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

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FI LED 

UNITED STATES COURT OF APPEALS 

FOR THE TENTH CIRCUIT 

Uoited States Court of Appeals 

Tenth Circl.l.it 

SEP 191989 

ROBERT L. HOECKER 

DENNIS Clerk ELCYZYN, ) 

) 

Plaintiff-Appellant, ) 

) 

v. ) 

) 

OTIS R. BOWEN, Secretary of the ) 

Department of Health & Human Services, ) 

) 

Defendant-Appellee. ) 

ORDER AND JUDGMENT* 

No. 88-2503 

(D.C. No. 84-70-T) 

( W. D. Ok la . ) 

Before MOORE, ANDERSON, and BRORBY, Circuit Judges. 

After examining the briefs and appellate record, this panel 

has determined unanimously that oral argument would not materially 

assist the determination of this appeal. See Fed. R. App. P. 

34(a); 10th Cir. R. 34.1.9. 

submitted without oral argument. 

The cause is therefore ordered 

Dennis Elcyzyn appeals a decision by the Secretary of Health 

and Human Services, affirmed by the district court, that he is not 

disabled under Titles II and XVI of the Social Security Act, 42 

* This order and judgment has no precedential value and shall 

not be cited, or used by any court within the Tenth Circuit, 

except for purposes of establishing the doctrines of the law of 

the case, res judicata, or collateral estoppel. 10th Cir. R. 

36.3. 

Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 1 
U.S.C. §§ 401-433, 1381-85 (1982 & Supp. IV 1986), and is 

therefore 

Secretary 

ineligible to receive 

concluded under step 

disability benefits. The 

four of the disability review 

process that, although Mr. Elcyzyn has a severe impairment, he is 

able to return to his former employment as a truck driver. See 

generally 20 C.F.R. SS 404.1520, 416.920 (1988}(outlining the 

sequential disability determination process}. Mr. Elcyzyn claims 

that this conclusion is not supported by substantial evidence. We 

agree, and we reverse and remand for further proceedings by the 

Secretary. 

Mr. Elcyzyn's personal and medical history are detailed in 

the report of the administrative law judge (ALJ} considering Mr. 

Elcyzyn's claim and in the district court's decision affirming the 

ALJ's decision on appeal. We review only those facts that are 

necessary to our determination herein. Mr. Elcyzyn's medical 

problems appear to have stemmed from a February, 1979, 

work-related accident in which he fell from the back of a truck 

while unloading some beams. He landed on his lower back, striking 

his head~ Injury to his lower spine and surrounding ·muscles was 

confirmed by several physicians, although it was anticipated that 

Mr. Elcyzyn would make a full recovery after several weeks of 

rest. 

By November, 1979, Mr. Elcyzyn's upper back and neck pain had 

substantially subsided, yet he continued to have pain in his lower 

back and began to experience bouts of fecal incontinence. Over 

the next three years, Mr. Elcyzyn was examined or treated by 

numerous physicians on over forty separate occasions to try to 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 2 
determine a physiological cause for his incontinence, or "dumping 

syndrome." Additionally, he underwent rehabilitative and 

biofeedback therapy to try to overcome this problem. His efforts 

to return to work failed, as his bowel problems prevented him from 

being away from a bathroom for more than a short period of time. 

Supp. Vol. I, Doc. 8 at 248. 

On June 18, 1982, Mr. Elcyzyn filed for disability benefits, 

claiming he was disabled primarily due to his incontinence, 

recurring lower back and leg pain, a hiatal hernia, and 

psychological problems. Mr. Elcyzyn's application was denied; 

however, upon review by this court, his case was remanded for 

reasons not germane to this appeal. On remand, the ALJ held a 

second hearing on Mr. Elcyzyn's claim. Since Mr. Elcyzyn was not 

working and had a severe impairment, the ALJ found that he met 

steps one and two under the disability review process. Next, the 

ALJ found that neither Mr. Elcyzyn's physical nor psychological 

complaints singly or in combination met or equalled a listed 

impairment 

considered 

under 

under 

step 

step 

three of the 

four whether 

determination. He then 

Mr. Elcyzyn's impairments 

prevented him from performing his past work. 

In addressing this issue, the ALJ focused primarily on Mr. 

Elcyzyn's complaints of lower back pain. He found that Mr. 

Elcyzyn's back injury appeared to have no permanent effects which 

would preclude him from performing work activities on a sustained 

basis, and that his hypertension was very well controlled with 

medication. As to Mr. Elcyzyn's gastrointestinal problems, the 

ALJ noted that ''numerous examinations by urinary and 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 3 
gastrointestinal specialists found no obvious relationship between 

the claimant's back injury and his complaints of incontinence." 

He acknowledged, however, that Mr. Elcyzyn was diagnosed as 

suffering from dumping syndrome and a hiatal hernia, but that 

"[w]hile this may cause some discomfort on occasion, the medical 

evidence indicates this is controlled with medication and proper 

eating habits and requires ·no surgical intervention." As to his 

mental problems, the ALJ found that Mr. Elcyzyn's symptoms, which 

included evidence of affective and somatoform disorders, did not 

meet or equal a listed impairment and posed no work-related 

restrictions. Based on these finding, the ALJ concluded that Mr. 

Elcyzyn would be able to perform medium work requiring him to 

occasionally lift objects weighing fifty pounds and frequently 

lift objects weighing twenty-five pounds, consistent with the 

demands of his previous work as a truck driver making local 

deliveries. We now consider whether this conclusion is supported 

by substantial evidence. Eggleston v. Bowen, 851 F.2d 1244, 1246 

(10th Cir. 1988). 

We do not question the ALJ's determinations under steps two 

and three of the disability analysis that Mr. Elcyzyn has a severe 

impairment and that his ailments, alone or in combination, do not 

meet or equal a lis~ed impairment. We likewise agree that the 

record does not support a finding that Mr. Elcyzyn's back injury 

alone is sufficient to render him disabled. We are not convinced, 

however, that there is substantial evidence to support the ALJ's 

conclusion under step four of the disability review process that 

Mr. Elcyzyn has the residual functional capacity to return to his 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 4 
former employment in light of his combination of impairments, 

particularly with respect to his problem with incontinence. 

Despite the fact that the majority of the medical evidence in 

the record concerns Mr. Elcyzyn's incontinence, it is apparent 

from the ALJ's findings that he considered this problem to be 

minor. In particular, the findings indicate that Mr. Elcyzyn's 

complaints relating to his dumping syndrome were discounted 

because the ALJ found no definitive evidence linking this disorder 

to Mr. Elcyzyn's 1979 back injury and because the medical records 

were not conclusive as to the physiological basis for this 

disorder. 1 The ALJ also concluded that Mr. Elcyzyn could control 

his incontinence with medication and a proper diet, and that 

corrective surgery was not required. 

Whether this disorder was caused by Mr. Elcyzyn's 1979 

accident or by other organic conditions is irrelevant. The 

undisputed medical findings are that Mr. Elcyzyn suffers from 

1 Several physicians suspected that Mr. Elcyzyn sustained nerve 

damage after his work-related injury which impaired his ability to 

control his bowel movements, and another advised that perhaps such 

nerve damage occurred when Mr. Elcyzyn underwent a 

hemorrhoidectomy. There is also evidence to suggest that Mr. 

Elcyzyn's bowel problems are, to a certain extent, psychosomatic. 

The most recent medical report, in which all of Mr. Elcyzyn's 

previous medical records were reviewed by a psychiatrist, 

concluded that Mr. Elcyzyn received "a rather severe nerve injury 

to the conus medullaris, and that there are actual organic changes 

affecting these nerves that tend to be the controlling mechanisms 

related to the bowel and bladder functions." Supp. Vol. I, Doc. 8 

at 250. The physician further noted that while such an injury is 

rare, it can result in partial incontinence. Id. at 249. In any 

event, as noted by another examining psychiatrist, "[t]he loss of 

bowel control, (encopresis) organic or imagined, is still real and 

is not a condition from which the patient can 'talk' himself into 

normal control. He needs specific treatment." Id. at 152. 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 5 
dumping syndrome, although the precise cause of this ailment has 

not been positively identified. Mr. Elcyzyn has continuously 

sought treatment for this condition, despite the fact that 

treatment was unsuccessful, and one physician recommended he 

consider a colostomy as a last resort. Contrary to the ALJ's 

finding that Mr. Elcyzyn's dumping syndrome could be controlled 

with medication and a proper diet, the medical records relate that 

dietary and other measures were ineffective in controlling Mr. 

Elcyzyn's symptoms. See Supp. Vol. I, Doc. 8 at 232. The ALJ 

also noted that Mr. Elcyzyn's weight did not vary significantly, 

as would be expected with such a disorder; yet, the record 

reflects that Mr. Elcyzyn's weight fluctuated within a ten-pound 

range, not the two-pound range cited by the ALJ. 

It is also clear that Mr. Elcyzyn's dumping syndrome 

significantly affects his daily life. Mr. Elcyzyn testified that 

he has difficulty sitting for extended periods of time, 

experiences pain in his lower back, bowels and legs, and must 

constantly be in close proximity to a bathroom, especially after 

eating. 2 This condition has significantly impacted Mr. Elcyzyn's 

2 With respect to Mr. Elcyzyn's complaints of pain, the ALJ 

concluded that he experienced only "some discomfort on occasion." 

While the ALJ is entitled to disregard or discount a claimant's 

subjective complaints of pain when he finds that the claimant's 

accounts lack credibility, see Huston v. Bowen, 838 F.2d 1125, 

1131 (10th Cir. 1988), we question his disregard of Mr. Elcyzyn's 

testimony as to his physical symptoms which limit his ability to 

sit in one place for more than fifteen or twenty minutes, require 

him to wear protective garments, and necessitate that he be near a 

bathroom. Moreover, the medical records submitted to support Mr. 

Elcyzyn's claim consistently noted that Mr. Elcyzyn was 

forthright, that he was cooperative in taking all measures 

necessary for his rehabilitation, that he did not appear to be 

malingering, and that his mental problems appeared at least in 

part to be due to his desire to resume a normal, productive life. 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 6 
mental status, in that he is severely depressed, has contemplated 

suicide, and is unable to function with a normal level of social 

interaction. With the exception of the psychological assessment 

completed by the ALJ, every psychological evaluation of Mr. 

Elcyzyn has resulted ' in a finding of a chronic, severe anxiety 

disorder. Although there is little discussion in the record as to 

Mr. Elcyzyn's residual functional capacity in light of his 

combination of impairments, the record indicates, at a minimum, 

that Mr. Elcyzyn's ability to lift heavy objects is limited, 3 and 

that his working conditions must accommodate his need to be near 

restroom facilities. 

We conclude that the ALJ's determination that Mr. Elcyzyn is 

not disabled because he was able to perform his prior work is not 

supported by substantial evidence. While Mr. Elcyzyn may, in 

fact, have the residual functional capacity to perform other, less 

strenuous jobs involving lighter lifting or more sedentary duties, 

the ALJ did not reach this step in the evaluation process. We 

therefore remand this case to permit the ALJ to consider whether, 

i n light of Mr. Elcyzyn's physical and mental impairments, Mr. 

Elcyzyn is still able to perform other work in the national 

economy. we note that, since Mr. Elcyzyn's impairments stemming 

from his dumping syndrome are nonexertional, the Secretary is 

3 His treating physician, Dr. Nick Knutson, stated that due to 

his hiatal hernia, Mr. Elcyzyn must "be extremely careful with 

bending over, straining, or lifting,'' and that his medical 

condition limited his "lifting, pushing, pulling, reaching, 

carrying or handling." Dr. Knutson expressed his opinion that Mr. 

Elcyzyn "could probably not do the type of work he did in the past 

which required loading and unloading trucks." 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 7 
required to obtain a vocational testimony as to the effect of Mr. 

Elcyzyn's limitations before making this determination. See Rambo 

v. Heckler, 728 F.2d 1583, 1584 (11th Cir. 1984); 

Heckler, 716 F.2d 483, 485 (8th Cir. 1983). 

Haynes v. 

The judgment of the United States District Court for the 

Western District of Oklahoma is REVERSED, and the cause is 

REMANDED for further proceedings in accordance herewith. The .mandate 

shall issue forthwith. 

ENTERED FOR THE COURT 

John P. Moore 

Circuit Judge 

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Appellate Case: 88-2503 Document: 01019973957 Date Filed: 09/19/1989 Page: 8