EMAIL TO A FRIEND COMMENT

 

Rheumatologists’ Opinions On Fibromyalgia Given Greater Weight Than Treating Doctor


A 44-year-old woman alleged that she was disabled due to breathing problems and painful joints. She applied for disability insurance benefits under Title II of the Social Security Act. Her application reported that she had worked as a secretary, ticketing agent, and file clerk. She had been laid off from her most recent job as a title searcher and had collected unemployment benefits for four months.

 

Prior to her alleged disability onset date, the woman consulted her family physician, who diagnosed her with chest wall pain, dyspnea, and gastroesophageal reflux disease. Her family physician continued to see her throughout the relevant time period. Following his initial diagnosis, he also concluded that she suffered from allergic rhinitis and fibromyalgia. He stated that she could not sit or stand for lengthy periods, and that she suffered from muscle cramps and blurred vision. He also diagnosed her with hypertension, asthma, bursitis of the hip, and anxiety disorder.

 

Her family physician consulted with a rheumatologist, who found that she did not have the more limited and localized tenderness that one would expect to find with fibromyalgia. The rheumatologist noted that her symptoms were more consistent with chronic pain syndrome because she displayed diffuse tenderness all over her body. The rheumatologist examined the woman throughout the relevant time period and consistently diagnosed her with chronic pain syndrome, not fibromyalgia.

 

At an administrative hearing on the woman’s application for benefits, a medical expert testified about the woman’s physical impairments. Based on her medical records, the expert found that the woman had problems with hypertension, asthma, irritable bowel syndrome, chronic pain, and obesity. The expert opined that the woman did not meet the criteria for fibromyalgia, and that her chronic pain could be explained by a vitamin D deficiency. A psychologist evaluated the woman and found that she had mildly impaired attention span, severely impaired concentration, and moderately impaired short-term memory. Based on the results of the Minnesota Multiphasic Personality Inventory (MMPI), the psychologist concluded that the woman may have exaggerated her symptoms. A neurologist examined the woman and found that she had multiple problems with severe pain affecting both upper and lower extremities leading to fatigue. He opined that she could not carry more than 10 pounds; sit more than two hours in a workday; bend, crawl or crouch; or perform jobs which required bilateral manual dexterity. In view of these findings, the neurologist diagnosed the woman with moderately severe fibromyalgia, bilateral radiculopathy, and post laminectomy pain syndrome. Another medical expert testified as to the results of the woman’s mental health evaluation. She explained that the MMPI results were invalid because of a very high “lie scale” score. She also found inconsistencies in the psychologist’s notes and concluded that the woman’s mental limitations were not severe. A vocational expert testified that the woman could perform her past work as a file clerk and other “unskilled work” as an electronics subassembler, bench assembler, and flatwork finisher.

 

The administrative law judge (ALJ) denied her application. The ALJ considered the intensity of the woman's symptoms in order to establish her residual functional capacity. In doing so, the ALJ gave “great weight” to the non-treating rheumatologist's opinion that she was capable of performing light work. According to the ALJ, the non-treating rheumatologist was not only qualified to evaluate fibromyalgia due to her specialty, but her opinion that the woman did not have the disease cohered with the treating rheumatologist’s diagnosis. The ALJ similarly afforded “great weight” to the second psychologist's testimony because her expertise allowed her to conclude that the woman's allegations lacked credibility. The ALJ did not however give “great weight” to the opinions of her family physician or the neurologist. In the ALJ's view, the family physician was less qualified to assess fibromyalgia because he lacked expertise as a family practitioner. The neurologist's opinion also contradicted the treating rheumatologist's opinion that the woman did not have fibromyalgia. The ALJ discounted the neurologist's opinion for the same reasons and because his examination did not reveal “tender points associated with fibromyalgia.”

 

In deciding the extent of the woman's impairments, the ALJ reviewed the woman’s own complaints and found them to lack credibility. Although she complained of fibromyalgia, cardiac disease, and other neurological disorders, the expert testimony contradicted her claims. Moreover, the first psychologist’s examination revealed a history of symptom embellishment, and her attempt to collect unemployment benefits at the same time she alleged a disability further undermined her credibility. Given her lack of credibility and the expert testimony of the non-treating rheumatologist and the second psychologists, the ALJ determined that the woman had the residual functional capacity to do light work.

 

The ALJ determined that the woman was not disabled under the Social Security Act because she could perform her past relevant work as a file clerk and other unskilled occupations such as electronics subassembler, bench assembler, and flat work finisher. She exhausted her administrative appeals. The woman appealed the final decision to the United States District Court for the Western District of Missouri, which affirmed.

 

The Eighth Circuit United States Court of Appeals affirmed. The court held that the ALJ did not err in giving greater weight to the non-treating rheumatologist's testimony than to testimony of treating physicians, was not required to seek clarification from the treating family physician and satisfied its obligation by expressly refusing to give that physician's opinion great weight and then explaining its reasons for doing so, had good reason and substantial evidence to question the woman’s credibility, considered the woman’s obesity and made findings about the demands of her prior work as a file clerk, and did not err in relying on the vocational expert's testimony.

 

The ALJ did not err in giving greater weight to the non-treating rheumatologist's testimony than to testimony of the treating physicians. The court held that, generally, a treating physician's opinion is not automatically controlling in social security disability cases. In reviewing claims for disability benefits, greater weight is generally given to the opinion of a specialist about medical issues in the area of the specialty. An ALJ may discount or disregard a treating physician's opinion where other medical assessments were supported by better or more thorough medical evidence, or where a treating physician rendered inconsistent opinions that undermined the credibility of such opinions. The court found that, although the woman’s treating family physician and neurologist opined that her fibromyalgia played a significant role in limiting her ability to work, their diagnoses contradicted opinions of her treating rheumatologist and non-treating rheumatologist who, based on their expertise in rheumatology, had both concluded that she did not have the more limited and localized tenderness they would expect to find with fibromyalgia. The family physician's diagnosis changed over the relevant time period whereas the rheumatologists consistently stated that she did not have fibromyalgia.

 

The ALJ was not required to seek clarification from the treating family physician and satisfied its obligation by expressly refusing to give that physician's opinion great weight and then explaining its reasons for doing so. The court held that ALJs are not required to seek clarifying statements from treating physicians unless a crucial issue is undeveloped in a social security disability case. ALJs need only clarify whether they discounted a treating physician's findings, and, if they did so, why.

 

The ALJ did not err in assessing the woman’s credibility because the ALJ had good reason and substantial evidence to question the woman’s credibility. The ALJ cited significant evidence in discounting the woman’s credibility before concluding that she could perform work of light exertion. The ALJ properly found that the woman lacked credibility given evidence of symptom exaggeration in the form of the first psychologist's affidavit that she may have exaggerated her disability and the second psychologist's testimony that her MMPI results displayed a very high “lie scale” score. Her collection of unemployment benefits during the period of her claimed disability reinforced this conclusion.

 

The ALJ did not fail to analyze the woman’s obesity with respect to its effects on her prior work as a file clerk because the ALJ considered the woman’s obesity and made findings about the demands of her prior work as a file clerk. The ALJ expressly referred to the woman’s obesity in concluding that her residual functional capacity was limited to light work because she could only occasionally climb stairs; kneel or stoop: and she could not climb ladders, ropes, or scaffolds. The ALJ made findings regarding the physical and mental demands of the woman’s past work as a file clerk. In doing so, the ALJ questioned the vocational expert about the duties of a file clerk, and the expert explained those duties in view of the woman's work history report. The ALJ then compared those demands to her residual functional capacity in concluding that she was physically and mentally capable of performing the “semi-skilled work” of a file clerk.

 

The ALJ did not err in relying on the vocational expert’s testimony. An ALJ may rely on a vocational expert's testimony as long as some of the identified jobs satisfy the social security disability claimant's residual functional capacity. The court reasoned that, although the vocational expert recommended the job of flat work finisher despite the woman's inability to perform such work, one mistaken recommendation does not devalue the rest of her opinion. The vocational expert testified that the woman could perform her past work as a file clerk and other “unskilled occupations” such as electronics subassembler and bench assembler. Her mental and physical condition, age, and education fully supported her ability to perform those jobs.

The Eighth Circuit United States Court of Appeals affirmed the trial court’s affirmation of the Commissioner of Social Security’s denial of the woman’s application for disability insurance benefits.

 

See: Grable v. Colvin, 2014 WL 5756209 (C.A.8 (Mo.), November 6, 2014) (not designated for publication).

 

See also Medical Law Perspectives, December 2011 Report: When Pain is the Only Proof: Subjective Impairments

 

See also Medical Law Perspectives, June 2013 Report: Independent Medical Evaluations: Legal Risks and Responsibilities

 

 

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