Lingenfelter v. Astrue

The Ninth Circuit applies a two-step framework to subjective-symptom testimony. A claimant first must produce objective medical evidence of an impairment that could reasonably cause some degree of the alleged symptoms; the claimant need not prove that the impairment objectively explains the full severity alleged. Once that threshold is met and there is no affirmative evidence of malingering, an ALJ may reject testimony about symptom severity only by giving specific, clear, and convincing reasons.

The Commissioner conceded that Lingenfelter satisfied the first step, and the ALJ found no malingering. The question therefore was not whether his extensive knee and foot conditions could cause pain, but whether the ALJ adequately justified rejecting testimony that he could sit or stand only briefly, needed to lie down several times a day, and needed to elevate his legs.

The ALJ's asserted medical-opinion consensus did not exist. Although several examining or reviewing physicians believed Lingenfelter could perform sedentary or semi-sedentary work, his two primary treating physicians reached the opposite conclusion. Dr. Caillouette, who treated him for years, documented severe knee and foot pain, prescribed a cane and wheelchair, and found him fully disabled pending treatment. Dr. Tischler likewise found him totally disabled and unable to do work requiring sitting or standing. The ALJ could not describe the record as a consensus while ignoring those opinions.

The ALJ also erred by failing to give specific and legitimate reasons for rejecting the treating physicians' opinions. A treating doctor's opinion cannot be effectively rejected merely by omitting it from the discussion and making a contrary finding. The treating physicians had longitudinal treatment relationships and their reports were supported by clinical findings, examinations, diagnostic testing, and the documented need for major surgery.

Lingenfelter's unsuccessful nine-week work attempt in 1999 was not a clear and convincing reason to disbelieve his symptom testimony. He tried to work after the relevant insured period because of severe financial necessity, but he could not sustain the work because of pain, swelling, and slow performance. An unsuccessful attempt to work despite disabling symptoms may support, rather than contradict, a claimant's account.

The timing further weakened the work-attempt rationale. Lingenfelter needed to establish disability during a twelve-month period between his 1993 onset date and the June 1998 expiration of his insured status; his brief employment began in February 1999. The court also found the Social Security trial-work rules instructive: if nearly nine months of trial work does not itself demonstrate that an existing beneficiary is no longer disabled, a failed nine-week work attempt does not clearly establish that an applicant's pain testimony is unreliable.

Other credibility considerations reinforced the conclusion. Lingenfelter's limited daily activities were consistent with his allegations; he took prescribed pain medication and pursued extensive treatment; he had undergone surgeries and wanted further recommended surgeries, but insurance would not authorize them; and the physicians who expressly evaluated his pain found it consistent with the objective record. The ALJ therefore lacked a valid basis to exclude his described limitations from the RFC.

An RFC must account for all of a claimant's functional limitations, including properly credited symptom testimony. Because the ALJ had no clear and convincing reason to reject Lingenfelter's testimony, the RFC could not omit his need to lie down two or three times daily, his limited tolerance for sitting and standing, and his need to elevate his legs.

The step-five finding also failed because it rested on a vocational hypothetical built from the defective RFC. A vocational expert's answer supports a denial only when the hypothetical includes all of the claimant's established limitations.

Here, the ALJ had posed alternative hypotheticals to the vocational expert that incorporated Lingenfelter's asserted restrictions. The expert testified that a worker who needed to lie down two or three times daily for as long as 45 minutes would be eliminated from the identified jobs and from sedentary work generally. Thus, if Lingenfelter's testimony was credited, the record compelled a disability finding at step five.

Further administrative proceedings were unnecessary under the credit-as-true rule. No unresolved factual issue remained material to the disability determination, and the vocational testimony established that the ALJ would have to award benefits if the improperly rejected testimony were accepted. The court therefore reversed the district court and directed a remand to the ALJ for calculation and award of appropriate past benefits.