Court: Court of Appeals for the Third Circuit; October 14, 2003; Federal Appellate Court
Janice Newell appealed the denial of her widow's disability benefits under Title II of the Social Security Act, which was originally denied by the Social Security Administration (SSA) and subsequently affirmed by the district court. Newell, who was 56 years old at the time of her hearing, claimed to be disabled since July 1, 1997, due to various health issues including liver disease, diabetes, and neuropathy. Her application for benefits was first denied on April 20, 1999, and again upon reconsideration. An Administrative Law Judge (ALJ) issued a final decision denying her benefits on April 17, 2000, after which Newell filed a complaint in the district court, which upheld the SSA's decision.
Newell was born on August 1, 1943, and married Robert S. Newell, a wage earner who died on August 9, 1990. Her eligibility for widow's benefits ceased on August 31, 1997, seven years post his death, necessitating that her disability began before this date. From 1994 to December 1996, she was self-employed and earned modest income, and worked part-time as a carpenter's assistant until her back injury in July 1997, after which she ceased all work activities. The appellate court has reversed the district court's decision and instructed a remand to the Commissioner for further proceedings consistent with its opinion.
Newell claims to have become disabled due to liver disease, diabetes, and neuropathy on July 1, 1997, but was unable to seek medical care until June 1, 1998, due to lack of insurance. Most medical evidence available is dated after her eligibility for widow's benefits expired on August 31, 1997. Despite this, she argues that her medical conditions existed before this date and progressed to disability during her eligibility.
The medical evidence includes reports from her family doctor and orthopedist, as well as assessments from the Social Security Administration (SSA). Prior to August 31, 1997, records show treatment for back issues and wrist contusions from 1990, including physical therapy and prescriptions. After August 31, 1997, Newell began seeing Dr. Harold Chafkin in June 1998 for diabetes and pain management, and later Dr. Alfred Greisman, who noted concerns about her liver condition. Notably, she lost 50 pounds in 1998, including muscle mass.
In November 1998, an EMG confirmed peripheral neuropathy. SSA records include a December 1998 Residual Physical Functional Capacity Assessment, indicating Newell's ability to lift and carry certain weights and stand or walk for about six hours a day. Consultative examiner Dr. Eatough observed that her back issues and neuropathy had progressed over several years and linked her weight loss to cessation of alcohol use.
Dr. Eatough assessed Newell with multiple medical conditions, including peripheral neuropathy, diabetes mellitus likely caused by chronic alcohol use, peripheral vascular disease, osteoarthritis with low back syndrome, and liver dysfunction. He noted her physical capabilities: occasionally lifting 20 pounds, frequently lifting 10 pounds, standing and walking for about two hours in an eight-hour workday, and sitting for approximately six hours with periodic standing. Her ability to push and pull was limited due to tenderness and neuropathy, but he found no significant manipulative, visual, communicative, or environmental limitations.
On May 1, 1999, Dr. Chafkin reported Newell's severe peripheral neuropathy and noted her poor prognosis, stating that her conditions rendered her unable to work. Newell testified that she was taking various medications for pain and diabetes, wore splints and a back brace, and had not engaged in work or housework since injuring her back in July 1997. She delayed seeking medical help due to lack of insurance and was diagnosed with diabetes and neuropathy in June 1998. She claimed to be incapable of bathing, dressing, or driving.
ALJ Ryan found Newell's claims unsupported by objective medical evidence and inconsistent with her own statements, noting a lack of medical treatment from 1990 to 1998 and the absence of treatment for her back injury in 1997. He concluded that her severe impairments did not begin until after she was last eligible for benefits and determined she was not entitled to widow's disability benefits.
The discussion section outlines the standard of review, indicating that the district court's order is reviewed de novo, while the Commissioner's decision is evaluated based on whether it is backed by substantial evidence defined as adequate relevant evidence to support a conclusion.
To establish a disability under the Social Security Act, a claimant must provide evidence of a medically determinable impairment that hinders their ability to engage in substantial gainful activity for at least twelve months. A claimant is deemed unable to work if their impairment is severe enough to prevent not only past employment but also any other substantial work available in the national economy, considering age, education, and experience.
The Social Security Administration (SSA) utilizes a five-step sequential evaluation process to determine disability status. Steps one and two involve assessing whether the claimant is currently working and if they have a medically severe impairment. If the claimant is engaged in substantial gainful activity or lacks a severe impairment, the claim is denied. Step three compares the claimant’s impairment against a list of severe impairments; if equivalent, the claim is granted without further analysis.
If the claim proceeds to step four, the Administrative Law Judge (ALJ) evaluates whether the claimant can perform past relevant work, placing the burden on the claimant to demonstrate an inability to return to such work. If the claimant cannot return to their previous occupation, step five shifts the burden to the Commissioner to show that the claimant can perform other jobs in significant numbers in the national economy, considering their impairments and residual functional capacity. The cumulative effect of all impairments must be analyzed to determine capability.
At step two, the ALJ must ascertain if the claimant has a medically severe impairment. An impairment is considered non-severe if it does not significantly limit basic work activities, which include fundamental abilities necessary for most jobs, such as walking, standing, and lifting.
The step-two inquiry serves as a minimal screening tool to dismiss unfounded claims, determining that an impairment is not severe only if there is evidence of a slight abnormality that minimally affects an individual's work ability. Claimants with more than slight abnormalities should not be denied benefits at this stage, and any reasonable doubts regarding severity should favor the claimant.
In Newell's case, ALJ Ryan denied her claim at step two, asserting a lack of medical evidence to support her disability allegations prior to August 31, 1997. However, this reasoning was deemed erroneous because Newell's infrequent medical visits could not adequately justify the conclusion of non-disability. Relevant case law indicates that not seeking treatment does not inherently negate the existence of an impairment. SSR 96-7p emphasizes that the adjudicator must consider explanations for irregular medical treatment before making inferences about a claimant's symptoms. Newell argued that financial constraints, confirmed by her low income and lack of insurance, prevented her from seeking earlier treatment.
Newell contended that her conditions were progressive and existed before their documentation in 1998, asserting that retrospective analysis of her medical history, even if not supported by contemporaneous records, could substantiate her claim of disability. The ALJ's failure to adequately consider this retrospective evidence and assess its relevance was a significant oversight in the evaluation of Newell's claim.
The ALJ incorrectly discredited Newell's credibility concerning her pain and functional level based on her lack of treatment before August 31, 1997. Lay evidence can be credible without corroboration by contemporaneous medical evidence, as established in Basinger v. Heckler. SSR 96-7p states that a claimant’s statements about pain intensity and its effects on work cannot be dismissed solely due to a lack of objective medical evidence. The ALJ also failed to provide adequate reasons for discrediting Newell's credibility. In Sousa v. Callahan, the court found insufficient justification for rejecting lay testimony based on the time elapsed and lack of corroborating evidence.
The ALJ neglected to apply SSR 83-20, which outlines the framework for determining a disability onset date. This SSR defines the onset date as the first day an individual is considered disabled. When the onset date is crucial for benefit eligibility, the ALJ must address this issue, particularly for slowly progressive impairments where medical evidence may not pinpoint the exact disabling date. In such cases, the onset date may be inferred from the medical history and symptomatology. If the evidence is insufficient to infer the onset, the ALJ should seek input from a medical advisor and gather additional documentation from family, friends, or former employers to clarify the individual's condition and the absence of medical records during relevant periods.
The ALJ erred by not consulting a medical advisor to determine the onset date of Newell's alleged disability, as mandated by SSR 83-20 and established case law (Walton v. Halter, 243 F.3d 703; DeLorme v. Sullivan, 924 F.2d 841). When medical evidence regarding the onset date is ambiguous, the ALJ is required to seek input from a medical advisor, as demonstrated in Spellman v. Shalala. The Appeals Council could not infer an onset date without this consultation, particularly since Newell's condition was complex and not clearly documented. The district court may affirm, modify, or reverse the Commissioner's decision under 42 U.S.C. 405(g), with the option to remand for further hearings or to directly award benefits if the record shows substantial evidence of disability. However, Newell's case was not fully developed; the ALJ's denial at step two was based on incorrect reasoning, including insufficient review of post-August 31, 1997 evidence and misinterpretation of Newell's treatment history. Consequently, the district court's affirmation of the Commissioner's decision must be reversed.
The order from December 3, 2002, is reversed, and the case is remanded to the district court, which will then send it back to the Commissioner for further proceedings as per the court's opinion. The Commissioner did not argue against considering Newell's case based on her alleged disability discussed during oral arguments. Initially, Newell claimed her eligibility for widow's benefits extended until August 1998; however, her attorney later conceded that August 31, 1997, was the appropriate cut-off date. The document references the administrative transcript (Tr.) and explains that while Social Security Rulings (SSRs) interpret the Social Security Administration's (SSA) statutes and regulations, they do not have the force of law but are binding within the SSA once published. SSR 85-28 emphasizes careful application of the "not severe impairment" concept, indicating that if an adjudicator cannot clearly assess the impact of an impairment on basic work activities, the evaluation should continue beyond the "not severe" step. Additionally, SSR 83-20 outlines that an Administrative Law Judge (ALJ) must consider the claimant's allegations, work history, and medical evidence when determining the onset date of a disability. The case Walton v. Halter establishes that an ALJ should engage a medical advisor when dealing with slowly progressing impairments and insufficient medical records from the relevant period.
