Source: https://www.orenlaw.com/fresno-chronic-fatigue-syndrome-social-security-disability-lawyer/
Timestamp: 2019-04-26 12:09:55+00:00

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In considering the nature of chronic fatigue syndrome, the First Circuit noted that chronic fatigue syndrome is diagnosed partially through a process of elimination and an “extended medical history of ‘nothing-wrong’ diagnoses” is not unusual for CFS patients. Rose v. Shalala, 34 F.3d 13, 18 (1st Cir. 1994). Due to the absence of definitive diagnostic tests, the failure of some doctors to state conclusive diagnoses does not constitute substantial evidence to support a finding that claimant did not suffer from the syndrome. Id. Given the uncontroverted medical evidence that the claimant suffered from CFS, the ALJ’s “blind reliance” on a lack of objective findings was wholly inconsistent with the POMS and other pertinent policy statements. Id. Even though the non-examining physicians’ notations suggested that the claimant’s fatigue did not significantly affect his functional capacity, the ALJ’s findings were not based on substantial evidence because “the subjective severity of a claimant’s fatigue associated with CFS is not something readily evaluated on an algid administrative record.” Id. at 19.
A New York district court noted that CFS is “a disease which, while not specifically addressed in the Listings, may produce symptoms which ‘significantly impair [a] claimant’s ability to perform even sedentary work . . . .’” Fragale v. Chater, 916 F. Supp. 249, 253 (S.D.N.Y. 1996), quoting Rose v. Shalala, 34 F.3d 13, 17 (1st Cir. 1994). When presented with documented allegations of symptoms which are consistent with the symptomology for evaluating CFS, the Commissioner cannot rely on the ALJ’s rejection of the claimant’s testimony based on the mere absence of objective evidence. Id. at 254-55. The Commissioner’s decision in such cases should “reflect a recognition of the increased significance to be given the claimant’s credibility in assessing residual functional capacity.” Id. at 254.
In Fragale, the ALJ mischaracterized the claimant’s daily activities and failed to properly resolve inconsistencies as required under the regulations, policies and case law. Id. at 255. The ALJ further erred in rejecting the claimant’s testimony based on a lack of medical diagnoses or objective findings. Id.
Id., citing Fudka, Straus, Hickie, Sharpe, Dobbins and Komaroff, The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study, Annals of Internal Medicine, Vol. 121, No. 12, pp. 953-59 (Dec. 15, 1994); Fragale v. Chater, 916 F. Supp.249, 255 (W.D.N.Y. 1996). In Schaffer, the court held that CFS is recognized by the SSA as a disease which, while not precisely addressed in the listings, may produce symptoms which “significantly impair [a] claimant’s ability to perform even sedentary work . . . .” Id. at 237, citing Rose v. Shalala, 34 F.3d 13, 16-17 (1st Cir. 1994); Sisco v. U.S. Dept. of Health & Human Servs., 10 F.3d 739 (10th Cir. 1993);Fragale at 253-54; Thaete v. Sec’y of Health & Human Servs., 804 F. Supp. 914 (E.D. Mich. 1992).
Where the claimant suffered from chronic fatigue syndrome, the court held that an ALJ may not reject the opinions of treating physicians solely because they are based on a claimant’s subjective complaints rather than specific medical signs or laboratory findings. Bischof v. Apfel, 65 F. Supp.2d 140, 146 (E.D.N.Y. 1999). An ALJ also may not find that a claimant’s testimony regarding chronic fatigue syndrome lacks credibility solely because it is unsupported by objective medical findings. Id., citing Fragale v. Chater, 916 F. Supp. 249, 253-54 (W.D.N.Y. 1996); Reddick v. Chater, 157 F.3d 715, 723-24 (9th Cir. 1998); Sisco v. United States Dep’t of Health & Human Servs., 10 F.3d 739, 743 (10th Cir. 1993). In Bischof, the ALJ rejected the treating physician’s assessments of the claimant’s functional capacity, finding them unsupported by “detailed, clinical, diagnostic evidence.” Id. The court noted that every doctor who examined the claimant reported that she complained of a similar collection of symptoms, including unexplained dizziness, fatigue, muscle and joint pain, low grade fever and inability to concentrate, which was consistent with the Commissioner’s policies for evaluating CFS. Id., citing Program Operations Manual at §§ DI 24515.007 (1997); SSR 99-2p. Additionally, at least three Epstein-Barr blood tests yielded positive results, and elevated levels of Epstein-Barr antibodies are among the few laboratory results that might support a diagnosis of CFS as set forth in SSR 99-2p. While a wide variety of clinical tests performed over several years could detect nothing wrong, “‘an extended medical history of ‘nothing-wrong’ diagnoses is not unusual for a patient [with Chronic Fatigue Syndrome].’” Id., quoting Rose v. Shalala, 34 F.3d 13, 18 (1st Cir. 1994). The court held that the ALJ acted without substantial evidence, and in contravention of the Commissioner’s policy regarding CFS and the treating physician rule in incorrectly discounting the claimant’s testimony on the ground that it was unsupported by specific objective evidence and in viewing the lack of objective medical indicators as undermining the treating physicians’ views regarding the severity of the claimant’s symptoms and her capacity to work. Id. at 147.
In Canals, the claimant sought disability benefits based on her chronic Epstein-Bar Virus Syndrome (EBS), Chronic Fatigue Syndrome (CFS), and other conditions. Canales v. Barnhart, 308 F. Supp.2d 523, 524 (E.D. Pa. 2004). This case was the subject of a prior federal court as well as a prior remand from the Appeals Council.Id.at 525. The court reversed and remanded for an award of benefits for the closed period at issue, holding that the ALJ did not adequately discuss all seven regulatory factors in evaluating the claimant’s subjective complaints of pain; failed to analyze the credibility of the third party witnesses; and did not pose hypothetical questions to the vocational expert. Id. at 528.
Id. at 177. The Fourth Circuit further found that the ALJ applied the correct legal standard in finding that the claimant’s CFS was not equivalent to a listed impairment as the record did not reveal the detailed record contemplated for a medical diagnosis based on symptoms, but instead disclosed a “hodgepodge of medical observations and treatments with annual gaps showing no progression in the claimant’s treatment.” Id.at 179.
The Sixth Circuit held that the ALJ’s finding that the claimant who suffered from Epstein-Barr virus and CFS was capable of either returning to her previous work or engaging in other work was not based on substantial evidence. Cohen v. Sec’y of Dept. of Health and Human Servs., 964 F.2d 524, 531-32 (6th Cir. 1992). Even though the claimant attempted to continue her ballroom dancing, enrolled as a part-time law student, passed her final exam, and participated in a national support group for persons suffering from Epstein-Barr virus, her activities did not discredit her testimony, but were examples of her efforts to maintain a semblance of a normal life.Id. at 531.
A district court in Indiana found that the failure of the claimant’s physician to state a conclusive diagnosis did not support a conclusion that the claimant did not suffer from CFS, as a diagnosis of CFS is achieved partially through a process of elimination, as was done in the instant case Olson v. Apfel, 17 F. Supp.2d 783, 790 (N.D. Ill. 1998), citing Rose v. Shalala, 34 F.3d 13, 16-18 (1st Cir. 1944); Sisco v. U.S. Dept. of Health & Human Servs., 10 F.3d 739, 744-45 (10th Cir. 1993). The court noted further that “the Commissioner’s own policy statement recognizes the inherent difficulties faced by adjudicators in assessing CFS allegations.” Id.
“Since CFS is commonly diagnosed on a symptomatic basis, rather than by the application of objective medical testing, the subjective representations of a claimant take on special significance, as do the corresponding credibility assessments of the ALJ.” Dornack v. Apfel, 49 F. Supp.2d 1129, 1140 (D. Minn. 1999). In Dornack, the court held that based on a less than fully developed record, the ALJ discounted the claimant’s subjective complaints on a less than competent basis. Id. at 1142. The court specifically held that “the elusive etiology of CFS requires the development of a Record that allows a thorough assessment of the Plaintiff’s physical and mental capabilities.” Id. Because the ALJ’s assessment of the treating physician’s opinion was premised upon his disbelief of the claimant’s subjective symptoms, the court held that this analysis was also flawed. Id. at 1144.
In sum, we part company with the ALJ’s analysis at the point where the ALJ implicitly treats CFS as a simple diagnostic phenomenon whose cause can be identified with some ease. As have Courts before us, we find that ‘[t]he ALJ’s failure to acknowledge the POMS guidelines may be emblematic of the reluctance to acknowledge CFS that appears to underlie his decision.’ . . . Here, the ALJ accepted the diagnosis of CFS by both Dr. Kind, and by Dr. Sandvick, . . . and yet the ALJ does not appear to employ a “totality of evidence” approach — preferring, instead, to tag the Plaintiff’s chronic fatigue to some perceived need for dependency. The cause and effect of the Plaintiff’s fatigability is not resolvable on any simplistic plane . . .
The court observed that “the ALJ did not seem to understand the symptoms the claimant reported, including joint and muscle pain, impaired memory and concentration, and a general feeling of lassitude, which are certainly consistent with the diagnosis of chronic fatigue syndrome which the Secretary of Health and Human Services has adopted for evaluating claims premised on chronic fatigue syndrome.”Martin v. Apfel, 118 F. Supp.2d 9, 18 (D.D.C. 2000), citing Fragale v. Chater, 916 F. Supp. 249, 253 (W.D.N.Y. 1996). Thus, the court concluded that since the physician’s diagnosis was supported by the symptoms he observed, the ALJ’s contrary conclusion was unsubstantiated and cannot stand. Id.

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