M.H. v. Kijakazi

Background

M.H. applied for Title II disability insurance benefits, alleging that she became disabled on June 1, 2018. The Social Security Administration denied the application initially and again on reconsideration. After a hearing, an administrative law judge (ALJ) denied the claim, and M.H. appealed to the district court.

M.H. argued that the ALJ improperly discounted her testimony about fibromyalgia symptoms, incorrectly evaluated medical opinions, and issued a constitutionally defective decision because the statute governing the Social Security Commissioner’s removal was unconstitutional.

M.H.’s Symptom Testimony

The court explained that when an ALJ finds that a claimant is not malingering and has a medically documented impairment that could reasonably cause the alleged symptoms, the ALJ must give specific, clear, and convincing reasons for rejecting testimony about the severity of those symptoms.

The ALJ recognized fibromyalgia as one of M.H.’s severe impairments but found that her testimony about the intensity and limiting effects of her symptoms was not sufficiently supported by the record. The ALJ relied on three reasons: M.H. reported fatigue but did not report falling asleep at inappropriate times or experiencing sleep-related hallucinations; medical records sometimes described her as being in no acute distress; and she had walked around Disneyland for several days and traveled internationally.

The court held that none of these reasons, alone or together, met the required standard. The absence of hallucinations or falling asleep at inappropriate times did not undermine M.H.’s testimony that she experienced chronic fatigue. The references to her being in no acute distress did not show a contradiction with her testimony because she alleged chronic pain that worsened when she lifted objects or used her hands, and there was no indication that she was doing those activities when the observations were made. Her trips to Disneyland and Mexico also did not establish that she could perform the activities she said were limited by pain, because the record did not show what she did during those trips or how much lifting or hand use they required.

The court concluded that the ALJ erred in rejecting M.H.’s fibromyalgia symptom testimony. Because her testimony about limitations on lifting and holding objects could prevent her from working, the error warranted a remand.

Medical Opinions

The court also reviewed the ALJ’s evaluation of the medical opinions. Under the regulations applicable to M.H.’s application, the ALJ had to evaluate the persuasiveness of each medical opinion, including its supportability and consistency. Those two factors were the most important and had to be expressly addressed.

The ALJ found the opinions of state-agency reviewing physicians almost entirely persuasive and the opinions of M.H.’s treating physician, Dr. Gonzalez, unpersuasive. The court found that the ALJ relied heavily on objective medical evidence without analyzing how M.H.’s fibromyalgia symptoms affected the persuasiveness of those opinions. Because the ALJ had improperly discounted M.H.’s symptom testimony, the court held that the ALJ also erred by failing to account for those symptoms when evaluating the medical opinions.

On remand, the ALJ must reassess the medical opinions in light of M.H.’s fibromyalgia symptom testimony.

Constitutional Claim

M.H. argued that the decision was constitutionally flawed because the statute governing the Commissioner’s removal was unconstitutional. She also asked the court not to decide that issue if other grounds supported a remand. Because the court found other grounds for remand, it did not reach the constitutional issue.

Disposition

The court reversed the Commissioner’s decision and remanded the case for further proceedings. The ALJ must reevaluate M.H.’s testimony about her fibromyalgia symptoms and, in light of that testimony, reevaluate the medical opinions to determine whether M.H. qualifies for Social Security benefits. Judge Nathanael M. Cousins signed the order.