Opinion ID: 2975099
Heading Depth: 3
Heading Rank: 2

Heading: Rheumatoid Arthritis

Text: The ALJ also found that Rogers does not suffer from rheumatoid arthritis. Although significantly more of the administrative decision was addressed to the absence of rheumatoid arthritis than was dedicated to a discussion of fibromyalgia, we again conclude that the decision on this point lacked the critical analysis necessary to meet the substantial evidence standard. No fewer than four physicians, including three treating physicians, have diagnosed Rogers with rheumatoid arthritis. Drs. Stein and Evans based their diagnoses on a lab test showing an elevated sedimentation rate, a finding consistent with rheumatoid arthritis. Moreover, both doctors’ progress notes demonstrate a history of joint swelling and pain, as well as extensive use of medications. Dr. Rosenberg likewise diagnosed Rogers with rheumatoid arthritis and treated her with a series of steroid injections to assist with her pain. Finally, Dr. Oliver was the fourth physician to diagnose Rogers with rheumatoid arthritis. When the record as a whole is considered, the 4 The importance of a non-examining source having a complete medical snapshot when reviewing a claimant’s file was emphasized in a 1996 Ruling of the Social Security Administration: In appropriate circumstances, opinions from State agency medical and psychological consultants . . . may be entitled to greater weight than the opinions of treating or examining sources . . . if the State agency medical . . . consultant’s opinion is based on a review of a complete case record that includes a medical report from a specialist in the individual’s particular impairment which provides more detailed and comprehensive information than what was available to the individual’s treating source. Soc. Sec. Rul. 96-6p, 1996 WL 374180, at  (July 2, 1996), Policy Interpretation Ruling Titles II and XVI: Consideration of Administrative Findings of Fact by a State Agency Medical or Psychological Consultants and other Program Physicians and Psychologists at the Administrative Law Judge and Appeals Council Level of Administrative Review; Medical Equivalence. No. 05-4369 Rogers v. Comm’r of Soc. Sec. Page 10 evidence offered by the ALJ in support of his finding that Rogers does not have active rheumatoid arthritis is not substantial. Again, rather than deferring to the medical opinions of Rogers’ treating physicians, the ALJ relied upon the testimony of non-treating physician Dr. Leeb. He opined that “there were no definitive laboratory studies confirming a diagnosis of rheumatoid arthritis” and that the “rheumatoid factor was very questionable.” On appeal, the Commissioner points to Dr. Leeb’s testimony that the objective evidence, including the x-ray and sedimentation reports, in conjunction with the clinical tests, demonstrated normal findings; that at least one other physician observed normal ranges of motion; and that Rogers’ joint swelling was not consistent with rheumatoid arthritis. However, even if we were to assume arguendo that Dr. Leeb’s testimony casts a sufficiently doubtful shadow over the diagnoses of Rogers’ treating physicians, the ALJ failed to explain in any illuminating way why he elected to elevate the opinion of a single non-treating nonexamining orthopedic surgeon over four conflicting opinions, three of which belonged to Rogers’ treating physicians, one of whom is a rheumatologist. Because this explanation by the ALJ is lacking, his rejection of rheumatoid arthritis as a severe impairment does not meet the substantial evidence standard. C. The ALJ Failed to Properly Evaluate Rogers’ Credibility In evaluating Rogers’ subjective complaints, the ALJ determined that her testimony was not fully credible. Specifically, the ALJ was persuaded by the absence of objective medical evidence supporting her symptoms, Rogers’ own testimony regarding her daily activities, and testimony by Dr. Leeb that the best treatment for fibromyalgia patients is to exercise regularly. Whether the ALJ permissibly found Rogers’ complaints not credible depends not only upon the scope of his authority in making such credibility determinations, but also upon his evaluation of the evidence on which the determinations were made. In many disability cases, the cause of the disability is not necessarily the underlying condition itself, but rather the symptoms associated with the condition. 20 C.F.R. § 416.929; Wyatt v. Sec’y of Health & Human Servs., 974 F.2d 680, 686 (6th Cir. 1992) (noting that “this court has previously held that subjective complaints of pain may support a claim for disability”). Claims based upon fibromyalgia are of this type as the complaints of pain, stiffness, and fatigue associated with the condition are the source of the alleged disability. Where the symptoms and not the underlying condition form the basis of the disability claim, a two-part analysis is used in evaluating complaints of disabling pain. 20 C.F.R. § 416.929(a); Buxton v. Halter, 246 F.3d 762, 773 (6th Cir. 2001); Felisky v. Bowen, 35 F.3d 1027, 1038-39 (6th Cir. 1994). First, the ALJ will ask whether the there is an underlying medically determinable physical impairment that could reasonably be expected to produce the claimant’s symptoms. 20 C.F.R. § 416.929(a). Second, if the ALJ finds that such an impairment exists, then he must evaluate the intensity, persistence, and limiting effects of the symptoms on the individual’s ability to do basic work activities. Id. Relevant factors for the ALJ to consider in his evaluation of symptoms include the claimant’s daily activities; the location, duration, frequency, and intensity of symptoms; factors that precipitate and aggravate symptoms; the type, dosage, effectiveness, and side effects of any medication taken to alleviate the symptoms; other treatment undertaken to relieve symptoms; other measures taken to relieve symptoms, such as lying on one’s back; and any other factors bearing on the limitations of the claimant to perform basic functions. Id.; see also Soc. Sec. Rul. 96-7p, 1996 WL 374186, at -3 (July 2, 1996) (Policy Interpretation Ruling Titles II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual’s Statements). It is of course for the ALJ, and not the reviewing court, to evaluate the credibility of witnesses, including that of the claimant. Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 531 (6th No. 05-4369 Rogers v. Comm’r of Soc. Sec. Page 11 Cir. 1997); Crum v. Sullivan, 921 F.2d 642, 644 (6th Cir. 1990); Kirk v. Sec’y of Health & Human Servs., 667 F.2d 524, 538 (6th Cir. 1981). However, the ALJ is not free to make credibility determinations based solely upon an “intangible or intuitive notion about an individual’s credibility.” Soc. Sec. Rul. 96-7p, 1996 WL 374186, at  4. Rather, such determinations must find support in the record. Whenever a claimant’s complaints regarding symptoms, or their intensity and persistence, are not supported by objective medical evidence, the ALJ must make a determination of the credibility of the claimant in connection with his or her complaints “based on a consideration of the entire case record.” The entire case record includes any medical signs and lab findings, the claimant’s own complaints of symptoms, any information provided by the treating physicians and others, as well as any other relevant evidence contained in the record. Consistency of the various pieces of information contained in the record should be scrutinized. Consistency between a claimant’s symptom complaints and the other evidence in the record tends to support the credibility of the claimant, while inconsistency, although not necessarily defeating, should have the opposite effect. Social Security Ruling 96-7p also requires the ALJ explain his credibility determinations in his decision such that it “must be sufficiently specific to make clear to the individual and to any subsequent reviewers the weight the adjudicator gave to the individual’s statements and the reasons for that weight.”5 In other words, blanket assertions that the claimant is not believable will not pass muster, nor will explanations as to credibility which are not consistent with the entire record and the weight of the relevant evidence. And given the nature of fibromyalgia, where subjective pain complaints play an important role in the diagnosis and treatment of the condition, providing justification for discounting a claimant’s statements is particularly important. Hurst v. Sec’y of Health & Human Servs., 753 F.2d 517, 519 (6th Cir. 1985). In the present case, the ALJ’s consideration of Rogers’ subjective pain complaints and assessment of her credibility do not comport with the Administration’s requirements. The ALJ provides three reasons for his finding that Rogers’ complaints and alleged limitations are not credible. First, he points out the lack of “objective” medical evidence and that she exhibited “normal reflexes” and “normal sensory testing.” But as previously discussed, the nature of fibromyalgia itself renders such a brief analysis and over-emphasis upon objective findings inappropriate. See Canfield v. Comm’r of Soc. Sec., No. CIV.A.01-CV-73472-DT, 2002 WL 31235758, at  (E.D. Mich. Sept. 13, 2002) (it would be “nonsensical to discount a fibromyalgia claimant’s subjective complaints of pain based upon lack of objective medical evidence, as such evidence is generally lacking with fibromyalgia patients”). By focusing on purely objective evidence, the ALJ failed to discuss or consider the lengthy and frequent course of medical treatment or the nature and extent of that treatment, the numerous medications Rogers has been prescribed, the reasons for which they were prescribed, or the side effects Rogers testified she experiences from those medications. Second, the ALJ emphasized that Rogers is “fairly active” by noting that she is still able to drive, clean her apartment, care for two dogs, do laundry, read, do stretching exercises, and watch the news, “[d]espite her numerous complaints.” Yet these somewhat minimal daily functions are 5 The requirement that the Commissioner fully explain his determinations of the claimant’s credibility is grounded, at least in part, upon the need for clarity in later proceedings. In Hurst v. Sec’y of Health & Human Servs., a panel of this Court noted: In the absence of an explicit and reasoned rejection of an entire line of evidence, the remaining evidence is “substantial” only when considered in isolation. It is more than merely “helpful” for the ALJ to articulate reasons . . . for crediting or rejecting particular sources of evidence. It is absolutely essential for meaningful appellate review. 753 F.2d 517, 519 (6th Cir. 1985) (quoting Zblewski v. Schweiker, 732 F.2d 75, 78 (7th Cir. 1984)). No. 05-4369 Rogers v. Comm’r of Soc. Sec. Page 12 not comparable to typical work activities.6 Moreover, the ALJ’s description not only mischaracterizes Rogers’ testimony regarding the scope of her daily activities, but also fails to examine the physical effects coextensive with their performance. Specifically, Rogers indicated that she does very little driving due to her inability to sit for longer than a few minutes; that she engages in light housekeeping only; that the extent of her care for her dog includes opening the door to let him out in the morning; that she likes to read but has difficulty holding a book; that fixing meals usually means a sandwich or cereal; and that buttoning her shirt is difficult due to the numbness in her fingers. The ALJ likewise failed to note or comment upon the fact that Rogers receives assistance for many everyday activities and even personal care from her children, who live close by. Finally, in discrediting Rogers’ testimony, the ALJ placed significance upon Dr. Leeb’s testimony that the best treatment for fibromyalgia is regular exercise, including walking and stretching. Of course, the fact that a patient is encouraged to remain active does not reflect the manner in which such activities may aggravate the patient’s symptoms. Notably, Rogers’ own treating physicians also recommended that she remain as active as possible, yet this did not alter their opinions as to her functional limitations and work restrictions. In sum, while credibility determinations regarding subjective complaints rest with the ALJ, those determinations must be reasonable and supported by substantial evidence. The decision in this case fails to “contain specific reasons for the finding on credibility, supported by the evidence in the case record,” nor is it “sufficiently specific to make clear to the individual and to any subsequent reviews the weight the adjudicator gave to [Rogers’] statements and the reasons for that weight.” SSR 96-7p, 1996 WL 374186, at ; see also Tuohy v. Sec’y of Health & Human Servs., 34 F.3d 1068, 1994 WL 454880, at  & n.4 (6th Cir. 1994) (unpublished table decision) (noting Commissioner erred where there was little if any evidence contradicting treating physicians’ opinions, other than Commissioner’s personal opinion); McBryde v. Sec’y of Health & Human Servs., 958 F.2d 371, 1992 WL 56755, at  (6th Cir. 1992) (unpublished table decision) (“While the Commissioner is best placed to determine matters of credibility, the Commissioner may not arbitrarily reject the testimony of the scientific experts in the case on the ground that his own personal opinion leads to a contrary result.”).