## Facts

- Nina Green-Younger, age 38, applied for Social Security disability insurance benefits alleging disability beginning in May 1995 due to fibromyalgia, degenerative disc disease, and chronic pain.
- She previously worked full-time as a long-distance telephone operator (1978–1995) and part-time as a mail sorter.
- After a 1982 car accident, she was diagnosed with degenerative disc disease; a 1992 discogram showed severe degeneration at L5–S1.
- Beginning in 1994, she treated regularly with Dr. Jeffrey Helfand, an osteopath and rheumatologist, who diagnosed fibromyalgia and documented widespread pain, tender points, fatigue, and functional limits.
- Dr. Helfand concluded Green-Younger was disabled under Social Security standards and reported limits consistent with inability to sustain full-time work (e.g., sitting/standing only in short intervals with significant breaks).
- A vocational expert testified that if Green-Younger’s and Dr. Helfand’s described limitations were credited, she could not perform her past work or other work in the national economy.
- The ALJ denied benefits, finding she retained the residual functional capacity for sedentary work and could perform her past work as a telephone operator, relying largely on non-examining consultants and a physical therapist’s evaluation.
- The Appeals Council denied review, and the district court affirmed; Green-Younger appealed.

## Issues

1. Whether the ALJ violated the treating physician rule by declining to give controlling weight to the treating rheumatologist’s diagnosis and functional assessment, particularly given fibromyalgia’s clinical features.
2. Whether the denial of benefits was supported by substantial evidence and applied the correct legal standard.
3. Whether the proper remedy was remand for further proceedings or remand solely for calculation of benefits.

## Decision

- The Second Circuit reversed the district court’s judgment.
- The court held the ALJ improperly refused to afford controlling weight to the treating physician’s opinion and applied an erroneous legal standard.
- The court held the Commissioner’s denial was not supported by substantial evidence.
- The case was remanded with instructions to remand to the Commissioner for calculation of benefits (not further proceedings).

## Legal Principles

- A treating source’s medical opinion must be given controlling weight if it is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence in the record.
- Opinions of non-examining consultants generally cannot constitute substantial evidence sufficient to override a well-supported treating physician’s opinion, especially where the treating source has a longitudinal treatment history.
- Fibromyalgia may lack traditional objective findings (e.g., motor deficits, arthritis, imaging abnormalities); ALJs may not discount the diagnosis or resulting limitations merely because such findings are absent.
- Tender-point examinations and consistent reports of widespread pain and fatigue are medically accepted methods for evaluating fibromyalgia and must be meaningfully considered.
- When the record is fully developed and compels a finding of disability, remand for calculation of benefits is appropriate.

## Conclusion

The Second Circuit held that the ALJ improperly rejected a treating rheumatologist’s well-supported fibromyalgia-related disability opinion by demanding objective findings inconsistent with the condition and by favoring non-examining and lesser-weight evidence; because the developed record supported disability, the court ordered a remand for calculation of benefits.


Green-Younger v. Barnhart, 335 F.3d 99 (2d Cir. 2003)