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Do you have a medical condition that doctors have had a challenging time diagnosing, which keeps you from continuing in your job? When a medical condition disables you from work, you may qualify for disability benefits from the Social Security Disability Insurance program. However, applicants with hard-to-diagnose conditions may face additional challenges in proving the existence and severity of their condition or symptoms to obtain SSDI benefits, including securing competent medical evidence and overcoming skepticism about conditions with subjective symptoms.
Understanding Hard-to-Diagnose Conditions
“Hard-to-diagnose” conditions refer to chronic illnesses or medical conditions that doctors typically cannot diagnose with clear diagnostic exams, radiology scans, laboratory tests, or other objective evidence. Instead, doctors frequently determine that a patient has one of the hard-to-diagnose medical conditions after ruling out other conditions that could cause the patient’s symptoms. Hard-to-diagnose conditions can also include illnesses that cause the same types of symptoms as other, more common conditions. Alternatively, hard-to-diagnose conditions may cause subjective symptoms whose severity doctors cannot determine except with the patient’s description.
Common examples of hard-to-diagnose conditions include:
- Chronic fatigue syndrome
- Migraine disorders
- Fibromyalgia
- Autoimmune diseases like multiple sclerosis or lupus
- Mental health disorders such as depression, anxiety, or post-traumatic stress disorder
Unfortunately, people who apply for SSDI benefits based on a hard-to-diagnose condition can face difficulties in getting approved for benefits due to the subjective nature of their symptoms, inconsistent symptoms or medical findings, or lack of objective medical data proving the existence of a condition.
The Challenge of Proving Disability to the SSA
The Social Security Administration may grant a worker SSDI benefits when they have a medically determinable impairment (a formal condition documented by medical evidence) that meets the SSA’s definition of a disability – a condition severe enough to prevent a person from working that will likely last for at least 12 months or result in death.
The SSA uses a five-step evaluation process to determine whether an applicant has a disability, assessing the applicant’s symptoms through a different metric at each step. When the SSA determines at any step that an applicant has a disability, it will approve their SSDI claim. But claims examiners may face difficulties in assessing the severity of an applicant’s condition based on their subjective complaints or symptoms.
However, because people with hard-to-diagnose conditions may struggle to obtain an official diagnosis from a medical provider or gather medical evidence proving the existence of the condition, those individuals may face additional scrutiny from claims examiners when applying for SSDI benefits. Due to the scrutiny that applicants with hard-to-diagnose conditions may face, maintaining consistent treatment records, including provider notes from medical specialists and detailed documentation of symptoms, can strengthen an SSDI claim.
Types of Evidence That Strengthen a Claim
An applicant for SSDI benefits can strengthen a claim based on a hard-to-diagnose condition by relying on evidence such as:
- Medical Evidence – A medical record supporting an SSDI claim can include treatment or exam notes from primary care providers and medical specialists, hospital visit records, and diagnostic test results. Alternatively, medical evidence can document physicians’ exclusion of other potential diagnoses, making a diagnosis for a hard-to-diagnose condition more likely.
- Symptom Documentation – An applicant may keep a journal to document symptoms on a daily or near-daily basis, including pain level, fatigue, or physical and cognitive limitations. Journals can also describe specific incidents in which symptoms limited an applicant’s ability to work or perform basic tasks. Applicants may also present letters or testimony from family members, friends, and co-workers to describe the applicant’s functional limitations.
- Functional Evidence – Applicants may obtain independent residual functional capacity assessments from vocational experts or assessments from physical and occupational therapists to document an inability to perform basic work tasks. Alternatively, applicants may also present employment records and other evidence documenting their inability to hold down various jobs due to their symptoms or limitations.
Furthermore, ensuring that evidence consistently documents diagnoses, symptoms, and limitations over time can support a finding that a condition meets the severity required for benefits and will last long enough to meet the Social Security Administration’s regulatory definition of a “disability.”
Common Reasons for Denials of SSDI Claims for Hard-to-Diagnose Conditions
Some of the most frequent reasons why the Social Security Administration denies SSDI claims for hard-to-diagnose conditions like fibromyalgia and chronic fatigue syndrome include:
- Inadequate medical documentation
- Lack of specialist treatment, especially when claiming a rare condition
- Inconsistency in diagnoses or descriptions of symptoms or limitations in medical records
- Gaps in medical treatment
- Failure to follow prescribed medication or therapy or to pursue recommended treatment
- Symptoms do not limit the applicant from performing past jobs they held or performing other work that exists in substantial numbers in the national economy
How an SSDI Attorney Can Help
When you apply for SSDI benefits with a hard-to-diagnose condition, an attorney can help you through the application process by:
- Gathering substantial medical and non-medical evidence to document the existence and severity of a condition
- Obtaining supporting statements from treating physicians and medical specialists
- Ensuring clients submit complete application paperwork
- Preparing clients for consultative exams requested by the Social Security Administration
- Pursuing administrative appeals after an initial denial and representing clients in administrative hearings
An SSDI attorney can help a client build a compelling application by showing how the symptoms of the client’s hard-to-diagnose condition cause functional limitations, rather than simply relying on documentation of an official diagnosis. An attorney can also work with medical professionals to ensure that letters or testimony explain symptoms and limitations using the same terminology in the SSA’s regulations.
Contact an SSD Lawyer Today
Even if you have a rare illness or a medical condition like chronic fatigue syndrome or fibromyalgia that doctors usually cannot diagnose with traditional tests or scans, you may still qualify for disability benefits from the Social Security Administration when your condition disables you from working. Contact Grech Law Firm today for a free, no-obligation consultation with a Social Security disability attorney to learn more about how we can help manage the challenges and issues you might face in pursuing SSDI benefits.