pseudoseizure may occur when someone is under extreme stress.
Somatic symptom disorders can be challenging for the advocate / attorney. Before taking a case to a decision maker, the advocate will meet with the client to discuss the case. Sometimes, clients have gained insight into how their symptoms are associated with a somatic symptom disorder by communicating with their medical providers, then listening to and understanding what they have to say. Most of the time, however, someone with a somatic symptom disorder will not understand what is happening or will reject the idea that their health problems are “in their head.” In these situations, an advocate must tread very lightly to maintain a good client relationship while at the same time providing the client with a fair analysis of their case. This does not need to involve being harsh or disingenuous at all. The symptoms are very much “real,” and if they prevent a client from working on a full-time basis, the client should be approved for benefits. As long as the advocate keeps this in mind, the client should understand that the advocate is acting in their best interest and this should foster a strong attorney-client relationship.
Then the attorney has the challenge of presenting the case to the judge. It’s possible that the attorney is faced with an inexperienced judge who has not yet grown to understand the importance of the mind-body relationship and the prevalence of somatic symptoms. Someone unsophisticated is likely to believe that when a disability claimant is complaining of symptoms which are not corroborated by medical tests or clinical examination, they are “malingering” or seeking “secondary gain” – fancy terms for faking it. I have been doing disability cases for many years and I can’t emphasize enough how extremely rare it is for someone to be making up symptoms and in fact I don’t think I have ever had a case when I felt someone was doing so or pursuing a disability benefit that they didn’t honestly believe they deserved. Nonetheless, no one wants to be “tricked” or “duped,” especially a new administrative law judge, and they therefore they are going to have their guard up and be highly suspicious of anyone complaining of symptoms which do not correspond with medical testing.
But let’s say we have an experienced judge who understands how real and incapacitating these symptoms can be. Even then, judges must follow the rules. They can’t make decisions willy-nilly. And the rules say that someone’s disability must be the result of a medically determinable impairment and that a judge must consider medical records when evaluating a claimant’s complaints. Sometimes the medical records can be lacking. Just like the conversation between a lawyer and a client about a somatic symptom disorder can be difficult, the same conversation between a doctor and a patient can also be very difficult. Patients want the doctor to find what is wrong with them and fix it with a procedure or medication. They get angry when doctors suggest that their symptoms may be a somatic symptom disorder, which is also known as a conversion disorder, whereby emotional distress is “converted” into physical manifestations. So doctors may tend to avoid these conversations or formally diagnosing a somatic symptom disorder, leaving an advocate without medical documentation on which to base arguments regarding a somatic symptom disorder.
In these situations, it can be helpful to seek the opinion of a medical professional who treats the patient or reviews the patient’s records and provides testimony in Social Security cases. While some doctors may prefer to avoid conversations about somatic symptoms disorders, others may be more communicative and supportive and may provide a written statement about how the patient’s somatic symptom disorder is disabling. Or, an attorney can ask a Social Security judge to consider the testimony or written report of a medical expert who can review records and provide guidance about how a disability claimant is limited by a somatic symptom disorder. This can solve both of the problems identified above. It can help the inexperienced judge understand what is going on. It can also provide the more experienced judge with the supportive evidence the judge needs to approve the claim.
Somatic symptoms disorders may vary from mild to extreme, but are much more common than you might expect. A patient experiencing this issue would likely benefit from a holistic approach to treatment involving mental health counseling and lifestyle modifications. If such a person is still unable to work, they can seek disability, and the attorneys at Keller & Keller can help.
