Opinion ID: 168760
Heading Depth: 4
Heading Rank: 3

Heading: Dr. Bow man’s E valuation of Fibromyalgia

Text: M s. M eraou takes issue with Dr. Bowman’s evaluation of her fibromyalgia. She argues that the evidence that she produced concerning this condition was sufficient to establish disability. She specifically criticizes Dr. Bowman for requiring objective evidence of a condition which, by its very nature, can be established only by the report of a patient’s subjective symptoms. See Welch v. U NU M Life Ins. C o. of Am ., 382 F.3d 1078, 1087 (10th Cir. 2004) (fibromyalgia presents conundrum for insurers and courts because no objective test exists for proving the disease, its cause or causes are unknown, and its symptoms are entirely subjective). Fibromyalgia is a disorder “‘characterized by achy pain, tenderness and stiffness of muscles, areas of tendon insertions and adjacent soft-tissue structures.’” Gilbertson v. Allied Signal, Inc., 328 F.3d 625, 627 n.1 (10th Cir. -17- 2003) (quoting The M erck Manual 481 (17th ed. 1999)). The condition can be diagnosed more or less objectively by examining for pain 18 trigger points on the body. See Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 919 (7th Cir. 2003). Dr. W elden’s notes indicate that M s. M eraou experienced pain at 18 out of 18 of these trigger points. Dr. Bowman acknowledged the diagnosis of fibromyalgia, but rejected the assertion that it was of disabling severity, stating that M s. M eraou “is noted to have fatigue and pain secondary to fibromyalgia. These are both subjective symptoms. The presence of trigger points [alone] w ould not constitute a disability.” A plt. Supp. App., Vol. I, at 237. M s. M eraou argues that Dr. Bowman’s comments do not provide a convincing rationale for concluding that her fibromyalgia was not disabling. She contends that disability cannot be rejected simply because fibromyalgia involves only subjective symptoms. If this were true, fibromyalgia could never be disabling, a proposition that courts have rejected. See Hawkins, 326 F.3d at 919. She also argues that trigger points are indicators of the underlying disease process that are used as a diagnostic tool, and that Dr. Bowman’s comment that their mere existence does not constitute a disability is therefore irrelevant and incorrect. W e note, however, that the Committee did not expressly adopt Dr. Bowman’s reasoning. It indicated instead that it could not credit M s. M eraou’s allegations concerning fibromyalgia without more comprehensive -18- evidence concerning her recent medical condition, which M s. M eraou failed to supply. Although acknowledging the diagnosis of fibromyalgia, it stated that as a general matter “there is no documentation within the last year of comprehensive musculoskeletal, joint, or neurologic examinations to support a significant functional impairment that would preclude you from working.” Aplt. Supp. App., Vol. I, at 256. In view of this deficiency, M s. M eraou was advised to submit medical data to support her appeal, including, but not limited to, a “Comprehensive Rheumatology evaluation.” Id. As we have noted, she submitted some additional information, after much delay, but not a comprehensive examination by a rheumatologist. Denial of benefits is permissible when the allegedly disabling condition has been established only by the claimant’s subjective complaints, and the claimant has failed to supply requested information that would allow the administrator to determine the ongoing effect of the condition. See Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 877 (9th Cir. 2004). In the case of a disease such as fibromyalgia, the claimant’s subjective, uncorroborated complaints of pain constitute the only evidence of the ailment’s severity. The medical inquiry is therefore intertwined with questions of the claimant’s credibility, which are the province of the Plan administrator. See id. at 878 (“W ith a condition such as fibromyalgia, where the applicant’s physicians depend entirely on the patient’s pain reports for their diagnoses, their ipse dixit -19- cannot be unchallengeable. That would shift the discretion from the administrator, as the plan requires, to the physicians chosen by the applicant, who depend for their diagnoses on the applicant’s reports to them of pain.”). M s. M eraou fails to show that the Committee’s decision, based on her failure to submit recent, comprehensive medical evidence sufficient to establish the disabling nature of her fibromyalgia, was arbitrary and capricious. W e therefore reject her challenge to this aspect of the Committee’s decision.