Fibromyalgia and Social Security Disability
The condition of fibromyalgia has received increasing attention in recent Social Security disability court decisions. The cases generally require the ALJ to evaluate carefully the effect of medically-documented fibromyalgia on a claimant’s ability to work. The following summary of cases includes only those cases where the issue of fibromyalgia was central to the court’s decision. Cases where the ALJ properly evaluated the claimant’s fibromyalgia condition or properly obtained vocational expert testimony as to the claimant’s residual functional capacity are not included in the summary. Detailed excerpts from several of the referenced cases are provided for the reader’s convenience and to facilitate understanding of the disabling nature of this disease.
Rulings
Social Security Ruling 99-2p
SSR 99-2p, pertaining to Chronic Fatigue Syndrome (“CFS”), recognizes the “considerable overlap” between the symptoms present in CFS and fibromyalgia. It explains that individuals with CFS who have tender points have a medically determinable impairment, and that claimants with impairments that fulfill the American College of Rheumatology criteria for Fibromyalgia (which includes a minimum number of tender points) may also fulfill the criteria for CFS. However, SSR 99-2p explains, even in cases where the claimant does not have the tender points sufficient to establish fibromyalgia, they will still be found to have a medically determinable impairment. Thus, in SSR 99-2p, SSA has clarified that fibromyalgia which is documented by tender points, as exists here, indeed, is a medically determinable impairment as defined in the regulations.
Social Security Ruling 96-3p
SSR 96-3p provides that symptoms, such as pain, fatigue, shortness of breath, weakness or nervousness, will not be found to affect an individual’s ability to do basic work activities unless the individual first establishes by objective medical evidence (i.e., signs and laboratory findings) that he or she has a medically determinable physical or mental impairment and that the impairment could reasonably be expected to produce the alleged symptoms.
Social Security Ruling 96-7p
In evaluating pain, the ALJ must evaluate whether an underlying medically determinable physical or mental impairment could reasonably be expected to produce the individual’s pain or other symptoms. If there is no medically determinable physical or mental impairment, or if there is a medically determinable physical or mental impairment but the impairment could not reasonably be expected to produce the individual’s pain or other symptoms, the symptoms cannot be found to affect the individual’s ability to do basic work activities.
Case Law
First Circuit
The district court held that because the ALJ did not consider the potentially debilitating effects of fibromyalgia, he did not have before him all of the necessary evidence to fully and fairly evaluate whether the claimant was disabled. Weiler v. Shalala, 922 F. Supp. 689, 698 (D. Mass. 1996). Fibromyalgia has been recognized by the courts as being potentially disabling. Id.at n. 11.
In Lacroix, the claimant argued that the ALJ failed to properly credit her primary treating physician’s diagnosis of fibromyalgia because the ALJ focused on objective medical tests, which was inappropriate, because there are no objective medical tests for fibromyalgia. Lacroix v. Barnhart, 352 F. Supp.2d 100, 113 (D. Mass. 2005). The court declined to “go into detail regarding this argument,” accepting the Commissioner’s argument that the ALJ acknowledged that the claimant had fibromyalgia which was a “severe” impairment and considered this impairment to be the primary cause of the functional limitations that confined her to sedentary work. Id.
Second Circuit
In Green-Younger v. Barnhart, 335 F.3d 99 (2d Cir. 2003), an ALJ rejected a treating physician’s opinion and found that a claimant who had fibromyalgia could perform sedentary work. Id. at 106. The Second Circuit held that the ALJ should have given controlling weight to the treating physician’s opinion about the claimant’s functional limitations. Id. “The fact that Dr. Helfand also relied on Green-Younger’s subjective complaints hardly undermines his opinion as to her functional limitations, as ‘[a] patient’s report of complaints, or history, is an essential diagnostic tool.'” Id. at 107, quoting Flanery v. Chater, 112 F.3d 346, 350 (8th Cir. 1997). Further, the Second Circuit held that fibromyalgia must be evaluated taking into account the precise nature of fibromyalgia and the ALJ erroneously required objective findings not present in fibromyalgia to reject the claim of disability based on fibromyalgia. Id. at 108.
The term fibromyalgia is often interchangeably used with the terms fibromyositis or fibrositis. Lisa v. Secretary of Health and Human Servs., 940 F.2d 40, 43 (2d Cir. 1991).
In Willoughby, the claimant argued that the ALJ improperly disregarded the medical evidence pertaining to her diagnosis of fibromyalgia and held that the ALJ’s decision that the claimant did not have fibromyalgia was based on legal error and was not supported by substantial evidence. Willoughby v. Comm’r of Soc. Sec., 332 F. Supp.2d 542, 546 (W.D.N.Y. 2004). The court cited to the numerous court decisions which “have recognized that evaluating the nature and severity of this condition in the context of social security disability review has proven to be difficult because of its elusive nature and the lack of objective tests that can conclusively confirm the existence of the disease. Id. at 546 n.3, citing Green-Younger v. Barnhart, 335 F.3d 99, 108 (2d Cir. 2003); Harman v. Apfel, 211 F.3d 1172, 1179-80 (9th Cir. 2000); Kelley v. Callahan, 133 F.3d 583, 585 n. 2 (8th Cir. 1998); Sarchet v. Chater, 78 F.3d 305, 306 (7th Cir. 1996); Preston v. Sec. of Health and Human Servs., 854 F.2d 815, 818 (6th Cir. 1988). “Nevertheless, despite the lack of objective medical screening devices, fibromyalgia is a potentially disabling impairment that can provide the basis for disability insurance and supplemental security income benefits in the appropriate case.” Id., citing Green-Younger, 335 F.3d at 108-109; Soto v. Barnhart, 242 F. Supp.2d 251, 256-57 (W.D.N.Y. 2003). The court also held that the ALJ improperly discounted the diagnosis of the claimant’s treating physician because it was not supported by objective medical findings. Id. at 547. The ALJ specifically reasoned that this physician failed to specify in her medical records the claimant’s specific “trigger points” which undermined the diagnosis. However, the court noted that this physician’s opinion was based, in part, on the report of a rheumatologist to whom she referred the claimant for her fibromyalgia symptoms, who found that the claimant had eleven out of eighteen tender points and experienced other symptoms consistent with the disease. However, the ALJ never addressed the rheumatologist’s report in his decision, nor explained why no weight was given to that “important evaluation.” Id. Finally, the court held that since the ALJ did not consider fibromyalgia as a medically determinable impairment and did not assess whether the degree of inactivity the claimant testified to was consistent with such a condition, the court remanded with directions to reconsider the claimant’s:
testimony and complaints of pain, fatigue, and limitations in daily activity in light of the diagnosis of fibromyalgia. In
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.
Id. at 548-59, citing Green-Younger, 335 F.3d at 109; Gang v. Barnhart, No. 02-CV-3647, 2003 WL 22183423, *5-*6 (E.D.N.Y. Sept. 23, 2003); Sarchet, 78 F.3d at 307; Preston, 854 F.2d at 819; Soto, 242 F. Supp.2d at 256-57.
In a case where the claimant alleged that the ALJ either misunderstood or disregarded her diagnosis of fibromyalgia or CFS, the New York district court looked to the Seventh Circuit’s decision in Sarchet which discussed fibromyalgia, noting:
The principal symptoms are ‘pain all over,’ fatigue, disturbed sleep, stiffness, and . . . 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 . . . . Some people may have such a severe case of fibromyalgia as to be totally disabled from working, but most do not and the question is whether [the plaintiff] is one of the minority.
Coyle v. Apfel, 66 F. Supp.2d 368, 374-75 (N.D.N.Y. 1999), quoting Sarchet v. Chater, 78 F.3d 305, 306-07 (7th Cir. 1996) (citation omitted). The court held that the claimant was never diagnosed with at least eleven trigger points that would indicate the presence of fibromyalgia, and even assuming that the evidence established this impairment, her condition was not so severe as to render her totally disabled. Id. at 375-76.
In Soto v. Barnhart, 242 F. Supp.2d 251 (W.D.N.Y. 2003), the court held that the ALJ’s finding that the claimant’s diagnoses of fibromyalgia and chronic pain syndrome were not well supported by objective medical evidence, and that the claimant had the RFC to perform light and sedentary work was not supported by substantial medical evidence and the ALJ improperly discounted the claimant’s subjective symptoms in making his determination. Id.at 254. Given the unavailability of clinical tests for fibromyalgia, an ALJ cannot reject a physician’s diagnosis of fibromyalgia on the grounds that it is not supported by objective medical findings. Id.at 254-55. Further, the ALJ improperly dismissed the many reports of the claimant’s treating physicians, who limited the claimant’s RFC to less than sedentary work. Id. at 255-56. These physicians clearly demonstrated the claimant’s long history of pain and opined that such pain supported the diagnoses of fibromyalgia and Chronic Pain Syndrome. Id. at 256. The court held that the opinions of the claimant’s treating physicians were entitled to controlling weight. Id. Finally, the ALJ’s rationale for discrediting the plaintiff’s subjective symptoms was totally unpersuasive. In fibromyalgia cases, the “credibility of a claimant’s testimony regarding her symptoms must take on substantially increased significance in the ALJ’s evaluation of the evidence.” Id. In cases where it is well documented that the claimant “has endured this pain for many years, and has as a result learned to tolerate such pain,” the co