Wang v. Saul

Background

Xiaomei Wang sought Social Security disability benefits for physical and mental conditions, including fibromyalgia, widespread joint and muscle pain, abdominal pain, hand weakness and pain, memory problems, anxiety, and depression. The Social Security Administration denied her application, and an administrative law judge found that she was not disabled. The administrative law judge recognized generalized joint and muscle pain, abdominal and epigastric pain, and bilateral hand weakness and pain as severe impairments, found that Wang could perform light work with limitations, and concluded that she could perform past relevant work. The Appeals Council declined review.

Wang asked the district court to review the Commissioner’s final decision under 42 U.S.C. § 405(g). Both sides moved for summary judgment, which asks the court to decide the case based on the record when there is no material factual dispute requiring a trial.

Fibromyalgia and mental impairments

The court held that the administrative law judge improperly found that Wang’s diagnosed fibromyalgia was not a medically determinable impairment. Social Security Ruling 12-2P requires a physician’s diagnosis, evidence satisfying one of two specified diagnostic criteria, and evidence that another disorder does not account for the pain. The court found that treating physician Dr. Law’s records supported the required findings under both the 1990 and 2010 American College of Rheumatology criteria. Those records described widespread pain lasting more than three months, at least 11 tender points, multiple related symptoms, and the exclusion of other causes. Dr. Masood’s examination, which found tenderness in all finger joints and pain when Wang moved her extremities, also supported the diagnosis.

The court also held that substantial evidence did not support the administrative law judge’s finding that Wang had no medically determinable mental impairment. Dr. Ozer conducted psychological, emotional, and cognitive testing and diagnosed unspecified anxiety and depressive disorders whose symptoms had persisted since at least 2007. The court found that this retrospective diagnosis constituted medical evidence relevant to the period under review. Because the administrative law judge had to consider all medically determinable impairments when assessing Wang’s work capacity, the court concluded that these errors were not harmless.

Wang’s symptom testimony

The court held that the administrative law judge did not give adequate reasons for rejecting Wang’s testimony about the severity and effects of her symptoms. The judge found no evidence of malingering, so the judge was required to identify specific, clear, and convincing reasons supported by substantial evidence. The court found that the judge’s statement that Wang’s allegations were not entirely consistent with the evidence was too general and did not identify which testimony was rejected or what evidence contradicted it.

The court also found that the administrative law judge selectively relied on evidence supporting the denial while overlooking findings concerning Wang’s anxiety, depression, severe psychological symptoms, and work-related impairments. In addition, the judge relied partly on Wang’s lack of mental-health treatment without addressing that she had been uninsured during some treatment in China and had difficulty finding a Mandarin-speaking therapist. The court held that these circumstances could not support the adverse evaluation of her testimony without considering the reasons for the lack of treatment.

Medical opinions

The court held that the administrative law judge improperly discounted the opinions of Dr. Law, Dr. Masood, and Dr. Ozer. Regarding Dr. Law, the court found that his treatment notes documented many symptoms identified in his fibromyalgia assessment and that the judge incorrectly treated the timing of his treatment as a reason to reject his opinions about limitations existing before Wang’s insured status ended. The court explained that later medical evaluations can be relevant to a claimant’s earlier condition. The judge also failed to provide the required specific and legitimate reasons for rejecting Dr. Law’s opinions based on other physicians’ findings.

Regarding Dr. Masood, the court found that the judge failed to provide adequate reasons for rejecting the opinion that Wang could use her hands or perform fine finger movements only occasionally, rather than frequently. Regarding Dr. Ozer, the court found that the judge did not provide clear and convincing reasons for rejecting the examining physician’s opinion merely because the examination occurred after Wang’s insured status ended.

Disposition

The court granted Wang’s motion for summary judgment, denied Saul’s cross-motion for summary judgment, and remanded for further proceedings. The court declined to order an immediate award of benefits because the record needed further development, including evaluation of the medical opinions and consideration of how Dr. Ozer’s opinion would affect the assessment of Wang’s mental impairments. The order disposed of docket numbers 18 and 21.