April 19, 2014

How to Describe Your Migraine Headaches to a Social Security Judge

How do you describe to a Social Security judge what it is like to experience migraine headaches?   Describing headaches is a difficult task at best, but you can assume it will be more difficult when you add in the stress of testifying in a Social Security courtroom before a judge.

One of the keys to successful testimony is to remember how Social Security looks at “disability” in a migraine case – your inability to perform a simple, entry-level job because of symptoms associated with your migraines, medication side effects and symptoms from any other medical condition you may have.

Another way to think about what you want your testimony to accomplish – how do I show the judge that I would not be a reliable worker?  that I would miss too many days of work and that I would have too many unplanned absences during the days I was there.

Here are some tips about how to prepare your testimony:

  • discuss duration and frequency of your headaches – even though your migraines may not follow a set pattern, for purposes of your disability hearing, decide how you will answer the judge’s questions about the frequency and duration of your headaches.  Do not say “I get bad headaches all the time and they can last all day.”  Instead, say something like this:  “I get severe migraine headaches at least once every 10 days.  When I feel a migraine coming on, I immediately take XYZ medicine and sometimes that will reduce the severity of the headache and it will only last five or six hours.  If I don’t catch it in time, my headache will last at least eight to ten hours.  During cold weather, the frequency of my headaches increases and I have them every 7 days.  If I am under stress, they could happen every 3 or 4 days.  Under the best of circumstances, my migraines will last five or six hours, at worst they can last eight to 24 hours.”
  • discuss severity of your headaches – do not say “when I get a migraine, it feels like a toothache.”  Instead, say something like this:  “when I get a migraine, the pain in my head is at a 9 or 10 on a ten point scale.  The pain is so bad that I cannot tolerate light or noise and I immediately go to bed, pull the shades down and avoid any light nor noise.” [Read more...]

The importance of medical evidence

medical recordsGood medical evidence to back up your claim for disability benefits is a must!

This point cannot be stressed enough.  If you suffer from migraine headaches and are claiming disability based on your migraines, you better believe that the adjudicator or Judge assessing your claim will look thoroughly through your comprehensive medical record for evidence to back up your claim. People are often denied benefits due to a lack of records or a failure of the records to match up with their alleged impairments.

Florida Social Security Disability attorney Elizabeth Stakenborg recently posted an article which highlights the importance of medical records in a migraine case.

The article tells the story of a migraine claimant who is actually approved early – without even having to appear at a hearing – thanks to having a solid medical record to confirm her allegations of pain arising from migraines.

When the Administrative Law Judge reviewed the record and saw that the claimant’s statements regarding her limitations were supported by the evidence (including medical records prior to the date she last worked) the claim was awarded.

If you are pursuing a migraine disability claim, please be sure to not only seek treatment for your condition but also to keep record of all of your medical treatment.  When the time comes to submit records to go along with your claim, you want to be sure to have medical records which confirm your allegations.

Does Your Migraine Case Have What It Takes? (Part 2)

In the last post, I introduced a brief migraine case study (involving 40-year-old Megan) and identified what I believed to be the winning elements of her case.  However, since the time of that post, a new issue has been brought to my attention, and that is the issue of whether to see a specialist if you are suffering from migraines and want to pursue a disability claim.

Do I need to see a specialist or is my general/family physician enough?

Physician on white

As we saw with Megan in the beginning of this article, she only consulted with her general physician.  Although the opinions and/or diagnosis of a family physician is credible and is in no way minimized or to be considered as such, the Social Security Administration often will not approve a disability claim on the finding of a general physician, family physician, chiropractor, or a DO (Doctor of Osteopathic Medicine) alone.

In considering whether to award an individual who suffers from migraine headaches disability benefits, significant weight is given by the SSA to those test results, opinions, and diagnoses of treating headache specialists, neurologists, and/or pain management specialists. So in essence, in order to strengthen your disability claim, it is always advisable to seek the opinion of a physician specializing in your chief complaint.

Does Your Migraine Case Have What It Takes To Win?

What are the elements of a winning migraine disability case? Sure, every disability case is a little different, but I believe there are some features which may separate good cases from not-so-good cases.  Let’s look at the following migraine case example and then assess what elements of this case are wining elements:

Migraine Case Example

Megan was a forty-year-old marketing executive who had worked with a prestigious company since high school.  Having worked during the day and attended night classes at a local university, Megan had earned a Masters degree in Business Administration.  Within the last twelve months, Megan had begun experiencing chronic headaches that were often accompanied by blurred vision and vomiting.  Having seen her general physician, he diagnosed Megan with migraine headaches.  She was prescribed the drugs Midrin and Compazin.  Feeling confident with the decision of her general physician of ten years, Megan did not pursue additional testing or seek a second opinion.

Following a migraine attack, Megan would often be physically unable to continue working and would require bed rest.  Although the majority of Megan’s migraines normally lasted a few hours, she commonly experienced one or two migraines per month that would last for several days.  Despite being prescribed medications by her general physician, Megan continued to experience migraine headaches at a minimum of four-to-six times per month.  Having missed an average of 10 days per month over the last twelve months, Megan resigned from her executive position and applied for Social Security Disability benefits.

Assessment

Megan’s case looks like a potentially strong one.  What elements make her case strong, you may ask?

A Diagnosis – Having a diagnosis is key to winning a disability claim.  In this case, Megan has been diagnosed with Migraine Headaches and has been prescribed associated meds.

Compliance with treatment – Judges always like to see that claimants have been compliant with treatment.  They are more willing to award benefits if they see that the claimant has made a good faith effort to get better. It appears from the information given that Megan has been compliant with the treatment for her migraine headaches.  Despite taking the appropriate medications, however, Megan’s severe Migraine Headaches continue to ail her.

Severity and frequency of headaches prevent work activity – In order to be approved for disability benefits, you must be able to prove that your condition prevents you from being able to work.  In a migraine case, therefore, you must show that your Migraines are frequent and severe enough so as to make employment impossible.  In Megan’s migraine case, her debilitating migraine symptoms occur so frequently that she misses 10 days of work on average. Missing this much work in itself precludes employment.

Condition Lasting in Excess of 12 Months – You may have noticed that the last sentence of the case example states that Megan’s symptoms have occurred over a period of 12 months.  This point is also key, since in order to be awarded disability benefits, your symptoms must have lasted or be expected to last for at least 12 months (or result in death).

(end of part 1 – part 2 will be published later this week)

Some functional limitations specific to Migraine cases

In migraine headache cases, the functional capacity limitations that I usually see involve job attendance and daily reliability. Migraine patients frequently experience headaches randomly, with no specific cause identified.  When a migraine hits, the claimant needs to lie down in a dark room and avoid all stimuli including noise or light.  If the claimant happens to be at work, he/she has to leave or be driven home.  Unscheduled absences from work are also common.  From what my clients tell me, severe migraine headaches cause pain at such a level that no activities of any type would be possible.

The main questions to be answered, therefore, have to do with:

  • the frequency of the migraines
  • the severity of the migraines
  • how long do the migraines last when they occur?

If your doctor will document activity limitations – preferably in a functional capacity checklist – you have a good chance at winning.  For example, you will want your treating doctor to state that you will need unscheduled breaks from work, that you will miss several days of work each month because you can’t come in, and that you need low stress activities.

The Functional Capacity Argument in Migraine Cases

As I mentioned on the main case strategies page of this site, there is no Social Security listing for migraine headaches.  In the absence of a listing, how does one go about proving disability?  One alternative is to argue that your capacity to perform work has been so reduced by your condition that you would not be a reliable employee in any job situation.

This type of argument is known in technical terms as the functional capacity argument (aka the residual functional capacity, or RFC, argument).  An argument like this says to the Judge that you can no longer work because of:

  • Your medical problems
  • additional medical problems that diminish your reliability
  • specific functional limitations (your limited ability to sit, stand, or walk, for example)
  • pain and other “non-exertional” limitations
  • medication side effects such as fatigue, drowsiness, nausea, poor concentration, etc.
  • depression/anxiety resulting from your physical condition and inability to work

Keep in mind, Social Security’s definition of disability looks to your capacity for work rather than just your medical problem.  So be sure to highlight all of the limitations brought on by your illness, not just your illness itself.

Also, since Social Security is concerned with whether you could perform any work, you have to demonstrate to the Judge that you would not be a reliable worker at even the easiest, sit-down, low stress job that exists in the national economy.  In many Social Security disability hearings, Judges even call upon vocational expert witnesses to testify as to the kind of work they think you may be capable of given your past work history and current limitations.

So the best way to prove disability is to really show the limitations brought on by your conditions.  The more limitations, the better; with every limitation that the Judge accepts, one category of work is potentially eliminated.  For example, if we show that you have medication side effects that cause occasional drowsiness, we would eliminate all jobs that require driving, or those that require the use or ropes, ladders and scaffolds. If the judge accepts that you cannot lift more than 5 pounds, then we eliminate all jobs that have greater lifting requirements.