Summary
finding that substantial evidence supported the ALJ's credibility determination, which was made with consideration given to the objective medical evidence
Summary of this case from Gamradt v. BarnhartOpinion
Cause No. IP00-1444-C-H/G
September 6, 2001
ENTRY ON JUDICIAL REVIEW
In this prolonged litigation over Social Security benefits, plaintiff Sandra Davis seeks judicial review of a final decision by the Commissioner of Social Security denying disability insurance benefits under Title II of the Social Security Act. Ms. Davis was last insured for disability insurance benefits on December 31, 1988. She claims that she became totally disabled on October 1, 1985, primarily as a result of chronic fatigue syndrome, though she did not apply for benefits until July 6, 1994, nearly nine years after the alleged onset date. The Commissioner determined that Ms. Davis suffered severe impairments from chronic fatigue syndrome, spondylosis of her cervical spine, and adjuvant breast disease. However, the Commissioner determined that she was not disabled within the meaning of the Act before her insured status expired. As explained below, the court finds that substantial evidence supports the Commissioner's denial of benefits in this difficult case, and therefore affirms the denial of benefits.
Background
Ms. Davis was born in 1947. She is a high school graduate and attended college classes from 1985 until the fall of 1986. Prior to attending classes, Ms. Davis worked for several years as a protective materials tester (checking the quality of protective gloves, for example). She stopped working on October 1, 1985. She became ill with mononucleosis, also known as Epstein-Barr virus, and eventually dropped out of her college courses. From 1987 through 1990, Ms. Davis ran a small business selling antiques out of a converted garage. She devoted three to four hours a day, three days a week, to running this business. Although Ms. Davis did not sell any antiques in 1991 or 1992, she resumed the business for a brief period in 1993. The antiques business was never profitable. In 1993, Ms. Davis also attempted to do substitute teaching, but she was unable to complete her first full day of work.
On July 6, 1994, Ms. Davis applied for disability insurance benefits, alleging that she had become disabled back on October 1, 1985. Her insured status had expired on December 31, 1988, when she was 41 years old. The Social Security Administration initially denied her application. Her case was considered in a hearing before an administrative law judge (ALJ) in October 1995. That hearing led to a denial of benefits. When Ms. Davis sought judicial review in this court, she and the Commissioner agreed that the decision should be remanded for a new hearing. On remand, another ALJ, Judge Robert E. Hanson, conducted a new hearing in 1998. Judge Hanson also denied benefits, and the Appeals Council denied further review in 2000, leading to this second action for judicial review.
Disability and the Standard of Review
To be eligible for disability insurance benefits, Ms. Davis must establish that she suffered from a disability within the meaning of the Social Security Act before December 31, 1988, which was the last date she was insured under the Act. She must show that she was unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which could be expected to result in death or which had lasted or could be expected to last for a continuous period of not less than 12 months. 42 U.S.C. § 423(d). Ms. Davis was disabled only if her impairments were of such severity that she was unable to perform work that she had previously done and if, based on her age, education, and work experience, she could not engage in any other kind of substantial work existing in the national economy, regardless of whether such work was actually available to her. Id.
Ms. Davis has not applied for supplemental security income. That benefit 2 program does not require that the claimant be insured, but benefits are subject to an income limit that may limit Ms. Davis' eligibility.
This is a rigorous standard. A claimant is not necessarily entitled to benefits even if she has substantial impairments. The Act does not contemplate degrees of disability or allow for an award based on partial disability. Stephens v. Heckler, 766 F.2d 284, 285 (7th Cir. 1985). Even substantial impairments do not necessarily entitle a claimant to benefits. The benefits are paid for with tax dollars, including taxes paid by people for whom working is quite painful and difficult. Under the statutory standard, these benefits are available only as a matter of nearly last resort.
To determine whether Ms. Davis was disabled under the Social Security Act, the ALJ followed the five-step analysis set forth in 20 C.F.R. § 404.1520. The steps are as follows:
(1) Is the claimant engaging in substantial gainful activity? If so, he or she is not disabled.
(2) If not, does the claimant have an impairment or combination of impairments that are severe? If not, he or she is not disabled.
(3) If so, does the impairment(s) meet or equal a listed impairment in the appendix to the regulations? If so, the claimant is disabled.
(4) If not, can the claimant do his or her past relevant work? If so, he or she is not disabled.
(5) If not, can the claimant perform other work given his or her residual functional capacity, age, education, and experience? If so, then he or she is not disabled. If not, he or she is disabled.
See 20 C.F.R. § 404.1520. The burden of proof is on the claimant for the first four steps and on the Commissioner for the fifth step, if it is reached. See Young v. Secretary of Health and Human Servs., 957 F.2d 386, 389 (7th Cir. 1992).
In this case, ALJ Hanson determined at step one that Ms. Davis had not engaged in substantial gainful activity since the alleged onset of disability on October 1, 1985. At step two, the ALJ concluded that Ms. Davis had severe physical impairments at the relevant time, including spondylosis of the cervical spine, chronic fatigue syndrome, and adjuvant breast disease (arising from problems with breast implants). These impairments did not meet or equal any 3 of the listings that would have automatically qualified Ms. Davis for benefits at step three. R. 385. At step four, the ALJ determined that Ms. Davis was unable to perform her past relevant work as a protective materials tester. R. 391.
The ALJ also determined that any mental impairments were not severe. R. 383-84. Ms. Davis has not contested that finding in this action.
At step five, the ALJ determined that Ms. Davis retained the residual functional capacity to perform simple and repetitive sedentary work not involving overhead lifting or more than occasional bending. R. 385. Based on the testimony of vocational expert Gail Ditmore, see R. 810-11, the ALJ found that a person with that residual functional capacity would have been able to work as a cashier or assembler.
Based on these findings, the ALJ determined that Ms. Davis was not entitled to receive disability insurance benefits. The Appeals Council denied further review of the ALJ's findings, so the ALJ's findings are treated as the findings of the Commissioner. Luna v. Shalala, 22 F.3d 687, 689 (7th Cir. 1994).
The Social Security Act provides for judicial review of the Commissioner's denial of benefits. See 42 U.S.C. § 405(g). This court's review focuses not on whether Ms. Davis was disabled during the relevant period but instead on whether the ALJ's findings were supported by substantial evidence. Schmidt v. Apfel, 201 F.3d 970, 972 (7th Cir. 2000); Estok v. Apfel, 152 F.3d 636, 638 (7th Cir. 1998). Substantial evidence is evidence that "a reasonable mind might accept as adequate to support a conclusion." Diaz v. Chater, 55 F.3d 300, 305 (7th Cir. 1995), quoting Richardson v. Perales, 402 U.S. 389, 401 (1971).
To determine whether substantial evidence exists, the court reviews the record as a whole, examining the evidence that favors the claimant as well as the evidence that supports the Commissioner's decision. Nelson v. Apfel, 131 F.3d 1228, 1237 (7th Cir. 1997). However, because the Commissioner is responsible for weighing the evidence, resolving conflicts, and making independent findings of fact, this court may not decide the facts anew, reweigh the evidence, or substitute its own judgment for that of the Commissioner to decide whether a claimant is or is not disabled. Butera v. Apfel, 173 F.3d 1049, 1055 (7th Cir. 1999). Where conflicting evidence allows reasonable minds to differ as to whether a claimant is entitled to benefits, the court must defer to the Commissioner's resolution of that conflict. Binion v. Chater, 108 F.3d 780, 782 (7th Cir. 1997).
A reversal and remand may be required, however, if the ALJ committed an error of law, Nelson v. Apfel, 131 F.3d at 1234, or if the ALJ's decision is based on serious factual mistakes or omissions. Sarchet v. Chater, 78 F.3d 305, 309 (7th Cir. 1996). The ALJ's decision must be based upon consideration of all the relevant evidence, and the ALJ must articulate at some minimal level his analysis of the evidence. Diaz, 55 F.3d at 307-08. Meaningful review requires that the court be able to trace adequately the path of the ALJ's reasoning. See id.
Discussion
The central problem in this case is posed by the difficulty of reconstructing Ms. Davis' condition from 1985 to 1988 at a hearing held in 1998 to decide an application made in 1994. Making matters more difficult, the principal issues involve the severity of Ms. Davis' chronic fatigue syndrome, which by definition is not shown by objective findings from laboratory tests or physical examinations.
Ms. Davis contends that the ALJ erred: (1) by rejecting the medical opinions of her treating physicians; (2) by finding that her daily activities were consistent with a wide range of sedentary work; (3) by applying the wrong legal standard when he assessed her credibility; and (4) by relying on her normal physical examinations and laboratory results.
I. Rejection of Dr. Griffin's Opinion on Disability
Back in 1985 and 1986, Ms. Davis was treated by Dr. Griffin for Epstein-Barr virus through a university health care program while she was a student.
Back in 1985 and 1986, Dr. Griffin did not address directly whether Ms. Davis was disabled from gainful employment. In answer to written interrogatories in 1995, however, Dr. Griffin wrote: "On the basis of (1) this patient's allegation of extreme and persistent, long-standing (1 year) fatigue, and (2) her concurrent withdrawal from (full-time) college enrollment, it is my medical opinion that Sandra Davis' fatigue was disabling in and around September 1986." R. 293. Asked about absenteeism, Dr. Griffin wrote: "It is likely, according to her alleged degree of fatigue, that her absenteeism would have exceeded the average." R. 295.
Ms. Davis contends that the ALJ erred in failing to give Dr. Griffin's opinion controlling weight. "A treating physician's opinion regarding the nature and severity of a medical condition is entitled to controlling weight if it is well supported by medical findings and not inconsistent with other substantial evidence in the record." Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 2000), citing 20 C.F.R. § 404.1527(d)(2). However, a claimant is not entitled to disability benefits simply because a physician states that the claimant is "disabled" or "unable to work." Clifford, 227 F.3d at 870. It is the Commissioner's duty to determine the ultimate issue of disability. See 20 C.F.R. § 404.1527(e).
In this case, Dr. Griffin provided her opinion almost nine years after she had last had any contact with Ms. Davis. The Seventh Circuit has written: "A retrospective diagnosis may be considered only if it is corroborated by evidence contemporaneous with the eligible period." Estok, 152 F.3d at 640 (affirming ALJ's rejection of treating physician's retrospective diagnosis of fibromyalgia). Although Dr. Griffin did not diagnose chronic fatigue syndrome in 1985 or 1986, her retrospective diagnosis of disabling fatigue is corroborated by evidence of chronic fatigue syndrome within the eligible period. The ALJ also agreed and found that Ms. Davis in fact suffered from chronic fatigue syndrome. The principle of Estok therefore does not bar all consideration of Dr. Griffin's opinion.
Still, it is far from clear that Dr. Griffin was actually opining in 1995 that Ms. Davis had been disabled in 1985 and 1986. Dr. Griffin phrased her opinions in terms of "the patient's allegation" and her "alleged degree of fatigue." The court does not read the 1995 interrogatory answers as a firm opinion on the credibility of those allegations or on the actual severity of Ms. Davis' condition.
Even if Dr. Griffin's 1995 answers should be treated as an opinion that Ms. Davis was in fact disabled in 1985 and 1986, the ALJ explained in some detail why he found that opinion was not consistent with medical and other evidence. The ALJ noted that Ms. Davis had not been treated by any doctor from April 1987 to December 1990, a gap that tends to undermine an opinion of total disability. R. 389. The ALJ also noted that Dr. Griffin's contemporaneous notes showed considerable uncertainty about Ms. Davis, indicating that Dr. Griffin still wanted to do further analysis and physical examination.
Even the letter Dr. Griffin wrote to explain Ms. Davis' withdrawal from school is phrased carefully in terms of what Ms. Davis had said rather than in terms of Dr. Griffin's medical opinion: "She advises me that her fatigue has obliged her to withdraw from school recently — against her wishes." R. 141.
The ALJ also considered substantial evidence tending to undermine Dr. Griffin's (provisional and retrospective) opinion that Ms. Davis' fatigue was disabling in 1986. Dr. Geisel testified that the effects of chronic fatigue syndrome range from mild to severe, and that the effect on a given individual can be assessed by evaluating the extent and nature of her daily activities. R. 795-96. The ALJ reviewed the evidence of Ms. Davis' daily activities in the late 1980s. He noted that Ms. Davis was married, maintained a fairly satisfactory relationship with her husband (at least for a time), and ran an antiques business that required significant driving and "a lot" of walking. R. 386.
The evidence is not one-sided. The marriage did not last, and Ms. Davis testified it was because her husband was tired of having his wife be sick all the time. The antiques business was not demanding and was not at all successful. The ALJ considered and weighed that evidence, however. The ALJ also reviewed the evidence of Ms. Davis' daily activities at home, and he noted that Ms. Davis had described herself in 1987 as having recently remarried, as being fairly happy with her life, and as having no major problems. R. 144 (notes of Dr. Stack). Dr. Stack concluded that her joint disease was mild, that she was apparently recovering from chronic Epstein-Barr virus, and that her depression was probably situational. R. 145.
In her memorandum, Ms. Davis denies this contrast by arguing that Dr. Stack "confirmed that his CEBV [chronic Epstein-Barr virus] diagnosis was synonymous with CFS [chronic fatigue syndrome]," thus corroborating Dr. Griffin's opinion. Pl. Mem. at 6-7. In support, she cites an excerpt from a questionnaire completed by Dr. Stack and a definition of Chronic Fatigue Syndrome from the Centers for Disease Control. R. 529-31. The first question asks whether any of the symptoms from a provided list contributed to Dr. Stack's CEBV diagnosis in 1987. Dr. Stack circled all but one of the symptoms. That evidence tends to show that Dr. Stack's diagnosis was based on symptoms also consistent with chronic fatigue syndrome, but it does not affect any analysis of the severity of Ms. Davis' condition. The issue here is the severity of her condition, not its existence.
The ALJ explained in his opinion that he discounted to some extent the notes from Dr. Griffin in 1985 and 1986 for four reasons. The court finds no error in those reasons.
First, not all the notes were based on Dr. Griffin's personal interaction with Ms. Davis. Some showed nurses' notes that had been initialed by the doctor. The ALJ wrote that such notes were not equivalent to a physician's report based on a personal interview and examination. R. 386. In fact, Dr. Griffin personally examined Ms. Davis and recorded her observations on at least two occasions, September 30, 1985, and September 23, 1986. R. 173, 181. There is one other substantial entry by Dr. Griffin on October 4, 1985, but it is not clear whether she conducted the full examination. The records for Ms. Davis' other five visits while under Dr. Griffin's care appear to have been written by nurses, with minor notations by Dr. Griffin if any at all.
The ALJ did not state incorrectly, as Ms. Davis argues, that Dr. Griffin never examined her. The ALJ focused instead on the functional limitations reported in the nurses' notes. Those notes are not equivalent to a physician's own report, as is plainly indicated by the phrasing of Dr. Griffin's answers about Ms. Davis' condition, in which the answers are based on Ms. Davis' complaints and allegations. The ALJ was entitled to discount the weight of the nurses' records. See Patti v. Schweiker, 669 F.2d 582, 585 (9th Cir. 1982) (discounting weight of nurse's notations as compared to those of treating physician).
The Ninth Circuit's decision in Patti has been described as being superseded on other grounds, see Warren v. Bowen, 804 F.2d 1120, 1121 (9th Cir. 1986), but that development does not affect this point.
Second, the ALJ stated that Dr. Griffin's notes cover only a small portion of the relevant three year period during which Ms. Davis was insured. Ms. Davis had to establish disability between October 1, 1985, her alleged onset date, and December 31, 1988, her date last insured. Dr. Griffin and nurses treated Ms. Davis' fatigue and related symptoms off and on for about one year, almost entirely within the insured period. However, Ms. Davis' visits were so tightly clustered that there was a significant period for which there is no medical record of continuing symptoms. Ms. Davis visited the IUPUI clinic five times between September 30, 1985, and January 11, 1986, and three times between September 4-23, 1986. The clinic does not have any record of Ms. Davis' condition for approximately eight months after her most severe mononucleosis.
The ALJ's observation that Dr. Griffin's notes covered only a limited portion of the insured period was accurate. Due to the ambiguity of the medical records during that period, it was reasonable for the ALJ to consider them an inadequate foundation on which to base a "longitudinal picture" of Ms. Davis' symptoms. The ALJ acted reasonably in discounting the notes in terms of the long-term severity of Ms. Davis' condition.
Third, the ALJ discounted Dr. Griffin's opinion because her notes indicate that she wanted to conduct a physical examination of Ms. Davis before deciding on a diagnosis. It was reasonable for the ALJ to weigh the ambiguity and incomplete nature of Dr. Griffin's opinion when actually treating Ms. Davis in 1986 when deciding the weight to give her retrospective opinion from 1995. See R. 141.
Fourth, the ALJ wrote that the significant gap between Ms. Davis' last visit to Dr. Griffin (September 1986) and her next visit to a physician, Dr. Stack in April 1987, suggested that she was not experiencing any incapacitating symptoms during that time. R. 386, citing Walker v. Bowen, 834 F.2d 635, 644 (7th Cir. 1987) (finding that claimant's failure to seek any medical care other than routine physical therapy for certain period suggested that claimant encountered no serious difficulties during that time). That is a reasonable view of the evidence, even if it is not the only reasonable view. In sum, the ALJ did not commit reversible error in his treatment of Dr. Griffin's records and opinions.
Other treating physicians opined in 1994 and 1995 that Ms. Davis had 6 been disabled back in 1988. Those physicians had not seen her during the relevant time period, and they saw her after her condition had apparently deteriorated. (Ms. Davis' adjuvant breast disease became more serious, and she was involved in the widespread litigation over problems with breast implants.) The ALJ explained sufficiently why those opinions were not persuasive. For purposes of gauging retrospectively the severity of Ms. Davis' condition from 1985 to 1988, the ALJ had a more complete picture of Ms. Davis' history than did those physicians who first saw her years after the relevant time.
II. Finding of Capacity to Perform Sedentary Work
Ms. Davis contends that the ALJ failed to establish that she had the residual functional capacity to perform sedentary work. See 20 C.F.R. § 404.1520; Pope v. Shalala, 998 F.2d 473, 477 (7th Cir. 1993) (if claimant does not have a listed impairment but cannot perform her past relevant work, the Commissioner has the burden of showing that the claimant can perform other work). If the ALJ's findings regarding Ms. Davis' residual functional capacity are supported by substantial evidence, this court must affirm. See Diaz v. Chater, 55 F.3d 300, 305 (7th Cir. 1995); Binion v. Shalala, 13 F.3d 243, 247 (7th Cir. 1994).Ms. Davis challenges the ALJ's reliance on objective medical evidence and her activities to support his determination that she had the residual functional capacity to perform sedentary work. Social Security regulations define sedentary work as requiring sitting, some walking and standing, and minimal lifting. See 20 C.F.R. § 404.1567(a). A claimant can do sedentary work if she can (1) sit up for approximately six hours of an eight-hour workday, (2) do occasional lifting of objects weighing up to ten pounds, and (3) occasionally walk or stand for no more than about two hours of an eight hour workday. Diaz, 55 F.3d at 306.
The ALJ acknowledged that Ms. Davis had to quit school and discontinue aerobics in 1986. R. 386. However, he also noted that during the relevant years, she maintained a fairly happy marriage (for a time) and started and ran an antiques business. R. 386. Even though Ms. Davis was not always present at the garage from which she sold antiques, she was involved enough in the business to keep it a continuing operation. Id. Further, Ms. Davis reported putting significant mileage on her car and doing a lot of walking while running the business. During the relevant period, Ms. Davis also performed light housework and some cooking. R. 387. When Ms. Davis applied for benefits in 1994, she recorded her activities as cleaning, shopping, paying bills, taking short walks, and driving. Id. She also read, listened to music, watched television, and played guitar. Id. The ALJ inferred that Ms. Davis might have been able to engage in even more extensive activities during the relevant period in light of the evidence that Ms. Davis' condition was much more severe later, when she applied for benefits in 1994, than it had been before she lost her insured status.
Ms. Davis asserts that these activities do not support the ALJ's determination that she could still perform a wide range of sedentary work. She argues that consideration of her daily chores such as cooking and cleaning is inappropriate because they do not reflect the more demanding requirements of full-time gainful employment. See Cohen v. Secretary of Department of Health and Human Services, 964 F.2d 524, 530 (6th Cir. 1992) (claimant with chronic fatigue syndrome should not be penalized for attempting to lead a normal life in spite of her limitations); Hatcher v. Apfel, 1999 WL 1029858, at *5 (N.D.Cal. Nov. 9, 1999) (same). However, such activities are relevant evidence of a claimant's capacity for substantial gainful employment, even if they are not controlling evidence. See Binion, 13 F.3d at 247; Pope, 998 F.2d at 487 (finding claimant's daily activities of reading and light chores consistent with sedentary work). In Binion, the ALJ based his decision in part on the claimant's ability to "cook, sew, put together jigsaw puzzles, read, wash dishes and clothes, mop floors, grocery shop, and drive a car." Id. In this case, the ALJ properly considered all of Ms. Davis' activities, not just her daily chores.
The conflicting evidence in this difficult case, requiring a determination of the severity of Ms. Davis' chronic fatigue syndrome ten years before the hearing in 1998, was subject to reasonable interpretation by the ALJ. The ALJ recognized that Ms. Davis was limited in terms of her ability to work, and he properly focused as best he could on the severity of her limitations. "I have no doubt that the claimant was limited by her condition, but not to the extent that she was limited from performing a wide range of sedentary work," at a level that "would have required very little by way of physical exertion." R. 386. The court finds no error in the ALJ's evaluation of the conflicting evidence on the severity of her condition.
III. Assessment of Ms. Davis' Credibility
The ALJ did not entirely credit Ms. Davis' account of the severity of her condition. That aspect of the ALJ's analysis was central to his final decision. Ms. Davis contends that the ALJ applied the wrong legal standard when he assessed her credibility.
The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and resolving ambiguities in the record. See, e.g., Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998); Knight v. Chater, 55 F.3d 309, 313-15 (7th Cir. 1995). The ALJ can discount subjective complaints of pain that are inconsistent with the evidence as a whole, but cannot discount such complaints merely because they are not supported by objective medical evidence. "The absence of objective medical evidence is just one factor to be considered along with: (a) the claimant's daily activities; (b) the location, duration, frequency and intensity of the pain; (c) precipitating and aggravating factors; (d) type, dosage, effectiveness and side effects of medication; (e) treatment other than medication; (f) any measures the claimant has used to relieve the pain or other symptoms; and, (g) functional limitations and restrictions." Knight, 55 F.3d at 314, citing 20 C.F.R. § 404.1529(c)(3); see also Pope, 998 F.2d at 482. The ALJ's credibility finding will not be disturbed unless "patently wrong." Diaz, 55 F.3d at 308; Herron v. Shalala, 19 F.3d 329, 335 (7th Cir. 1994).
The ALJ analyzed Ms. Davis' credibility with respect to each enumerated factor. He addressed her daily activities, as discussed above, and found that they were inconsistent with the limitations she claimed during the relevant period. The ALJ also noted that Ms. Davis attended college classes until the fall of 1986, one year after she claimed to have become completely disabled.
With respect to the particular details of Ms. Davis' pain and other symptoms, the ALJ noted that she complained of a sore throat, fever, and fatigue when she was first diagnosed with mononucleosis in 1985. In 1986, she again complained of pain and fatigue, but later in 1987 reported that she was fairly happy with life and had no major problems. The ALJ considered the latter statement inconsistent with the inability to perform even sedentary work. R. 388. The ALJ also noted Dr. Stack's impression in 1987 that Ms. Davis' degenerative joint disease of the cervical spine was mild and should not account for her lack of range of motion. R. 388.
The ALJ next considered the complications arising from Ms. Davis' breast implants as a precipitating and aggravating factor. He noted that she had neck pain that precluded her from bending forward for more than one hour. Given that limitation, the ALJ stated that Ms. Davis could still perform sedentary work that did not require extensive bending. R. 388. Similarly, the ALJ stated that Ms. Davis' fatigue problems upon overexertion could be accommodated through sedentary work that required very little exertion. Id.
With respect to medication, the ALJ found that Ms. Davis was using only ordinary aspirin, vitamins, and laxatives in April 1987. Prior to that date, she did not take any medication. As for other treatment, the ALJ noted that Ms. Davis was instructed to engage in an exercise program in April 1987. The ALJ did not consider either of these factors inconsistent with sedentary work.
In evaluating Ms. Davis' functional limitations, the ALJ discussed the medical records of her treating physicians both during and after the relevant time period. The ALJ's assessment of Dr. Griffin's records and opinion was addressed above. The ALJ also questioned the weight to be given the physicians' diagnoses after 1992 based on the opinion of Dr. Geisel that it is difficult to project a medical opinion back over several years. R. 389. The ALJ noted that several of Ms. Davis' later physicians did not have a substantial medical record from the relevant period, beyond Ms. Davis' subjective complaints, to support their retrospective diagnoses. Ms. Davis saw Dr. Stack in April 1987 and reported she was fairly happy and had no major problems. Dr. Stack described her spinal condition as "mild," her chronic Epstein-Barr virus condition as "recovering," and her depression as "probably situational." R. 145. After that visit, Ms. Davis did not see another physician until 1990, more than a year after her insured status had expired.
Thus, the ALJ considered all the relevant factors in assessing the credibility of Ms. Davis' subjective complaints. (The lack of objective medical findings is discussed in more detail below.) Substantial evidence supports the ALJ's credibility determination, which was not "patently wrong" and must stand.
IV. Normal Physical Examinations and Laboratory Results
The ALJ also considered objective medical evidence to support his credibility determination. He noted that most of Ms. Davis' physical examinations and clinical work-ups were within normal ranges. R. 386-87. He wrote: "In determining the claimant's residual functional capacity, I have also carefully considered the credibility of her subjective complaints as required by the regulations and the rulings. The claimant's subjective complaints and allegations concerning the severity of her impairments are not reasonably consistent with the objective medical and other evidence of record." R. 387.
From these statements, Ms. Davis argues that the ALJ erred by denying her claim because of the lack of objective findings. By definition, chronic fatigue syndrome lacks objective findings. If there were objective findings, the diagnosis would be different. See Rose v. Shalala, 34 F.3d 13, 18-19 (1st Cir. 1994); Olson v. Apfel, 17 F. Supp.2d 783, 789-90 (N.D.Ill. 1998); cf. Sarchet v. Chater, 78 F.3d 305, 306-07 (7th Cir. 1996) (discussing similar problems associated with fibromyalgia). At the same time, the ALJ is required by law to consider whether there are objective findings supporting the claimant's subjective symptoms. Thus, in cases of chronic fatigue syndrome, the absence of objective findings cannot be treated as controlling, but the law requires the ALJ to consider the totality of the evidence, including the (lack of) objective findings. See Rose, 34 F.3d at 19.
The Commissioner has established a policy for evaluating claims based on chronic fatigue syndrome:
CFS is characterized by the presence of persistent unexplained fatigue and by the chronicity of other symptoms. The most prevalent symptoms include episodes of low-grade fever, myalgias, headache, painful lymph nodes, and problems with memory and concentration. These symptoms fluctuate in frequency and severity and may be seen to continue over a period of many months. Physical examination may be within normal limits. Individual cases must be adjudicated on the basis of the totality of the evidence, including the clinical course from the onset of the illness, symptoms, signs, and laboratory findings. Consideration should be given to onset, duration, severity and residual functional capacity following the sequential evaluation process.
Program Operations Manual System § DI 24515.075. The Commissioner's policy statement has been used as a framework for judicial review of claims based on chronic fatigue syndrome. See Rose, 34 F.3d at 17; Olson, 17 F. Supp.2d at 790 (Commissioner's statement on CFS is instructive but not binding).
The ALJ found that Ms. Davis did in fact suffer from chronic fatigue syndrome during the relevant time period. The issue here is the severity of the condition during that time. The ALJ evaluated Ms. Davis' activities to determine how severely she was affected. He noted the prolonged gaps in medical treatment. He considered Dr. Stack's evaluation in April 1987, followed by a three-year gap before she next saw a doctor. After considering her activities and these other relevant factors, he determined that the limits were not so severe as to have prevented her from engaging in some types of sedentary work.
Reasonable people could differ on the proper decision here, but it was the ALJ's job to evaluate and weigh the evidence. He considered the proper factors and did not make the kinds of mistakes or omissions that can undermine confidence in his analysis. He considered the absence of objective findings, as he was required to do, but he did not give that absence controlling weight. His analysis does not, as Ms. Davis argues, amount to return "to a pre-Sarchet mentality." His treatment of the objective evidence does not call for a remand.
Conclusion
For the reasons explained above, the ALJ's decision denying disability insurance benefits is affirmed. Final judgment shall be entered accordingly.