Court Opinion

ID: 9398231
Source: CourtListenerOpinion
Date Created: 2023-05-30 17:01:28.984646+00
Date Added: 2024-06-11T17:19:31.763441
License: Public Domain

NOT FOR PUBLICATION                           FILED
                    UNITED STATES COURT OF APPEALS                        MAY 30 2023
                                                                      MOLLY C. DWYER, CLERK
                                                                       U.S. COURT OF APPEALS
                           FOR THE NINTH CIRCUIT

NICHOLE KLINGENBERG,                            No.    22-35423

                Plaintiff-Appellant,            D.C. No. 2:20-cv-00282-JAG

 v.
                                                MEMORANDUM*
KILOLO KIJAKAZI, Acting Commissioner
of Social Security,

                Defendant-Appellee.

                   Appeal from the United States District Court
                      for the Eastern District of Washington
                   James A. Goeke, Magistrate Judge, Presiding

                       Argued and Submitted May 10, 2023
                              Seattle, Washington

Before: HAWKINS, W. FLETCHER, and IKUTA, Circuit Judges.

      Appellant Nichole Klingenberg (“Klingenberg”) appeals the district court’s

decision affirming the Commissioner of Social Security’s (“Commissioner”)

decision denying her social security disability benefits.         She contends the

Administrative Law Judge (“ALJ”) erred in rejecting the opinion of doctors who

      *
             This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
diagnosed her with fibromyalgia and severe mental impairments. We agree in part

and remand for further proceedings.

      We may set aside the final decision of the ALJ denying a claim for disability

benefits when the findings are based on legal error or not supported by substantial

evidence. Martinez v. Heckler, 807 F.2d 771, 772 (9th Cir. 1986). “Substantial

evidence is more than a mere scintilla but less than a preponderance; it is such

relevant evidence as a reasonable mind might accept as adequate to support a

conclusion.” Gutierrez v. Comm’r, 740 F.3d 519, 522‒23 (9th Cir. 2014) (internal

quotation marks and citation omitted).

      We conclude the ALJ erred at Step Two by rejecting Dr. Byrd’s fibromyalgia

diagnosis. In evaluating medical opinions, the ALJ is required to consider multiple

factors, including supportability and consistency, as well as the doctor’s

relationship with claimant and specialization. 20 C.F.R. § 416.920c(c); see

generally Woods v. Kijakazi, 32 F.4th 785 (9th Cir. 2022). The ALJ described the

record evidence regarding Klingenberg’s diagnosis as follows:

      The claimant testified to fibromyalgia-related pain. She describes
      fibromyalgia as pain in her hip or cramps in her legs. She has flares
      when she cannot sleep through the night.
      • September 2017 medical records references a “possible” diagnosis
          of fibromyalgia versus premenstrual dysphoric disorder.
      • On exam in January 2019, the claimant had greater than 11 tender
          points on exam but no overt evidence of active synovitis. She had
          normal range of motion with handgrip, wrist, elbow, shoulder, hip,
          and knee. James Byrd, MD diagnosed polyarthralgia.

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      • In April 2019, Dr. Byrd indicated that her presentation was
        consistent with fibromyalgia. However, [] she had negative lab
        workup except for low vitamin D.

The ALJ then summarily concluded:

      It does not appear that the claimant meets the criteria for fibromyalgia
      set forth in SSR 12-2p. However, even if established fibromyalgia and
      or polyarthralgia does not meet the 12-month durational requirement.

      This explanation is insufficient and conclusory. See Woods, 32 F.4th at 792

(“Even under the new regulations, an ALJ cannot reject an examining or treating

doctor’s opinion as unsupported or inconsistent without providing an explanation

supported by substantial evidence.”).      The ALJ does not elaborate why he

concluded Klingenberg does not meet the criteria set forth in SSR 12-2p.1 The few

1
 As we explained in Revels v. Berryhill:
      The ruling provides two sets of criteria for diagnosing [fibromyalgia],
      based on the 1990 American College of Rheumatology Criteria for the
      Classification of Fibromyalgia and the 2010 American College of
      Rheumatology Preliminary Diagnostic Criteria. Pursuant to the first
      set of criteria, a person suffers from fibromyalgia if: (1) she has
      widespread pain that has lasted at least three months (although the pain
      may “fluctuate in intensity and may not always be present”); (2) she
      has tenderness in at least eleven of eighteen specified points on her
      body; and (3) there is evidence that other disorders are not accounting
      for the pain. Pursuant to the second set of criteria, a person suffers
      from fibromyalgia if: (1) she has widespread pain that has lasted at
      least three months (although the pain may “fluctuate in intensity and
      may not always be present”); (2) she has experienced repeated
      manifestations of six or more fibromyalgia symptoms, signs, or co-
      occurring conditions, “especially manifestations of fatigue, cognitive
      or memory problems (“fibro fog”), waking unrefreshed, depression,

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comments made prior to this conclusion—a lack of active synovitis, normal range

of motion on exam, or “negative lab workup”—are not inconsistent with a

fibromyalgia diagnosis, whereas the eleven positive tender points, pain flare ups

that prevent sleep, and ruling out other disorders through lab work are entirely

consistent with fibromyalgia. See Revels v. Berryhill, 874 F.3d 648, 656‒57 (9th

Cir. 2017). Although an ALJ can discount fibromyalgia symptoms due to an

inconsistency with a claimant’s daily activities, id. at 667, here he erred in doing so

because “moving as much as 100 pounds on at least one occasion and regularly

walking 1-2 miles” were not inconsistent with limitations caused by fibromyalgia.

Id. at 657 (“SSR 12-2p recognizes that the symptoms of fibromyalgia ‘wax and

wane,’ and that a person may have ‘bad days and good days.’” (citation omitted)).

      Nor does substantial evidence support the ALJ’s conclusion, again without

explanation, that “even if established” this diagnosis would not meet the 12-month

durational requirement.      In April 2019, Dr. Byrd specifically opined that

Klingenberg had suffered from fibromyalgia since at least August 2016. “[M]edical

reports are inevitably rendered retrospectively and should not be disregarded solely

on that basis.” Smith v. Bowen, 849 F.2d 1222, 1225 (9th Cir. 1988).

      anxiety disorder, or irritable bowel syndrome”; and (3) there is
      evidence that other disorders are not accounting for the pain.

874 F.3d 648, 656‒57 (9th Cir. 2017) (internal citations omitted).

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      Although the Commissioner advances various theories in its brief to support

discounting Dr. Byrd’s diagnosis, we are constrained to review the reasons actually

asserted by the ALJ in its decision. Connett v. Barnhart, 340 F.3d 871, 874 (9th

Cir. 2003). As the questions posed to the vocational expert may not have included

all of Klingenberg’s limitations from this diagnosis, we remand for the ALJ to re-

evaluate Klingenberg’s residual functional capacity, construing the medical

evidence “in light of fibromyalgia’s unique symptoms and diagnostic methods, as

described in SSR 12-2P.” Revels, 874 F.3d at 662.

      However, substantial evidence supports the ALJ’s determination that

Klingenberg’s mental health issues were not severe impairments. The ALJ gave

sufficient reasons for finding the opinion of Dr. Genthe unpersuasive, including that

Dr. Genthe examined Klingenberg only one time, did not review any records

pertaining to her mental health history, and relied almost exclusively on her self-

reporting, which even he noted suggested “an exaggeration of certain problems.”

See Bayliss v. Barnhart, 427 F.3d 1211, 1217 (9th Cir. 2005). Dr. Genthe’s

conclusions were not supported by objective indications and also not consistent

with other reports in the record, which suggested her depression was mild and

adequately controlled with medication. See Tonapetyan v. Halter, 242 F.3d 1144,

1149 (9th Cir. 2001).

      We remand for further proceedings consistent with this disposition.

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       AFFIRMED IN PART, REVERSED IN PART, REMANDED.

Each party shall bear their own costs on appeal.

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