Caseflicks

Court of Appeals for the Ninth Circuit • 1989

Jack FAIR, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services of the United States, Defendant-Appellee

885 F.2d 597 | 1989 U.S. App. LEXIS 13625

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Takeaway

In short, this case confirms that an ALJ may reject disabling-pain testimony and a dependent treating-physician opinion when specific, substantial evidence shows that the claimant's conduct and daily activities conflict with the claimed limitations.

Background

Jack Fair, a sixty-one-year-old former San Francisco tax investigator, sought Disability Insurance benefits based on back and leg pain, arthritis, headaches, obesity, gastric problems, hypertension, allergies, and psychological symptoms. He had stopped working in 1980, when the city placed him on disability retirement. His past work as a tax investigator was primarily sedentary.

This was Fair's third benefits application. His first two applications had been denied, with the second denial becoming final on July 12, 1983. Fair filed this application in July 1984. At a 1986 hearing, Fair testified that severe pain limited his walking, sitting, sleeping, and daily functioning. His treating physician, Dr. Bliss, testified that Fair could not sustain ordinary sedentary work if Fair's reports of pain and limitations were accepted.

The ALJ found Fair capable of returning to his prior tax-investigator work. The ALJ discounted Fair's testimony about disabling pain because his limited treatment, failure to follow recommended weight-loss and exercise measures, and reported daily activities conflicted with the asserted severity of his symptoms. The ALJ also discounted Dr. Bliss's disability opinion because it depended largely on Fair's subjective reports. The Appeals Council adopted the decision, and the district court granted summary judgment for the Secretary. Fair appealed.

Issues

Issue #1

Whether Fair was barred from claiming disability before July 12, 1983 and bore the burden to show that his condition worsened after that date.

Holding

Yes. The prior final denial precluded a new disability claim for the earlier period and created a presumption that Fair remained able to work unless he proved worsening after July 12, 1983.

Reasoning

Although res judicata is not applied rigidly in Social Security disability cases, Fair neither sought nor established grounds to reopen his earlier determinations. The final 1983 denial therefore barred him from relitigating disability for the period it covered.

The prior denial also created a presumption of continuing nondisability. To obtain benefits on his new application, Fair had to produce evidence that his medical condition had deteriorated since the earlier final decision.

Issue #2

Whether the ALJ lawfully rejected Fair's testimony that pain prevented him from working.

Holding

Yes. The ALJ made specific credibility findings, supported by substantial evidence, that permissibly undermined Fair's allegations of disabling pain.

Reasoning

A claimant must first present objective medical evidence of an impairment that could reasonably produce some pain. Once that threshold is met, an ALJ may not reject testimony about the severity of pain merely because objective findings do not fully corroborate it. Pain beyond what medical testing can measure may nevertheless be disabling.

But an ALJ need not accept every assertion of disabling pain. The ALJ may rely on specific evidence bearing on credibility, including daily activities that are meaningfully transferable to work and an unexplained failure to seek treatment or follow prescribed treatment.

Here, the ALJ identified concrete inconsistencies between Fair's claimed incapacitating pain and his conduct. Fair had pursued only minimal conservative treatment, had not recently received physical therapy or been hospitalized for his symptoms, and had not followed his physician's repeated advice to lose weight and exercise, without providing a persuasive explanation.

The ALJ also found that Fair remained able to care for his personal needs, clean his apartment, shop, drive, and use public transportation. Those activities did not by themselves prove an ability to work, because disability law does not demand utter incapacity. But together with Fair's treatment history, they supplied substantial evidence for the ALJ's credibility determination.

The court emphasized that credibility determinations belong primarily to the ALJ. Another factfinder might have credited Fair's testimony, but the appellate court could not reweigh evidence once the ALJ had given specific, legally adequate reasons supported by the record.

Issue #3

Whether the ALJ improperly rejected the opinion of Fair's treating physician, Dr. Bliss.

Holding

No. The ALJ gave a specific and legitimate reason, supported by substantial evidence, for declining to accept Dr. Bliss's conclusion that Fair was disabled.

Reasoning

A treating physician's opinion ordinarily receives special weight, and an ALJ who rejects it must give specific and legitimate reasons grounded in substantial evidence. That standard recognizes the treating physician's ongoing familiarity with the claimant while preserving the ALJ's duty to evaluate the basis for the opinion.

Dr. Bliss's stated work restrictions rested substantially on Fair's own descriptions of the intensity and functional effects of his pain. At the hearing, Dr. Bliss confirmed that his assessment assumed the truth of Fair's subjective complaints.

Because the ALJ had properly found Fair's assertions of disabling pain not credible, the ALJ could also discount a treating physician's disability opinion that uncritically relied on those same assertions. The ALJ therefore did not err in refusing to adopt Dr. Bliss's opinion.

Issue #4

Whether the district court was required to remand for consideration of a CT scan performed after the ALJ's decision.

Holding

No. The later CT scan was not material because it revealed nothing beyond what earlier medical evidence had already shown.

Reasoning

A remand for new evidence requires evidence that is material to the disability determination. Fair's CT scan occurred nine months after the ALJ issued the decision and did not demonstrate a significant new condition or a deterioration relevant to the period at issue.

The scan disclosed no material information beyond the degeneration already reflected in Fair's 1981 x-ray. It therefore did not justify reopening the administrative proceedings.