James F. LAMB, A/N 252-48-2311, Plaintiff-Appellant v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee
Docket: 87-3114
Court: Court of Appeals for the Eleventh Circuit; June 16, 1988; Federal Appellate Court
James F. Lamb appealed the decision of the district court, which upheld the Secretary of Health and Human Services' denial of his Social Security disability benefits claim. The Eleventh Circuit found that the Secretary's decision was not backed by substantial evidence and failed to apply the correct legal standards, prompting a reversal and remand.
Lamb, born on September 20, 1928, has a fifth-grade education and previously worked as a construction project engineer. Following a fall from a ladder on October 13, 1982, he sustained compression fractures of the twelfth thoracic and second lumbar vertebrae. He was treated at Tallahassee Memorial Regional Medical Center and discharged after a treatment regimen that included bedrest, pain management, and prescribed exercises.
An examination by Dr. William J. Hutchison on October 29, 1982, noted that Lamb experienced ongoing mid-dorsal and lumbar pain, along with a moderate dorsal kyphosis and lumbar lordosis, and a fifty percent limitation of back motion. A subsequent bone scan revealed fresh multiple fractures. Dr. Hutchison advised activity restriction for three months and recommended a lumbosacral corset.
On April 25, 1983, a follow-up examination showed Lamb had a marked back deformity and tenderness in the lumbosacral area, with limited forward flexion and muscle weakness. X-rays indicated bilateral pars defects at L5 with minimal spondylolisthesis. By July 1, 1983, Dr. Hutchison assessed that the compression fractures were not problematic and attributed Lamb's symptoms to the minimal spondylolisthesis, suggesting further diagnostic testing and a different back support for treatment.
On May 16, 1983, Dr. Max E. Burr examined the appellant, noting slow movement but no acute distress or spinal deformity. The examination revealed tenderness in the mid to lower back, with X-rays showing healing multiple compression fractures in the lower thoracic and upper lumbar spine, approximately seven months old. Dr. Burr could not identify the cause of the appellant's left leg pain and recommended rehabilitative therapy.
In a follow-up in June 1983, Dr. Burr noted improvement but continued pain, projecting at least four to five months before the appellant could return to work. By August 29, 1983, the appellant's condition had not significantly improved, although there was slight relief in left leg pain. Dr. Burr suggested hospitalization for further diagnostic studies.
Upon admission to Doctors Hospital on September 19, 1983, the appellant showed no acute distress but reported increasing tightness in the lower thoracic region. Diagnostic tests, including a lumbar myelogram and CT scan, indicated nerve root abnormalities and a compression fracture of the T12 vertebral body with some pressure on the conus. No herniated nucleus polposus was found. After receiving therapy, the appellant felt significantly better upon discharge, and Dr. Burr recommended continued observation and rehabilitation but could not determine a specific disability or prognosis.
On January 5, 1985, the appellant returned to Dr. Burr, who noted the absence of intense muscle spasms but acknowledged that pain relief required significant activity restriction. Dr. Burr determined that the appellant could not return to his previous work. A letter from Dr. Wilton R. Kane on June 19, 1984, corroborated that the appellant's activity restrictions were incompatible with his former employment. By January 7, 1985, Dr. Burr concluded that no further improvement was expected and deemed the appellant permanently unemployable.
Appellant initially applied for disability and disability insurance benefits on June 23, 1983, citing an onset date of October 13, 1982. His application and subsequent request for reconsideration were denied by the Social Security Administration (SSA), and he did not pursue judicial review at that time. On January 12, 1984, he filed a second application, again related to his back condition, which was also denied after a reconsideration request. Following this, appellant requested a hearing on April 30, 1984, leading to a hearing held by an administrative law judge (ALJ) on June 19, 1984. The ALJ ruled on August 8, 1984, in favor of the appellant, stating he was entitled to benefits starting from October 13, 1982, based on credible pain allegations supported by medical evidence of severe residual pain syndrome and other spinal issues. The ALJ concluded that the appellant's severe impairment limited him to sedentary work, taking into account his age, education, and work experience.
However, the Appeals Council later reviewed the ALJ's decision and, citing 20 C.F.R. Sec. 404.970(a)(3, 1986), found it lacked substantial evidence. The Secretary reversed the ALJ's decision, determining that the appellant had a severe skeletal impairment but was capable of light work. The Secretary also deemed appellant's pain allegations inconsistent with the evidence and concluded that his skills were transferable to other employment, thus ruling him not disabled. Subsequently, appellant appealed this decision to the United States District Court for the Northern District of Florida, which upheld the denial of benefits based on the Magistrate's recommendation. Appellant has now appealed the district court's ruling to a higher court.
The court's review focuses on whether the Secretary's decision is supported by substantial evidence and adheres to proper legal standards, as mandated by 42 U.S.C. Sec. 405(g). The judicial review is confined to the complete record to assess the reasonableness of the Secretary's findings, without a presumption of validity attached to the Secretary's legal standards. Errors in applying the correct legal standards can lead to a reversal, not merely a remand. When the Appeals Council reverses an ALJ's decision, the review is limited to substantial evidence supporting the Appeals Council's action.
In this case, there are multiple errors warranting remand, including issues with the substantial evidence for the Secretary's decision and procedural failures by the Secretary. The court reiterates the standard for evaluating complaints of disabling pain, requiring either objective medical evidence confirming the pain's severity or evidence that the underlying medical condition is severe enough to reasonably cause the alleged pain. The Secretary acknowledged the claimant's underlying medical condition but the determination of whether the claimant meets the second prong of the standard remains unresolved.
Medical records lacked documentation on the severity of the claimant's pain, prompting an assessment of whether the established medical condition could reasonably cause the reported pain. This assessment is inherently subjective but must adhere to a standard of substantial evidence. The fact-finder must consider the credibility of the claimant’s testimony regarding pain, as established in Parker v. Bowen, which requires the Appeals Council to explicitly articulate reasons when rejecting credibility findings made by the Administrative Law Judge (ALJ).
The Appeals Council implicitly rejected the claimant's pain testimony by concluding that the medical condition could not reasonably produce the reported symptoms. However, the record contains substantial evidence supporting the existence of a medical condition likely to cause the alleged pain, with no examining physician disputing the claimant's pain, even if they were unable to provide treatment.
The ALJ, who directly observed the claimant, found the pain complaints credible, warranting some deference to this determination. The Appeals Council's assertion that the objective clinical evidence failed to substantiate a radiculopathy or the claimed severity of the impairment is deemed an improper evaluation of the evidence and lacks substantial support. The Council's reliance on reports from nonexamining physicians, who noted minimal activity restrictions, over the consistent findings from examining physicians contradicts established legal principles regarding the weighting of evidence.
Treating physicians' opinions are to be given significant weight unless good cause is shown to do otherwise, as established in Broughton v. Heckler and MacGregor v. Bowen. Reports from nonexamining physicians cannot serve as substantial evidence for administrative decisions, particularly if they contradict treating physicians' reports. The necessity for good cause is emphasized, indicating that nonexamining reports do not suffice to diminish the weight of treating physicians' opinions. The Secretary's reliance on nonexamining physician observations represents a procedural error and highlights flaws in the decision-making process.
The Secretary argued that Dr. Burr had not declared the appellant permanently unemployable until January 7, 1985, and cited prior statements from Dr. Hutchison and Dr. Kane indicating potential for returning to work. However, Dr. Kane's opinions did not recommend light work, and his silence on the issue of any type of work should not lead to assumptions. Dr. Burr's comments about a return to work were misrepresented; he indicated a lengthy recovery period without suggesting an eventual return to employment. Dr. Hutchison's recommendation for activity restriction was misconstrued as suggesting a return to work. Overall, Dr. Burr's treatment approach consistently indicated that returning to work was not a near-term possibility, culminating in a conclusion that did not contradict earlier assessments.
The Appeals Council failed to adequately consider expert vocational testimony presented by the appellant, which indicated the appellant's inability to engage in substantial gainful activity. It was established that the appellant could not return to past work, thus necessitating an evaluation of his residual functional capacity (RFC). The Council's determination that the appellant was capable of light work lacked substantial evidentiary support and contradicted the findings of the vocational expert, as well as the majority of the medical evidence in the record. The Appeals Council relied on reports from two nonexamining Social Security Administration physicians, which were insufficient to substantiate its conclusion. Given that the administrative law judge (ALJ) had made a recommendation supported by substantial evidence and appropriate legal procedures, the court found it unnecessary to gather further evidence. Consequently, the District Court's decision was reversed, and the case was remanded with instructions to grant benefits in accordance with the ALJ's recommended decision from August 8, 1984.
