United States District Court, D. Maryland
Dionne M. Knight
Commissioner, Social Security Administration;
8, 2016, Plaintiff Dionne M. Knight petitioned this Court to
review the Social Security Administration's final
decision to deny her claim for Disability Insurance Benefits.
(ECF No. 1). I have considered the parties' cross-motions
for summary judgment, and Ms. Knight's reply. (ECF Nos.
14, 17, 18). I have also considered the supplemental briefing
filed by each side. (ECF Nos. 20, 25). I find that no hearing
is necessary. See Loc. R. 105.6 (D. Md. 2016). This
Court must uphold the decision of the Agency if it is
supported by substantial evidence and if the Agency employed
proper legal standards. See 42 U.S.C. §§
405(g), 1383(c)(3); Craig v. Chater, 76 F.3d 585,
589 (4th Cir. 1996). Under that standard, I will deny both
motions, reverse the judgment of the Commissioner, and remand
the case to the Commissioner for further analysis pursuant to
sentence four of 42 U.S.C. § 405(g). This letter
explains my rationale.
Knight filed a claim for Disability Insurance Benefits
(“DIB”) on October 9, 2012, alleging a disability
onset date of September 5, 2012. (Tr. 155-56). Her
claim was denied initially and on reconsideration. (Tr.
83-86, 93-94). An Administrative Law Judge
(“ALJ”) held a hearing on December 4, 2014. (Tr.
38-61). Following that hearing, on January 7, 2015, the ALJ
determined that Ms. Knight was not disabled during the
relevant time frame. (Tr. 19-37). The Appeals Council denied
Ms. Knight's request for review, (Tr. 1-5), so the
ALJ's decision constitutes the final, reviewable decision
of the Agency.
found that Ms. Knight suffered from the severe impairments of
rheumatoid arthritis, osteoarthritis, and fibromyalgia. (Tr.
24). Despite these impairments, the ALJ determined that Ms.
Knight retained the residual functional capacity
perform light work as defined in 20 CFR 404.1567(b) except
lift and carry 20 pounds occasionally and 10 pounds
frequently; stand and walk for 6 hours in an 8 hour day; sit
for 6 hours in an 8 hour day; must avoid concentrated
exposure to extreme cold and vibration, as well as hazards
such as machinery and heights; and, due to the effects of
pain and medication side effects, is limited to simple,
(Tr. 26). After considering the testimony of a vocational
expert (“VE”), the ALJ determined that Ms. Knight
could perform jobs existing in significant numbers in the
national economy and that, therefore, she was not disabled.
Knight raises three primary arguments on appeal: (1) that the
ALJ erred in considering her fibromyalgia; (2) that the ALJ
assigned inadequate weight to the opinions of her treating
physician, Dr. Landis; and (3) that the ALJ should have
identified and considered chronic fatigue syndrome (CFS) as
an impairment. In addition, in a supplemental filing, Ms.
Knight argues that the ALJ did not comply with Lewis v.
Berryhill, 858 F.3d 858 (4th Cir. 2017). I concur that the
ALJ's analysis of Ms. Knight's fibromyalgia does not
fulfill the requirements of SSR 12-2p, including her basis
for assigning little weight to Dr. Landis's opinions, and
therefore remand the case for further discussion. In
remanding for additional explanation, I express no opinion as
to whether the ALJ's ultimate conclusion that Ms. Knight
is not entitled to benefits is correct or incorrect.
appears to have rejected Ms. Knight's complaints of
disabling pain from fibromyalgia, largely relying upon
certain findings made upon physical examinations. (Tr.
27-30). That analysis does not take into account the fact
that fibromyalgia is difficult to corroborate through
specific objective findings. See, e.g. Gavigan v.
Barnhart, 261 F.Supp.2d 334, 340 (D. Md. 2003) (noting
that fibromyalgia “poses particular challenges to
credibility analyses due to the limited available objective
medical evidence.”). Additionally, the nature of
fibromyalgia means that a patient's ability to perform
certain tasks or postural maneuvers on a given day does not
necessarily reflect an ability to perform those tasks and
maneuvers on a sustained basis. Social Security Ruling
(“SSR”) 12-2p, which became effective on July 25,
2012, governs the evaluation of fibromyalgia in disability
claims. See SSR 12-2p, 2012 WL 3104869 (July 25,
2012). It emphasizes consideration of the “longitudinal
record” of fibromyalgia “whenever possible
because the symptoms of FM [fibromyalgia] can wax and wane so
that a person may have ‘bad days and good
days.'” SSR 12-2p, at *6. Thus, the fact that Ms.
Knight had normal range of motion and no signs of swelling,
redness, or synovitis at various examinations does not
disprove her allegations of persistent pain. See,
e.g, Green-Younger v. Barnhart, 335 F.3d
99, 108-09 (2d Cir. 2003) (noting that for fibromyalgia
patients “physical examinations will usually yield
normal results - a full range of motion, no joint swelling,
as well as normal muscle strength and neurological
reactions.”) (citation omitted).
characterized Ms. Knight's treatment as
“essentially routine and/or conservative in nature,
” further noting that there have been no
hospitalizations or emergency room visits. (Tr. 29). However,
it is unclear, in the context of fibromyalgia, what other
forms of treatment might have been available to Ms. Knight or
her treating physicians. Chronic, incurable conditions such
as fibromyalgia are customarily managed by
“conservative” measures such as medications and
dietary changes. See Lapeirre-Gutt v. Astrue, 382
Fed.Appx. 662, 2010 WL 2317918 at *1 (9th Cir. June 9, 2010)
(noting that the claimant “cannot be discredited for
failing to pursue non-conservative treatment options”
for fibromyalgia since “none exist.”);
Brosnahan v. Barnhart, 336 F.3d 671, 677 (8th Cir.
2003) (noting that “the lack of any need for surgery is
also not a reason to discredit [Plaintiff]: the [American
College of Rheumatology] does not recommend surgery for
fibromyalgia.”). Thus, her “conservative”
treatment regimen is attributable to the lack of more
intensive treatment options for her condition, and is not a
reason to discredit her treating physician or her own
description of the severity of her impairments.
while various doctors' reports refer to her fibromyalgia
symptoms as “controlled” on medications, the
record does not suggest a consistent course free of pain. For
example, in one such report suggesting that the fibromyalgia
was “controlled” by Lyrica as of May 24, 2013,
mild tenderness remained in several sites. (Tr. 456-57). By
the next appointment, Ms. Knight believed her fibromyalgia
was “flaring” and the dose of Lyrica had to be
increased. (Tr. 496). At another appointment on August 4,
2014, although the records suggested the fibromyalgia was
controlled by medication, she still had significant
complaints of pain and demonstrated joint tenderness in the
wrists, knees, and shoulder blades on examination. (Tr.
578-79). Finally, at an appointment on March 13, 2014, the
notes again stated that the fibromyalgia was
“controlled, ” but Dr. Landis referred Ms. Knight
to pain management for back pain and to an orthopedist for
her left knee, and the examination records mentioned both
fatigue and paraspinal tenderness. (Tr. 571).
the ALJ's reliance on evidence from isolated medical
records to discredit Ms. Knight's credibility and
undermine the opinion of her treating physician does not
comport with the guidance of SSR 12-2p, which explains that a
claimant with fibromyalgia may have inconsistent symptoms
that “wax and wane” such that a person may have
“bad days and good days.” 12-2p, at *6. On
remand, the ALJ should provide a more extensive explanation
of her consideration of Ms. Knight's physical impairments
from fibromyalgia, her credibility regarding her description
of those impairments, and the effect, if any, of those
conditions on her ability to sustain the demands of full time
Ms. Knight contends that the ALJ should have identified
chronic fatigue syndrome as an impairment at Step Two.
Because chronic fatigue syndrome is a diagnosis of record, on
remand, the ALJ should also address that issue, either by
categorizing chronic fatigue syndrome as a severe or
non-severe impairment or by explaining the reason it is not
reasons set forth above, Plaintiff's Motion for Summary
Judgment (ECF No. 14) is DENIED and Defendant's Motion
for Summary Judgment (ECF No. 17) is DENIED. Pursuant to
sentence four of 42 U.S.C. § 405(g), the
Commissioner's judgment is REVERSED IN PART due to
inadequate analysis. The case is REMANDED for further
proceedings in accordance with this opinion. The Clerk is
directed to CLOSE this case.
the informal nature of this letter, it should be flagged as