The First Circuit has a new memorandum decision which discusses fibromyalgia symptoms in the context of a Social Security disability claim.
In Johnson v. Astrue, 597 F.3d 409 (1st Cir. 2009), the Court heard an appeal of an ALJ’s denial of disability benefits. The ALJ in her decision discounted the opinion of Dr. Ali, the treating rheumatologist. The First Circuit panel looked at the reasons offered by the ALJ, and found each of them to be unpersuasive. Here is an excerpt from the First Circuit’s opinion:
This leaves what appears to be the ALJ’s primary reason for giving little weight to Dr. Ali’s limited RFC assessment — i.e., that such limitations were “of necessity based on the claimant’s subjective allegations as the doctor’s examinations of the claimant were, with the exception of the presence of tender points, relatively benign.” Trans. at 27. Dr. Ali’s “need” to rely on claimant’s subjective allegations, however, was not the result of some defect in the scope or nature of his examinations nor was it even a shortcoming. Rather, “a patient’s report of complaints, or history, is an essential diagnostic tool” in fibromyalgia cases, and a treating physician’s reliance on such complaints “hardly undermines his opinion as to [the patient’s] functional limitations.” Green-Younger v. Barnhart, 335 F.3d 99, 107 (2d Cir. 2003) (internal punctuation and citation omitted). Further, since trigger points are the only “objective” signs of fibromyalgia, the ALJ “effectively [was] requiring objective evidence beyond the clinical findings necessary for a diagnosis of fibromyalgia under established medical guidelines,” and this, we think, was error. See id. at 106-07
The ALJ’s decision also discredited the claimant’s allegations of severe chronic pain. On this issue, the First Circuit panel had quite emphatic language:
Second, once the ALJ accepted the diagnosis of fibromyalgia, she also “had no choice but to conclude that the claimant suffer[ed] from the symptoms usually associated with [such condition], unless there was substantial evidence in the record to support a finding that claimant did not endure a particular symptom or symptoms.” See Rose, 34 F.3d at 18 (emphasis added). The primary symptom of fibromyalgia, of course, is chronic widespread pain, and the Commissioner points to no instances in which any of claimant’s physicians ever discredited her complaints of such pain. Given this, we do not think that the ALJ’s decision to discredit claimant was supported by substantial evidence.
This is good stuff. It is an important acknowledgment of fibromyalgia’s unique signs and symptoms, and how that uniqueness affects the analysis in a Social Security disability claim.