This article discusses a real Social Security disability claim for conversion disorder that was denied and appealed to federal court. I'll explain the history of the case and the 2016 decision from the Eighth Circuit Court of Appeals.
Kimberly Nowling, the disability claimant, suffered from "conversion disorder," a type of disorder in which an individual experiences neurological symptoms without an apparent medical cause. (Conversion disorder is one type of somatoform disorder, a term used when physical symptoms manifest without any clinical basis. When the symptoms include neurological problems, it is called conversion disorder.)
For the claimant, the disorder manifested itself in the form of non-epileptic “pseudo-seizures,” which were thought to be stress-related. The claimant's seizure-like episodes, which varied in frequency from two to three times per month to the same number per week, started prior to 2007. In 2008, the episodes became so severe that she resigned from her job as a nurse’s aide.
The claimant's treating neurologists failed to locate any clinical cause of her seizures, and diagnosed her with conversion disorder. The claimant also suffered from migraine headaches, which often preceded her seizures, as well as mood disorder, personality disorder, and obesity.
After the claimant's disability claim was denied at the hearing level and in district court, she appealed.
The judge began by discussing why evaluating disability claims based on conversion disorder can be difficult:
The judge emphasized that when Social Security's administrative law judges (ALJs) are assessing the credibility of a claimant with conversion disorder, they should set out what they believe to be the true nature and severity of the claimant's symptoms and limitations. Observations from friends and family and medical opinions from treating providers may be especially valuable in making this determination, the judge wrote.
The judge ruled that, in this case, the ALJ’s failure to give sufficient weight to the opinions of the claimant's treating doctors—instead relying on the opinion of a psychologist who had examined the claimant once during a consultative exam—was erroneous. (Social Security regulations state that the treating physician is generally in the best position to assess the claimant's functional limitations.)
Moreover, in light of the importance of the testimony of friends and relatives in conversion disorder cases, the judge found that the ALJ’s failure to even discuss the testimony of the claimant’s sister-in-law was in error.
The judge sent the case back to the Social Security Administration for further proceedings.
Disability claims based on conversion disorder (and other conditions without apparent physiological causes) are some of the most difficult to win. Social Security ALJs tend to be highly skeptical of these sorts of cases, ignoring the fact that a lack of clinical evidence is entirely consistent with a somatoform disorder.
The Nowling decision serves as a reminder to ALJs that subjective reports of symptoms should not be discounted simply because they are not supported by clinical evidence. Where clinical evidence is scarce, as it often is in cases involving somatoform disorders, the testimony of friends, family, and especially long-time treating providers should be given careful consideration. This decision should also be encouraging to those with conditions such as fibromyalgia and chronic fatigue syndrome, whose subjective reports of symptoms are not always fully supported by objective medical testing.
Read the full text of the case, Nowling v. Colvin, 813 F.3d 1110 (8th Cir. 2016).
Update: Social Security updated its regulations in 2017 (after this case was decided) regarding how Social Security should decide the amount of weight to give to doctor's decisions and other evidence. Social Security no longer automatically gives more weight to a treating doctor's opinion. Instead, a claims examiner or ALJ will evaluate a doctor's opinion to see if it is supported by medical evidence and consistent with information from other doctors and nonmedical sources.