Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-6_05-cv-06064/USCOURTS-arwd-6_05-cv-06064-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

HOT SPRINGS DIVISION

HELEN MORRIS ROJAS PLAINTIFF

v. Civil No. 05-6064

JO ANNE B. BARNHART, 

Commissioner, Social 

Security Administration DEFENDANT

MEMORANDUM OPINION

Factual and Procedural Background:

Helen Rojas appeals from the decision of the Commissioner of the Social Security

Administration (hereinafter “Commissioner”), denying her application supplemental security

income benefits (hereinafter “SSI”), pursuant § 1602 of Title XVI of the Social Security Act

(hereinafter “the Act”), 42 U.S.C. § 1381a. 

Plaintiff was 41 years of age at the time of the administrative hearing, and has an eighth

grade formal education (T. 241, 242-243, 252). She has worked in the past as a care giver,

however, the ALJ found that she had no past relevant work experience (T. 79, 22, 101, 233-

245, 62, 20). Plaintiff alleges a closed period of disability beginning November 3, 2000 and

ending December 1, 2001 (T. 57, 239-240), due to a kidney condition described as uteropelvic

junction obstruction (left); a heart condition; fatigue; weakness/numbness; low back pain; right

heel fracture; anxiety; headaches; and, memory loss. She protectively filed her application on

January 16, 2001 (T. 56-59).

 The Social Security Administration denied plaintiff’s applications initially and on

reconsideration. Plaintiff then requested and received a hearing before an Administrative Law

Judge (hereinafter “ALJ”), which hearing was held on February 4, 2002 (T. 238-264). The ALJ

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 The plaintiff alleges an onset date of November 3, 2000 (T. 56-57). However, we 1

note that with respect to SSI, benefits are not payable for a period prior to the date of the

application. Cruse v. Bowen, 867 F.2d 1183, 1187 (8th Cir.1989). 

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rendered an unfavorable decision on August 23, 2002 (T. 19-26). By Order entered July 11,

2005, the Appeals Council denied the plaintiff’s Request for Review of the hearing decision (T.

3-5), thus making the ALJ’s decision the final decision of the Commissioner. Plaintiff now

seeks judicial review of that decision. The parties have filed appeal briefs (Doc. #8 & 9), and

this matter is now ready for consideration. 

Applicable Law:

The ALJ evaluated the plaintiff’s claim according to the five-step sequential evaluation

analysis prescribed by the social security regulations. See 20 C.F.R. §§ 404.1520(a)-(f); see

also Bowen v. Yuckert, 482 U.S. 137, 140-42 (1987) (describing five-step analysis). At the first

step, the ALJ found the plaintiff had not engaged in substantial gainful activity since her alleged

onset date. In the next two steps, the ALJ determined that plaintiff had a severe impairment in

1

the form of recurrent uteropelvic junction obstruction (T. 21), but that she did not have an

impairment or combination of impairments listed in, or medically equal to one listed in

Appendix 1, Subpart P, Regulations No. 4 (T. 25). The ALJ determined that, during the

relevant time period, the plaintiff retained the residual functional capacity (hereinafter “RFC”)

for the full range of sedentary work. See Young v. Apfel, 221 F.3d 1065, 1069 n. 5 (8th

Cir.2000) (residual functional capacity determined at step four, where the burden of proof

 rests on the claimant). However, the ALJ found plaintiff had no past relevant work (T. 25). At

the fifth step, the burden of production shifts to the Commissioner. Krogmeier v. Barnhart, 294

F.3d 1019, 1022 (8th Cir.2002). Utilizing the Medical-Vocational Guidelines, specifically,

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Rule 201.24, Appendix 2, Subpart P, Regulations No. 4, the ALJ concluded that a finding of

“not disabled” was directed for the closed period (T. 26). Thus, the ALJ concluded that the

plaintiff was not under a “disability” as defined in the Social Security Act, during the period

beginning November 3, 2000, and ending December 1, 2001 (T. 26).

Our role on review is to determine whether the Commissioner’s findings are supported

by substantial evidence in the record as a whole. See Prosch v. Apfel, 201 F.3d 1010, 1012 (8th

Cir.2000). Substantial evidence is less than a preponderance but is enough that a reasonable

mind would find it adequate to support the Commissioner’s decision. Id. In determining

whether existing evidence is substantial, we consider evidence that detracts from the

Commissioner's decision as well as evidence that supports it. See Craig v. Apfel, 212 F.3d 433,

436 (8th Cir.2000). As long as substantial evidence in the record supports the Commissioner's

decision, we may not reverse it because substantial evidence exists in the record that would

have supported a contrary outcome, see id., or because we would have decided the case

differently. See Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir.1993).

To establish entitlement to benefits, the plaintiff must show that she had been unable to

engage in any substantial gainful activity by reason of a medically determinable impairment

which had lasted or could have been expected to last for not less than 12 months. See 42

U.S.C. §§ 423(d)(1)(A) and 1382c(a)(3)(A). 

Further, step four of the sequential analysis used in Social Security disability

determinations requires the ALJ to review the plaintiff's residual functional capacity and the

physical and mental demands of the plaintiff's past work. See 20 C.F.R. § 404.1520(e). "[T]he

ALJ has a duty to fully investigate and make explicit findings as to the physical and mental

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demands of a plaintiff's past relevant work and to compare that with what the plaintiff herself is

capable of doing before he determines that she is able to perform her past relevant work." 

Nimick v. Secretary of Health & Human Servs., 887 F.2d 864, 866 (8th Cir.1989) (emphasis in

original). These findings require evidence of the "actual functional demands and job duties of a

particular past relevant job" or the "functional demands and job duties of the occupation as

generally required by employers throughout the national economy." See id. n. 2 (quoting S.S.R.

No. 82-61, Soc.Sec.Rep. 836, 838 (West 1983)). 

The record documents that the plaintiff was involved in a serious motor vehicle accident

on April 30, 1998. She underwent numerous surgeries. at the University Hospital of Arkansas. 

On May 1, 1998, Dr. Johannes Gruenwald, Dr. Jason Stewart, Dr. Patrick Gannon and Dr.

Robert Garrison performed an irrigation and debridement of plaintiff’s left thigh wound and

femur fracture, and left knee bridging external fixator (T. 98-100). This surgery was repeated

on May 4, 1998 (T. 103-104). On May 6, 1998, Dr. Gruenwald, Dr. Gannon and Dr. Stewart

again irrigated and debrided the open femur fracture, and performed an open reduction and

internal fixation of the left femur fracture, with complex wound repair involving greater than 10

centimeters, on the left lower extremity (T. 95-97). On May 8, 1998, Dr. Robert Ingraham and

Dr. Daniel Pieper performed an L1 laminectomy, L1-2 discectomy, posterior stabilization from

T11 to L3 with pedicle screws at L2-3 and laminar hooks at the T11-12 laminar mass. The

doctors also performed a procedure including the harvesting of the left posterior iliac crest bone

graft and bone graft placement (T. 107-110). On May 26, 1998, Dr. Gruenwald and Dr.

Stewart performed a split-thickness skin graft to the left thigh (T. 122-125). The plaintiff

returned to University Hospital of Arkansas for followup treatment, and also continued to see

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her family physician locally, Dr. A.H. Tilley. 

On October 30, 1998, Dr. Tilley opined, as follows:

Erin Hedges is a 19-year old white female who was involved in a near tragic

motor vehicle accident on May 1, 1998. She had severe injuries to her leg and

back requiring numerous surgeries and a long recuperative period. She was seen

on October 22, 1998 in the office for follow-up and continues to have difficulty

maintaining activity for any length of time. Specifically, she can stand for 30

minutes, walk for 3 blocks and sit for 1 hour before the pain in her back and leg

become[s] severe. She has continual pain in her low back and left knee and is

unable to squat or due (sic) any type of kneeling maneuvers. Physical

examination was remarkable for flexion of only 90 degrees of her left knee with

full extension. She does have crepitus in her left knee and healing graft site in

her left thigh with some still open oozing areas that have not completely healed.

Given the young age of this patient and the recovery to this point I do feel that

she will have meaningful recovery in the future, but it is unknown at what time

this will occur. It is also unknown whether she will have a complete recovery

but at this time she is unable to maintain any type of gainful employment and

will not likely be able to do so for an indefinite period of time calculated to be at

least 12 months.

(T. 141). The record reflects that Dr. Tilley saw the plaintiff on November 24, 1998, at which

time she was on crutches, and her knee was noted to be inflamed, with crepitus. The skin graft

was healing (T. 140). 

On October 29, 1998, Dr. Gruenwald wrote the following:

As of October 29, 1998, due to her Orthopaedic injuries Ms. Hedges will be

totally temporarily disabled for a period of six-months to one year.

If you have any questions please do not hesitate to contact my office at (501)

686-5321.

(T. 149). Dr. Gruenwald’s progress notes, and all records from the surgeries described above,

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are contained in the administrative record, herein. 

The plaintiff asserted at the administrative hearing that, at the very least, she is entitled

to a closed period of disability (T. 28). Under 20 C.F.R. § 404.316, the Commissioner can

award Social Security disability benefits either on a continuing basis or for a "closed period."

The United States Court of Appeals for the Eighth Circuit has consistently held that disability is

not an "all-or-nothing" proposition; a plaintiff who is not entitled to continuing benefits may

well be eligible to receive benefits for a specific period of time. See Van Horn v. Heckler, 717

F.2d 1196, 1200 (8th Cir.1983); see also Atkinson v. Bowen, 864 F.2d 67, 71 (8th Cir.1988).

The Commissioner frequently awards such a closed period disability benefit. See, e.g., Ness v.

Sullivan, 904 F.2d 432, 434-35 (8th Cir.1990); Woods v. Bowen, 854 F.2d 288, 290 (8th

Cir.1988). Here, the ALJ erred by evaluating only plaintiff's eligibility for disability benefits,

and by failing to consider whether she was entitled to a closed period of benefits under 20

C.F.R. § 404.316. The record is quite clear regarding plaintiff's condition from April 30, 1998

until October, 1999; it is less helpful in determining whether her disability continued beyond

that period. See Harris v. Secretary of Dept. of Health and Human Services 959 F.2d 723, 724

(8th Cir.1992).

Additionally, in finding that the plaintiff retains the residual functional capacity

(hereinafter “RFC”), to perform substantially all of the requirements of sedentary work, the ALJ

had to disregard the opinions of plaintiff’s treating physicians, and rely on the opinion of a

physician who had merely reviewed her medical records, and had neither treated nor examined

plaintiff (T. 17, ¶ 3; T. 132-139). The ALJ did so by finding that the opinions of Dr.

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Gruenwald and Dr. Tilley were “conclusory” and not supported by “specific findings or

observations” and were “based upon an unqualified acceptance of the claimant’s complaints

and a desire to accommodate the claimant’s request.” (T. 16). We find it highly unlikely that

one of the team of specialists/surgeons who labored to get the plaintiff to the point where she

was, medically, at the time of the administrative hearing, would author a letter opinion such as

that which is found at page 149 of this transcript, merely because the plaintiff “requested” such

a letter, or due to an “unqualified acceptance” of the plaintiff’s subjective complaints (T. 16, ¶

1). Therefore, we decline to accept this as an adequate basis upon which to discount the

opinions of plaintiff’s treating physician and specialist. 

Under the Commissioner's regulations, a treating physician's opinion is given

"controlling weight" if it "is well-supported by medically acceptable clinical and laboratory

diagnostic techniques and is not inconsistent with the other substantial evidence." 20 C.F.R. §

404.1527(d)(2). Accordingly, an ALJ should "give good reasons" for discounting a treating

physician's opinion. Dolph v. Barnhart 308 F.3d 876, 878 -879 (8th Cir.2002); Prosch v.

Apfel, 201 F.3d at 1013.

The treating physician rule is premised, at least in part, on the notion that the treating

physician is usually more familiar with the plaintiff’s medical condition than are other

physicians. Thomas v. Sullivan, 928 F.2d 255, 259 n. 3 (8th Cir.1991); see 20 C.F.R. §§

404.1527(d)(2); 416.927(d)(2). Generally, more weight is given to the opinion of a specialist

about medical issues related to the area of the specialty than to the opinion of a source who is

not a specialist. 20 C.F.R. §§ 404.1527(d)(5); 416.927(d)(5); see Hinchey v. Shalala, 29 F.3d

428 (8th Cir.1994). By contrast, "[t]he opinion of a consulting physician who examines a

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claimant once or not at all does not generally constitute substantial evidence." Jenkins v. Apfel

196 F.3d 922, 925 (8th Cir.1999), citing Kelley v. Callahan, 133 F.3d 583, 589 (8th Cir.1998). 

Consequently, reports of nonexamining physicians deserve little weight in the overall

evaluation of disability, especially in light of evidence to the contrary. See Woodward v.

Schweiker, 668 F.2d 370, at 374 (8th Cir.1981); Brand v. Secretary of the Department of

Health, Education and Welfare, 623 F.2d 523, 527 n.6 (8th Cir.1980). 

Conclusion:

Accordingly, the ALJ’s decision denying benefits to the plaintiff is not supported by

substantial evidence and should be reversed. This matter should be remanded to the

Commissioner for consideration of the issue of a closed period of disability, and for proper

consideration of the opinions of plaintiff’s treating physicians, or adequate explanation as to

why said opinions and findings are discounted. Upon remand, interrogatories should be

directed to the treating physicians, to aid in determining the question of a closed period of

disability. See Bishop v. Sullivan, 900 F.2d 1259, 1262 (8th Cir.1990).

ENTERED this 7 day of August, 2006. th

/s/ Bobby E. Shepherd 

HONORABLE BOBBY E. SHEPHERD 

 UNITED STATES MAGISTRATE JUDGE

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