Smolen v. Chater

The statute requires that an applicant for disabled child benefits be under a disability that began before age twenty-two. Agreeing with other circuits, the court concluded that the claimant must be continuously disabled, without interruption, from before age twenty-two until the application date.

The ALJ had treated early 1987, when Smolen developed breast cancer, as the end of the relevant period, apparently assuming that later disabilities could be tacked onto earlier impairments. The court noted uncertainty about whether successive unrelated impairments may be tacked, but did not resolve that question.

Smolen presented evidence that the impairments arising from her childhood cancer and treatment—not her breast cancer—continued to limit her from before November 1982 through March 1988 and afterward. Thus, she needed to establish the same disability across that full period.

Under the Ninth Circuit's two-stage framework, a claimant first must produce objective medical evidence of an impairment that could reasonably be expected to produce some degree of the alleged symptom. She need not provide objective proof of the symptom itself, its exact severity, or a medically proven causal mechanism.

Smolen met that threshold. Uncontradicted evidence showed that she had one kidney, reduced lung capacity, anemia and bone-marrow suppression, radiation-related lung changes, and scoliosis. Medical opinions also supported the reasonable inference that these impairments, considered together, could cause fatigue and pain.

The ALJ improperly ignored several documented impairments and focused narrowly on whether mild anemia alone could cause the full severity of fatigue alleged. That approach was legally mistaken because Smolen was not otherwise healthy, her impairments had to be considered in combination, and she needed to show only that they could cause some fatigue or pain.

Because there was no evidence of malingering, the ALJ could discredit the claimed severity of Smolen's symptoms only with specific, clear, and convincing reasons. The sparse medical records did not contradict her testimony, and the ALJ identified no actual contradiction.

Smolen's limited daily activities supported rather than undermined her account. Her failure to take medication was not a valid basis for disbelief because she testified that, after losing work and insurance, she could not afford treatment. Her work record, school difficulties, physician observations, counselor evidence, and family testimony also corroborated her symptoms.

A treating physician's opinion ordinarily receives greater weight because the physician has a greater opportunity to know the patient. Likewise, a specialist's opinion on matters within the specialist's field receives more weight than that of a nonspecialist. Dr. Hoeflich was Smolen's treating physician, and Dr. Smolen was the only physiatrist—the specialty the record identified as most appropriate to assess her functional capacity.

Their opinions were not genuinely contradicted by the Commissioner's nonexamining internist, Dr. Maxwell. Although he stated that mild anemia alone would not ordinarily cause disabling fatigue in an otherwise healthy person, he agreed that Smolen's combined childhood illness, surgeries, chemotherapy, and radiation could have impaired her ability to function.

The ALJ criticized counsel's summary of the evidence given to the physicians as biased and incomplete. But the supposed omissions either were implicit in the information provided, immaterial to the physicians' conclusions, or did not reasonably support a contrary inference. The ALJ therefore lacked substantial evidence for treating the opinions as unreliable on that basis.

Nor could the ALJ reject the opinions merely because counsel asked leading, hypothetical, yes-or-no questions. Expert opinions may be elicited through hypotheticals, and Dr. Smolen gave explanatory comments grounded in his medical knowledge and experience.

If the ALJ believed that Dr. Hoeflich's brief responses needed further explanation, the ALJ had a duty to develop the record by seeking clarification, submitting additional questions, subpoenaing the physician, or continuing the hearing. The ALJ could not fail to develop the record and then reject an uncontroverted treating opinion for lack of detail.

Lay witnesses may provide relevant evidence about how an impairment affects a claimant's ability to work. When symptoms such as pain and fatigue are not fully documented in medical records, agency policy specifically calls for detailed observations from third parties likely to know the claimant's daily limitations.

The ALJ dismissed the family witnesses collectively as biased advocates. That was not a witness-specific, germane reason, and family relationship alone is not a valid ground for disregarding testimony. Family members who observe the claimant daily can be especially valuable witnesses of fatigue, pain, and functional decline.

The ALJ also relied on the absence of contemporaneous chart notes corroborating severe fatigue and back pain. That reasoning conflicted with the governing policy, which requires consideration of lay testimony precisely when medical records do not adequately document subjective symptoms.

Step two is only a de minimis screening device. An impairment may be found nonsevere only when it is a slight abnormality with no more than a minimal effect on basic work activities. The ALJ was required to consider all impairments in combination, including subjective fatigue and pain.

The ALJ found only slight scoliosis to be severe, while ignoring the combined effects of Smolen's kidney loss, reduced lung capacity, radiation-related lung changes, anemia, bone-marrow suppression, scoliosis, fatigue, and pain. Evidence that she could not walk, stand, sit, lift, carry, or perform sustained activities without fatigue or pain showed more than a minimal limitation.

At step five, the Commissioner bore the burden to show that Smolen could perform other work on a regular and continuing basis. The ALJ's finding that she could perform sedentary jobs omitted the severe fatigue and related attendance problems that the ALJ had improperly discredited.

The credited evidence showed that Smolen fatigued even during sedentary tasks, needed daytime naps, missed school and work because of fatigue and infections, and could not sustain regular attendance. The vocational evidence indicated that this attendance pattern would prevent maintenance of even sedentary employment. No evidence affirmatively supported the contrary conclusion.

The court may order benefits rather than another administrative hearing when the record is complete, no unresolved factual issues remain, and the ALJ would be required to find disability if the improperly rejected evidence were credited.

Those conditions were met. Smolen's symptom testimony, medical opinions, and lay evidence were improperly rejected; when credited, they established that she could not sustain full-time sedentary work throughout the relevant period.

Smolen had already waited more than seven years for a disability decision. Further proceedings would serve no useful purpose and would only delay benefits, so the court reversed and remanded for calculation and payment of benefits.