A ft erexami ni ng t he br i efs and appe l l at e r ecor d, t hi s panel has det erm i ned * unani m ous l yt o gr antt he part i es ’ r eques tfora dec i s i on on the br i efs w i thoutor al a rg u m e n t. See F ed . R . A p p . P . 3 4 (f); 10 th C ir . R . 3 4 . 1 (G ). T h e c ase is th ere fo re or der ed s ubm i t t ed w i t houtor al ar gum ent . T hi s or derand j udgm enti s notbi ndi ng pr ece dent , exce ptundert he doctr i nes of l aw of the ca s e, r es j udi cat a, and col l at er al es t oppel . I tm aybe ci t ed, how ever , fori t s per s uas i ve val ue cons i s t ent w i t h Fed. R . A pp. P. 32. 1 and 10th C i r . R . 32. 1. FI LED Unite d St at e s C ourt o f Appe als

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### O c t ob e r 31, 2007 Elisab eth A. Shumaker Clerk of Court UNI TED S TATES CO URT O F AP PEALS F O R T H E T E N T H C IR C U IT BEA TRI CE G UTI ERREZ,

P lain tiff-A p p e llan t, v. M I C H A E L J . A ST R U E , C om m i s s i oner of the Soci al Secur i t yA dm i ni s tr at i on,

D efe ndant - A ppel l ee. N o. 07- 2057 ( D . C . N o . C I V - 0 6 - 1 6 - J H / K B M)

(D . N .M .)

ORDE R AND J UDGM EN T * B efor e P O R F IL IO , AN DE RS ON , and BA LD OCK , C i rcui tJudg es.

B eatr i ce G ut i err ez a ppeal s an or derof the di s tr i ctcourtt hataff i r m ed a f

i nal deci s i on of the C om m i s s i onerof the Soci al Secur i tyA dm i ni s tr at i on (C o m m is s io n e r) th a t s h e w a s n o t d is a b le d a n d th u s n o t e n title d to b e n e fits . W e h a v e j u r i s d i c t i o n u n d e r2 8 U. S . C. § 1 2 9 1 a n d we a ffi r m.C R E ST s yndr om e i s “a va r i antof s y s t emi c sc ler o sis char act er i zed by 1 c a lc in o s is , R a yn a u d p h e n o m e n o n , e s o p h a g e a l m o tilit yd is o rd e rs , s c l e r o d a c tyl y, and t el angi ect as i a. ” St edm an’s Medi calD i ct i onar y 1 7 5 1 (2 7 th e d . 2 0 0 0 ). -2- Backg r ound In the m i d-199 0’s, M s. G uti err ez w as di agn osed w i th d i abetes , hyper t ens i on, hypot hyr oi di s m , edema, and obes i ty . A ft erw or ki ng fort he St at e of N ew M exi co fort w enty - fi ve y ear s as a ca s ew or kers upervi s or , s he r et i r ed i n 1997 to sp e n d m o re tim e w ith h e r fa m ily . F o llo w in g re tirem e n t, sh e w o rk e d b rie flyin 1998 as a w ai t r es s and ca s hi erata r es t aur ant ; how ever , s he l eftt hatj ob aft ers he h u rt h e r k n e e a n d th e b u sin e ss c lo se d . B e c a u se sh e “ w a s ju st b u rn t o u t,” A p lt. A pp. at416, s he di d notl ook foranyw or k unt i l 1999. O n Ja n u a ry2 9 , 2 0 0 4 , M s. G u tierr e z filed a n a p p lica tio n fo r d isa b ili ty be ne fi t s i n whi c h s he a l l e ge d d i s a bi l i tya s of Se pt e mber1, 20 01 , du e t o CR EST s yndr om e, os t eopeni a, l ym phedema, di abet es , and hypothyr oi di s m . Fol l ow i ng

1 t he admi ni s t r at i ve deni al of herappl i cat i on, s he appe ar ed w i th a l ay r epr es ent at i ve foran admi ni s t r at i ve hea r i ng on M ar ch 21, 2005. O n M ay23, 2005, an admi ni s t r at i ve l aw j udge ( A L J ) i s s ued a w r i t t en dec i s i on deny i ng her a p p lic a tio n . T h e re a f

te r, t h e A p p e a ls C o u n c il d e n ie d h e r r e q u e s t fo r r e v ie w . A ct i ng on hercompl ai ntfi l ed i n fede r al di s tr i ctcourt , a magi s tr at e j udge i s s ued a r epor tand r ecomm endat i on t hataff i r m ed the C om m i s s i oner ’ s deci s i on. T he r epor tand r ecomm endat i on w as adopt ed byt he di s tr i ctcourtand thi s appea l fo llo w e d .-3- M edi cal R ecor d O n Ju n e 1 5 , 2 0 0 1 , M s. G u tierr e z sa w h e r tre a tin g p h y sic ian , D a v id C um m i ngs , M . D . , aboutheredema. I n a fol l ow - up vi s i ton J une 22, s he r eport ed “doi ng m uch bett er , ” id . a t3 0 1 , h o we v e r , s h e d i d h a v e b u r s i t i s i n h e rr i g h te l b o w. D r . C um m i ngs nexts aw M s . G ut i err ez on J ul y6, 2001, w hen he tr eat ed her fora “mi l d crus h i nj ur yt o herr i ghtfoot , ” id . at 2 9 8 , su ffe re d in a m o to rc y c le acc i dent . A tt hi s s ame appoi nt m ent , and on the bas i s of herr eportof m orni ng s t i ffne s s and pr i orl ab t es t s t hats how ed “mi l d anemi a, ” D r . C um m i ngs “w onder [ed] i f thi s m i ghtbe an a nemi a of c hr oni c di s eas e. ” Id . T her efor e, he or der ed furt herl ab t es t s t o rul e outaut oi m m une di s eas e. M s . G ut i err ez r etur ned t o D r . C um m i ngs on A ugus t9, 2001. T her e w as fl ui d on herr i ghtel bow and l ab r es ul t s s how ed the nee d forfur theras s es s m entof a po ssi ble aut oim m un e con dit i on . D r. C um m i ng s r eferr ed h er t o R od eri ck F i el ds, M . D . fort he aut oi m m une condi t i on and an orthopedi s tforr emoval of the fl ui d. H ow ever , s he di d notfol l ow up w i th D r . Fi el ds unt i l near l yfi ve mont hs aft ert he r efe r r al . I n t he meant i m e, s he s aw D r . C um m i ngs on tw o occa s i ons , butdi d not re p o rt a n ys ym p to m s o f a u to im m u n e d is e a s e . W hen D r . Fi el ds fi r s texami ned M s . G ut i err ez on J anuary3, 2002, he th o u g h it “ lik e ly” t h a t s h e h a d C R E S T s yn d ro m e , id . at218, and he pr es cr i bed hy dr oxy chl or oqui ne. A s of J ul y23, 2003, D r . Fi el ds w as s t i l l of the opi ni on t hat s he “pr obabl y[has ] C R E ST s yndr om e. ” Id . at179. A l though D r . Fi el dsF o r e x a m p le: (1 ) o n A p ril 4 , 2 0 0 1 , M s. G u tierr e z re p o rte d try in g to q u it 2 sm o k in g a n d th a t “[ w ]ith [ ] c h a n g e s in th e law it i s g o in g to b e h a rd fo r h e r to s m oke anyw ayw hi l e s he i s w or ki ng, ” id . at306; ( 2) on J une 22, 2001, s he r epor t ed “w ear [i ng] hercompre s s i on s t ocki ngs atw or k, ” id . at301; ( 3) on Ja n u a ry1 8 , 2 0 0 2 , sh e w a s “ h a v in g tro u b le m a n a g in g h e r d iab e tes b e c a u se sh e is undera l otof s t r es s havi ng t o l ook aft erherm other [, ] . . . hel pi ng w i th her dece as ed s i s t er ’ s hus band and c ont i nui ng t o w or k, ” id . at292; ( 4) on February7, 2 0 0 3 , “ [ s ]h e w a s a m b u la tin g a t w o rk w h e n s h e . . . fe lt a tw is t in h e r k n e e ,” id . a t 1 3 4 ; a n d (5 ) o n O c to b e r 3 0 , 2 0 0 3 , s h e a s k e d fo r a “ n o te to re tu rn to w o rk . S h e h a s b e e n o ff

a f te r h e r fa ll [ o n S e p te m b e r 1 1 , 2 0 0 3 ] a n d inju ry to h e r fo o t,” id . at247. C ont r ol of M s . G ut i err ez’ s di abet es var i ed as a r es ul tof heri ncons i s t ent 3 effor t s t o fol l ow a pr operdi et , t es therbl ood- s ugarl evel s , ort ake he rm edi cat i on. -4- cont i nued t o s ee M s . G ut i err ez e veryfew m onths thr ough 2004, none of hi s not es i ndi cat e thathercondi t i on pr event ed herfr om w or ki ng. I n fac t , thr ough m i d- 2004, hi s r ecor ds s how no j oi nts w el l i ng, deform i ty , l i m i t ed r ange of m ot i on, te n d e rn e s s , c re p itu s , o r t ri g g e r p o in ts in e ith e r h e r u p p e r o r l o w e r e x tr e m itie s . Si m i l ar l y , al t hough M s . G ut i err ez c ont i nued t o s ee D r . C um m i ngs on a r egul arbas i s fort r eatm entof herdi abet es , hypert ens i on, hypothyr oi di s m , edema, and obes i t y , none of hi s not es s aythatanyof thes e condi t i ons pr event ed herfr om w o rkin g . T o the c o n tr ary , the n o tes reflect th at M s. G u ti errez co n ti n u ed to w o rk th ro u g h 2 0 0 3 , a n d th a t h e r c o n d iti o n s w e re g e n e ra llyw e ll-co n tro lled w ith 2 m edicat i on s. 3 O n D ece m ber29, 2003, t w o day s befor e the l as tdat e s he w as i ns ur ed for di s abi l i t ybenef

i t s , s he s aw D r . C um m i ngs , w ho admi t t ed hert o the hos pi t al . T he admi s s i on di agnos i s w as “gas t r oi nt es t i nal hemorrhage, ” id . at 1 4 3 , an d th e re su lts-5-

of an uppe rgas tr oi nt es t i nal endos copyr evea l ed “[ e] s ophagea l var i ces [and] [m ] i ni m al gas t r i t i s . ” Id . at146. O n a fol l ow up vi s i tt o D r . C um m i ngs on J anuary26, 2004, M s . G ut i err ez c om pl ai ned of w eakne s s and di zzi nes s and he referred h er to D o m inic W o n g , M . D . w h o lat er d iagn o sed h er w ith b il iary ci r r hos i s and es ophagea l var i ces s econda ryt o C R E ST s yndr om e. A tvar i ous t i m es t hr oughout2004, D r . W ong per form ed fours ucce s s ful out - pat i ent proced ures t o tr eatt he v ari ces. M i d- w ayt hr ough D r . W ong’ s tr eatm entand fol l ow i ng the admi ni s tr at i ve deni al of hercl ai m , D r . C um m i ngs w r ot e a l et t eron M ay28, 2004 t o the C om m i s s i oneroffe r i ng hi s opi ni on thatM s . G ut i err ez w as di s abl ed.

M s . G ut i err ez ha s appl i ed fordi s abi l i tyand appa r ent l yhas been tur ned dow n. She has aut oi m m une di s eas e, w hi ch has caus ed m ul t i pl e j oi ntand muscl e s ym pt om s . I n the pas tthi s has di s abl ed herfr om w or ki ng. I ni t i al l ys he w as doi ng bett erw i th m edi cat i ons s t ar t ed byt he rheumat ol ogi s tback i n 2001. She unfor tunat el yhad an upperG I bl eed e ar l i ert hi s y earand s ubs equent l yw as found t o have bi l i aryci r r hos i s and es ophagea l var i ces s econda ryt o heraut oi m m une di s eas e. T hi s has l i m i t ed ourabi l i tyt o us e a numberof m edi cat i ons w ith h e r a n d h e r d ia b e te s h a s s u b s e q u e n tly b e c o m e p o o rl yc o n tr o lle d . H e r a u to im m u n e d ise a se , d iab e tes , o b e sitya n d liv e r c irrh o sis w ith pul m onaryhyper t ens i on al l go t ogethert o effect i vel ydi s abl e her f ro m g a in f

u l em p lo ym e n t. I am goi ng t o as k t he pat i entt o getl et t er s fr om her r heumat ol ogi s t , D r . Fi el ds , and hergas tr oent er ol ogi s t , D r . W ong, reg ard ing h er c o n d it ion s. T h an k s fo r y o u r co n side rati o n []. Id . at226.-6-

D r . Fi el ds w r ot e t o t he C om m i s s i oneron O ct ober24, 2004, that M s . G ut i err ez “ has C R ST s yndr om e, pr i m arybi l i aryci rrhos i s w i th a hi s t or yof b lee d in g e so p h a g e a l v a ric e s, a n d fib ro m y a lg ic p a in . I ag re e w ith d isa b ili ty eval uat i on fort he pat i ent . ” Id . at34 9. T he record reveal s that D r. F i el ds’ d ia g n o s is o f

fib ro m y a lg ia w a s n o t m a d e u n til J u n e 6 , 2 0 0 4 , a t th e e a rl ie s t. N o l et t erw as r ece i ved fr om D r . W ong. T he A L J’ s D eci s i on T he A L J det erm i ned thatM s . G ut i err ez’ s dat e l as ti ns ur ed w as D ece m ber31, 2003. H e cons i der ed al l of the condi t i ons m ent i oned i n herm edi cal r ecor ds , and found theyw er e nots ever e ordi d notm eetanyof the C om m i s s i oner ’ s L i s t i ng of I m pai r m ent s . B as ed on the t es t i m onyof a voc at i onal e x p e rt, h e f

u rth e r fo u n d th a t sh e re tain e d th e re sid u a l f u n c tio n a l ca p a c ityto per form a l i m i t ed r ange of s edent aryw or k. H e conc l uded thats he w as not d is a b le d a n d d e n ie d b e n e fits . A n a ly sis W e r evi ew t he A L J ’ s deci s i on “t o det erm i ne w hethert he fa ctual fi ndi ngs ar e s uppor t ed bys ubs t ant i al evi dence i n the r ecor d and w hethert he corr ectl egal st and ards w ere appli ed. S ub st anti al evidence is such rel evan tevidence as a r eas onabl e mi nd m i ghtacc eptas adequa t e t o s uppor ta conc l us i on. ” Ham l i n v. B arnh art , 3 6 5 F . 3 d 1 2 0 8 , 1 2 1 4 (10 th C ir . 2 0 0 4 ) (qu o tat ion an d cit ati o n o m itted).-7-

M s . G ut i err ez a r gues fi r s tthatthe A L J s houl d have r econt act ed D r . C um m i ngs pur s uantt o 20 C . F. R . § 404. 1512( e) on the bas i s of hi s M ay28, 2 0 0 4 , letter th a t o p in e d sh e w a s d isa b led . W e d isa g re e b e c a u se th e d u tyto re c o n ta c t a m e d ic a l s o u rc e is n o t tr ig g e re d u n le s s th e e v id e n c e “ is in a d e q u a te . . . t o det erm i ne w hether[the cl ai m anti s ] di s abl ed. ” Id. ; see also White v. B arnh art , 287 F. 3d 903, 908 ( 10t h C i r . 2002) . T her e w as notonl yadequa t e, buts ubs t ant i al evi dence i n t he r ecor d t o s uppor tthe A L J ’ s concl us i on thatM s . G ut i err ez w as not d isab led. A lso, th e d ec isi o n reg ard ing d isab il ityis r ese rve d to the C o m m issi o n er, id . at 9 0 7 , an d th e fa c t th a t D r. C u m m in g s h a d a d iffe re n t o p in io n th a n th e A L J is n o t th e typ e o f

e v id e n tiary co n flict o r a m b ig u ityth a t re q u ire d f u rth e r c o n tac t. T he nextal l eged e r r ori s t he A L J ’ s fai l ur e t o cal l a medi cal expertpur s uant to S o c ial S e c u rityR u lin g 8 3 -2 0 , 1 9 8 3 W L 3 1 2 4 9 (S .S .A . 1 9 8 3 ) (S S R 8 3 -2 0 ) to d e ter m in e th e o n se t d a te o f M s. G u tierr e z ’s d isa b ili ty . T h is a rg u m e n t als o fa ils beca us e the nee d t o det erm i ne an ons etdat e i s r el evantonl yw her e a c l ai m anthas b e e n fo u n d d isa b led : “T h e o n se t d a te o f d isa b ili tyis th e first d a ya n in d iv id u a l is di s abl ed as defi ned i n t he A ctand the r egul at i ons . ” Id . at*; s ee als o B l ea v. B arnh art , 46 6 F . 3d 90 3, 90 8-10 (10 th C i r. 20 06 ) ( app l y i ng S S R 83 -20 i n a case w h ere the c lai m an t w as fo u n d d isab led b u t th e o n set d ate w as u n clea r). L as t , M s . G ut i err ez a s s ert s thatthe A L J ’ s hypothet i cal ques t i on t o the vocat i onal expertw as defi ci entbeca us e i tdi d notpr oper l ydefi ne heral l eged i nabi l i t yt o conce nt r at e. W e agr ee that“[t ] es t i m onyel i ci t ed byhypothet i cal-8-

ques t i ons t hatdo notr el at e w i t h pr eci s i on al l of a c l ai m ant ’ s i m pai r m ent s cannot cons t i tut e s ubs t ant i al evi dence t o s uppor tthe [Com m i s s i oner ’ s ] deci s i on. ” Ha rg is v. Sul l i van , 9 4 5 F .2 d 1 4 8 2 , 1 4 9 2 (1 0 th C ir . 1 9 9 1 ) ( q u o ta tio n o m itte d ). H ow ever , “s uch i nqui r i es m us ti ncl ude al l ( and onl y ) thos e i m pai r m ent s borne out byt he evi dent i aryr ecor d. ” E vans v. C hat er , 5 5 F .3 d 5 3 0 , 5 3 2 (1 0 th C ir . 1 9 9 5 ). B eca us e the A L J found thatM s . G ut i err ez’ s depr es s i on ( fr om w hi ch s he cl ai m ed h e r in a b ili tyto c o n c e n tra te s tem m e d ) w a s n o t se v e re , h e w a s n o t re q u ire d to in c lu d e th is lim itatio n in h is h yp o th e tica l q u e stio n to th e v o c a tio n a l ex p e rt. T h e j u d g me n to f

t h e d i s t r i c tc o u r ti s AF F I RMED . E n tered fo r th e C o u rt B obbyR . B al dock C i r cui tJ udge