Opinion ID: 715825
Heading Depth: 3
Heading Rank: 1

Heading: The ALJ Improperly Rejected Certain Evidence

Text: 25 Smolen presented extensive testimony about her fatigue and pain and the effect those symptoms had on her ability to function during the relevant period. However, the ALJ rejected her testimony on the grounds that her complaints regarding incapacitating fatigue ... and severe back pain were [n]ot supported by contemporaneous medical evidence and were not credible. 26 In deciding whether to accept a claimant's subjective symptom testimony, an ALJ must perform two stages of analysis: the Cotton analysis and an analysis of the credibility of the claimant's testimony regarding the severity of her symptoms. 1 The Cotton analysis is a threshold test that we set out in Cotton v. Bowen, 799 F.2d 1403 (9th Cir.1986), and reaffirmed in Bunnell v. Sullivan, 947 F.2d 341 (9th Cir.1991) (en banc); see also Orteza v. Shalala, 50 F.3d 748, 749-50 (9th Cir.1994) (applying Cotton standard to disability determination based on pain and fatigue); Swenson v. Sullivan, 876 F.2d 683, 687 (9th Cir.1989) (rules developed to assure proper consideration of excess pain apply equally to other symptoms). If the claimant produces evidence to meet the Cotton test and there is no evidence of malingering, the ALJ can reject the claimant's testimony about the severity of her symptoms only by offering specific, clear and convincing reasons for doing so. See Dodrill v. Shalala, 12 F.3d 915, 918 (9th Cir.1993). 27 a) The Cotton Test. 28 1) Applicable standards. 29 Under the Cotton test, a claimant who alleges disability based on subjective symptoms must produce objective medical evidence of an underlying impairment 'which could reasonably be expected to produce the pain or other symptoms alleged....'  Bunnell, 947 F.2d at 344 (quoting 42 U.S.C. § 423(d)(5)(A) (1988)); Cotton, 799 F.2d at 1407-08. The Cotton test imposes only two requirements on the claimant: (1) she must produce objective medical evidence of an impairment or impairments; and (2) she must show that the impairment or combination of impairments could reasonably be expected to (not that it did in fact) produce some degree of symptom. 30 The claimant need not produce objective medical evidence of the pain or fatigue itself, or the severity thereof. Bunnell, 947 F.2d at 347-48. Nor must the claimant produce objective medical evidence of the causal relationship between the medically determinable impairment and the symptom. Id. at 345. By requiring that the medical impairment could reasonably be expected to produce pain or another symptom, the Cotton test requires only that the causal relationship be a reasonable inference, not a medically proven phenomenon. See Howard v. Heckler, 782 F.2d 1484, 1488 (9th Cir.1986) ([W]e have never required that the medical evidence identify an impairment that would make the pain inevitable.). 31 Finally, the claimant need not show that her impairment could reasonably be expected to cause the severity of the symptom she has alleged; she need only show that it could reasonably have caused some degree of the symptom. Orteza, 50 F.3d at 749-50; Fair v. Bowen, 885 F.2d 597, 601 (9th Cir.1989). This approach reflects the highly subjective and idiosyncratic nature of pain and other such symptoms. See, e.g., Cotton, 799 F.2d at 1407; Fair v. Bowen, 885 F.2d at 601. The amount of pain caused by a given physical impairment can vary greatly from individual to individual. Fair, 885 F.2d at 601. This is also true for fatigue. Thus, the ALJ may not reject subjective symptom testimony under the Cotton analysis simply because there is no showing that the impairment can reasonably produce the degree of symptom alleged. 2 32 2) Evidence of underlying impairments. 33 Smolen produced uncontradicted objective medical evidence of the following physical impairments existing during the relevant period: (1) loss of one kidney; (2) loss of part of her left lung; (3) mild anemia; (4) suppression of her bone marrow production (as evidenced by anemia); (5) changes in her left lung tissue; and (6) spinal scoliosis. 34 The ALJ limited his review of the medical records to a search for anemia, scoliosis, back pain, and fatigue. Without explanation, he ignored medical evidence of Smolen's other impairments and thereby erred. See, e.g., Cotton, 799 F.2d at 1408-09 (legal error where ALJ's findings completely ignore medical evidence without giving specific, legitimate reasons for doing so). The ALJ also erred by rejecting Smolen's symptom testimony on the ground that her medical charts did not document prior statements corroborating her fatigue and pain; such evidence is not required to satisfy the Cotton test. 35 In addition, the ALJ failed to find Smolen anemic during the relevant period, even though substantial and undisputed evidence supported such a finding. Smolen produced hemoglobin levels demonstrating that she was anemic in 1967 and 1968, after her childhood cancer treatment, and that she was still anemic in 1987, prior to her adult chemotherapy, and thereafter. The fact that Smolen could not produce hemoglobin levels for the interim period does not support the ALJ's failure to find Smolen anemic. Once Smolen produced hemoglobin levels to prove she was anemic in early 1987, SSR 83-20 required the ALJ to consider other evidence to infer the onset date of the anemia. Three physicians, including the ALJ's expert whose testimony the ALJ credited, testified without contradiction that the hemoglobin levels Smolen produced indicated that she likely suffered anemia throughout the period from 1968 to 1987 and thereafter. 36 3) Causal relationship between impairments and symptoms. 37 Smolen offered uncontroverted medical opinions establishing that her medical impairments could reasonably be expected to have caused fatigue and pain. 3 Dr. Harry Smolen stated that Smolen's fatigue could reasonably have resulted from her childhood cancer treatment which, he explained, caused the combination of impairments from which Smolen suffered. 4 Dr. Bert Hoeflich stated that Smolen's fatigue could reasonably have been caused by her childhood chemotherapy and radiation treatment. Finally, although Dr. Winston Maxwell testified that mild anemia by itself, in an otherwise well  person, would not have caused disabling fatigue, (emphasis added), he also indicated that mild anemia by itself would cause some degree of fatigue 5 and that all of Smolen's conditions combined could have been disabling. More specifically, Dr. Maxwell concluded that a perfectly good hypothesis is that everything Smolen went through related to her childhood cancer--including horrendous illness, two major surgeries, chemotherapy and x-ray therapy--impaired her ability to function. 38 Although the evidence showed that Smolen's impairments could reasonably have caused her symptoms, as required by Cotton, the ALJ failed to take into account all the evidence and misapplied the Cotton test. First, the ALJ focused his questioning of Dr. Maxwell on whether mild anemia by itself, in an otherwise well person, would have caused the fatigue about which Smolen complained. However, Smolen did not have mild anemia alone and she was not an otherwise well person. The ALJ ignored the objective medical evidence of Smolen's other impairments and failed to develop the record, as he was required to do, by asking Dr. Maxwell whether the combination of those impairments could reasonably have caused fatigue. See Brown v. Heckler, 713 F.2d 441, 443 (9th Cir.1983) (ALJ has special duty to fully and fairly develop record). 39 Second, the ALJ focused on whether Smolen's impairments could have caused the severity of fatigue Smolen alleged; however, Smolen only had to prove that her impairments could reasonably have caused some degree of fatigue. See Fair, 885 F.2d at 601. As noted above, Dr. Maxwell testified that mild anemia alone would have caused some level of fatigue, just not the degree Smolen alleged. See supra p. 1283. Under the Cotton test, no more was required. See supra pp. 1281-82. 40 Finally, the ALJ erroneously focused on whether the causal relationship was medically determinable through scientific studies, instead of whether it was reasonable to expect such a relationship. See Bunnell, 947 F.2d at 344-45 (test is whether impairment could reasonably be expected to have caused the subjective symptom); Howard, 782 F.2d at 1488 ([W]e have never required that the medical evidence identify an impairment that would make the pain inevitable.). 41 The opinions of these physicians were sufficient to establish that the combination of impairments from which Smolen suffered during this period could reasonably have caused her fatigue and pain, thus satisfying the Cotton test. 42 b) Credibility Analysis. 43 Once a claimant meets the Cotton test and there is no affirmative evidence suggesting she is malingering, 6 the ALJ may reject the claimant's testimony regarding the severity of her symptoms only if he makes specific findings stating clear and convincing reasons for doing so. Dodrill, 12 F.3d at 918. The ALJ must state specifically which symptom testimony is not credible and what facts in the record lead to that conclusion. Id. 44 To determine whether the claimant's testimony regarding the severity of her symptoms is credible, the ALJ may consider, for example: (1) ordinary techniques of credibility evaluation, such as the claimant's reputation for lying, prior inconsistent statements concerning the symptoms, and other testimony by the claimant that appears less than candid; (2) unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment; and (3) the claimant's daily activities. 7 See, e.g., Fair, 885 F.2d at 602-04; Orteza, 50 F.3d at 750; Bunnell, 947 F.2d at 346-47. In evaluating the credibility of the symptom testimony, the ALJ must also consider the factors set out in SSR 88-13. See Bunnell, 947 F.2d at 346. Those factors include the claimant's work record and observations of treating and examining physicians and other third parties regarding, among other matters, the nature, onset, duration, and frequency of the claimant's symptom; precipitating and aggravating factors; functional restrictions caused by the symptoms; and the claimant's daily activities. See SSR 88-13. 8 45 According to the ALJ's ultimate findings, he rejected Smolen's complaints of severe fatigue and severe back pain because they were not credible and were not supported by contemporaneous medical evidence. The ALJ also made the following subsidiary findings: (1) that Smolen's daily activities were quite limited; (2) that, although Smolen graduated from high school and earned a college certificate, those activities could be compatible with her symptoms; (3) that Smolen was not taking pain medication; and (4) that contemporaneous medical records contradict severe back pain or dysfunction or severe anemia-based fatigue. 46 The first of these subsidiary findings supports a finding that Smolen's testimony was credible. The second is not persuasive in either direction. 47 As to the third, Smolen presented testimony at the hearing that she had not sought treatment (and therefore was not taking medication) for her chronic fatigue and pain because, as a result of not being able to maintain a job, she had no insurance and could not afford treatment. Where a claimant provides evidence of a good reason for not taking medication for her symptoms, her symptom testimony cannot be rejected for not doing so. See Bunnell, 947 F.2d at 346; Fair, 885 F.2d at 602. Thus, the fact that Smolen was not taking medication is not a clear and convincing reason for discrediting her symptom testimony. 48 As to the fourth, although Smolen's sparse medical records during the relevant period do not contain prior consistent statements to corroborate Smolen's claims of pain and fatigue, nothing in them appears to contradict Smolen's statements, and the ALJ made no finding identifying a contradiction. 49 Furthermore, in evaluating a claimant's subjective complaints of pain [or other symptoms], the adjudicator must give full consideration to all of the available evidence, medical and other, that reflects on the impairment and any attendant limitations of function. SSR 88-13 (emphasis added). Such other evidence includes the claimant's prior work record, her daily activities, and observations by treating and examining physicians and third parties about the claimant's symptoms and their effects. See SSR 88-13, quoted in part at supra p. 1284 n. 8. Here, Smolen offered substantial other evidence to corroborate her subjective symptom testimony, including her work history; lay testimony from family members regarding her daily activities at home and her ability to function at school; observations of her high school guidance counselor regarding her energy level in school; and opinions and observations from treating and examining physicians. 9 Given this substantial corroborating evidence, the fact that Smolen's few available medical records do not document prior consistent statements regarding her symptoms does not constitute a clear and convincing reason to reject her symptom testimony. 50 In conclusion, having failed to find clear and convincing reasons for rejecting Smolen's subjective symptom testimony, the ALJ erred in doing so. 51
52 Because treating physicians are employed to cure and thus have a greater opportunity to know and observe the patient as an individual, their opinions are given greater weight than the opinions of other physicians. Rodriguez v. Bowen, 876 F.2d 759, 761-62 (9th Cir.1989); Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir.1987). Therefore, an ALJ may not reject treating physicians' opinions unless he makes findings setting forth specific, legitimate reasons for doing so that are based on substantial evidence in the record. Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir.1989) (quoting Winans v. Bowen, 853 F.2d 643, 647 (9th Cir.1987)). In addition, if the treating physicians' opinions are uncontroverted, those reasons must be clear and convincing. Rodriguez, 876 F.2d at 761-62. Similarly, the opinions of a specialist about medical issues related to his or her area of specialization are given more weight than the opinions of a nonspecialist. See 20 C.F.R. § 404.1527(d)(5). See also Bunnell v. Sullivan, 912 F.2d 1149, 1153 (9th Cir.1990), aff'd on reh'g, 947 F.2d 341 (9th Cir.1991) (en banc). 53 Smolen produced the opinions of four physicians--Drs. Smolen, Hoeflich, Bowen, and Morich--in support of her application for benefits. Here, we need only consider the ALJ's rejection of the opinions of two of those physicians--Dr. Hoeflich and Dr. Smolen. Dr. Hoeflich was Smolen's treating physician. Dr. Smolen was a specialist in the area of medicine that was most relevant to assessing Smolen's condition--physiatry; both Dr. Morich and Dr. Pesado, one of the ALJ's experts, stated that a physiatrist would be the most appropriate specialist to evaluate Smolen's condition and her residual functional capacity during the years in question. Dr. Smolen was the only physiatrist to give an opinion in this case. Therefore, both Dr. Hoeflich's and Dr. Smolen's opinions were entitled to greater weight than the opinions of Dr. Maxwell--a nontreating, nonexamining internist called by the ALJ. Rodriguez, 876 F.2d at 761-62 (opinions of treating physician given greater weight than nontreating physician); Bunnell, 912 F.2d at 1153 (opinions of specialist given greater weight than nonspecialist). See also Pitzer v. Sullivan, 908 F.2d 502 (9th Cir.1990) (conclusion of nonexamining physician entitled to less weight than conclusion of examining physician). 54 The opinions of both physicians were also uncontroverted. The ALJ appears to have treated Dr. Smolen's and Dr. Hoeflich's opinions as controverted by the testimony of Dr. Maxwell, especially regarding the cause of Smolen's fatigue and its effect on her ability to function. However, this treatment was erroneous. Dr. Smolen and Dr. Hoeflich opined that Smolen's fatigue could reasonably have resulted from Smolen's childhood radiation treatment and chemotherapy and that the fatigue and related conditions would have made it impossible for her to have sustained even sedentary work on a full-time basis beginning before November 1, 1982, and continuing thereafter. As previously noted, Dr. Maxwell, while ruling out mild anemia by itself  in an otherwise well  person as a cause of disabling fatigue, also testified that a perfectly good hypothesis is that everything Smolen went through related to her childhood cancer--including horrendous illness, two major surgeries, chemotherapy and x-ray therapy--impaired her ability to function. That testimony was consistent with Dr. Smolen's and Dr. Hoeflich's opinions. 55 In addition, the three physicians agreed that it was reasonable to infer from available lab reports that Smolen had anemia beginning before November 1, 1982, and continuing ever since. And, Dr. Smolen and Dr. Maxwell agreed that Smolen suffered from at least mild bone marrow suppression, which could possibly have caused her to be susceptible to viral infections. 56 Accordingly, the opinions of Drs. Smolen and Hoeflich were uncontroverted opinions entitled to great weight. Moreover, because Dr. Hoeflich's opinions were the uncontroverted opinions of a treating physician, the ALJ could reject those opinions only on the basis of specific, clear and convincing reasons, supported by substantial evidence. See supra p. 1285. With those principles in mind, we now examine the ALJ's rejection of Dr. Hoeflich's and Dr. Smolen's opinions. 57 In denying Smolen's application for disabled child's benefits, the ALJ discussed only the opinions Dr. Smolen and Dr. Hoeflich offered in response to four questions Smolen's counsel posed to them; he did not discuss the opinions Dr. Smolen and Dr. Hoeflich offered in other letters. By disregarding those opinions and making contrary findings, he effectively rejected them. His failure to offer reasons for doing so was legal error. 58 The ALJ also rejected the opinions he did discuss. Those opinions were offered in response to a letter in which Smolen's counsel summarized relevant evidence in the record and applicable legal standards and asked four questions. Dr. Hoeflich and Dr. Smolen both answered yes to each question and Dr. Smolen added explanations for his answers. The ALJ stated that those opinions were not entitled to much weight and ultimately rejected them entirely by making contrary findings. The ALJ offered the same reasons for rejecting both physicians opinions. 59 The first reason the ALJ gave for rejecting Dr. Smolen's and Dr. Hoeflich's responses was that they were based on a somewhat biased and incomplete summary of the evidence and therefore were themselves somewhat biased and incomplete. However, the summary prepared by counsel generally reflected the evidence in the record accurately. The summary was neither materially incomplete nor improperly inclusive. 60 Regarding incompleteness, the ALJ stated generally that the summary omitted facts from which contrary inferences could have been drawn. But he failed to explain what those inferences would have been and in what way they would have been contrary to the opinions the physicians offered. Upon review of the omitted facts about which the ALJ was concerned, it appears that each of those facts was either implicit in other facts set out in the summary of evidence or was immaterial to the questions or physicians' responses. We address each of these omitted facts. 61 First, the ALJ pointed out that the summary did not mention that Smolen graduated from high school in 1980. However, the summary did state that Smolen attended community college, which implies she graduated from high school. The ALJ also noted that the summary omitted that Smolen completed a course and was certified as a CNA [Certified Nurses' Aide]. However, the summary stated that Smolen worked two jobs as a CNA, which implies that she completed a course and was certified as a CNA. 62 Second, the ALJ stated that the summary omitted that Smolen graduated 170th out of 238 in her high school class. However, the summary gave complete information about Smolen's activities during the relevant period-including her attendance at community college starting in the Fall of 1982, her grade point average and attendance record in college, and detailed information regarding her work history from May 1982 through 1987. Nothing suggests that knowledge of Smolen's high school class rank would have changed the opinions Dr. Smolen and Dr. Hoeflich offered, especially given that the rank was low. 63 Third, the ALJ noted that the summary omitted the fact that Smolen had not been tested for anemia between 1982 and 1987 and possibly wrongly implied that she had been tested during that period, but that the records had been destroyed. However, the only information material to the questions asked was that there were no records showing Smolen's hemoglobin levels between 1968 and 1987; the summary accurately stated that fact. The reason for the gap in the records was immaterial. 64 Finally, the ALJ noted that the summary omitted the fact that there was a 16-year gap in Smolen's medical records 10 and included only selected medical records. Regarding the 16-year gap, the ALJ's main concern was that there were no medical records during that period documenting Smolen's complaints of disabling fatigue or her anemia. However, the physicians' responses did not address whether Smolen had in fact experienced the fatigue she alleged; if they had, a lack of medical records documenting complaints of fatigue might have been relevant. Moreover, the questions directed to the physicians regarding anemia were specifically premised on the gap in records documenting hemoglobin levels. Regarding the inclusion of only selected medical records, the ALJ failed to point to anything in the omitted records that might have led to different responses to any of the four questions and our examination of the records has disclosed nothing. 65 Other than omitted facts, the ALJ's only other specific concern related to bias was that the summary was a legal medical argument ... including even citations to Social Security Rulings and a discussion of the claimant's work history and quotations from portions of her doctor's opinions. However, Smolen's work history, the opinions of other physicians, and applicable legal standards were relevant to her claim and thus properly provided to the expert witnesses to enable them to fully understand the questions they were asked. 66 The second reason the ALJ gave for rejecting Dr. Smolen's and Dr. Hoeflich's opinions was that the questions to which they responded contained unsubstantiated assumptions. The ALJ cited only one example of an unsubstantiated assumption: that the claimant was so fatigued by anemia that she could not function during the relevant period. But Smolen's counsel did not ask Dr. Smolen and Dr. Hoeflich to assume that Smolen's fatigue resulted from anemia, or that Smolen's fatigue prevented her from functioning. Instead, he asked them to assume, for the purpose of question one, that Smolen suffered the fatigue she alleged and, for the purpose of question four, that she suffered that fatigue and other impairments related to her childhood cancer. These assumptions were fully substantiated. 11 67 The third reason the ALJ gave for rejecting Dr. Smolen's and Dr. Hoeflich's responses was that the questions were leading and called for only yes-or-no, check-the-box answers. However, the use of leading, hypothetical questions to elicit expert opinions is entirely appropriate. See Fed.R.Evid. 703, Notes of Advisory Committee on 1972 Proposed Rules. Moreover, the questions called not only for yes-or-no answers, but also for comments from the physicians in support of their answers. Dr. Smolen's responses were accompanied by comments explaining the reasons for each of his responses. Those comments do not reflect that they are based on assumptions derived from counsels summary or questions; on the contrary, they appear to be based on Dr. Smolen's knowledge of his sister's medical history and his experience in his specialty. 68 Dr. Hoeflich, on the other hand, did not provide comments to support his answers and did not testify at the hearing. Therefore, the ALJ did not know the basis for Dr. Hoeflich's opinions and thought that they might have been based on unwarranted assumptions. As a preliminary matter, we note that Dr. Hoeflich's responses are cumulative to Dr. Smolen's and not necessary to support Smolen's claim. However, the ALJ still could not reject those responses without clear and convincing reasons for doing so. 69 In Social Security cases the ALJ has a special duty to fully and fairly develop the record and to assure that the claimant's interests are considered. Brown v. Heckler, 713 F.2d 441, 443 (9th Cir.1983). This duty exists even when the claimant is represented by counsel. Id. If the ALJ thought he needed to know the basis of Dr. Hoeflich's opinions in order to evaluate them, he had a duty to conduct an appropriate inquiry, for example, by subpoenaing the physicians or submitting further questions to them. See 42 U.S.C. § 405(d)(1988); 20 C.F.R. § 404.950(d)(1991); 20 C.F.R. § 404.1527(c)(3). He could also have continued the hearing to augment the record. See 20 C.F.R. § 404.944 (1991). Having failed to fully develop the record regarding the basis for Dr. Hoeflich's opinions, the ALJ could not then reject those opinions--which were uncontroverted and corroborated--because they were given in response to leading, hypothetical questions. 70 In conclusion, we find that the reasons the ALJ gave for rejecting Dr. Smolen's testimony were not supported by substantial evidence in the record. Given that Dr. Smolen was an appropriate specialist who offered significant explanations for each of his opinions, we find that the ALJ's rejection of Dr. Smolen's testimony without substantiated grounds for doing so constituted legal error. In addition, we find that the ALJ rejected Dr. Hoeflich's opinions without clear and convincing reasons for doing so; therefore, such rejection constituted reversible error. See Cotton, 799 F.2d at 1408. 71
72 Disregard of the testimony of friends and family members violates 20 C.F.R. § 404.1513(e)(2)(1991). Sprague, 812 F.2d at 1232; Dodrill, 12 F.3d at 918. According to that regulation, the Commissioner will consider observations by nonmedical sources about how impairments affect a claimant's ability to work. See 20 C.F.R. § 404.1513(e)(2). More specifically, the Commissioner's Rulings require the ALJ to consider lay witness testimony in certain types of cases. SSR 88-13 states that where a claimant alleges pain or other symptoms that are not supported by medical evidence in the file, the adjudicator shall obtain detailed descriptions of daily activities by directing specific inquiries about the pain and its effects to ... third parties who would be likely to have such knowledge. SSR 88-13 (emphasis added). The ruling then requires the ALJ to give full consideration to such evidence. Id. Having been directed to consider the testimony of lay witnesses in determining a claimant's disability, the ALJ can reject the testimony of lay witnesses only if he gives reasons germane to each witness whose testimony he rejects. Dodrill, 12 F.3d at 919. 73 Here, Smolen's alleged disability is based on fatigue and pain. Her medical records are sparse and do not provide adequate documentation of those symptoms. Under SSR 88-13, the ALJ therefore had to consider the testimony of Smolen's family members, as lay witnesses, regarding her symptoms. Instead, he rejected that testimony. 74 The first reason the ALJ gave for doing so was that the testimony was from family witnesses who were therefore understandably advocates, and biased. This amounted to a wholesale dismissal of the testimony of all the witnesses as a group and therefore does not qualify as a reason germane to each individual who testified. Moreover, the same could be said of any family member who testified in any case. The fact that a lay witness is a family member cannot be a ground for rejecting his or her testimony. To the contrary, testimony from lay witnesses who see the claimant every day is of particular value, see Dodrill, 12 F.3d at 919 ([a]n eyewitness can often tell whether someone is suffering or merely malingering ... this is particularly true of witnesses who view the claimant on a daily basis ...); such lay witnesses will often be family members. 75 The second reason for rejecting the testimony of Smolen's family members was that medical records, including chart notes made at the time, are far more reliable and entitled to more weight than recent recollections made by family members and others, made with a view toward helping their sibling in pending litigation. Contrary to the testimony of Smolen's family members, the ALJ concluded that, because Smolen's medical records through 1987 did not reflect symptoms of fatigue and severe back pain, it was simply beyond belief that Smolen suffered such fatigue ... back pain and dysfunction during her 14-year gap between her two severe bouts of cancers.... The rejection of the testimony of Smolen's family members because Smolen's medical records did not corroborate her fatigue and pain violates SSR 88-13, which directs the ALJ to consider the testimony of lay witnesses where the claimant's alleged symptoms are unsupported by her medical records. See SSR 88-13 (where allegation [of subjective symptom] is not supported by objective medical evidence in the file, the adjudicator shall obtain detailed descriptions of daily activities by directing specific inquiries about the [symptom] and its effects to ... third parties who would be likely to have such knowledge.). 76 Thus, the ALJ erred in rejecting the testimony of Smolen's family members. 77