Source: https://www.orenlaw.com/fresno-fibromyalgia-social-security-disability-lawyer/
Timestamp: 2019-04-26 12:09:50+00:00

Document:
In Green-Younger v. Barnhart, 335 F.3d 99 (2d Cir. 2003), an ALJ rejected a treating physician’s opinion and found that a claimant who had fibromyalgia could perform sedentary work. Id. at 106. The Second Circuit held that the ALJ should have given controlling weight to the treating physician’s opinion about the claimant’s functional limitations. Id. “The fact that Dr. Helfand also relied on Green-Younger’s subjective complaints hardly undermines his opinion as to her functional limitations, as ‘[a] patient’s report of complaints, or history, is an essential diagnostic tool.’” Id. at 107, quoting Flanery v. Chater, 112 F.3d 346, 350 (8th Cir. 1997). Further, the Second Circuit held that fibromyalgia must be evaluated taking into account the precise nature of fibromyalgia and the ALJ erroneously required objective findings not present in fibromyalgia to reject the claim of disability based on fibromyalgia. Id. at 108.
In Willoughby, the claimant argued that the ALJ improperly disregarded the medical evidence pertaining to her diagnosis of fibromyalgia and held that the ALJ’s decision that the claimant did not have fibromyalgia was based on legal error and was not supported by substantial evidence. Willoughby v. Comm’r of Soc. Sec., 332 F. Supp.2d 542, 546 (W.D.N.Y. 2004). The court cited to the numerous court decisions which “have recognized that evaluating the nature and severity of this condition in the context of Social Security disability review has proven to be difficult because of its elusive nature and the lack of objective tests that can conclusively confirm the existence of the disease. Id. at 546 n.3, citing Green-Younger v. Barnhart, 335 F.3d 99, 108 (2d Cir. 2003); Harman v. Apfel, 211 F.3d 1172, 1179-80 (9th Cir. 2000); Kelley v. Callahan, 133 F.3d 583, 585 n. 2 (8th Cir. 1998); Sarchet v. Chater, 78 F.3d 305, 306 (7th Cir. 1996); Preston v. Sec. of Health and Human Servs., 854 F.2d 815, 818 (6th Cir. 1988). “Nevertheless, despite the lack of objective medical screening devices, fibromyalgia is a potentially disabling impairment that can provide the basis for disability insurance and supplemental security income benefits in the appropriate case.” Id., citing Green-Younger, 335 F.3d at 108-109; Soto v. Barnhart, 242 F. Supp.2d 251, 256-57 (W.D.N.Y. 2003). The court also held that the ALJ improperly discounted the diagnosis of the claimant’s treating physician because it was not supported by objective medical findings. Id. at 547.
Testimony and complaints of pain, fatigue, and limitations in daily activity in light of the diagnosis of fibromyalgia.
In this regard, the ALJ should not simply discount plaintiff’s credibility based on the fact that there are no lab results or other objective medical findings to support her testimony about her limitations. The ALJ must consider the fact that there is no clinical test that can identify fibromyalgia or determine its severity. In fact, as a number of courts have recognized, the absence of abnormal clinical signs and findings (such as swollen joints, limited ranges of motion, or weakened muscles) is consistent with a diagnosis of fibromyalgia.
In Aragon-Lemus v. Barnhart, 280 F. Supp. 2d 62 (W.D.N.Y. 2003), the court held that the ALJ erred in placing “great weight” on the opinion of an examining physician’s “incomplete report” in determining the claimant’s RFC because this report did not take into consideration the claimant’s subsequent diagnosis of fibromyalgia by her treating physician. Id. at 69. The ALJ’s credibility finding was also not supported by substantial evidence and the “consequence of this error is amplified where, as here, the claimant had fibromyalgia, an ailment which has been recognized as difficult to diagnose with tangible clinical evidence.” Id. at 70, citing Green-Younger v. Barnhart, 335 F.3d 99, 107-09 (2d Cir. 2003). See also Johnson v. Barnhart, 312 F. Supp.2d 415, 426 (W.D.N.Y. 2003) (holding that the ALJ’s determination that the claimant did not suffer from fibromyalgia was not supported by substantial evidence in the record and the ALJ erred in not clarifying the treating physician’s “suggested” diagnosis of fibromyalgia by contacting him to determine whether additional information on his fibromyalgia diagnosis was readily available).
While remanding the case on other grounds, a Texas district court held that the ALJ did not err in not considering the claimant’s alleged tinnitus and fibromyalgia as there was no evidence that these conditions would limit the claimant’s ability to perform a limited range of sedentary work. Brown v. Barnhart, 285 F. Supp.2d 919, 935-36 (S.D. Tex. 2003).
[F]ibrositis causes severe musculoskeletal pain which is accompanied by stiffness and fatigue due to sleep disturbances. In stark contrast to the unremitting pain of which fibrositis patients complain, physical examinations will usually yield normal results — a full range of motion, no joint swelling, as well as normal muscle strength and neurological reactions. There are no objective tests which can conclusively confirm the disease; rather it is a process of diagnosis by exclusion and testing of certain ‘focal tender points’ on the body for acute tenderness which is characteristic in fibrositis patients. The medical literature also indicates that fibrositis patients may also have psychological disorders. The disease commonly strikes between the ages of 35 and 60 and affects women nine times more than men. Id.
Fibromyalgia has been described as an “elusive and mysterious” disease that shares common features with chronic fatigue syndrome. Aidinovski v. Apfel, 27 F. Supp.2d 1097, 1099 (N.D. Ill. 1998), citing Sarchet v. Chater, 78 F.3d 305, 306 (7th Cir. 1996). In Aidinovski, the court rejected the ALJ’s reliance on medical opinions offered by a general practitioner and a pediatrician, which showed the claimant’s limitations to be far less than that opined by a rheumatologist, the “relevant specialist” qualified for diagnosing and evaluating fibromyalgia. Id. at 1105. The court further noted that, by definition, the claimant’s fibromyalgia diagnosis meant that in all likelihood her reports of pain and fatigue would seem out of proportion with the available objective evidence. Id. at 1103. Accordingly, the ALJ did not appear to have considered its peculiar characteristics at all in evaluating the claimant’s credibility, and therefore, absent proper consideration of the subjective nature of the symptoms of the illness, the ALJ’s credibility determination was inadequate. This was especially so since the ALJ did not discuss (1) why she rejected the evidence favorable to the claimant, and (2) how the uniquely subjective nature of the claimant’s illness factored into the analysis.Id.
A Wisconsin district court explained that the ALJ’s decision was not clear as to why he found that the claimant’s doctor visits were either intermittent or infrequent, which was one of the reasons he found that the claimant’s allegations were incredible. Dominguese v. Massanari, 172 F. Supp.2d 1087, 1096 (E.D. Wis. 2001). However, the record contained no medical evidence concerning how regularly or how often a patient experiencing plaintiff’s stated level of pain related to fibromyalgia and plaintiff’s other afflictions would be expected to see a doctor. In the absence of such evidence, the ALJ made his own independent medical determination about the appropriateness of doctor visits. This determination was not within the ALJ’s province to make. Additionally, the court noted that fibromyalgia sufferers should engage in a “comprehensive treatment course that includes pain management, exercise and referral to psychiatric sources,” and that the record indicated the claimant’s regimen involved most of these elements, including “regular medical treatment, pain management, and exercise.” Id. Therefore, to the extent the ALJ based his credibility finding on the claimant’s record of doctor visits, the court found that “his conclusion was not supported by substantial evidence and did not logically follow from the evidence.” Id. The court also noted that one of the bases for the ALJ’s rejection of the treating physician’s opinion was his determination that it was not well-supported by medically acceptable data and that the ALJ sought “hard evidence.” Id. at 1100. However, the court pointed out that the claimant’s primary alleged disabling condition was fibromyalgia, and that, in most cases, “there will be no objective evidence indicating [its] presence or severity.” Id. Therefore, “in light of the nature of the condition, the absence of hard evidence was not a ‘good’ or even logical reason for rejecting [the treating physician’s] opinion or for according it lesser weight.” Id.
In a case where a claimant suffered from fibromyalgia, the court held that the ALJ failed to “give good reasons” for her decision because she failed to explain how her findings could be squared with the contrary opinions of the claimant’s treating doctors, upon whose opinions she claimed to afford “significant weight.” Wates v. Barnhart, 274 F. Supp.2d 1024, 1035 (E.D. Wis. 2003). In fact, one physician opined that the claimant suffered from fatigue of sufficient severity to significantly interfere with a full-time work schedule and that the claimant would require breaks due to fatigue and would incur frequent work absences because of her fibromyalgia. Id. at 1034-35. The court also reversed and remanded for reconsideration of the credibility of the claimant’s testimony, noting, in part, that the ALJ failed to cite to any medical support for her conclusion that the claimant’s doctor visits were “infrequent,” observing that “there was no evidence as to how often someone with plaintiff’s conditions should reasonably see her physician.” Id. at 1039-40, citing Dominguese v. Massanari, 172 F. Supp.2d 1087, 1096 (E.D. Wis. 2001).
The Eighth Circuit held that fibromyalgia, “which is pain in the fibrous connective tissue components of muscles, tendons, ligaments, and other white connective tissues, can be disabling” and “often leads to a distinct sleep derangement which often contributes to a general cycle of daytime fatigue and pain.” Kelley v. Callahan, 133 F.3d 583, 589 (8th Cir. 1998), citing Cline v. Sullivan, 939 F.2d 560, 563, 567 (8th Cir. 1991). The court further described fibromyalgia as a “degenerative disease which results in symptoms such as achiness, stiffness, and chronic joint pain.” Id. at 590, citing Cline, 939 F.2d at 567; Stedman’s Medical Dictionary 222 (4th ed. 1976). In Kelley, the court held that in rejecting the treating physician’s 4-hour workday restriction, the ALJ wrongly assumed that physicians cannot opine as to the hours a claimant can work, stating that doctors regularly make such judgments which are not only allowed but encouraged. Id., citing Smallwood v. Chater, 65 F.3d 87, 89 (8th Cir. 1995).
In Garza, the claimant argued that the ALJ erred by not listing fibromyalgia as a severe impairment. Garza v. Barnhart, 397 F.3d 1087, 1089 (8th Cir. 2005). The Eighth Circuit agreed that the ALJ misunderstood fibromyalgia and that this misunderstanding affected the ALJ’s RFC findings, and her hypothetical question posed to the VE. Id. But see Strongson v. Barnhart, 361 F.3d 1066, 1072 (8th Cir. 2004) (affirming the ALJ’s decision, in part, based on its finding that the ALJ’s credibility finding was supported by the fact that no “trigger points were not identified to support her claimed fibromyalgia”); Hutton v. Apfel, 175 F.3d 651, 655 (8th Cir. 1999) (holding that the record supported the ALJ’s determination that the claimant’s subjective complaints of disabling pain were not credible to the extent alleged, noting that the claimant had undergone 75 trigger point injections over a 2-year period for her fibromyalgia and stated that the injections relieved the pain and made the “knots go down”).
In a fibromyalgia case, the Eighth Circuit held that the reasons given by the ALJ for discrediting the claimant’s testimony were unsupported by the record. Brosnahan v. Barnhart, 336 F.3d 671, 677 (8th Cir. 2003). Regarding the “degree of medical treatment required,” the ALJ did not specify the physician’s reports and findings upon which he relied, and the claimant received treatments recommended by the American College of Rheumatology (ACR) for fibromyalgia. Regarding the ALJ’s finding that the claimant had made inconsistent statements about her pain and ability to walk and lift, the Eighth Circuit found that the statements reflected her attempt to describe the variability of her symptoms. The lack of any need for surgery, another reason cited by the ALJ, was also not a reason to discredit the claimant as the ACR does not recommend surgery for fibromyalgia. Regarding missed doctor appointments, another reason cited by the ALJ, the claimant testified that she missed these appointments only because of the very symptoms for which she sought benefits, namely, she felt too weak and ill to dress. Id. The Eighth Circuit also held that the claimant’s testimony and reports were supported by objective medical evidence of fibromyalgia – consistent trigger-point findings – and by her consistent complaints during her relatively freque nt physicians’ visits of variable and unpredictable pain, stiffness, fatigue, and inability to function. Id. at 677-78. Finally, the court reiterated that fibromyalgia can be disabling because of its potential for sleep derangement and resulting daytime fatigue and pain, and the VE testified that a claimant who could not perform reliably on a full-time basis because of pain and fatigue could not work. Id. at 678.
Fibromyalgia (or fibrositis) consists of a constellation of symptoms associated with few physical findings and essentially normal laboratory tests. The disease primarily affects women. Its cause is unknown. The main complaints include joint and muscle pain and stiffness, easy fatigability, and difficulty with sleep. The symptoms usually appear insidiously, although some patients may recall a precipitating physical or emotional event. There is usually a significant degree of functional impairment with inability to work or difficulty with chores at home.
In Haines v. Apfel, 986 F. Supp. 1212 (S.D. Iowa 1997), the court stated that “fibromyalgia is not a diagnosis of exclusion,” and “[a]lthough the symptoms are subjective, there is a test upon which, when done properly by a rheumatologist, a diagnosis can be based.” Id. at 1214, citing Sarchet v. Chater, 78 F.3d 305, 306-07 (7thCir. 1996). The court also criticized the ALJ’s comments at the hearing regarding fibromyalgia and the fact that it is diagnosed from symptoms and cannot be explained objectively. Since the court found that neither the claimant’s fibromyalgia nor depression were properly developed, the court remanded the case with instructions to “arrange for consultative examinations by a rheumatologist and a psychiatrist, unless [the claimant] is already being treated by doctors in these specialties, so that proper diagnoses can be obtained.” Id.
Id. at 594. The court further observed that the opinion of each rheumatologist is given greater weight than those of the other physicians and that “[r]heumatology is the relevant specialty for fibromyalgia.” Id. at 594 n.4, citing 20 C.F.R. § 404.1527(d)(5);Jordan v. Northrop Grumman Corp., 370 F.3d 869, 873 (9th Cir. 2004). “Specialized knowledge may be particularly important with respect to a disease such as fibromyalgia that is poorly understood within much of the medical community.” Id.
A Kansas district court held that the record showed that the ALJ failed to follow the recognized law in evaluating the medical opinions concerning fibromyalgia and further ignored uncontroverted medical evidence regarding the severity of the claimant’s symptoms. Priest v. Barnhart, 302 F. Supp.2d 1205, 1213 (D. Kan. 2004). The court reiterated its prior decision in Anderson v. Apfel, 100 F. Supp.2d 1278, 1286 (D. Kan. 2000) in which it summarized what other courts had said about fibromyalgia as a possible disabling condition. Id. The court also referenced the Eighth Circuit’s decision in Brosnahan v. Barnhart, 336 F.3d 671, 672 n. 1 (8th Cir. 2003) discussing fibromyalgia. Id. at 1213-14. The court considered these decisions and concluded that the ALJ’s finding “that the diagnosis of fibromyalgia cannot be medically determined” was not supported by substantial evidence. Id. at 1214. “The ALJ reveals his fundamental misunderstanding of fibromyalgia in asserting that there must be objective documentation of this condition (other than the plaintiff’s complaints) before there is a medically determinable impairment.” Id. Finally, the court held that the ALJ committed legal error when he discredited the claimant’s testimony for lack of objective medical evidence and remanded with instructions for the ALJ to “consider all of the Luna factors for evaluating pain testimony in light of the diagnosis of fibromyalgia and the entire record.” Id. at 1216.
An Alabama district court noted that “[f]ibromyalgia presents unique problems in the context of Social Security cases” which have been recognized by the courts. Bennett v. Barnhart, 288 F. Supp.2d 1246, 1249 (N.D. Ala. 2003), citing Sarchet v. Chater, 78 F.3d 305 (7th Cir. 1996) and Kelley v. Callahan, 133 F.3d 583, 589 (8th Cir. 1998). However, despite its “illusive nature,” the presence of fibromyalgia can be objectively verified by the presence of “tender areas,” or “trigger points,” which are well defined and cause pain upon palpation. Id., citing Sarchet. Additionally, the court noted that clinical support for a diagnosis of fibromyalgia may be present if “injections of pain medication to the trigger points are prescribed.” Id., citingKelley, 133 F.2d at 589. The court also stated that “fibromyalgia if properly diagnosed satisfies the pain standard.” Id. In Bennett, one of the reasons cited by the ALJ for refusing to credit the claimant’s pain testimony was the fact that none of the claimant’s physicians recommended surgery, “which would indicate the claimant’s condition is not as severe as alleged.” Id. at 1251. The court found it “particularly troubling” that the ALJ relied on the lack of a surgical recommendation despite finding that the claimant suffered from fibromyalgia and myofascial pain syndrome, “neither of which is amenable to surgical treatment.” Id. See also Harrison v. Barnhart, 346 F. Supp.2d 1188, 1193 (N.D. Ala. 2004) (holding that the ALJ erred in concluding that there must be objective evidence in a fibromyalgia case, as there are no objective clinical tests to determine the severity of fibromyalgia, noting that the ALJ failed to note findings of trigger points, which is indicative of fibromyalgia); White v. Barnhart, 336 F. Supp.2d 1183, 1189 & 1189 n. 15 (N.D. Ala. 2004) (holding that the ALJ failed to properly evaluate Plaintiff’s fibromyalgia which was diagnosed by her treating physicians and holding that the ALJ erred in failing to find the claimant’s fibromyalgia to be a severe impairment and in failing to explain why he was not crediting the diagnosis).

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