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Parties Involved:
Minnie A. Cude
Appellant
Louis W. Sullivan
Appellee

Document Text:

FILED 

UNITED STATES COURT OF APP~ States Court ~f Appeals ,.."""th C,i!'tWt 

FOR THE TENTH CIRCUIT 

MINNIE A. CUDE, 

Plaintiff-Appellant, 

v. 

LOUIS w. SULLIVAN, M.D., Secretary of 

Health and Human Services, 

Defendant-Appellee. 

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ORDER AND JUDGMENT* 

JAN 2 9 1991 

ROBERT L. HOECKER 

Clerk 

No. 89-7083 

(D.C. No. 88-213-C) 

(E.D. Okla.) 

Before MOORE, BARRETT, Circuit Judges, and SPARR,** District 

Judge. 

**Honorable Daniel 

District Court for 

designation. 

B. Sparr, District Judge, 

the District of Colorado, 

United States 

sitting by 

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. The case is therefore ordered 

submitted without oral argument. 

Claimant Minnie Cude appeals from a decision of the district 

court affirming the final decision of the Secretary denying 

* 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 estoppal. 10th Cir. R. 

36.3. 

Appellate Case: 89-7083 Document: 010110083538 Date Filed: 01/29/1991 Page: 1 
claimant's applications for disability insurance benefits under 

Title II of the Social Security Act, 42 u.s.c. S 423(a)(l), and 

for supplemental security income (SSI) benefits under Title XVI, 

42 U.S.C. S 1382(a)(l). Claimant filed her applications on 

August 12, 1986, alleging she was disabled as of 

December 31, 1980, due to arthritis and high blood pressure. The 

Social Security Administration (SSA) denied claimant benefits, so 

she requested a de novo hearing before an administrative law judge 

(ALJ) • Claimant was the only witness at the hearing, which was 

held on August 5, 1987. 

On October 13, 1987, the ALJ issued his decision denying 

claimant benefits. The Appeals Council denied claimant's request 

for review, thereby making the ALJ's decision the final decision 

of the Secretary. Claimant then filed a complaint in district 

court seeking review of the Secretary's decision. The district 

court affirmed the decision and this appeal followed. We reverse 

and remand. 

The ALJ made the following findings in his decision of 

October 13, 1987: 

1. The claimant met the disability insured status 

requirements of the Act on December 31, 1980, the date 

the claimant stated she became unable to work, and 

continue(d] to meet them through March 31, 1982. 

2. The claimant has not engaged in substantial gainful 

activity since December 31, 1980. 

3. The medical evidence establishes that the claimant 

has severe degenerative arthritis of the knees, 

essential hypertension and obesity, but that she does 

not have an impairment or combination of impairments 

listed in, or medically equal to one listed in Appendix 

1, Subpart P, Regulations No. 4. 

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4. The claimant 

severity as to 

activity. 

does not experience pain of such 

prevent all substantial gainful work 

5. The claimant has the residual functional 

to perform work-related activities except 

involving medium or greater physical demands 

404.1545 and 416.945). 

capacity 

for work 

(20 CFR 

6. The claimant's past relevant work as cook and 

waitress did not require the performance of work-related 

activities precluded by the above limitation(s) (20 CFR 

404.1565 and 416.965). 

7. The claimant's impairments do not prevent the 

claimant from performing her past relevant work. 

8. The claimant was not under a "disability" as 

defined in the Social Security Act, at any time through 

the date of the decision (20 CFR 404.1520(e) and 

416.920(e)). 

Rec. Vol. II at 13-14. 

Claimant raises the following issues on appeal: whether the 

Secretary erred in determining claimant did not meet the listings; 

whether the Secretary failed to consider objective medical 

evidence of pain; whether the Secretary failed to consider all 

evidence of pain; and whether the Secretary's decision is 

supported by substantial evidence. 

We must uphold the Secretary's decision if it is supported by 

substantial evidence and if the correct legal standards were 

applied. Frey v. Bowen, 816 F.2d 508, 512 (10th Cir. 1987). 

Substantial evidence is "'such relevant evidence as a reasonable 

mind might accept as adequate to support a condition.' It must be 

'more than a mere scintilla.'" Broadbent v. Harris, 698 F.2d 407, 

414 (10th Cir. 1983)(quoting Richardson v. Perales, 402 U.S. 389, 

401 (1971)). "Evidence is not substantial 'if it is overwhelmed 

by other evidence ••• or if it really constitutes not evidence 

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but mere conclusion.'" Knipe v. Heckler, 755 F.2d 141, 145 (10th 

Cir. 1985)(quoting Kent v. Schweiker, 710 F.2d 110, 114 (3d Cir. 

1983)). 

"In determining whether the evidence in support of the 

Secretary's decision is substantial, we must take into account 

whatever in the record fairly detracts from its weight." Nieto v. 

Heckler, 750 F.2d 59, 61 (10th Cir. 1984). "In reviewing the 

Secretary's decision, we meticulously examine the record and view 

it in its entirety." Williams v. Bowen, 844 F.2d 748, 750 (10th 

Cir. 1988). 

Furthermore, the "'[f]ailure to apply the correct legal 

standard or to provide this court with a sufficient basis to 

determine that appropriate legal principles have been followed is 

grounds for reversal.'" Byron v. Heckler, 742 F.2d 1232, 1235 

(10th Cir. 1984)(quoting Smith v. Heckler, 707 F.2d 1284, 1285 

(11th Cir. 1983)). 

The term "disability" is defined as the inability "to engage 

in any substantial gainful activity by reason of any medically 

determinable physical or mental impairment which can be expected 

to result in death or which has lasted or can be expected to last 

for a continuous period of not less than twelve months." 42 

U.S.C. SS 423(d)(l)(A), 1382c(a)(3)(A). The Secretary has 

established a five-step sequential analysis for determining 

whether a claimant is disabled. The steps are as follows: 

(1) Is the claimant presently pursuing work that 

constitutes substantial gainful activity? If so, he or 

she is not disabled, even if medically impaired. 

(2) If the claimant is not presently doing substantial 

gainful activity, then does the claimant have a severe 

4 

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impairment--i.e., one that significantly limits one's 

physical or mental ability to do basic work activities? 

If not, there is no disability. 

(3) If the claimant has a severe impairment, does the 

impairment meet or equal a listed impairment in 20 

C.F.R. S 404, Subpart P, Appendix 1 (1986)? If so, and 

if it has lasted or can be expected to last for at least 

twelve months, it constitutes a disability, and there is 

no need to proceed with further evaluation. 

(4) If the severe impairment does not meet or equal a 

listed impairment, does it, when considered along with 

claimant's residual functional capacity and the physical 

and mental demands of the job, prevent the claimant from 

doing past relevant work? If not, there is no 

disability, and the evaluation process stops. 

(5) If the claimant cannot return to past relevant work 

because of a severe impairment, the final question is 

whether the claimant's residual functional capacity, 

age, education, and work experience allow the 

performance of other work? If not, there is a 

disability. 

Jozefowicz v. Heckler, 811 F.2d 1352, 1355 (10th Cir. 1987) 

(footnote omitted). 

Claimant contends that the Secretary's determination that she 

was not disabled is not supported by substantial evidence because 

her impairment met the requirements listed in 20 C.F.R. Pt. 404, 

Subpt. P, App. 1, 1.03, for arthritis of a major weight-bearing 

joint. We agree that the Secretary's determination that claimant 

"was not under a 'disability' as defined in the Social Security 

Act, at any time through the date of the decision," Rec. Vol. II 

at 14, is not supported by substantial evidence. The record shows 

that claimant's arthritis met the listings as of May 6, 1987, the 

date of the most recent x-ray of her knees. 

To show that her arthritis met the listing, claimant had to 

establish: 

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Arthritis of a major weight-bearing joint (due to 

any cause): 

With history of persistent joint pain and stiffness 

with signs of marked limitation of motion or abnormal 

motion of the affected joint on current physical 

examination. 

With: 

A. Gross anatomical deformity of the hip or knee 

(e.g., subluxation, contracture, bony or fibrous 

ankylosis, instability) supported by X-ray evidence of 

either significant joint space narrowing or significant 

bony destruction and markedly limiting ability to walk 

and stand; or 

B. Reconstructive surgery or surgical arthrodesis 

of a major weight-bearing joint and return to full 

weight-bearing status did not occur, or is not likely to 

occur, within 12 months of onset. 

20 C.F.R. Part 404, Subpt. P, App. 1, 1.03. 

The Secretary does not dispute that claimant has degenerative 

arthritis in both knees. The medical records show that claimant 

complained of pain in her knees to physicians at numerous times 

during 1976, 1981, 1985, and 1986. She received pain and 

anti-inflammatory medications during those years, as well, and 

indicated that at the time of the hearing she was taking Feldene 

and Extra Strength Tylenol every day. Both are pain medications 

recommended for the treatment of arthritis (Feldene also is an 

anti-inflammatory agent). In addition, claimant testified that 

she has pain in her knees "practically all the time," and that the 

medications only help ease the pain to a certain extent. Rec. 

Vol. II at 27. 

Claimant also testified that she cannot sit for any length of 

time because she gets very stiff and can hardly walk when she does 

stand up. She said there are days when she is unable to move 

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around in the morning after she gets up, and it takes her until 

noon or later to be able to do anything. The SSA employee who 

assisted claimant in filling out her application for benefits 

noted on claimant's disability report that "[s]he had difficulty 

getting up from her chair. She also moaned as if in pain when she 

got up. She limped and walked slowly." Id. at 83. 

In May of 1981, when client underwent surgery for a tear of 

the medial meniscus in her right knee, Dr. Tull noted that 

claimant had a "full range of motion of the knees with mild 

crepitation with passive extension and flexion, worse on the right 

than the left." Id. at 108. By November of 1986, however, 

claimant's condition had degenerated so, that Dr. Kuykendall, who 

examined claimant at the · request of the Secretary, noted that 

claimant's "[k]nee flexion is limited to approximately 80 to 90 

deg[rees] bilaterally. She can extend both knees pretty well 

completely." Id. at 133. Normal flexion of the knee is 150 

degrees. American Medical Ass'n, Guides to the Evaluation of 

Permanent Impairments 38 (2d ed. 1984). Flexion limited to ninety 

degrees constitutes a twenty-one percent impairment of the lower 

extremity; flexion limited to eighty degrees constitutes a 

twenty-five percent impairment of the lower extremity. Id. 

Thus, the record contains substantial evidence that claimant 

had arthritis in her knees, which are major weight-bearing joints, 

and a "history of persistent joint pain and stiffness with signs 

of marked1 limitation of motion .•• of the affected joint on 

1 "Marked" means "having 

character: Noticeable." 

Dictionary 1383 (unabridged 

a distinctive or strongly pronounced 

Webster's Third New International 

1976). 

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current physical examination." 

App. 1, 1.03. 

20 C.F.R. Pt. 404, Subpt. P, 

The listings require that the claimant establish the 

existence of a gross anatomical deformity of the hip or knee 

supported by x-ray evidence of either significant joint space 

narrowing or significant bony destruction. The x-rays in the 

record establish all three: a gross anatomical deformity of the 

knee; significant joint space narrowing; and significant bony 

destruction. An x-ray report dated May 19, 1981, states that 

claimant's left knee showed "minimal lateral subluxation of the 

tibia on the femur." Rec. Vol. II at 113. "Subluxation," which 

is "[a] partial or incomplete dislocation," Taber's Cyclopedic 

Medical Dictionary 1384 (14th ed. 1981), is specifically listed in 

the regulations as an example of a gross anatomical deformity. An 

x-ray report dated May 6, 1987, states: "BOTH KNEES: Severe 

degenerative arthritic changes are present in both knees with bony 

eburnations2 and market [sic] narrowing of the medial knee joint 

spaces, as well as depressed tibial plateaues [sic] bilaterally. 

Also seen are joint mice especially in the right knee. 

IMPRESSION: Severe degenerative osteoarthritis both knees." Rec. 

Vol II at 155. 

The ALJ did not mention either x-ray report in his discussion 

of the evidence. 

The Social Security Act provides that, in 

considering whether a person is disabled under Title II, 

"[o]bjective medical evidence of pain or other symptoms 

established by medically acceptable clinical or 

2 "Eburnation" is defined as "Changes in bone causing 

become dense and hard like ivory." Taber's at 447. 

them to 

8 

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laboratory techniques ... must be considered in 

reaching a conclusion as to whether the individual is 

under disability." 42 U.S.C. S 423(d)(S)(A) (Supp. IV 

1986) (emphasis added). This requirement equally 

applies to disability determinations for the purposes of 

SSI benefits. Id. S 1382c(a)(3)(G). Thus, the Act 

makes clear that the Secretary must consider all 

relevant medical evidence of record in reaching a 

conclusion as to disability. 

Baker v. Bowen, 886 F.2d 289, 291 (10th Cir. 1989). "'[A]n ALJ 

must weigh all the evidence and may not ignore evidence that 

suggests an opposite conclusion.'" Taylor v. Schweiker, 739 F.2d 

1240, 1243 (7th Cir. 1984)(quoting Whitney v. Schweiker, 695 F.2d 

784, 788 (7th Cir. 1982)). 

Finally, the listings require that claimant establish a 

markedly limiting ability to walk or stand. The record is replete 

with such evidence. Claimant testified at the hearing that she 

cannot stand for any length of time, and Dr. Sneed, who examined 

claimant in September of 1981, noted that claimant had stiffness 

and soreness when she stood less than a minute unless she shifted 

her weight. Dr. Kuykendall noted that claimant had a lot of pain 

especially going up and down stairs and that she avoided inclines 

and rough ground. Claimant also testified that she was unstable; 

she stumbled because she had problems picking up one leg and so 

dragged her toe, which was very painful. An SSA employee noted 

that claimant had difficulty arising from a chair and that she 

limped and walked slowly. Dr. Kuykendall reported that if 

claimant supported her weight by putting her hand on a chair it 

helped ease her pain and that claimant had not yet resorted to a 

cane or other assistive device. 

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The only other evidence in the record that suggests claimant 

does not have a limited ability to walk or stand is that contained 

in the forms completed by Ors. Fiegel and Harns, respectively, at 

the request of the Secretary. Both doctors checked the box 

labeled "about six hours" in response to the question how long per 

eight-hour day could claimant stand and/or walk. Rec. Vol. II at 

95, 102. Neither doctor examined claimant, however, and the forms 

were "unaccompanied by thorough written reports or persuasive 

testimony." Frey v. Bowen, 816 F.2d at 515. Therefore, the forms 

were not substantial evidence. Id.; see also Gilliam v. Califano, 

620 F.2d 691, 693 (8th Cir. 1980). 

The only evidence concerning claimant's ability to walk or 

stand that the ALJ discussed was the fact that she did not use an 

assistive device. The listings do not require claimant to use an 

assistive device to walk or stand, however; they only require that 

she have a markedly limiting ability to walk or stand, which the 

evidence establishes claimant does. 

Based on our review of the record, we conclude that the ALJ's 

finding that claimant "does not have an impairment or combination 

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

Appendix 1, Subpart P, Regulations No. 4," Rec. Vol. II at 13, is 

not supported by substantial evidence. To the contrary, the 

record contains substantial evidence that as of May 6, 1987, 

claimant's arthritis met the listing for arthritis of a major 

weight-bearing joint. See 20 C.F.R., Pt. 404, Subpt. P, Appendix 

1, 1.03. Claimant was not still eligible for disability benefits 

under Title II on May 6, 1987, but she was eligible for SSI 

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benefits under Title XVI on that date. On remand, the Secretary 

is directed to award claimant SSI benefits as of May 6, 1987. 

We turn now to the Secretary's denial of claimant's 

application for disability benefits under Title II from 

December 31, 1980, the alleged onset date, to March 31, 1982, the 

date claimant was last insured for benefits, as well as his denial 

of claimant's application for SSI benefits between the onset date 

and May 6, 1987. 

The basis for the Secretary's denial of benefits was the 

ALJ's finding that claimant's impairments do not prevent her from 

performing her past relevant work as a cook and waitress. "Past 

relevant work is defined as work that (1) occurred within the past 

fifteen years (the so-called recency requirement), (2) was of 

sufficient duration to enable the worker to learn to do the job 

(the so-called duration requirement), and (3) was substantial 

gainful employment." Jozefowicz v. Heckler, 811 F.2d at 1355. 

The record shows that claimant worked as a cook and/or 

waitress from 1977 to 1980. Rec. Vol. II at 64, 80. The record 

also shows, however, that for the years 1977 to 1980, claimant's 

earnings were not sufficient for her work to qualify as 

substantial gainful activity. See id. at 61-62; 20 C.F.R. 

S 416.974(b)(3). Since claimant's past work as a cook and 

waitress during the years from 1977 to 1980 did not constitute 

substantial gainful employment, "it was an error of law to 

conclude that her [ability to] perform[] ••• it disqualifies her 

from receipt of disability .benefits." Vaughn v. Heckler, 727 F.2d 

1040, 1042 (11th Cir. 1984). 

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The record also shows that during the fifteen years preceding 

claimant's application for benefits, claimant's earnings were too 

low to show she engaged in substantial gainful activity in any 

year except 1971, 1972, and 1984. During those three years, 

claimant's earnings were above the level that would constitute 

insubstantial gainful activity but were below the level necessary 

to establish substantial gainful activity. See Rec. Vol. II at 

61-62; 20 C.F.R. S 416.974(b)(2) and (3). 

On remand, the ALJ must consider the other information 

discussed in 20 C.F.R. S 416.974(6) to determine whether 

claimant's work during 1971, 1972, or 1984 constituted substantial 

gainful activity. See Jozefowicz v. Heckler, 811 F.2d at 1356. 

If the ALJ determines that claimant's work during either 1971 or 

1972 constituted substantial gainful activity, he must then 

determine whether claimant was capable of returning to that work 

between the alleged onset date and the date she was last insured 

for benefits, for purposes of claimant's Title II claim. If the 

ALJ determines that claimant's work during 1971, 1972, or 1984 

constituted substantial gainful activity, he must then determine 

whether she was capable of returning to that work between the 

alleged onset date and May 5, 1987, for purposes of claimant's 

Title XVI claim. If the ALJ determines that claimant's work 

during the years in question did not constitute substantial 

gainful activity, he must proceed to step five and determine 

whether "claimant's residual functional capacity, age, education, 

and work experience allow the performance of other work" in the 

national economy. See id. at 1355. 

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In determining whether claimant was capable of performing her 

past relevant work or, if not, other work in the national economy, 

the ALJ must properly evaluate all the objective medical evidence 

and claimant's subjective symptoms of pain. From the record on 

appeal, we cannot determine whether the ALJ applied the proper 

analysis with respect to claimant's alleged pain. For instance, 

the ALJ did not mention, and perhaps did not consider, significant 

pieces of objective medical evidence such as the x-rays of 

claimant's knees taken in May of 1981 and May of 1987, and the 

records of claimant's treating physicians (Dr. Tull and the 

physicians at PHS Indian Clinic). Furthermore, the ALJ did not 

make any explicit credibility determinations regarding claimant's 

subjective allegations of pain. 

We have previously outlined the legal standards for 

evaluation of pain as follows: 1) the ALJ must determine whether 

the objective medical evidence demonstrates an impairment 

reasonably expected to produce pain; 2) if yes, the ALJ must 

determine if a loose nexus exists between the demonstrated 

impairment and claimant's allegations of pain, accepting the 

latter as true; 3) if yes, the ALJ must determine, considering all 

the evidence, whether claimant's pain is disabling. Williams v. 

Bowen, 844 F.2d 748, 753 (10th Cir. 1988). At the third step, the 

ALJ must make explicit findings regarding claimant's credibility 

and may not disregard her subjective allegations of pain if he 

finds her credible. Donato v. Secretary of Dep't of Health & 

Human Serve., 721 F.2d 414, 418-19 (2d Cir. 1983); see also Cannon 

v. Bowen, 858 F.2d 1541, 1545 (11th Cir. 1988)("If the Secretary 

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discredits [subjective pain] testimony, 'he must articulate 

explicit and adequate reasons.'"(quoting Hale v. Bowen, 831 F.2d 

1007, 1011 (11th Cir. 1987))). Additionally, subjective pain, 

even if unsubstantiated by objective medical evidence, cannot be 

ignored; it "must be evaluated with due consideration for 

credibility, motivation, and medical evidence." Nieto v. Heckler, 

750 F.2d at 61. 

The judgment of the United States District Court for the 

Eastern District of Oklahoma is REVERSED and the case is REMANDED 

for remand to the Secretary for the award of benefits under Title 

XVI as of May 6, 1987, and for further proceedings consistent with 

this order and judgment. 

ENTERED FOR THE COURT 

PER CURIAM 

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