Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca10-93-06040/USCOURTS-ca10-93-06040-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 

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PUBLISH 

}ril..~U UNITED STATES COURT OF APPEALSUnited Statal Court ot Appeal& Tenth Ciruuit 

FOR THE TENTH CIRCUIT 

LINDA L. SISCO, ) 

) 

Plaintiff-Appellant, ) 

) 

v. ) 

) 

UNITED STATES DEPARTMENT OF HEALTH ) 

AND HUMAN SERVICES, Louis W. ) 

Sullivan, M.D., Secretary, ) 

) 

Defendant-Appellee. ) 

NOV 3 0 199~ 

ROBEE'! L. HOECKER 

C!e!'k 

No. 93-6040 

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE WESTERN DISTRICT OF OKLAHOMA 

(D.C. CIV-91-1675-C) 

Submitted on the briefs. 

Jim Merz, Oklahoma City, Oklahoma, for Plaintiff-Appellant. 

Joe L. Heaton, United States Attorney for the Western District of 

Oklahoma; M. Kent Anderson, Assistant United States Attorney, 

Western District of Oklahoma; Donald A. Gonya, Chief Counsel for 

Social Security; Randolph W. Gaines, Deputy Chief Counsel for 

Social Security; A. George Lowe, Deputy Chief Counsel for Disability Litigation; and Charlotte M. Connery-Aujla, Attorney, 

Office of General Counsel, Social Security Division, Department of 

Health and Human Services, Baltimore, Maryland, for DefendantAppellee. 

Before McKAY, Chief Judge, SETH and BARRETT, Circuit Judges. 

McKAY, Chief Judge. 

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The parties have agreed that this case may be submitted for 

decision on the briefs. See Fed. R. App. P. 34(f); lOth Cir. R. 

34.1.2. The case is therefore ordered submitted without oral 

argument. 

I. 

This is an appeal from a federal district court's ruling 

affirming an Administrative Law Judge's (ALJ) denial of Social 

Security benefits. Plaintiff is a 45-year-old mother whose health 

began to deteriorate in 1983 when she acquired a lymph gland 

infection. The infection lasted for several months. Although she 

suffered from symptoms suggestive of mononucleosis, her doctors 

were unable to diagnose the source of the infection. Despite her 

illness, she was able to finish her master's degree in educational 

counseling and psychology and in October of 1983 began work as a 

psychological assistant for the Oklahoma Department of Corrections. In the early months of her new job Plaintiff began experiencing extreme fatigue and severe headaches to the point where she 

was unable to perform her work satisfactorily. These symptoms led 

to the termination of her employment in January of 1984. 

Plaintiff then worked in temporary jobs as a data entry 

operator until she enrolled at Oral Roberts University in January 

of 1985 for a master's degree in divinity. Soon after attempting 

to return to school, however, Plaintiff was forced to drop out 

because her physical condition had continued to deteriorate. She 

was suffering from severe muscle pains over her entire body, 

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excessive fatigue, headaches, and stomach nausea. She has been 

unable to return to full-time employment since she left Oral 

Roberts in February of 1985. 

During the period when her condition was worsening, Plaintiff 

sought medical help for her ailments. Between April of 1985 and 

May of 1989, she was examined by more than fifteen doctors of various specialties. None were able to diagnose a physical problem 

or disease that could adequately explain the severity of her symptoms. After being unable to find a physical cause, a few doctors, 

including one Social Security consultant, suggested personality 

disorders or hypochondriasis as the root of Plaintiff's problems. 

In October of 1989, Plaintiff was evaluated by a team of doctors at the Mayo Clinic in Rochester, Minnesota. After performing 

a series of tests and reviewing Plaintiff's medical history, the 

reporting doctor at Mayo diagnosed tension myalgia and chronic 

fatigue syndrome. (Appellant's App. at 141.) Chronic fatigue 

syndrome is a disease that did not become widely known in the medical community until 1988 when the first diagnostic article concerning it was published. It was also in 1988 that the Centers 

for Disease Control in Atlanta accepted chronic fatigue syndrome 

as a disease. See Reed v. Secreta~ of Health and Human Services, 

804 F. Supp. 914 (E.D. Mich. 1992). It is believed to be caused 

by an as yet unidentifiable virus, (Appellant's App. at 150.), or 

a "chronic [i]mmunologically mediated inflammatory process of the 

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central nervous system." Lawrence M. Tierney, Jr., M.D., et. al., 

Current Medical Diagnosis and Treatment 19 (1993). 

In July of 1990, Dr. Becker, Plaintiff's treating physician, 

reviewed plaintiff's medical history and the report from the Mayo 

Clinic. In response to interrogatories posed by Plaintiff's 

attorney, Dr. Becker stated that the Plaintiff met both the major 

and minor criteria for the disease as established by the National 

Centers for Disease Control. He also stated that the chronic 

fatigue syndrome rendered Plaintiff totally disabled, unable to 

sustain activity--or even sit upright in a chair--for more than 

fifteen to twenty minutes without having to lie down to resolve 

fatigue. 

Plaintiff filed her initial application for Title II disability benefits on September 5, 1986. After denial on initial 

and reconsideration determinations, Plaintiff requested a hearing 

before an Administrative Law Judge (ALJ), which was held on 

August 7, 1987. The ALJ denied Plaintiff's claim for disability 

insurance benefits on April 22, 1988, and that decision was 

affirmed by the Appeals Council on October 13, 1988. Plaintiff 

filed a second application for disability insurance benefits and 

supplemental security income on March 18, 1989. After again being 

denied benefits at both the initial and reconsideration stages, 

Plaintiff was granted a second hearing on March 14, 1990. On 

August 7, 1990, the ALJ once again denied disability insurance 

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benefits to the Plaintiff, a decision ultimately affirmed by the 

Appeals Council and the federal district court. 

Plaintiff requests that we review the ALJ's decision of 

August 7, 1990, stemming from the hearing held on March 14, 1990. 

In addressing Plaintiff's claim, the ALJ employed the five-step 

sequential evaluation process set forth in 20 C.F.R. §404.1520 

(b)- (f). At the first step, the ALJ found that Plaintiff was not 

working or engaging in substantial gainful activity. At step two, 

he found that Plaintiff suffered from a severe impairment. At the 

third step, the ALJ found that Plaintiff's impairment did not meet 

or equal a listed impairment. The ALJ then decided the case 

against Plaintiff at the fourth step. The fourth step requires 

the ALJ to determine whether the severe impairment prohibits the 

claimant from performing her past relevant work. He found that it 

did not, stating that, "the evidence, here, supports a conclusion 

that the claimant is able to return to her past relevant work as a 

general office clerk, which was light work. She would also be 

able to work as a data entry clerk, which was sedentary and semiskilled work." (Appellant's Supp. App. at 13.) Plaintiff contends that the ALJ's decision on the fourth step was not supported 

by substantial evidence. 

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II. 

The role of this court under 42 U.S.C. § 405(g) is to determine whether there is substantial evidence in the record to support the decision of the Secretary, and not to reweigh the evidence or try the issues de novo. See Brown v. Bowen, 801 F.2d 

361, 362 (lOth Cir. 1986). If supported by substantial evidence, 

the Secretary's findings are conclusive and must be affirmed. 

Richardson v. Perales, 402 U.S. 389, 390 (1971). Substantial evidence is more than a scintilla, less than a preponderance, and is 

such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion. Id. at 401. 

In holding that Plaintiff was capable of working as an office 

clerk or data entry operator, the ALJ claimed to rely on 

Plaintiff's testimony as to her lifestyle and physical capabilities. He recapitulated Plaintiff's testimony in his opinion, 

writing, "In the morning, she would get up, get dressed, take a 

shower, wash her hair, have breakfast, [and] do a few household 

chores " (Appellant's Supp. App. at 9-10.) However, the 

record reveals that, when questioned at the hearing about her 

routine in the morning, Plaintiff's actual response was: 

[U]sually I lay there [until] I have enough energy to 

get out of bed and then I always, I always try to at 

least get up and get dressed and try to take a shower 

and sometimes it may take me [thirty minutes] to an hour 

but I, I always try to do that because then I always 

feel better about my day and then I go back and lay down 

for 30 minutes to an hour. If I wash my hair it's more 

like an hour [that I have to lie down] but if I don't 

wash my hair I can get by with about 30 minutes or so 

and then I try to get cereal or something for breakfast 

and if I'm having a bad day I might have to go right 

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back to bed and if I'm having a good day, three or four 

times a month, then I can try to do maybe a household 

chore. 

(Appellant's App. at 246) (emphasis added). Plaintiff testified 

that she takes showers instead of baths because when she,has tried 

to take baths in the past she has been unable to climb out of the 

bathtub. (Id.) 

The ALJ represented that Plaintiff routinely cleans the 

house, washes the dishes, and dusts her furniture without hindrance from her disability. (Appellant's Supp. App. at 9-10.) As 

to her ability to dust the furniture and clean the dishes, Plaintiff actually stated: 

Well I get the dishes done about every -- I, like I never 

get them all done at once except maybe every other week 

so usually I just do what has to be done to keep from 

really being dirty and I dust about every month or month 

and a half but I [split] the dusting over three days so I 

try to do what I can one day and the next three or four 

days if I feel good I dust another part of the house and 

[then] maybe the dining room and then maybe my bedroom 

later. 

(Appellant's App. at 246-247.) 

Without further elaboration, the ALJ noted that Plaintiff 

entertains herself during the day by watching television and reading. (Appellant's Supp. App. at 10.) Plaintiff's actual testimony was that she usually ends up watching TV on a little set in 

her bedroom "because I just cannot somet~mes even sit up to watch 

TV in the living room." (Appellant's App. at 247.) As to reading 

books, Plaintiff testified: 

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I can't sit here and read but maybe a few minutes. I 

have to lay down to read . . . and rest the book on my 

chest or, or read a real light book like a paperback 

that I won't have to hold, that's not very heavy and I 

can read maybe, sometimes I can read 30 minutes and 

sometimes I read 2 or 3 pages then I'll sleep 10 or 15 

minutes then I'll read 2 or 3 more pages and, if that's 

what I have to do that's what I do sometimes to, to 

read. 

(Id. at 247-248.) 

The ALJ was persuaded that Plaintiff can work as an office 

clerk because "the only medication she takes for pain appears to 

be aspirin occasionally." (Appellant's Supp. App. at 13.) 

Although the record appears to make no mention of aspirin, 

Plaintiff's testimony and exhibits indicate that over the past ten 

years doctors have prescribed a plethora of medications and remedies in an effort to ease her discomfort, including Naprosyn, 

Clonidine, Carafate, Elavil, Entex, and physical therapy. Moreover, in 1986, a TENS unit was connected to her cervical and midthoracic area in an attempt to provide some relief for her severe 

pain. (Appellant's App. at 95.) 

The ALJ was also impressed by the fact that Plaintiff can 

walk the length of a street block. (Appellant's Supp. App. at 

10.) In her testimony, Plaintiff did indicate that she could walk 

a block. She went on to say that if she did, "I couldn't get 

back, you'd have to go get the wheelchair and come and get me." 

(Appellant's Supp. App. at 89.) She further testified,. "I can't 

walk, my body starts shutting down and I'll just, I'll just sit 

down on the floor right where I'm at. It's very embarrassing." 

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(Id. at 88-89.) The ALJ noted that Plaintiff visits with friends, 

shops, and occasionally goes to church. Plaintiff testified to 

being able to do these activities very infrequently and only if 

she's feeling well. When she attempts to complete one of these 

tasks, she must have the assistance of a driver and someone to 

push her wheelchair. (Id. at 87-88.) 

Plaintiff's testimony in these respects was completely unrebutted at the hearing. Her testimony was corroborated by the 

opinions of her treating physician and the Mayo Clinic, both of 

which indicated that her severe symptoms and lifestyle are consistent with their diagnoses of chronic fatigue syndrome. The ALJ's 

decision was not compelled by credibility determinations, and in 

fact, he complimented Plaintiff's general demeanor at the hearing. 

(Id. at 9.) The ALJ built his factual basis by taking Plaintiff's 

testimony out of context and selectively acknowledging parts of 

her statements while leaving important segments out. He offered 

no justification whatsoever for distorting her testimony, but presented his findings as an accurate reflection of Plaintiff's 

statements. We do not suggest that the ALJ acted in bad faith or 

is incompetent at synthesizing a factual basis from a record. 

Rather, his written opinion and oral statements at the hearing 

reveal that he was operating under several fundamental misconceptions that have haunted this case from the beginning. 

The most glaring misconception is the ALJ's belief that the 

language in§ 223(d) (S) (A} of the Social Security Act (SSA) 

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requiring proof of a disability by "medically acceptable clinical 

or laboratory diagnostic techniques" means that a disability is 

covered by the Act only if it can be conclusively diagnosed by a 

"laboratory-type" test. While going through the motions of applying the five-step test and evaluating Plaintiff's testimony, the 

ALJ returned time and time again to his erroneous belief that 

Plaintiff had not presented the type of medical evidence necessary 

to receive benefits. The ALJ revealed his philosophy at an early 

hearing, stating: 

It's easy enough to run tests. There are many 

things that you can run a test on, as you know. 

And you know that the person has a [disease] or 

they do not have a [disease] simply because it's 

just like you put the dip stick in the gas tank. 

You know, when you pull it out if it's wet there 

you know you have gas in there. If it isn't wet, 

why you don't have any gas. Well, the same thing 

is true with some of these things. 

(Appellant's Supp. App. at 65-66.) 

Several times in his opinion the ALJ cited the symptoms from 

which the Plaintiff suffers and then discounted those symptoms by 

reiterating that "[t]he claimant's subjective complaints are not 

realistically supported by the medical evidence." (Appellant's 

Supp. App. at 2.) When discussing his finding that Plaintiff is 

capable of returning to work full-time as an office clerk or data 

entry operator, for example, the ALJ cited the "medically acceptable clinical or laboratory diagnostic techniques" language in the 

SSA and stated: 

From a physical point of view, [I] simply can find no 

impairment that would interfere with the claimant's 

[ability] to function. There is a diagnosis, or impression, given by some doctors that she has, may have, or 

could have a chronic fatigue syndrome; however. there is 

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no documentation of record which establishes this syndrome as required by law . . . . [I]t [is] up to the 

claimant to produce such medical and other evidence of 

the existence of an impairment as may be required by the 

Secretary. Her statements as to pain and other symptoms 

are not alone to be considered conclusive evidence of 

disability. There must be medical signs and findings, 

established by medically acceptable clinical or laboratory diagnostic techniques, which show the existence of 

a medical impairment .... 

The claimant, here, has been repeatedly tested and in 

each instance those findings have not been forthcoming . . . . Those physicians that have. indicated the 

chronic [fatigue] syndrome as an assessment. have not 

supported it with any kind of objective findings or laboratory testing which would support those conclusions. 

(Appellant's Supp. App. at 12) (emphasis added). 

Thus, the ALJ impeached Plaintiff's unrebutted testimony, 

discredited her treating physician's unchallenged diagnosis, and 

rebutted the findings of the Mayo Clinic solely because he was 

looking for some sort of conclusive "dipstick" laboratory 

test--such as a blood test--under his interpretation of 

§ 223 (d) (5) (A) of the SSA. The district court adopted the same 

interpretation as the ALJ, noting that the diagnoses were based on 

"literature" rather than on "objective medical findings." Sisco 

v. Sullivan, No. CIV-91-1675-C, slip op. at 4. The ALJ cited no 

support for his assumption that "medically acceptable clinical or 

laboratory diagnosis techniques" can only mean conclusive laboratory tests. Indeed, the plain meaning of the language simply 

indicates that a claimant's disability must be diagnosed through 

the use of a technique, either clinical or laboratory, -that has 

been accepted by the medical community. 

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At this point there is no "dipstick" laboratory test for 

chronic fatigue syndrome. If there were such a test, and had it 

been reasonably accessible, the ALJ might have been justified in 

drawing inferences from Plaintiff's failure to have it administered. The ALJ's and the district court's reading of 

§ 223(d) (5) (A) of the Social Security Act would mean that chronic 

fatigue syndrome, and other disabilities that cannot be diagnosed 

with a "dipstick, " could never be recognized as disabilities under 

the Act. Yet the Social Security Administration's own internal 

operations manual, which lists chronic fatigue syndrome as a 

disease to be adjudicated on a case-by-case basis, defies this 

interpretation. See Program Operations Manual System, § DI 

24575.005; Reed, 804 F. Supp. at 918. Furthermore, since its 

"discovery" a few years ago, numerous cases involving chronic 

fatigue syndrome have been adjudicated across the country and we 

are unable to find any suggestion in these cases that this 

disease--or any other disease--is per se excluded from coverage 

because it cannot be conclusively diagnosed in a laboratory setting. See, eg., Thaete v. Shalala, 826 F. Supp. 1250 (D. Colo. 

1993) Irey v. Sullivan, 1993 U.S. App. LEXIS 11643 (9th Cir. 

1993); Cohen v. Secretary, 964 F.2d 524 (6th Cir. 1992); and 

Reed v. Secretary, 804 F. Supp. 914 (E.D. Mich. 1992). 

Plaintiff's treating physician identified the clinical technique used by the medical community to diagnose chronic fatigue 

syndrome. (Appellant's App. at 143.) The first method of diagnosis of this type was set forth in 1988 in the Annals of Internal 

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Medicine, Vol. 108, Jan.-March 1988. The "operational" diagnosis 

technique used by the medical community at the present time 

involves testing, the matching of a detailed list of symptoms, the 

painstaking exclusion of other possible disorders, and a thorough 

review of the patient's medical history. (Appellant's App. at 

145-168, 170-172.) Both her treating physician and the Mayo 

Clinic appeared to reach their conclusions by using this type of 

step-by-step diagnostic procedure. Plaintiff's treating physician 

stated that his diagnosis was reached under the guidelines established by the National Centers for Disease Control in Atlanta. 

(Appellant's App. at 143.) Although this type of clinical diagnostic method may not be as dramatic or impressive to a layman as 

a "dipstick" laboratory test, it is the technique presently used 

and accepted by the medical community. Section 223(d) (5) (A) of 

the Social Security Act does not require more. In the ALJ's mind, 

chronic fatigue syndrome may not be a legitimate disease until it 

can be diagnosed in a laboratory setting. However, he cannot substitute his lay opinion for that of Congress, the Mayo Clinic, 

1 . . ff d d h . d. 1 . 1 P a1nt1 's octor, an t e ent1re me 1ca commun1ty. Reed, 804 

1 The district court essentially reiterated and adopted the 

ALJ's interpretations and findings without significant discussion. 

Two points raised by the district court deserve mention. First, 

the district court opined that the report by the Mayo Clinic 

"doesn't completely support plaintiff's position in this appeal." 

Presumably, the court was influenced by the report's language, 

"and wonder if there may be some psychological overlay." A review 

of the medical literature in the record demonstrates that a psychological overlay is consistent with a diagnosis of chronic 

fatigue syndrome; it often develops as a secondary reaction to the 

physical aspects of the disease. (Appellant's App. at 158.) Furthermore, an overlay is simply an overlay. It does not change the 

nature of the underlying diagnosis. The district court might also 

have been persuaded by the language, "I find no evidence for a 

metabolic myopathy, including periodic paralysis." As previously 

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F. Supp. at 919. 

The second major misconception held by the ALJ and the district court was that Plaintiff's early medical history somehow 

rebutted or contradicted the two recent diagnoses of chronic 

fatigue syndrome. From 1983 through 1989, Plaintiff was examined 

by dozens of doctors who were unable to diagnose a physical problem sufficient to explain the severity of her symptoms. After 

being unable to find a physical cause, a few assessed her as a 

hypochondriac or as suffering from personality disorders. In his 

opinion, the ALJ discredited the eventual diagnoses of chronic 

fatigue syndrome by referring to the early examinations and stating, "The claimant, here, has been repeatedly tested and in each 

instance those findings have not been forthcoming. Some of the 

physicians who have treated the claimant have been unable at all 

discussed, chronic fatigue syndrome is diagnosed partially by 

excluding other possibilities. Thus, the doctor's exclusion of 

other illnesses cannot be seen as inconsistent with his final 

diagnosis of tension myalgia and chronic fatigue syndrome. 

Second, the district court attempted to discredit the findings of Plaintiff's treating physician by noting, "It is not 

apparent from his report that he had even examined plaintiff." 

Sisco v. Sullivan, No. CIV-91-1675-C, slip op. at 4. After carefully scrutinizing Dr. Becker's report, we have been unable to 

determine how the district court arrived at this conclusion. 

Indeed, Dr. Becker's report makes clear that he not only spent a 

significant amount of time researching and studying chronic 

fatigue syndrome, but that he thoroughly examined and treated 

Plaintiff for four months prior to making his report. Dr. Becker 

stated that he was Plaintiff's treating physician, and had been 

treating her since April of 1990. (Appellant's Second Supp. App. 

at 1.) Dr. Becker then described Plaintiff's symptoms and physical problems in great detail. We note that Dr. Becker used the 

word "evaluation" synonymously with "examination." However, we 

have never held that a treating physician must use specific, technical language before we will consider his findings. Dr. Becker's 

report is clear on its face and is sufficient. 

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to find anything of significance wrong with her. Some have indicated either little or no disability." (Appellant's Supp. App. at 

12.) Similarly, the district court noted that her eventual diagnosis "is completely contradicted by the other medical evidence of 

record." Sisco v. Sullivan, No. CIV-91-1675-C, slip op. at 3. 

Under the facts of this case, the early examinations cannot 

be considered as contradicting or rebutting her recent diagnoses. 

As previously mentioned, chronic fatigue syndrome was not even 

recognized as a disease until 1988, and the first technique to 

diagnose it was not published until that same year. The Mayo 

Clinic was finally able to provide an explanation for Plaintiff's 

symptoms late in 1989. It was precisely because of the Mayo 

Clinic's reputation for diagnosing new and rare diseases that 

Plaintiff's doctors referred her there. It is highly unlikely 

that any of the physicians who examined Plaintiff prior to the 

Mayo Clinic would have considered or even been aware of chronic 

fatigue syndrome. The government has not cited to a single physician who examined Plaintiff after the Mayo Clinic or in light of 

the medical community's new understanding of chronic fatigue syndrome who contradicted or in any way questioned the conclusions of 

the Mayo Clinic and her treating physician. 

Moreover, because chronic fatigue syndrome is diagnosed partially through a process of elimination, an extended medical history of "nothing-wrong" diagnoses is not unusual for a patient who 

is ultimately found to be suffering from the disease. The Mayo 

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Clinic and her treating physician considered Plaintiff's entire 

medical history--including all the failed attempts to diagnose--in 

making their assessments. Finally, in a purely linguistic sense, 

an early report that "I am unable to find the cause" does not contradict a later report that "I have now found the cause." These 

statements together demonstrate an evolution rather than a contradiction. None of the pre-Mayo physicians ruled out chronic fatigue syndrome; they merely expressed an inability to discover an 

adequate physical explanation for her symptoms. When viewed in 

the proper light, Plaintiff's medical history does not rebut her 

recent diagnoses. See Reed, 804 F. Supp. at 921 (holding that 

conclusions of specialists who examined patient before chronic 

fatigue syndrome became widely known could not rebut recent diagnosis of treating physician who was a generalist). Thus, 

Plaintiff's testimony and medical evidence stood entirely unchallenged in front of the ALJ. 

For all of the above reasons, we hold that the ALJ's decision 

that Plaintiff is capable of performing full-time sedentary or 

light work was not supported by substantial evidence. Because 

sedentary work is the lowest classification under the statute, 

there is no need for further proceedings in this matter other than 

a remand for an award of benefits. See 42 U.S.C. § 405(g) ("The 

court shall have the power to enter, upon the pleadings and transcript of the record, a judgment affirming, modifying, or reversing the decision of the Secretary, with or without remanding the 

case for a rehearing."); Thaete, 826 F. Supp. 1250 (reversing and 

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.... 

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remanding for an award of benefits after ALJ refused to properly 

consider the claimant's diagnosis of chronic fatigue syndrome, 

claiming that it was not based on "significant medical findings"); 

and Cohen, 964 F.2d 914 (reversing and remanding for an award of 

benefits after ALJ refused to give proper consideration to 

claimant's diagnosis of chronic fatigue syndrome). 

Plaintiff's disability has been evaluated by an adjudicatory 

body no fewer than ten times over the past several years--eight of 

which have been at various levels in front of the Secretary. In 

the meantime, Plaintiff has lived on a meager income and tried to 

support a teenage son. As far as quantum of proof, Plaintiff has 

exceeded what a claimant can legitimately be expected to prove to 

collect benefits under the Act. Her case stands unchallenged. 

The record reveals that the ALJ has resented Plaintiff's 

persistence, refused to take her disease seriously, and at times 

treated her claim with indifference or disrespect. The Secretary 

is not entitled to adjudicate a case "ad infinitum until it 

correctly applies the proper legal standard and gathers evidence 

to support its conclusion." Thaete, 826 F. Supp. at 1252 (citing 

Sanders v. Secretary of Health and Human Services, 649 F. Supp. 

71, 73 (N.D. Ala. 1986)). The judgment of the district court is 

reversed and the case is remanded to the district court with 

instructions to remand to the Secretary for an immediate award of 

benefits. 

REVERSED and REMANDED. 

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