Summary:
In Hultz v. Bisignano, the United States Court of Appeals for the Fourth Circuit reversed the denial of Social Security Disability benefits to Crystal Hultz, a claimant whose primary disabling condition was fibromyalgia. Relying heavily on its earlier decision in Arakas v. Commissioner, the Fourth Circuit held that Administrative Law Judges may not discount a claimant’s subjective testimony about the severity of fibromyalgia symptoms based on the absence of objective medical evidence—even as one factor among many.
The court emphasized that fibromyalgia is a condition that eludes objective measurement, waxes and wanes, and is proven largely through consistent subjective reports corroborated by treatment history and lay testimony. Because the ALJ repeatedly relied on objective findings, treatment gaps, and periods of apparent improvement to discredit Ms. Hultz’s testimony—and improperly discounted her treating rheumatologist’s opinion—the Fourth Circuit reversed outright and remanded for calculation of benefits rather than another hearing.
Commentary:
Although Hultz arises in the Social Security context, bankruptcy courts —especially those adjudicating hardship discharges under Chapter 13 and undue hardship claims under the Brunner standard for student loans—should take careful notice.
At its core, Hultz is not just a fibromyalgia case. It is a judicial reminder about how courts must evaluate human suffering when medicine cannot neatly quantify it. The Fourth Circuit makes explicit what bankruptcy courts too often forget: when a condition is inherently subjective, demanding objective proof of severity is not “skepticism”—it is legal error.
This matters enormously in bankruptcy.
Hardship discharges under § 1328(b) and Brunner-based student loan discharges routinely turn on judicial assessments of a debtor’s medical condition, functional capacity, and future prospects. Too often, those determinations devolve into a search for lab results, imaging, or physician statements phrased with actuarial certainty—precisely the kind of evidence that conditions like fibromyalgia, chronic fatigue, severe depression, long COVID, and many autoimmune disorders simply do not generate.
What Hultz reinforces—echoing Arakas—is that subjective evidence is not second-class evidence when the disease itself is subjective in manifestation. Consistent testimony, corroborating family statements, long treatment histories, medication trials, and waxing-and-waning functionality are not red flags; they are clinical hallmarks.
Translating that to bankruptcy practice:
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In Chapter 13 hardship discharge cases, a debtor should not be denied relief because they occasionally function, attend appointments, or experience partial symptom relief. As Hultz underscores, intermittent capacity is fully consistent with total inability to sustain full-time work.
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In student loan cases, Brunner’s “additional circumstances” and “certainty of persistence” prongs must be evaluated through this same lens. A debtor with fibromyalgia (or similar conditions) does not fail Brunner simply because their MRI looks fine or their doctor notes temporary improvement.
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Most importantly, bankruptcy courts should resist the impulse—explicitly rejected by the Fourth Circuit—to treat the absence of objective medical findings as evidence of exaggeration, malingering, or insufficient hardship.
There is a quiet but important throughline here: law must adapt to the limits of medicine, not punish debtors for them. The Fourth Circuit has now said, more than once, that courts err when they substitute demands for clinical certainty in places where science itself cannot deliver it.
Bankruptcy judges within the Fourth Circuit—and practitioners litigating these issues—should treat Hultz as persuasive authority well beyond Social Security law. When evaluating medical hardship, the question is not “Where is the objective proof?” but rather: Is the debtor’s lived experience credible, consistent, and supported by the record as a whole?
That shift in framing can—and should—change outcomes.
To read a copy of the transcript, please see:
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