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Subjective Evidence of Fibromyalgia – N.D. Ill.

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  • Subjective Evidence of Fibromyalgia – N.D. Ill.

    Here’s a new case out of the Northern District of Illinois, Cheryl Watson v. Reliance Standard Life Insurance Company. In this matter, the plaintiff was paid for two years under the mental/nervous limitation and now she is seeking benefits beyond the 24 months due to her physical condition of fibromyalgia and chronic fatigue syndrome. The court first notes that it must consider how a person’s degree of pain and fatigue limits functional capabilities.

    But the Court cannot just stop at Watson’s diagnoses, as the Court must consider “how much an individual’s degree of pain or fatigue limits his functional capabilities.” Williams v. Aetna Life Ins. Co., 509 F.3d 317, 322 (7th Cir. 2007). Although courts have found functional capacity evaluations helpful in determining the extent to which an individual’s pain or fatigue limits her ability to perform her occupation, see Warner v. Unum Life Ins. Co., No. 12 C 02782, 2014 WL 7497233, at *8 (N.D. Ill. Dec. 31, 2014) (collecting cases), no such evaluation occurred in this case. Instead, the Court is left with Watson’s self-reports of her ability to work, the opinions of Watson’s treating physicians, the IME and INE, and the ALJ’s decision.
    The court finds that the plaintiff’s treating physician’s opinions are more credible.

    Dr. Weisberger, on the other hand, opined that, based on Watson’s physical symptoms and particularly her fatigue and difficulty concentrating, Watson could not work in a sedentary occupation. Although the Court is not required to defer to Watson’s treating physicians, it finds it appropriate to give weight to those physicians’ subjective judgments of Watson’s limitations “given the subjective nature of [chronic fatigue syndrome and fibromyalgia], the fact that its symptoms are sporadical inasmuch as they fluctuate in frequency and severity, and the fact that it can exist even though physical examinations may be within normal limits.” Perryman v. Provident Life & Accident Ins. Co., 690 F. Supp. 2d 917, 946 (D. Az. 2010) (noting as well that “the consistent diagnosis of [chronic fatigue syndrome] by [plaintiff’s] physicians and consistent observations of the manifestations of her impairments by those physicians can be viewed as objective medical evidence of her condition”). The Court finds this to be particularly true here where Reliance Standard did not pursue a functional capacity examination or an independent medical evaluation with a rheumatologist.

    Finally, the ALJ’s disability finding, although not binding on Reliance Standard under ERISA, supports the conclusion that Watson’s physical disabilities prevent her from performing her occupation. See Love v. Nat’l City Corp. Welfare Benefits Plan, 574 F.3d 392, 398 (7th Cir. 2009) (“SSA determinations are often instructive, but they are not determinative.”); Krolnik, 570 F.3d at 844 (“[A] finding of disability under the Social Security program need not imply disability for any other purpose.”). The ALJ, in granting Watson SSDI benefits, found that Watson’s impairments, including fibromyalgia, chronic fatigue syndrome, degenerative disc disease of the lumbar spine, and demyelinating cerebral disease, render her disabled. Reliance Standard reads the ALJ’s decision as support for its argument that Watson suffers primarily from a psychiatric condition, pointing out that the ALJ noted that objective testing had found no cognitive deficits and that Watson had been diagnosed with fibromyalgia, chronic fatigue syndrome, and somatic symptoms disorder, with the last qualifying under Reliance Standard’s mental or nervous disorder limitation. Reliance Standard also highlights that the ALJ recounted
    Watson’s treatment with antidepressant and antianxiety medication. According to Reliance Standard, these findings support Reliance Standard’s determination that when Watson’s physical conditions are looked at in isolation, she retains the capacity to return to a sedentary job. But the Court does not find Reliance Standard’s reading of the ALJ’s decision plausible. The ALJ did not list somatic symptom disorder as a severe impairment but did find fibromyalgia and chronic fatigue syndrome to be so. The ALJ noted specific evidence concerning her physical limitations, including that provided by her treating physician, Dr. Weisberger, and found Dr. Weisberger’s opinion to be “consistent with her treatment notes, the treatment received, and the claimant’s reports.” SAR 75. The ALJ also conducted a vocational analysis, finding Watson’s work history to suggest that “she would be working if she were able to do so.” SAR 74. This analysis supports the Court’s conclusion that Watson remains totally disabled based on her physical limitations. As a result, Watson is entitled to long-term disability benefits under the Policy, dating back to June 10, 2015.
    The court awards the plaintiff pre-judgment interest and orders the parties to brief the attorney’s fees and costs. The opinion is attached below.
    Attached Files