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ESTRADA v. SAUL (2021)

United States Court of Appeals, Ninth Circuit.2021-03-31No. No. 19-35734

Summary

Holding. The court vacated the denial of benefits and remanded for the ALJ to reconsider the credibility of Estrada's symptom testimony in light of fibromyalgia's diagnostic methods and the understanding that fibromyalgia symptoms can fluctuate over time.

Cindy Estrada sought disability and supplemental security income benefits, but the Social Security Administration denied her application. The administrative law judge (ALJ) rejected her testimony about her symptoms, finding it inconsistent with the medical evidence because objective findings were lacking. However, Estrada had fibromyalgia, which the ALJ had already recognized as a severe impairment supported by medical evidence.

The appellate court found that the ALJ made an error similar to one addressed in a recent precedent. That precedent established that normal examination results are actually consistent with fibromyalgia because the condition is diagnosed based entirely on patient-reported symptoms rather than objective medical tests. The court concluded the ALJ failed to properly evaluate Estrada's symptom testimony in light of fibromyalgia's unique diagnostic characteristics and decided to send the case back for reconsideration.

Summary generated by law.co from the public-domain opinion. The opinion text itself is public domain.

Key issues

  • Whether an ALJ may discount disability claimant's symptom testimony based on lack of objective medical findings when the claimant has fibromyalgia
  • Proper evaluation of medical evidence in fibromyalgia cases given the condition's reliance on patient-reported symptoms
  • Credibility assessment of testimony regarding pain in fibromyalgia disability claims

Procedural posture

Estrada appealed the district court's affirmance of the Social Security Commissioner's denial of her disability benefits application.

Authorities cited

No cited authorities resolved to law.co cases yet.

Opinion

MEMORANDUM **

Cindy Estrada appeals the district courts affirmance of the Social Security Commissioners denial of her application for disability insurance benefits and supplemental security income under Titles II and XVI of the Social Security Act. The parties are familiar with the facts, so we do not repeat them here. We have jurisdiction under 28 U.S.C. § 1291, and we vacate the denial of benefits and remand for reconsideration in light of Revels v. Berryhill, 874 F.3d 648 (9th Cir. 2017).

The ALJ concluded that Estradas “statements concerning the intensity, persistence and limiting effects of [her] symptoms are not entirely consistent with the medical evidence and other evidence in the record․” The ALJ noted that the record “lacks significant findings to support [Estradas] extreme allegations,” “support for her neck and hand complaints is elusive,” examinations are within “normal limits,” neck pain patterns do not correlate with MRI findings, and “diagnostic imaging of the hips and hands were repeatedly negative,” among other statements. Estrada argues that the ALJ improperly discounted her testimony because the lack of objective findings is consistent with her fibromyalgia—a diagnosis that the ALJ recognized as a severe impairment adequately supported by medical evidence at step two.

The ALJ did not have the benefit of our decision in Revels, which was issued two months after the ALJs decision. In Revels, we concluded that the ALJ erred in rejecting a claimants testimony where the ALJ stated that the testimony was “undercut by the lack of ‘objective findings’ supporting her claims of severe pain” because examinations showing mostly normal results “are perfectly consistent with debilitating fibromyalgia.” 874 F.3d at 666. We noted that the ALJs error “arose from an apparent fundamental misunderstanding of fibromyalgia,” id. at 662, and emphasized that fibromyalgia “is diagnosed entirely on the basis of patients’ reports of pain and other symptoms, and there are no laboratory tests to confirm the diagnosis,” id. at 666 (quotations omitted). Here, in assessing the credibility of Estradas symptoms testimony, the ALJ appears to have similarly failed to construe the medical evidence “in light of fibromyalgias unique symptoms and diagnostic methods.” Id. at 662. For this reason, we remand.

On remand, the ALJ should address how the fibromyalgia diagnosis weighs on his evaluation of the medical evidence for purposes of assessing the credibility of Estradas symptoms testimony, id. at 666, explain why he deemed Estradas treatment “conservative” for fibromyalgia, id. at 667, and address how evidence that Estrada at times denied pain comports with the recognition that “the symptoms of [fibromyalgia] can wax and wane so that a person may have ‘bad days and good days.’ ” Social Security Ruling, SSR 12-2p (Jul. 25, 2012); see also Revels, 874 F.3d at 663. Because we remand for consideration of Revels, we do not reach Estradas other challenges to the ALJs decision.

VACATED and REMANDED.

Each party shall pay its own costs on appeal.