Caseflicks

Court of Appeals for the Seventh Circuit • 2000

Donna J. Clifford v. Kenneth S. Apfel, Commissioner of Social Security

227 F.3d 863 | 2000 U.S. App. LEXIS 23253

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Takeaway

In short, this case requires an ALJ to explain, with medical support and a logical evidentiary bridge, why a treating physician's opinion, pain testimony, and the combined effects of all impairments do not establish disability.

Background

Donna Clifford, then 53, sought Supplemental Security Income based on hypertension, depression, double vision following a stroke, arthritis, spinal and nerve problems, hand pain and numbness, and leg and back pain. Her medical record included repeated emergency-room visits, degenerative arthritis in both knees, hand osteoarthritis and paresthesias, depression, and permanent double vision requiring alternating eye patches. Her treating orthopedic specialist, Dr. Andrew Combs, stated that her knee arthritis severely restricted work requiring standing or walking, that her hand conditions prevented repetitive work, and that her vision problem severely limited reading and computer-monitor work.

Clifford reported that she could do limited household tasks, but only with rest and assistance from her husband. She could walk several blocks for exercise but needed to stop and rest because of leg pain. She testified that pain required her to sit or lie down periodically and that depression, vision problems, and hand numbness also limited her functioning.

An Administrative Law Judge found that Clifford had several severe impairments but did not meet a listed impairment. The ALJ discounted Dr. Combs's opinions and Clifford's pain testimony, found that she could perform a restricted range of light work, and concluded at step five that jobs such as hand packer, cook helper, and assembly worker existed in significant numbers. The Appeals Council denied review, making the ALJ's ruling final. The district court affirmed the Commissioner, and the Seventh Circuit reversed and remanded.

Issues

Issue #1

Whether the ALJ properly declined to give controlling weight to treating orthopedist Dr. Combs's opinions about Clifford's standing, walking, and repetitive-hand-use limitations.

Holding

No. The ALJ failed to give adequate, medically grounded reasons for discounting Dr. Combs's opinions.

Reasoning

A treating physician's opinion on the nature and severity of an impairment receives controlling weight when it is well supported by medical findings and is not inconsistent with other substantial evidence. Although the Commissioner decides the ultimate legal question of disability, the ALJ must minimally articulate sound reasons for accepting or rejecting a treating source's medical assessment.

The ALJ said Clifford's walking, shopping, and household activities conflicted with Dr. Combs's conclusion that her knee arthritis severely restricted standing and walking. But the ALJ did not explain why those limited activities were inconsistent with an inability to stand or walk on a sustained work basis, nor did the ALJ identify medical evidence contradicting Dr. Combs. By treating his own interpretation of daily activities as a medical basis to reject the orthopedist, the ALJ impermissibly substituted his judgment for the physician's.

The ALJ also inadequately rejected Dr. Combs's restriction against repetitive hand work. The ALJ relied on descriptions of Clifford's osteoarthritis as mild, the absence of an EMG recommendation, and earlier findings of intact hand function and good grip. Yet Dr. Combs evaluated persistent bilateral hand pain, osteoarthritis, and paresthesias in 1997, while the cited consultative findings were older and did not address the same combined limitations. The ALJ did not explain why the conditions Dr. Combs described could not limit repetitive work or consider evidence that Clifford's hand condition may have worsened.

Issue #2

Whether the ALJ properly discredited Clifford's testimony that pain and other symptoms limited her ability to work.

Holding

No. The credibility assessment lacked a logical, adequately explained connection between the evidence and the conclusion.

Reasoning

A claimant's pain testimony must be considered when medical signs and findings show an impairment that could reasonably produce the alleged symptoms. If objective evidence does not fully substantiate pain, the ALJ must still investigate its intensity, aggravating factors, medications and treatment, functional restrictions, work history, medical observations, and daily activities.

The record contained substantial evidence consistent with pain: frequent treatment for arthritic and related symptoms, diagnoses of degenerative knee disease, medication for pain, documented knee tenderness, and an unsteady gait. The ALJ nevertheless stated conclusorily that the medical evidence did not support Clifford's claimed limitations, without explaining why this evidence did not support disabling pain.

The activities on which the ALJ relied were modest and qualified. Clifford prepared simple meals, performed chores for roughly two hours with rest, received help from her husband, shopped only occasionally, could lift but not carry a twenty-pound bag for long, and had to rest after walking three to five blocks. Such limited daily functioning does not by itself show an ability to sustain substantial physical activity in competitive employment. On remand, the ALJ had to reassess Clifford's symptoms in light of the complete medical record and Dr. Combs's opinion.

Issue #3

Whether the ALJ's step-three and residual-functional-capacity findings adequately considered the combined effect of Clifford's impairments.

Holding

No. The ALJ needed to reconsider the aggregate effects of Clifford's impairments, including her significant obesity, before reassessing her capacity for work.

Reasoning

The regulations require consideration of the combined effect of all impairments, even when no single impairment is independently disabling. Although Clifford did not expressly list obesity as an impairment, the evidence repeatedly identified her as obese or markedly overweight, and it documented a long-standing weight problem.

Clifford was 5 feet 3 inches tall and weighed 199 pounds, while also suffering from severe knee arthritis and hypertension—conditions materially related to excess weight. Her weight did not independently meet the then-applicable obesity listing, but the ALJ could not ignore its likely cumulative effect on her arthritis, mobility, blood pressure, and other conditions. The record gave no indication that the ALJ conducted the required multiple-impairments analysis.

The light-work finding was also unsupported because it disregarded or insufficiently addressed evidence pointing in the opposite direction: Dr. Combs's restrictions, Clifford's pain, her weight, and her limited activities. A reviewing court must be able to follow an accurate and logical bridge from the evidence to the residual-functional-capacity conclusion. If the ALJ reaches step five on remand, the ALJ must develop the record as needed and make a new, adequately explained assessment.

Issue #4

Whether the ALJ was required to give weight to an Indiana agency's finding that Clifford was disabled and eligible for Medicaid.

Holding

No. The ALJ was not bound by the state agency's disability determination.

Reasoning

Social Security regulations provide that the Commissioner independently determines disability under the Social Security Act and is not bound by disability findings made by governmental or nongovernmental agencies. The ALJ therefore was not required to adopt the Indiana agency's Medicaid decision, though the ALJ could consider it.