Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca10-86-01741/USCOURTS-ca10-86-01741-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 

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~ttite~ jtates Qfourt of J\ppeafs 

TENTH CIRCUIT 

OFFICE OF THE CLERK 

C404 UNITED STATES COURTHOUSE 

DENVER, COLORADO 80294 

ROBERT L. HOECKER February 5, 1988 

CLERK 

TO: 

RE: 

ALL RECIPIENTS OF THE CAPTIONED OPINION 

No. 86-1741; Huston V$. Bowen 

Filed February 2, 1988. 

Attached is a new page 12 to be substituted for page 

12 in the original opinion which was sent to you on Februarv 

2, 1988. 

Very truly yours, 

ROBERT L. HOECKER 

Clerk 

TELEPHONE 

(303) 844·3157 

<FTSl 564·3157 

Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 1 
In Channel, we acknowledged that pain could be a 

nonexertional impairment. Id. at 580. Although the boundaries 

between nonexertional pain and the pain experienced upon exertion 

or overexertion may be difficult to draw, it is important to 

recognize the distinction. Nonexertional pain perhaps can be 

characterized as pain that is present whether or not a claimant 

is exerting himself or herself in activities that relate to the 

strength requirements of the grid's RFC ranges (sedentary through 

very heavy). Under the regulatory framework, exertion appears to 

be measured primarily in terms of the strength requirements for 

such physical activities as walking, standing, lifting, carrying, 

pushing, pulling, reaching, and handling. Cf. 20 C.F.R. 

§ 404.1545(b) (1987). Within such a framework, sitting and lying 

down would seem to be primarily nonexertional in character. 5 In 

the record before us, there is testimony stating that claimant 

experienced pain while lying down and while riding on (and feeling 

the vibrations of) a tractor, both essentially nonexertional 

activities. Although the pain is aggravated by strenuous activity 

and may originally have been caused by overexertion, the evidence 

suggests that it was present for claimant during 1975-76 when he 

was not exerting to any significant degree. The claimant's 

5 We express no view as to whether certain kinds of work in the 

sedentary and light categories could or should be considered 

primarily exertional in nature. We are of the view, however, that 

exertional pain can not be the equivalent of pain occurring upon 

any movement, even though any movement requires some exertion. 

The regulatory framework for the exertional demands of employment 

categories addresses the exertion required on a sustained basis to 

perform in a given work category. It is our view that this 

framework precludes from the exertional pain category the kind of 

pain, for instance, that is experienced upon shifting position or 

upon being passively moved. 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 2 
PUBLISH 

UNITED STATES COURT OF APPEALS 

TENTH CIRCUIT 

ROBERT T. HUSTON, 

Plaintiff-Appellee, 

FILE.D 

United States Court of Appeals Tenth Circuit 

FEB 02 1988 

ROBERT L. HOECKER 

Clerk 

v. 

) 

) 

) 

) 

) 

) 

) 

) 

) 

) 

No. 86-1741 

OTIS R. BOWEN, M.D., Secretary 

of Health and Human Services, 

Defendant-Appellant. 

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF WYOMING 

(D.C. No. C85-0274) 

Jeffrey C. Blair, Assistant Regional Counsel, Dept. of Health and 

Human Services (Richard A. Stacy, United States Attorney, Tashiro 

Suyematsu, Assistant U.S. Attorney, Ronald S. Luedemann, Chief 

Counsel, Region VIII, Dept. of Health and Human Services, and 

Thomas A. Nelson, Jr. Deputy Chief Counsel, Region VIII, Dept. of 

Health and Human Services, with him on the briefs), Denver, 

Colorado, for Defendant-Appellant. 

Caroyl J. Long (Robert T. Huston with her on the brief), Cheyenne, 

Wyoming, for Plaintiff-Appellee. 

Before MCKAY, ANDERSON and BALDOCK, Circuit Judges. 

ANDERSON, Circuit Judge. 

Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 3 
The claimant, Robert Huston, is an overweight sixty-one-yearold man with a bad back. He applied for Social Security 

disability insurance benefits in 1984, eight years after the date 

that his insured status expired. This eight year gap creates some 

difficulty and confusion, because while substantial evidence 

exists of the disabling character of the claimant's back problems 

at the time of his application for insurance benefits, the 

claimant's eligibility for continuing benefits since 1976 turns on 

the severity of his back problems in 1975-76, not in 1984. 

The Administrative Law Judge (''ALJ") found that the claimant 

retained the residual functional capacity for light work from 

August 10, 1975, the alleged date of onset of his disability, 

through December 31, 1976, the date he last met the insured status 

requirements. 

entitled to 

The ALJ, therefore, held that the claimant was not 

disability insurance benefits under Title II of the 

Social Security Act. The federal district court reversed, finding 

that the record as a whole established substantial evidence of 

claimant's disability in 

convinces us that (1) 

1975-76. Our review of the record 

the ALJ did not properly gauge the legal 

standards surrounding the role of pain in establishing a 

disability, failing to make findings as to the credibility of 

nonmedical pain testimony, and (2) the district court usurped the 

function of the ALJ by reweighing the evidence and making, in 

effect, its own determination of witness credibility. We reverse 

and remand to the Social Security Administration for findings as 

to whether testimony from the claimant and three other witnesses 

as to claimant's pain in 1975-76 was credible. If it was, then 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 4 
the combined medical and nonmedical evidence of both exertional 

and nonexertional pain was sufficient to preclude mechanical 

application of the Secretary's medical-vocational guidelines and 

would appear to dictate a finding of disability. If the 

nonmedical testimony was not credible, then on remand the reasons 

for such a finding should be specified. 

BACKGROUND 

The claimant originally injured his back in Guam during World 

War II. In the late 1950s he became a farmer, an occupation he 

pursued until 1972. Off and on during this time, he suffered 

periods of acute back pain, as evidenced by various treatments by 

the Wheatland Medical Center in Wheatland, Wyoming and the 

McBride Clinic in Oklahoma City, Oklahoma. Medical records refer 

to disc surgery in 1962 or 1963 for degeneration of the lumbar 

spine. Throughout this period the claimant continued to operate 

his farm with help from his wife and children. In November 1970 

he was hospitalized for severe pain and sciatica (nerve pain) of 

the right leg, accompanied by foot numbness and increased 

tenderness upon straight leg raising. After discharge indicating 

a ''moderate recovery," R. Vol. II at 93, he again continued to 

operate his farm, apparently despite discomfort and with 

increasing assistance from family members. 

In 1972, at the age of forty-six, the claimant sold his farm 

and bought a hardware store. At that time his treating physician 

at the McBride Clinic, Dr. Marvin K. Margo, wrote a ''To-Whom-ItMay-Concern" letter stating that the claimant had a "probable 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 5 
pseudoarthrosis" (formation of a false joint from failure of the 

discs to fuse properly) and that "any type of heavy work, 

especially on a farm and riding a tractor would be aggravating to 

[claimant's] back. 111 Id. at 97. In December 1975 the claimant 

was treated in the emergency room of the McBride Clinic for back 

strain that came from lifting a tire. Dr. Kenneth Gimple's 

medical entry at the time stated that although the claimant's disc 

fusion had apparently resulted in a pseudoarthrosis, he "has had 

relatively little difficulty with his back except a chronic ache 

in cold weather." He found ''no suggestion of sciatic pain down 

either leg." The recorded impression was "mild low back pain." 

Id. at 98,99. With the exception of a brief record of a physical 

examination in July, 1976, there are no further medical reports 

until 1978--after the period of time in which the claimant must be 

found to be disabled in order to be eligible for insurance 

benefits. 

Beginning in 1981 the medical reports show deterioration of 

claimant's back condition. In July 1982 Dr. R.E. Torkelson stated 

that while claimant had experienced back pain for a number of 

years, he "apparently did fairly well until a year ago when he 

developed gradual onset of increasing low back pain •.. " Id. at 

143, 197. Since 1981 the medical record demonstrates significant 

pain levels, repeated physical therapy treatments, increased 

1 The year before, in 1971, Dr. Margo had interpreted the 

claimant's back x-rays as revealing a "fairly good fusion of the 

LS [lumbosacral] joint although biplane x-rays were not made." R. 

Vol. I~·at 101. X-rays in 1975 showed no significant change from 

the 1971 x-rays. Id. The basis for Dr. Margo's 1972 statement 

that the claiman-t-had a pseudoarthrosis is not specified in the 

record. 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 6 
medication levels, and use of a TNS unit. Recent physical therapy 

objectives consistently have been to try to keep the claimant 

functional. 

Supplementing the limited medical record during 1975 and 

. 1976, the claimant and three witnesses testified to the claimant's 

pain during that time. The claimant and his wife both testified 

that on many days he either stayed home from the hardware store 

because of pain or regularly sought respite for several hours on a 

hammock in the stockroom. In response to a question from the ALJ, 

the claimant's wife stated that by mid 1975, when her husband 

stopped working at the hardware store, "probably 90° [sic] of the 

time, he was in some degree of pain, and it was very seldom that 

he was free of some degree of pain." Id. at 49. 

The claimant's brother testified that when he visited the 

claimant during the years he was operating the farm he found him 

unable to lift milk cans weighing approximately twenty pounds. 

During semi-annual visits in the years in which the claimant 

operated the hardware store the brother frequently found him 

experiencing pain. "[W]hen we were home I had to watch were [sic] 

I walked because I'd stumble over him in the night like going to 

the bathroom and things." Id. at 51. (The inference was that the 

claimant was crawling around because of the pain of standing up.) 

A friend testified to the claimant's long-standing pain, his 

dependence on his children and wife to help operate the farm, and 

his inability to load and unload items at his hardware store. Id. 

at 53-55. 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 7 
The claimant himself testified to back and leg pain from 

operating the farm tractors. He said he learned over time that 

lying on a mattress on the floor of his home for extended periods 

of time could relieve bouts of back strain and negate the need for 

comparable periods of hospitalization. In response to a question 

from the ALJ as to whether he could work in a "lighter or more 

sedentary position," the claimant stated that at the time he quit 

the hardware store "[i]t was getting to the point, no sir." Id. 

at 43. He discussed the nature of his pain at that time by saying 

that he hurt the most in "[t]he small of my back and then 

radiating down my legs. Sometimes it would feel like the pain was 

shooting right out the bottom of my feet, my heel." Id. at 44. 

At the time he left the hardware business he was taking Darvon 

Compound 65, two aspirin, and a shot of whiskey to "knock the 

pain • 11 Id • at 4 5 • 

LEGAL ANALYSIS 

The primary question for resolution is whether the ALJ 

applied the correct legal standards regarding disabling pain. 

Pain can be a disabling condition under Title II of the Social 

Security Act. For conclusive evidence of disabling pain, however, 

the act requires: 

"medical signs and findings, established by medically 

acceptable clinical or laboratory diagnostic techniques, 

which show the existence of a medical impairment that 

results from anatomical, physiological, or psychological 

abnormalities which could reasonably be expected to 

produce the pain or other symptoms alleged and which, 

when considered with all evidence required to be 

furnished under this paragraph (including statements of 

the individual or his physician as to the intensity and 

persistence of such pain or other symptoms which may 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 8 
reasonably be accepted as consistent with the medical 

signs and findings), would lead to a conclusion that the 

individual is under a disability. Objective medical 

evidence of pain or other symptoms established by 

medically acceptable clinical or laboratory techniques 

(for example, deteriorating nerve or muscle tissue) must 

be considered in reaching a conclusion as to whether the 

individual is qnder a disability." 

42 u.s.c.A. § 423(d)(5)(A)(l987). While this provision is not a 

model of clarity, it suggests that pain testimony should be 

consistent with the degree of pain that could be reasonably 

expected from a determinable medical abnormality. A close reading 

of the provision reveals that the medical findings themselves need 

not establish or confirm the degree of pain alleged but that the 

medical impairment itself must be shown to exist and should be 

reasonably capable of producing the alleged pain level in some 

individuals. 

This court has recently determined that the relationship 

between the impairment and the alleged pain need only be a loose 

one and that "if an impairment is reasonably expected to produce 

some pain, allegations of disabling pain emanating from that 

impairment are sufficiently consistent to require consideration of 

all relevant evidence." Luna v. Bowen, 834 F.2d 161,164 (10th 

Cir. 1987)(emphasis in original). 

The ALJ apparently concluded that the claimant did not have 

disabling pain during 1975-76. He stated that he could "find no 

medically determinable impairment which would have prevented the 

claimant from performing light work.'' R. Vol. II at 10. Implicit 

in this statement is the ALJ's recognition that the claimant did 

have a medically determinable impairment sufficient to preclude 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 9 
medium and heavy work. 2 Restating his findings he concluded that 

"[t]he claimant's allegations regarding his current pain and 

limitations were found credible but the findings regarding any 

disabling limitations prior to the date last insured were absent." 

Id. at 11 (emphasis added). After so concluding, he mechanically 

applied the Secretary's medical-vocational guidelines (the 

"grids") to determine that jobs existed in the national economy 

which the claimant could perform. See 20 C.F.R. part 404, subpt. 

P, App. 2 (1987). 

What is glaringly missing from the ALJ's decision is anything 

more than the most meagre consideration of the claimant's 

testimony as to his pain during 1975-76, 3 any consideration of the 

testimony of the other three witnesses, and any finding as to the 

credibility of that testimony, individually and collectively, for 

the years 1975-76. The ALJ's decision that he could find "no 

medically determinable impairment which would have prevented the 

claimant from performing light work" ignores the fact that the 

claimant had established the existence of a medically determinable 

back impairment that can cause and had caused pain. The law in 

this circuit provides that, where such is the case, a 

2 There is some ambiguity in the ALJ's opinion because in the 

findings section he states that "[d]uring the period in question, 

the claimant had the residual functional capacity to perform the 

physical exertion requirements of work except for work involving 

heavy lifting." R. Vol. II at 11. The ALJ, however, makes no 

attempt to rule that the claimant could perform work in the medium 

category, instead finding that the claimant had the RFC for light 

work. 

3 The only comment as to claimant's pain testimony with respect 

to 1975-76 was that the claimant was experiencing pain in the 

small of his back which radiated to his legs and feet. R. Vol. II 

at 9. 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 10 
determination of no disability cannot be made without a full 

evaluation of all subjective and objective evidence of pain. 

Luna, 834 F.2d at 165. 

While objective medical findings must be considered in 

evaluating pain, neither the regulations nor their interpretation 

in this circuit preclude consideration of subjective pain. In 

fact, we have consistently required the ALJ to consider 

assessments of subjective pain, at least where they have been made 

by treating physicians. See Frey v. Bowen, 816 F.2d 508, 515-16 

(10th Cir. 1987); Teter v. Heckler, 775 F.2d 1104, 1105 (10th Cir. 

1985); Turner v. Heckler, 754 F.2d 326, 330 (10th Cir. 1985); 

Nieto v. Heckler, 750 F.2d 59, 61-62 (10th Cir. 1984); Byron v. 

Heckler, 742 F.2d 1232, 1235 (10th Cir. 1984); Broadbent v. 

Harris, 698 F.2d 407, 413 (10th Cir. 1983); Celebrezze v. Warren, 

339 F.2d 833, 838 (10th Cir. 1964). 

What distinguishes these earlier decisions from the present 

case is that in all of them the treating physicians themselves, 

based on medical test results and their own clinical impressions 

of the claimant's subjective pain, had opined that their patients 

were in severe pain or were disabled. In each case the claimant 

defeated attempts by the Social Security Administration to negate 

assessment of the claimant's subjective pain and to require 

medical substantiation of disabling pain on the basis of 

physiological data or medical test results alone. 

Admittedly, the situation is somewhat different here. The 

clinical assessments of the treating physicians, the claimant's 

medical history, and diagnostic and laboratory test results do not 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 11 
establish the claimant's disability during 1975-76. 4 In effect, 

the claimant is trying to establish his disability on the basis of 

additional, nonmedical testimony--his own and that of his 

relatives and a friend. He is arguing that the medical records 

need not be viewed as inconsistent with the nonmedical testimony 

as to the severity of the pain and that, together, the nonmedical 

and medical evidence establish a disability. To establish 

disabling pain without the explicit confirmation of treating 

physicians may be difficult. Nonetheless, the claimant is 

entitled to have his nonmedical objective and subjective testimony 

of pain evaluated by the ALJ and weighed alongside the medical 

evidence. See Luna, 834 F.2d at 165. See also Cotton v. Bowen, 

799 F.2d 1403, 1407 (9th Cir. 1986); Avery v. Secretary of Health 

and Human Servs., 797 F.2d 19, 21 (1st Cir. 1986); MacGregor v. 

Bowen, 786 F.2d 1050, 1054 (11th Cir. 1986}; Green v. Schweiker, 

749 F.2d 1066, 1070 (3d Cir. 1984). An ALJ may not ignore the 

evidence and make no findings. 

While the ALJ's findings may be virtually absent with respect 

to the claimant's nonmedical evidence of pain, the record is not 

silent. The record contains evidence that the claimant's pain not 

only constituted an impairment sufficient to limit the claimant to 

light work but sufficient to preclude the claimant from any 

4 Neither laboratory nor clinical findings indicate severe or 

long-standing pain sufficient to preclude light or sedentary work. 

The medical records do not suggest that the claimant was receiving 

frequent treatment for pain at the time, nor that he was using 

extensive or heavy medication to manage the pain. All the medical 

. records show is a back injury and back surgery for disc 

degeneration, low back pain, intermittent flare-ups of severe pain 

sufficient to require medical attention, and a medical opinion 

that the claimant could not continue to do farm work. 

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Appellate Case: 86-1741 Document: 010110017123 Date Filed: 02/02/1988 Page: 12 
substantial gainful employment on a sustained basis. Although the 

medical evidence alone may be insufficient to establish the 

disabling character of the claimant's pain, if the nonmedical 

evidence of pain is credible, it will preclude the mechanical 

application of the grids and, in this situation, would seem to 

dictate a finding of disabling pain when combined with the medical 

evidence. If, on the other hand, the nonmedical evidence is 

contradicted by the medical evidence or is otherwise not credible, 

then the ALJ would have reason to apply the grids. He may not, 

however, neglect to make findings regarding credibility of the 

testimony pertaining to the years 1975-76. 

Automatic application of the grids is appropriate only where 

a claimant's residual functional capacity (RFC) and other 

characteristics 

a grid category. 

(age, work experience, education) precisely match 

20 C.F.R., part 404, subpt. P, App. 2, § 200.00 

(1987). RFC is primarily a measure of exertional capacity, i.e., 

strength. Residual capacity, however, sometimes is curtailed by 

nonexertional limitations, such as postural or sensory 

limitations. Where such is the case, the grids may not be applied 

mechanically but may serve only as a framework to aid in the 

determination of whether sufficient jobs remain within a 

claimant's RFC range (sedentary, light, medium, heavy, and very 

heavy). Id. at§ 200(e)(2). See also Talbot v. Heckler, 814 F.2d 

1456 (10th Cir. 1987); Teter v. Heckler, 775 F.2d 1104 (10th Cir. 

1985); Turner v. Heckler, 754 F.2d 326 (10th Cir. 1985); Channel 

v. Heckler, 747 F.2d 577 (10th Cir. 1984). 

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In Channel, we acknowledged that pain could be a 

nonexertional impairment. Id. at 580. Although the boundaries 

between nonexertional pain and the pain experienced upon exertion 

or overexertion may be difficult to draw, it is important to 

recognize the distinction. Nonexertional pain perhaps can be 

characterized as pain that is present whether or not the claimant 

is exerting himself in activities that relate to the strength 

requirements of the grid's RFC ranges (sedentary through very 

heavy). Under the regulatory framework, exertion appears to be 

measured primarily in terms of the strength requirements for such 

physical activities as walking, standing, lifting, carrying, 

pushing, pulling, reaching, and handling. Cf. 20 C.F.R. 

§ 404.1545(b) (1987). Within such a framework, sitting and lying 

down would seem to be primarily nonexertional in character. 5 In 

the record before us, there is testimony stating that claimant 

experienced pain while lying down and while riding on (and feeling 

the vibrations of) a tractor, both essentially nonexertional 

activities. Although the pain is aggravated by strenuous activity 

and may originally have been caused by overexertion, the evidence 

suggests that it was present for claimant during 1975-76 when he 

was not exerting to any significant degree. The claimant's 

5 We express no view as to whether certain kinds of work in the 

sedentary and light categories could or should be considered 

primarily exertional in nature. We are of the view, however, that 

exertional pain can not be the equivalent of pain occurring upon 

any movement, even though any movement requires some exertion. 

The regulatory framework for the exertional demands of employment 

categories addresses the exertion required on a sustained basis to 

perform in a given work category. It is our view that this 

framework precludes from the exertional pain category the kind of 

pain, for instance, that is experienced upon shifting position or 

upon being passively moved. 

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tenderness, numbness, and limited range of motion would also fall 

within the category of nonexertional impairments if they occurred 

during activities requiring little exertion. 

Although the ALJ noted that the claimant believed he could 

still lift items weighing 15-20 pounds, the ALJ made no findings 

as to the credibility of the multiple testimony which indicated 

significant exertional and nonexertional pain during 1975-76. 

While the pain on exertion spoke to the claimant's difficulty 

lifting milk cans and hardware stock, the nonexertional pain spoke 

to his intermittent inability to leave the house or even function 

in a standing-up position. Even if the exertional pain may not 

have limited the claimant's ability to meet the lifting 

requirements of light work, the nonexertional pain certainly 

affected the claimant's sustained capacity for light work. Yet 

the ALJ applied the grids as if all pain factors were 

insignificant during 1975 and 1976. If the nonmedical testimony 

of nonexertional pain is credible, then substantial evidence would 

seem to exist that pain factors significantly limited the 

claimant's ability to perform a full range of light work jobs on a 

sustained basis. 

As the claimant observes correctly, once the claimant has 

made a prima facie showing of inability to return to past relevant 

work because of a severe medical impairment, the Secretary must 

shoulder the burden of proof to show that the claimant can perform 

other work on a sustained basis, given both exertional and 

nonexertional limitations. Channel, 747 F.2d at 579-81. The ALJ 

can not meet the Secretary's burden by saying that findings 

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regarding limitations on the claimant's ability to perform the 

full range of light work were absent; it is his job to make them. 

And if the ALJ meant that evidence was missing, then again it 

shows that he entirely neglected the testimony of the claimant and 

the other witnesses. The ALJ must give "full consideration" to 

"all relevant facts," before concluding that a claimant either is 

or is not disabled, and the ALJ may not meet the burden of proof 

by invoking the grids where they are not fully applicable. 20 

C.F.R. pt. 404, subpt. P, App. 2, § 200.00(a) (1987). Here, if 

the testimony is credible for the years 1975-76, it would have 

been difficult for the claimant to perform a full range of light 

work because the testimony suggests that on any given day the 

claimant did not know whether he could get out of bed or leave the 

house. In other words, if the testimony is credible, then the 

claimant would seem to be eligible for disability insurance 

benefits. 6 On the other hand, if the testimony is not credible 

for those years and if the ALJ is able to sufficiently explain 

such a finding, then the grids could be invoked and a decision of 

no disability would be sustainable under the substantial evidence 

standard. 

Our decision here does not dictate any given outcome upon 

remand. It simply assures that the correct legal standards are 

invoked in reaching a decision based on the facts of this case. 

The ALJ can weigh and evaluate numerous factors in determining the 

credibility of pain testimony for the years in question. Some of 

6 If the claimant has the RFC for only sedentary work, then the 

applicable grid rule, 201.14 of Appendix 2, would dictate a 

determination that the claimant is disabled. 

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the possible factors include: the levels of medication and their 

effectiveness, the extensiveness of the attempts (medical or 

nonmedical) to obtain relief, the frequency of medical contacts, 

the nature of daily activities, subjective measures of credibility 

that are peculiar1y·within the judgment of the ALJ, the motivation 

of and relationship between the claimant and other witnesses, and 

the consistency or compatibility of nonmedical testimony with 

objective medical evidence. 7 See Luna, 834 F.2d at 165-66. See 

also Polaski v Heckler, 751 F.2d 943, 948 (8th Cir. 1984), vacated 

and remanded on other grounds, 106 S. Ct. 2885 (1986). Before 

finding that a claimant experiencing pain from a medically 

determinable impairment is not disabled, an ALJ must carefully 

consider all the relevant evidence, including subjective pain 

testimony, and expressly reflect that consideration in the 

findings. Findings as to credibility should be closely and 

affirmatively linked to substantial evidence8 and not just a 

conclusion in the guise of findings. 

7 When weighed in combination, such factors can shed light on 

the determination of credibility. They are not exhaustive, 

however, but merely illustrative. Moreover, they work less well 

in some situations than in others. For instance, some people find 

the side effects of pain medication to offset its benefits, others 

find little relief in pain medication, while others cannot afford 

certain prescription medications. Yet their pain can be 

disabling, nonetheless. Furthermore, supporting medical evidence 

need not be developed simultaneously with the onset of disabling 

pain in every case. Some who are disabled may not have been able 

to afford medical treatment or may have resisted medical help out 

of pride, fear, or other valid reasons. In some situations it 

will be enough if, at some point, objective medical evidence is 

developed that, in combination with nonmedical evidence, supports 

a finding of disability during the period at issue. 

8 We read the recent case of Campbell v. Bowen, 822 F.2d 1518 

(10th Cir. 1987) as consistent with this view. 

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We REVERSE and REMAND to the Social Security Administration 

for findings consistent with this opinion. 

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