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  • Darrin Andrus

NALYSIS: Evaluation of Migraines and Fibromyalgia



In Crystal T. v. Commissioner, Social Security, No. 1:22-cv-1483 (D. Md. Feb. 3, 2023), a"er filing an extensive brief on various issues pertaining to legal and factual errors and substantial evidence, the Commissioner agreed to a Voluntary Remand under Sentence 4 of Section 205(g) of the Social Security Act, 42 U.S.C. § 405(g).

The primary focus of issues leading to the voluntary remand pertained to the ALJ’s improper evaluation of the claimant’s well- documented chronic migraine headaches and fibromyalgia, all of which were supported by substantial medical evidence and non- medical evidence (including claimant’s headache journal showing more than 15 migraines in a 30-day period, all requiring medication and extensive rest in a dark, quiet location).

Citing to various controlling case law in the 4th Circuit and other circuits, as well as cases directly on point in the U.S. District Court for the District of Maryland itself, the Plainti!’s case was well supported and warranted remand. Specifically, the various authority cited to confirms that an ALJ may not rely on lack of objective medical evidence (or purported lack thereof such as “normal” MRI findings, neurological testing and exams, etc.) to discount the severity of migraines and fibromyalgia and the resulting pain and other symptoms and limitations, as such impairments are never diagnosed in that manner, nor are they a proper indicator of the severity of the same.

There was also citation to various well supported and accepted medical journal articles standing for the same proposition regarding objective testing for these types of impairments. In addition, the Plainti! cited to 4th Circuit and other circuit case law to support the requirement of an ALJ to make specific findings in the RFC regarding how the severity, frequency and duration of headaches and fibromyalgia symptoms is important because the resulting absences or breaks from work leading to time o! task may be disabling, and the failure to account for the same in the RFC is clearly reversible error.

Further, the Plainti! established with supporting case law that an ALJ may not discount the nature and severity of migraine headaches and fibromyalgia on the basis of purported “conservative” treatment, when it is well documented that these types of impairments do not warrant “invasive” treatment, nor do they respond to it; additionally, citing to the 4th circuit Arakas case, where the ALJ improperly relied upon periods of purported improvement with treatment, all of which was temporary in nature, ALJ’s must “appreciate the waxing and waning nature” of medical conditions and need to “consider the longitudinal records of [the claimant’s] symptoms as a whole” and failing to do so is also reversible error.

Finally, the ALJ’s decision contained numerous instances of improperly cherry picking favorable evidence and improperly playing doctor, thus failing to build an accurate and logical bridge from the evidence to the ultimate findings and conclusions, and also failed to perform a function-by-function analysis of time o! task in light of the symptoms from migraines and fibromyalgia, as well as mental health impairments leading to findings of moderate limitations in Concentration, Persistence and Pace as required under the 4th Circuit’s ruling in the Mascio case.

The case was briefed by Andrew Sindler of Severna Park, Maryland. This piece is a guest column, provided by a NOSSCR member. Views, opinions, or analysis presented in this column represent the views of the author alone. ***

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