Robert Ellis v. Jo Anne B. Barnhart, Commissioner of Social Security Administration.
Docket: 03-3945
Court: Court of Appeals for the Eighth Circuit; January 3, 2005; Federal Appellate Court
Robert Ellis appeals the district court's affirmation of the Commissioner of Social Security's denial of his disability benefits claim. Ellis applied for Supplemental Security Income (SSI) in October 2000, citing disabilities from back and leg issues, chronic pain, hepatitis C, and limited physical activity. An Administrative Law Judge (ALJ) held a hearing in November 2001 and subsequently denied the application in January 2002, with the Appeals Council upholding this decision in April 2002.
During the hearing, Ellis testified to multiple health issues, including a recent diagnosis of hepatitis C, non-insulin-dependent diabetes, and a blood clot in his leg. He also reported a CT scan revealing a possible pinched nerve or torn rotator cuff in his shoulder. Ellis argued that his chronic back pain and degenerative disc disease prevented him from performing any jobs suggested in prior hearings.
Dr. Patrick Johnson, Ellis's treating physician, supported this claim in a November 2001 opinion, stating that Ellis's chronic medical conditions rendered him unable to engage in sustained gainful employment. Dr. Johnson highlighted severe pain, diabetes, hepatitis C, deep vein thrombosis, dental issues, and hypertension as significant impediments. He asserted that Ellis could walk for only two hours in an eight-hour workday, sitting for a maximum of four hours but only one hour at a time due to pain and the risk of developing blood clots. The court ultimately affirmed the denial of benefits, agreeing with the ALJ's findings.
Ellis has been under the care of Dr. Johnson since 1993 for chronic back and hip pain, with most visits since a denied disability application in 1999 involving routine examinations and prescription refills. During a visit on September 5, 2000, Dr. Johnson noted that Ellis's hepatitis C was quiescent, and by April 9, 2001, he reported that Ellis's chronic pain was stable under current medication. Ellis first reported shoulder pain on August 9, 2001, leading to an increase in his OxyIR prescription and a DepoMedrol injection, with a subsequent MRI on October 5, 2001, confirming tendinitis and a pinched nerve.
Ellis has experienced two episodes of Deep Vein Thrombosis (DVT), with the most recent hospitalization on September 9, 2001, where treatment led to rapid improvement. His first episode occurred in August 1993 following a pelvic fracture, and subsequent examinations showed no recurrence. Regarding his back pain, an MRI on July 1, 2000, revealed mild to moderate degenerative changes but no significant herniations or stenosis.
A consultative examination by Dr. Richard Secor on January 18, 2001, indicated that Ellis had full range of motion in most joints and only slight limitations in certain areas. Ellis exhibited chronic pain managed with narcotics and utilized a cane part-time, which Dr. Secor deemed unnecessary. The Administrative Law Judge (ALJ) identified Ellis as having severe impairments of DVT, diabetes, and fibromyalgia, while considering hepatitis C non-severe due to normal liver enzyme levels and stable condition. The ALJ concluded that Ellis's back and leg issues did not present severe impairments, nor did his shoulder pain outside the context of fibromyalgia.
The ALJ determined that Ellis did not meet the criteria for a listed impairment and assessed his residual functional capacity (RFC). The ALJ found Ellis's subjective complaints regarding the severity of his symptoms to lack credibility due to insufficient objective medical evidence and an inadequate treatment history. Nevertheless, the ALJ allowed for some limitations, concluding that Ellis could lift and carry no more than ten pounds, sit for up to six hours, and stand for up to two hours during an eight-hour workday, which indicated he could perform a full range of sedentary work. Consequently, based on his age, education, and ability to engage in sedentary work, the ALJ ruled that Ellis was not disabled.
Following the ALJ's decision, the Appeals Council denied Ellis's request for review, leading him to appeal to the district court. The magistrate judge reviewed the medical evidence and upheld the ALJ's denial of benefits. Ellis's appeal to the court is subject to a de novo review, affirming the decision if substantial evidence supports the Commissioner’s findings.
The ALJ followed a five-step analysis to determine disability, concluding at the fifth step that Ellis was not disabled. The Commissioner must demonstrate that there are a significant number of jobs available in the national economy that the applicant can perform, considering his RFC, age, education, and work experience. Ellis raised three issues on appeal: the ALJ’s failure to adequately develop the medical record and give controlling weight to his treating physician's opinion, improper application of the Polaski factors regarding his pain complaints, and the lack of vocational expert testimony.
Specifically, regarding the treating physician's opinion, Dr. Johnson, the ALJ did not give it controlling weight due to a lack of supportive clinical evidence and absence of signs such as muscle atrophy. Ellis contends that the ALJ had a duty to seek clarification from Dr. Johnson instead of dismissing the opinion as conclusory.
A social security hearing is characterized as a non-adversarial process where the Administrative Law Judge (ALJ) is responsible for fully developing the record. The ALJ's duty to seek clarification from a treating physician arises only when a crucial issue is undeveloped; in this case, Ellis did not claim that any relevant medical records were missing. The ALJ kept the record open for 30 days post-hearing to allow Ellis to provide a recent opinion from Dr. Johnson, which was included in the record. Ellis's attorney argued that the record was adequately developed to support Dr. Johnson's assertion of Ellis's disability but did not specify what further medical evidence was needed. Consequently, Ellis failed to demonstrate that any alleged shortcomings in record development resulted in prejudice, negating grounds for remand.
The ALJ did not grant controlling weight to Dr. Johnson's opinion that Ellis was disabled and had significant limitations on sitting and standing. Instead, the ALJ assessed Ellis's Residual Functional Capacity (RFC) as allowing six hours of sitting and two hours of standing, indicating some acknowledgment of Dr. Johnson's medical opinions. Although ALJs typically must give controlling weight to treating physicians' opinions supported by the record, opinions regarding disability status are reserved for the Commissioner and are not treated as medical opinions. Thus, the ALJ appropriately discredited Dr. Johnson's conclusion that Ellis was unable to work. The Commissioner considers treating physicians' opinions about the nature and severity of impairments, but the final RFC determination rests with the Commissioner, who defers to treating physicians' well-supported opinions that align with substantial evidence in the record.
Dr. Johnson opined that Ellis's chronic back and hip pain limited him to standing for two hours and sitting for four hours per workday, with the additional limitation of not being able to sit or stand for more than one hour at a time. However, the ALJ found these limitations unsupported by medical evidence, noting that while Ellis has chronic pain, his medications effectively alleviate it. Ellis's testimony indicated he spends leisure time reading and watching television, contradicting his claims of limited sitting ability. Dr. Johnson did not impose any restrictions on Ellis's sitting or standing, nor did Ellis report such limitations during consultations. Furthermore, Dr. Johnson cited blood clot concerns as a basis for his opinion, yet did not recommend any restrictions to mitigate this risk. Other medical records indicated that Ellis could walk briskly without a cane, which was deemed unnecessary by Dr. Secor, and he showed no mobility issues during examinations. Consequently, the ALJ appropriately discredited Dr. Johnson's opinion due to its lack of support from the medical record and its inconsistency with other evidence.
In evaluating Ellis's subjective claims of pain, the ALJ assessed his credibility using the Polaski factors, concluding that Ellis was not fully credible regarding the severity of his symptoms due to insufficient objective medical evidence and a limited treatment history. The ALJ noted that Ellis's pain was managed by medication, which had no reported adverse side effects, and that no medical professional observed signs consistent with Ellis's claimed limitations. While the ALJ recognized the need for objective evidence to support Ellis's claims, he also identified inconsistencies throughout the record as a basis for discounting those claims.
Credibility findings are primarily the jurisdiction of the Administrative Law Judge (ALJ), who adequately explained the inconsistencies that led to the discounting of Ellis's subjective complaints regarding pain. Ellis has not worked since 1993, and his sporadic work history is relevant to the credibility analysis. Although Ellis claimed severe back and hip pain, medical examinations showed normal range of motion, and medications alleviated his pain. Concerns about potential addiction to narcotics, noted as early as 1995, further supported the ALJ's skepticism regarding the severity of Ellis's complaints.
Ellis contended that the ALJ improperly relied on the Medical-Vocational Guidelines (grids) due to his non-exertional impairments, which typically require a vocational expert’s opinion. However, if non-exertional impairments do not significantly limit the claimant’s ability to perform a full range of sedentary work, the grids can still be applied. The ALJ determined that Ellis's pain did not restrict him from performing sedentary work, justifying the reliance on the grids without needing vocational expert testimony.
Ellis argued that his inability to sit or stand for over an hour limited his job prospects significantly, which should have prompted the ALJ to consult a vocational expert. Sedentary jobs involve primarily sitting, with allowances for breaks, and the ability to alternate between sitting and standing is considered in the assessment of residual functional capacity (RFC). If the ALJ had accepted Dr. Johnson’s opinion that Ellis could sit for only one hour, expert testimony would have been necessary. However, the ALJ discredited Dr. Johnson's opinion and found that Ellis could sit for up to six hours, thus affirming the use of the grids in the decision-making process.
Ellis has a challenging history of multiple automobile accidents that resulted in significant injuries. The Administrative Law Judge (ALJ) and the district court's evaluations led to the decision to deny Ellis benefits, which is upheld on appeal. The district court noted that Ellis's claim, which alleged a disability onset date of 1978, was interpreted by the ALJ as a request to reopen previously denied applications. The ALJ applied res judicata, restricting the current disability assessment to the period after the last denial on May 28, 1999. Ellis did not contest this limitation on appeal.
The evaluation of disability was based on a five-part test, which considers employment status, severity of impairment, comparison to listed impairments, capability to perform past work, and ability to engage in other work. However, dissenting Circuit Judge Heaney argued that the ALJ improperly discounted the opinion of Ellis's long-time treating physician, who indicated that Ellis was permanently disabled, in favor of a consultant's one-time examination. Heaney contended that the ALJ wrongly dismissed Ellis's testimony regarding debilitating pain and believed the evidence warranted a finding of disability benefits starting November 1, 2000. He further highlighted that the ALJ failed to adequately consider Ellis's comprehensive medical history, which should inform the disability determination, even if some evidence dates back to previously adjudicated periods. Heaney advocated for a remand to the district court for an award of benefits based on substantial evidence supporting Ellis's claim.
Ellis has a history of multiple serious injuries from various accidents. In 1979, at age 19, he suffered severe injuries as a passenger in a car accident, including fractured femurs and a collapsed lung. In 1993, he was involved in two separate incidents: one where he sustained a pelvic fracture from a truck rollover and another where he was thrown from a vehicle in a rear-end collision, resulting in facial injuries. After returning to work as a roofer, he experienced additional injuries from falls, including a bruise to his tailbone. In 1997, Ellis was again injured in a rollover accident, suffering a severe scalp laceration, and in 1998, he had minor injuries from a car hitting a tree. Overall, he has been injured in five serious car accidents and two falls from roofs, accumulating various injuries, including fractures and lacerations.
The ALJ's decision to dismiss the opinion of Ellis’s treating physician, Dr. Patrick E. Johnson, is challenged. The law states that a treating physician's opinion should be given controlling weight if it is well-supported by clinical evidence and consistent with other substantial records. Dr. Johnson has treated Ellis since 1993 for injuries from his accidents and for conditions such as deep vein thrombosis, chronic pain, and other medical issues, including hepatitis C and diabetes. In 2001, Ellis was hospitalized for deep vein thrombosis, highlighting ongoing health complications stemming from his medical history.
Dr. Johnson provided multiple letters asserting that the claimant, Ellis, is totally disabled due to a range of chronic medical issues, including severe chronic pain from multiple motor vehicle accidents, diabetes, chronic hepatitis C, recurrent deep vein thromboembolism, severe dental caries, and hypertension. He emphasized that these conditions prevent Ellis from engaging in any sustained gainful employment, asserting that Ellis cannot sit or stand for more than an hour at a time due to pain and health risks. Dr. Johnson concluded that Ellis is permanently and completely disabled and should be considered for disability benefits.
Dr. Richard M. Secor, a state consultant, examined Ellis once but did not provide an opinion on his ability to work full-time or address the disabling nature of Ellis's pain, failing to consider Dr. Johnson's findings on Ellis's limitations. The opinion of Dr. Johnson, as the treating physician, is deemed well-supported by clinical evidence and should carry significant weight in the evaluation process. Additionally, the Administrative Law Judge (ALJ) failed to adequately analyze five Polaski factors related to the impact of Ellis's pain on his work capabilities, which include daily activities, pain characteristics, medication effects, and functional restrictions.
The ALJ's assessment of Ellis's daily activities misapplied legal standards, interpreting daily tasks like watching television and reading as evidence that Ellis could perform sedentary work for extended periods. This interpretation contradicts established case law, such as McCoy v. Schweiker, which emphasizes that the ability to perform sedentary work involves the capacity to engage in physical activities consistently in real-world conditions, rather than merely participating in passive activities. The ALJ also misinterpreted Dr. Johnson's medical findings, which clearly stated that Ellis could not sit or stand for more than one hour due to chronic pain and other limitations, indicating he was incapable of sedentary work. Ellis's medical history reflects severe and chronic pain, supported by a regimen of multiple pain medications, with no evidence suggesting these alleviated his condition to enable full-time sedentary work. Additionally, while the ALJ could discount subjective complaints based on inconsistencies, he failed to adequately explain his reasoning for rejecting Ellis's claims, as required by Polaski v. Heckler.
The exhibits referenced by the ALJ do not align with Ellis's pain complaints and fail to substantiate the ALJ's conclusions. Exhibit B-1F, a comprehensive clinical report from August 1993 to November 2000, is misrepresented by the ALJ, who suggests that Ellis's examinations were "essentially normal." The report specifically notes normal liver enzymes but does not indicate overall normality. Dr. Johnson recommended continued use of Oxycontin and OxyIR for pain management, and documented that Ellis sustained minor injuries from a single-car accident.
Exhibit B-7F, detailing Ellis's hospitalization post-accident on April 12, 2000, highlights significant injuries, including facial trauma and lower back pain, alongside a history of serious medical conditions such as hepatitis C and multiple fractures. This contradicts the ALJ's assertion of a normal physical examination. Documented chronic back pain following the accident supports Ellis's ongoing pain complaints.
Exhibit B-11F shows selective reading by the ALJ, focusing on a comment from Dr. Johnson indicating no new complaints, while ignoring subsequent statements that chronic back and leg pain persisted. Ellis's physical limitations are evident, including a capacity to stand or walk for only two hours in an eight-hour day and sit for four hours with breaks.
The ALJ relied on Dr. Secor's report (Exhibit B-4F), which noted Ellis's ability to sit, stand, and lie down without assistance. However, Dr. Secor did not assess Ellis's ability to work consistently in a competitive environment, adding little value to the evaluation of Ellis's work capabilities.
Dr. Hoff, treating Ellis for deep vein thrombosis, documented severe back pain requiring substantial pain medication, attributed to degenerative joint disease and past injuries. His findings included multiple surgical scars and a swollen left leg, with a final diagnosis of left lower extremity deep venous thromboembolism, stable and improved, alongside chronic severe pain from prior accidents and a history of hepatitis C.
The report supports Ellis's claims of pain and addresses two main issues he raised. First, it finds no merit in Ellis's assertion that the Administrative Law Judge (ALJ) failed to fully develop the record, stating the record was indeed fully developed but that the ALJ selectively ignored significant portions. Second, Ellis contends that a vocational expert should have been consulted with a comprehensive hypothetical scenario. The report concludes there is substantial evidence supporting Ellis's entitlement to disability benefits starting November 1, 2000, and indicates that remanding for further testimony from a vocational expert is unnecessary. The review of the record, including Ellis's extensive medical history involving multiple injuries and treatments, reinforces the decision to award benefits without further proceedings.
