Source: https://www.harrisonlamar.com/fibromyalgia-legal/
Timestamp: 2019-06-26 10:58:22
Document Index: 151513360

Matched Legal Cases: ['art, 261', 'art, 336', 'art, 379', 'art, 302', 'art, 336', 'art, 2000', 'art, 2000']

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 Gavigan v. Barnhart, 261 F. Supp.2d 334 (D. Md. 2003), a case where the claimant suffered from fibromyalgia and a back disorder, the court held that the ALJ?s credibility analysis did not comport with the required two-step process for assessing the credibility of a claimant?s subjective complaints of pain as set forth in Craig v. Chater, 76 F.3d 585, 594 (4th Cir. 1996). Id. at 338. First, the ALJ did not address step one, which is whether the objective medical evidence shows the existence of a medical impairment which could reasonably be expected to produce the actual pain in the amount and degree alleged by the claimant. Id. at 339-40. The court concluded that the ?the need for a clear, cogent step one analysis is heightened because plaintiff suffers from fibromyalgia, a disease that poses particular challenges to credibility analyses due to the limited available objective medical evidence.? Id. at 340. On remand, the ALJ should determine whether the claimant?s fibromyalgia could reasonably be expected to cause her pain and ?should discuss the symptoms associated with fibromyalgia (particularly pain) and explain what pain could reasonably be expected from the disease.? Id. at 341. Second, as the ALJ did not adequately address step two, which requires consideration of the various actors set forth at 20 C.F.R. ? 416.929, the court was unable to conclude that substantial evidence supported the ALJ?s decision. Id. at 341-42. In basing his step two analysis solely on the objective medical evidence, ?the ALJ may have improperly required plaintiff to show objective medical evidence of the pain itself,? which is particularly inappropriate in a fibromyalgia case, where symptoms are subjective and there are no laboratory or radiographic tests. Id. at 342. The court noted that the ALJ pointed to x-rays and an MRI as inconsistent with the claimant?s pain, yet ?unremarkable MRI and x-ray results do not support the ALJ?s conclusion that plaintiff?s alleged pain is inconsistent with the objective medical evidence.? Id.
[Fibromyalgia?s] cause or causes are unknown, there is no cure, and, of greatest importance to disability law, its symptoms are entirely subjective. There are no laboratory tests for the presence or severity of fibromyalgia. The principal symptoms are ?pain all over,? fatigue, disturbed sleep, stiffness, and ? the only symptom that discriminates between it and other diseases of a rheumatic character ? multiple tender spots, more precisely 18 fixed locations on the body (and the rule of thumb is that the patient must have at least 11 of them to be diagnosed as having fibromyalgia) that when pressed firmly cause the patient to flinch. All these symptoms are easy to fake, although few applicants for disability benefits may yet be aware of the specific locations that if palpated will cause the patient who really has fibromyalgia to flinch. There is no serious doubt that [the claimant] is afflicted with the disease but it is difficult to determine the severity of her condition because of the unavailability of objective clinical tests. Some people may have such a severe case of fibromyalgia as to be totally disabled from working, Michael Doherty & Adrian Jones, Fibromyalgia Syndrome (ABC of Rheumatology), 310 British Med. J. 386 (1995); Preston v. Secretary of Health & Human Services, 854 F.2d 815, 818 (6th Cir. 1988) (per curiam), but most do not and the question is whether [the claimant] is one of the minority.
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 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.
A claimant who suffered from fibromyalgia appealed the district court?s decision remanding the case for further administrative proceedings instead of an immediate award of benefits.
Benecke v. Barnhart, 379 F.3d 587, 589 (9th Cir. 2004). The Ninth Circuit reversed and remanded to the district court with instructions to remand to the Commissioner for an award of benefits, finding that there were no outstanding issues that must be resolved and it was clear from the record that the claimant was entitled to benefits. Id. The Ninth Circuit found that the ALJ erred in discounting the opinions of the claimant?s treating physicians, relying on his disbelief of the claimant?s testimony regarding her symptoms as well as his misunderstanding of fibromyalgia, stating:
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.
3d 1208, 1211 (11th Cir. 2005), citing Stewart, 2000 U.S. App. LEXIS 33214, at *9, n. 4. The Eleventh Circuit further noted that in Stewart, it stated that a ?treating physician?s testimony can be particularly valuable in fibromyalgia cases, where objective evidence is often absent.? Id. at 1212, citing Stewart, 2000 U.S. App. LEXIS 33214 at *9. In Moore, the Eleventh Circuit distinguished Stewart, and held that the ?absence of laboratory evidence was not the basis for the ALJ?s own negative credibility determination? but, rather, relied on the inconsistencies between the claimant?s descriptions of her diverse daily activities and her claims of infirmity. Id. Since the ALJ provided a detailed factual basis for his credibility determination, which ?did not turn on the lack of objective evidence documenting fibromyalgia, Stewart is unavailing to Moore.?Id.