## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it

N o. 11

- 1846 J EANNINE A. T UM M INA RO, Plai nt i f f

-Appe l l ant, v. M ICHAEL J. A S T RUE, Com m i ssi onero fS oci alS ecuri ty, D efend a nt-A pp ellee.
Appeal from the United States District Court fo r the N o rthernDi stricto f Illino is, We stern Div isi on. No . 09 C50116

—Philip G. Re inha rd, Judge
.
A RG UE D O CT OB ER 4, 2011

— D ECI DE D N OVE MBE R 1, 2011

Befo re C UDAH Y, F LA UM, a nd T INDER, C ircu it Judges. P E R C UR I AM . An Admi ni s t r a t i v e La w J ud g e ( “ ALJ ”) f ound th at Jea nnine Tum m i naro had bee n dis abl ed by chro ni c ba ck pai n but a fterf our yea rs sho w ed “m edi cal i m prove m ent” and re tu rn ed to full

- ti m e work

. A per i od ofdi sabi l i ty ends i fthe cl ai m ant s how s m edi cali m prove m ent o r en g ag es i n s ubs ta nt i al gai nfula ct i vi ty, b ut Tum m in ar o ar gues that the AL J ’ s fi nd i ng o fm edi cal i m prove m en t i s no t s up port ed by substa nti alev i dence.2 N o. 11

- 1846 Tum m i na r o fur th era r g ue s th athe r r en ewe d e m pl o y m en t ( wh i c h a p p e a r s t o b e o n g o i n g ) wa s n o ta n i n d e p e nde nt basi s fordecl arin g that her disabi l i ty had ended bec ause the AL J neve r evaluated wh etherthat work const i tuted an au th o r i ze d ( an d e nc o ur ag ed) “ tr ial w o r kpe r i o d” an d th us co uld notbe l abel ed as substa nti alga i nfulact i vi ty. W e agree . Acco r di ng l y, we r ev er se the j udg m en t an d re m and w i th i nstr ucti ons th at the case be re turned t o the S oci alS ecuri ty A dm i ni str atio n f oraddit i onalpro c e e di ng s t o a ddr e s s T ummi na r o ’ s t r i a lwo r kp e r i o d.

I. Tum m i na r o unde r wentthr ee back su r g er i es a fte r s he w as tw i ce hi t bycar s in unrel ate d i nci de n ts . Th e fi rs t tim e, in Jun e 2002 , sh e w as stru ck b y a c ow orker’s p ickup truc k w hile w orking as a con stru ct io n flagger. S he c o nt i nu e d wo r k i ng the da y s he wa s hi t b utl ate r re p or te d se ve re ba c k p ain . B y Ja n u ar y 2 00 4, p ain m edi ci ne and physi c al thera py had not al l evi ate d Tum m i na r o ’ s pain, s o s he u nd erwenta s pi na lfus i o n, and doctor s inser ted a m eta lfusi on ca ge i n herl ower back . S he so ught t re atm ent in Se ptem ber20 04 fro m Dr. Ja m es W i l son, a pai n speci al i st, wh o presc ribed fou r d iffe r e n t p ain m ed ica tio n s. T u m m in ar o’s ba c k p ain continued , how eve r, and i n J anuary20 05 she had anothe r oper ati on t o re m ove the cag e fro m herbac k. S he r e t urne d to he r j o b a s a fl a g g e r i n Apr i l2 0 0 5 , a ppar en tlywi th o utc o m pl i ca ti o ns wi thhe r b ac k

. But that J uly, wh i l e e n ro ute t o w or k, she w as i n a s ec ond car acci dent, w hi ch re quir ed a thi rd back surg er y. A ye arN o. 11

- 1846 3 after th is su rgery, D r. W il son b egan trea ting T um m inaro’s backpain with s ter oi d i nj ecti ons. S he r epor ted to Dr. W i l son that the inj ecti on s pro vi ded her“4 0- 50% reli ef, ” so he con tinu ed gi ving h e r these i njections every few m onths. Tum m i naro fi rs t a p pli ed f orDis abi l i ty I nsurance Ben efits and Supple m entalS ecuri ty I ncom e in Octob er 20 03 , bu t in for m at ion ab ou t t h at ap p lica tio n is n otin the r eco rd. S he appli ed f orbene fi ts aga i n i n M ar ch 200 5 an d a ss er te d th ats he ha d b ee n di sabl ed sinc e be i ng st r uckb y the pi ckup i n 2 00 2. Herc l ai m was de ni ed , a nd she di d not s eek reco nsi derat i on. Tum m i naro appli ed o nc e m o r e f o r b en efi ts i n S ept embe r 2 00 6, thi s ti m e m aintaini ng tha t s he had been d isabl ed si nce J anuary20 04. A fterheri ni tial c lai m and re quest forr eco nsi derat i on w ere d en ied , Tu m m inaro requ ested a hearing be fore an A L J. I n the mean ti m e Dr

. W i l so n c o nt inu ed tr ea ting Tum m i na r o ’ s ch r o ni c ba ckpa i n w ith m edi cine a nd ste ro i d i nj ecti ons, wh i ch br ought her “s igni fi cant r elief” be t w e e n 20 07an d 20 08 . For e x am p le, sh e t old Dr. W i l son that an i nj ecti on in A p ril20 08 had provi ded

“ 8 0 % r e l i e f

. ” D u r i n ga n a p p o i n t me n ti n J u l y 2 0 08 , h o weve r, Tum m i naro com pla i ned of const ant, shar p b ack pai n that ra ted 9 i n seve ri ty on a scal e of1 to 10. Dr. W i l son noted t hat Tum m i naro ’ s m edi cati on had i m prove d her “da i l y l i vinga ct i vi ti es , ” re fi l l ed he r pr es cr i pti o ns , a nd ask ed her to re turn i n a m onth. A t that next vis it, in A ugus t 2008, Tum m i naro ag ai n descr ibed herbac k pai n as “co nstant, shar p and stab b in g,” but Dr. W i l son4 N o. 11

- 1846

s i mp l y c o n t i n u e d th e me d i c a t i o n a n d p r e s c r ib e d h o me exer ci ses . W hen she re turned i n Se ptem ber f oranother i nj ec ti o n, s he rated h erpa i n a s a 10 a nd r epo r te d no i m prove m ent s i nce herl astvi sit. Dr. W i l son i nstr ucted h er to r etur n i n a c ouple weeks, co nti nue “act i vi ty as to l er at ed, ” an d pe r f o r m s tr et ch i nga nd s tr engthe ni ng exer ci ses . The A LJ c onducted a hear i ng i n Octobe r 2008
. Tum m i naro te sti fi ed that she s ti l lexper i enced “m aj or ba ckpr o bl em s a nd hi p pr o bl ems” a nd was t ak i ngf o ur pain medi ca ti o ns tha t o cc as i o na l l y made he r t i r ed. The s t e r o i d i nj e c t i o n s , s h e a c k n o wl e d g e d , h e l p e d “ t o s o me e x t e n t, ” bu t sh e i n s i s t e d th a th e r b a c kp a i n h a d n o ti mprov e d s i nc e h e r fi r s ts ur g e r y i n 2 0 0 4

. T ummi na r o nonethel ess co nceded that, al though s he pre vi ousl y had needed hel p taking ca re o fher sel fand herhom e, by20 06 she no l onge r need ed a ssi sta nce. S he al so had res um ed d rivi ng i n 2 00 6. And des pi te he r c hr o ni c ba ckpa i n s he h ad re tu rn ed to w or k full tim e in Fe b ru ar y 200 8 , i n i t i ally as a for kl i ft dri verand then in a cler i calposi ti on with the s am e c om pany. Tum m i naro al so w or ked ab out once a week i n herf or m erposi ti on a s a co n st ru c tio n fl agg er and wa s p e r f o r mi ngb o th j o b s a tthe t i me o fh e a r i ng . W o r k i ngmade he r b ac kpain w o r se , s he e xpl aine d, b ut she ne eded the m oney . The A LJ c oncl ud ed that Tum m i naro ’ s chr oni c ba ck p ain h ad ren d er ed h er d isa b led from Jan u ar y 2 00 4 u n til he r r e t urn t o ful l

- t i me wo r ki n F e b r ua r y 2 0 08. T he ALJ ass er ted tha t T u m m i naro had “te sti fi ed to , and m edi cal re c or d s s h ow , i m p ro ve m en t a n d h er ret u rn in g t o w o r k.”N o. 11

- 1846 5 The A L J d id notm enti on the m edi calev i dence or Tu mm i na r o ’ s t e s t i mon y p e r t a i ningt o the p e r i o d a f ter Febru ary 2008 bu t a p p aren tly inferred from her retu rn to w or k that s he had “exper i enced m edi cali m prove men t a nd i s e ng a g e d i n s ub s t a nt i a l g a i nful a c t i vi ty an d, th er efo re , no lon ge r d isa b led .” T u m m i n ar o re q u es te d rev iew by th e A p p ea ls C ou n c il. S he a r g ue d tha t th e ev i den ce do es no t su ppo r t th e ALJ ’ s fi nd i ngo fme di c a li mpr o v e men t, a nd tha tthe ALJ sh ou ld ha ve view ed he r retu rn to w ork as a “tria l w ork p er iod .” C laim a n t s fou n d to be d isa b led m ay te st th eir abi l i ty to r esum e work i ng byacc epti ng em plo ym ent for up to ni n e m onths w i thout f or fei ti ng the i r deter m i nati on of d is abili ty or their bene fi ts. 20 C

. F.R. § 404.1592(a). Tum m i naro co ntended that heraward ofbene fi ts shoul d have be en o ngoing and not lim ited to a cl ose d peri od. The A pp eal s Counci ldeni ed Tum m i naro ’ s r equest for r evi ew , and w hen she soughtr evi ew i n the dist ri ct c ou rt, see 42 U
. S. C. § 4 05( g) , the case was re fer re d to a m agi str ate j ud ge. I n m oving f or sum m ar y jud gm ent, Tum m i naro r eas ser ted t h e s am e co ntenti ons m ade to th e A p p ea ls C ou n c il. T he m agistrate j ud ge reason ed , m uc h l ike th e A L J, th a tT u mmin a r o mu s th a v e e x p e r i e n c e d me di c a l i mp ro ve m en t by F eb ru ar y 2 00 8 b ec au se sh e re tu rn ed to fu llti m e w or k. A nd o nce Tum m i naro dem onst ra ted m edi cal i m prove m ent, the m agi str ate j ud ge continued , hertr i al w or k per i od beca m e i rr el evant
. Thus the m agi str ate j udg e i ss ue d a Re po r t an d Re co m m en dat i o n pr o po sing tha tthe di s t r i c tc o ur t up ho l d the ALJ ’ s l i mi t e d a wa r d.6 N o. 11

- 1846 The m agi str ate j ud ge i n for m ed Tum m i naro thatshe had 14 d ays to fi le obj ection s to the rep ort, bu t Tu m m inaro did notdo s o. T h e di str i ct c ourtadopted the m agi str ate j ud ge’s recom m en d ation an d up he ld th e A L J’ s aw ard of b en efi ts f orthe cl ose d peri od fro m J anuary20 04 to February20 08.

II. B e c a u s e th e Ap p e a l s C o u n c i ld e c l i n e d r e v i e w, we r ev i ew the ALJ ’ s dec i si o n a s th e fi na lde ci si o n o fthe C om m issi one r. Ge t ch v. As t r ue, 539 F.3d 473 , 4 8 0 ( 7 t h C ir. 2008 )

. W e co nfine o ur r evi ew to the ratio nal e o ffer ed by th e A L J. S e eS ECv . C h e n e ryCorp. , 3 18 U

. S. 80 , 93

- 95 (19 43 ); Spi va v . As t r ue, 628 F.3d 346 , 353 (7th C ir. 2010). The parti es agr ee that Tum m i naro was d isa b l ed betw ee n Jan u ar y 2 00 4 a n d Fe b r u a r y 2 00 8. T h e is su e h er e is w hethe r s he wa s di s ab l e d fo r a nyp e r i o d a ft e r tha t poi nt. Tum m i naro m ai ntai ns t h at the AL J sho uld have con side red her r e t u r n to w ork i n Feb rua ry 2008 as p art o fa tria lwor kpe r i o d a nd a r gue s th atthe ALJ ’ s fi ndi ng ofm edi cali m prove m ent l acks ev i denti ar y s up port
. T he Com m issi one r first conten d s tha t Tu m m inaro wa i v e d h e r r i g htt o c ha l l e ng e o n a pp e a lth e i s s ue s a dd r e s s e d i n th e ma g i s t r a t e j u d g e ’ s R e p o r ta n d R e c o mm endati on be cause she di d not fil e any o bj ecti ons. W e di sa g r ee . I t i s true tha t a par tyno r m al ly w ai ve s th e ri ght t o c on te st a m agi str ate j ud ge’ s co ncl usi ons, bo th f ac tu ala nd l eg al, b y n ot pr es en tinga n obj ec ti o n t o the d i st ric t c ou rt . 28 U .S.C . § 63 6(b )(1) (B ), (C ); E s t a t eo f S i msN o. 11

- 1846 7

ex re l

. Si m s v. Cnty. o

f Bure au , 506 F.3d 509 , 516 (7th C ir. 2007 ); Sn yd e rv . N o l en , 380 F.3d 279 , 284 (7th C ir. 2004). Forwaive r to apply, however, a m agi str ate j ud ge m ust i nf o r m the pa r tyabo utb o ththe t i m efr ame fo r fi l in g o bj ec ti o ns a nd th atwai ve r wi l lf o l l o w f r o m i na ct i o n. Ash ki n v . Time War ne rCab l eCorp. , 52 F. 3d 140, 14 2 ( 7th C ir. 1995); Pr ovi de ntBank v . M a nor St e e l Corp. , 88 2 F
. 2d 258, 26 1 ( 7th Ci r. 19 89)

. In thi s ca se the m agi str ate j u d ge ex p lain ed th a t T u m m in ar o h ad 14 d ay s t o file obj ec tio ns but did notwarn herexpl i ci tl y that a ny o bj ecti o n no t m ade by th at dea dl i ne woul d be wai ve d. The o mi s s i o n o fth a te s s e n t i a lw a r n i n gme a n s th a tT u mm i naro di d not wai ve her ri ght t o chal l enge o n appeal the m agi str ate j ud ge’ s co ncl usi ons. Tum m i na r o a r g ue s th atthe ALJ i g no r ed he r e nt i tl ement to a tri al w ork period w he n h e li m ited th e aw ard o f b e n e fi t s t o th e p e r i o d b e f o r e s h e r e s ume d fu l l

- t i me em plo ym ent in Feb ruar y 2 008. Bef or e l i m i ti ng be nefi ts to a cl ose d peri od, an AL J m u st co ncl ud e e i therthata c laim an t e x p er ien c ed “m ed ica l im p ro ve m en t” as ev idenced by change s in the sym p tom s, si gns, o r tes t resu l ts ass oci ate d w i th heri m pai rm ents, o r el se that an ex c ep tio n to th is ru le a p p lies

. See 2 0 C .F .R

. § 404.1594(a), (b )(1) ; V

eino v. B a rnh a rt, 312 F.3d 578 , 586-87 (2d Cir. 20 02 ); Wat e rs v. Bar nha rt, 2 7 6 F. 3d 716, 719 (5th Cir. 2002); Jo hn son v. A pfel , 19 1 F

. 3d 77 0, 77 3 ( 7th Ci r. 19 99)

. That deter m i nati on i s info rm ed by an ei ght- ste p evaluati on that begin s w ith a pri nci pal exce pti on t o the ne ed f or m ed ica l im p ro ve m en t: H as t h e c laim an t e n ga ge d in substa nti alga i nfulact i vi ty a fterthe com ple ti on o f a tr i al w ork period ? 20 C

. F.R. § 404.1594(f).8 N o. 11

- 1846 I nd ivi d ua ls entitled to recei v e d isabil ity benefits are en ti tl ed, abs en t ce r ta i n di squa l i fy i ngf ac to r s no t pr es en t he re, to a trial w ork p eriod. 20 C

. F.R. § 404.1592(d )( 1), ( 2); see B ARBA RA S AMU ELS, S OC IAL S EC URITY D ISA BILI TY C LAIM S § 2 9:1 1. S oci alS ecuri ty re gul ati ons author i ze thi s t ri alper i od to enco urag e be nefi t r eci pien ts to ass ess thei r ability t o re turn t o w or k without the i m pli catio n th at th eir d isa b ility h as en d ed . S OC IAL S ECURI TY L AW A ND P RACTI CE § 4 4:1 23 ; S OC IAL S EC URI TYAN D M EDICARE A NSW ER B OO K4 :7 5 . W ork perform ed after a claim an t becom es en titl ed to bene fi ts w il l b e ch arac te r i ze d a s par t o fa tri al p erio d unt i ls ucht i m e as the cl ai m ant has ta l l i ed 9 m onths of“s er vi ce” ( w h et her co ns ecut i ve o r no t) o ve r a 6 0- m o nth pe r i o d. 2 0 C. F
. R. § 4 0 4

. 1 5 9 2 ( e )

. Du r i ngthi s “r o l l i ng ” t r i a lp e r i o d, a n ALJ cannot consi der the work bei ng per f or m ed as evi dence that th e c lai m ant i s no l onge r disabl ed but m ay re l y o n o th ere vi den ce t o r ea chthatc o nc l us i o n. 2 0 C. F
. R. § 4 04 .15 92 (a), (e); see POM S DI1 30 10

. 03 5( D) ( 2)

. Onc e th e tr i alperiod is o ver, however, the A LJ m ay l oo k b ack at th e wor kpe r f o r m ed dur i ngtha t ti m e in a ss es sing w hether t h e d i sabi l i ty ended at s om e point “ a fter the t ri al w ork period

. ” 2 0 C

. F.R. § 404.1592(a) (em p ha sis add ed ); seeLi nge nf

e l t e rv. As t r ue, 5 04 F
. 3d 10 28 , 1 03 9 ( 9th Cir. 2007 ); New to n v . Ch a ter, 92 F.3d 688, 692-93 (8th Cir. 1996). C om p let ion of n in e m o n t h s of se rv ice d oe s n otby its elf m ar k t h e e n d of a c laim an t’s d isa b ility . Ra t h e r , a c lai m ant’ s di sabi l i ty ceas es the fi rs t m onth s he eng age s i n substa nti al gain fu l ac ti vi ty a fter the e nd o fa tr i al peri od. 20 C. F. R. § 404. 1592 a( a) ( 1) . Di sabi l i ty benefi ts continue, h ow ev er , f orthatm onth a nd the tw o that fol low

. 20 C

. F.R. § 404.1592a (a)( 2)(i ).N o. 11

- 1846 9 Tum m i naro ’ s t ri alwork p er iod beg an i n J anuary20 04, w hen she becam e enti tl ed to disabi l i ty i nsuranc e benefi ts. She sh o u ld h ave be en all ow ed nine m ont hs of “servi ce” w i thout j eopar dizing here n ti tl em ent t o benefi ts. The A LJ never m enti oned the possibi l i ty of a t ri al w or k per i od, how eve r, and i nstea d concl ud ed that Tum m i naro ’ s e nti tl em ent to b en efi ts ended in Februar y 2 008 w hen she re turned t o w or k. B u t a s o f Fe b ru ar y 2 00 8 T u m m in ar o’s tria l p er iod co u ld not have ended. W or k qual i fi es as “se rv i ce” und era tr i al per i o d b as ed o n a c l ai m an t’ s m ont hly ea r ni ng s. 2 0 C. F
. R. § 40 4. 15 94 ( b) ( 1) ( i i )

. In 2 00 5 th r o ugh 2007, a c l ai m an t ha d t o e arn monthl y wag es o fa t leas t $5 90 , $ 62 0, a nd $ 6 4 0 b efo re w or k c ou ld co n st itu te “s er vic e” co u n ta b le ag ains t a tr i alpe r i o d. 2 0 C. F
. R. § 4 04

. 15 94 ( b) ( 1) ( i i) (B). Tum m i naro did n ot provi de a m onthl y b re akdown o f her earni ngs f or that ti m e peri od, but w e can read ily see fro m herannualea rni n gs that she did notco m ple te n in e m ont hs of service d uring that tim e. T um m inaro ea r ne d $2, 76 5 i n 20 05 , $1 , 68 7 i n 20 06 , and $6 22 i n 20 07
. S he m ayha ve e arne d m o r e th anthe qua l i fy i ngwag e dur i ng her f our- m onth r etur n to w or k in 20 05, but her annual i ncom e in 20 06 sup port s, atm ost, two m onths ofse rv i ce, an d he r i nc o m e i n 20 07 ca nno t co unta s ev eno ne month. I n February 2008 , ther ef or e, Tum m i naro coul d h ave com ple ted a m axi m um o f s ix m onths ofse rv i ce, so her tri alper i od had not ended. Thu s, the A LJ i m prop er ly consi dered herr etur n to work as evi dence t h at h er di sab ility h ad en d ed

. See 20 C

. F.R. § 404 .1 5 92(a); Lin gen felter, 504 F. 3d at 1039 ; Ne wton , 92 F. 3d at 692- 93.10 N o. 11

- 1846 It is im p os sib le t o d isc er n from th e re c or d ex ac tly w he n Tu mm i na r o c o mpl e t e d h e r n i nth mon th o fs e r vi ce. She tes ti fi ed at th e hearing i n Octobe r 2008 thatshe had been w or ki ng co nti nuousl y in the ei ght m onths si nce F eb r ua r y . I t i s thus p ossibl e th atTumm i na r o ha d e xha us te d he r tr i al per i o d at so m e po i nt be f ore the hear i ng, but w i thout see i ng herm onthl y wages f or 20 08 th at c o n c lu sio n ca n n otbe fairly d ra w n . A n d if Tum m i naro co n ti nued to work afterhertr i alper i od ended (and thus s he c ou l d be s ai d to have re sum ed substa ntial ga i nfulact i vi ty) , she sti l lwould be enti tl ed to ben efi ts f o r the th ree m ont hs f oll ow ing her retu rn to w or k. 20 C. F. R. § 404. 1592 a( a) ( 2) ( i )

. M or e info rm atio n an d an aly sis w as n ec es sa ry be fo r e t h e A L J co u ld p ro p er ly d ec id e if

— and w hen

— Tum m i naro ’ s abi l i ty to w or k re n d er ed h er n o lon ge r d isa b l e d , s o a rem an d is necess ar y. T he Com m issi one r asserts th at even i f T um m inaro’s tr i alwork p er i od had not ended, a r em and i s unneces sary bec au se su bsta nt ialevid e n ce su p p orts the A L J’ s c on cl usi on that s he had experi enced m edi cali m prove men tb y F e b r ua r y 2 0 0 8 a nd thu s wa s n o l o ng e r di s ab l e d. An A LJ m ay rel y o n medi ca lo r o th ere vi den ce dur i ng a t ri alper i od to c oncl ud e that a di sabi l i ty ended. 20 C.F

. R. § 404. 1592 ( e) ( 3)

. But the A LJ in thi s ca se i nfe rr ed m edi cali m prove m ent s ol el y fro m Tum m i naro ’ s re turn t o wor k, no t he r medi ca lr ec o r ds. The A LJ pr o vi ded no an aly si s o fthe medi ca le vi den ce a fte r Febr ua r y 2 00 8 an d si m plyr em ar ked thatTum m i na ro “ tes ti fi ed to , and her m ed ica l rec or d s s h ow , i m p ro ve m en t.” T u m m in ar o t es tifi e d , h o we v e r, th a th e r b a c kp a i n h a d noti m prove d si nceN o. 11

- 1846 11 2004 and that her re turn t o w or k had ag gr avat ed her con d iti on. Th e A L J’ s con clusory sta tem en t to the con trary does not supp or t a fi nd i ng o fm edi cal i m prove m ent. Se eD e l ph v. As t r ue, 538 F.3d 940 , 9 4 5 -46 (8th C ir. 2008); D ixo n v . B a rnh a rt, 324 F.3d 997, 1001-02 (8th Cir. 2003). On rem and th e A LJ m ust a dd re ss Tum m i naro ’ s e nti tl em ent to a tr i al w or k peri od. The A LJ shoul d deter m i ne, base d on Tum m i naro ’ s m onthl y wages, wh ether

— an d w hen

— sh e exh au ste d allnine m ont hs of he r tri al w ork peri od. I fshe com ple ted the tr i alper i od, the A LJ m ust as se ss whethe r sh e i s ca pab l e o fs ubs ta nt i alg ainful activity before term inating h er ben efi ts . I f T um m inaro re gained that abi l i ty, she sti l li s e nti tl ed to bene fi ts for th re e m on th s a fte r th e e n d o fh er tria l p er iod . In th e alternat ive, th e A L J m ay term inate T u m m inaro’s benefi ts i fhe c oncl ud es, r el yi ng o n evi dence other than Tu mmi n a r o ’ s wo r k d u r i n g h e r t r i a l p e r i o d , th a ts he experi enced m edi cali m prove m ent. W e V ACATE the j udg m ent o fthe di st r i ctc o ur t an d R EMA ND with instr ucti ons that the c ase be re turned t o the S oci al S ecuri ty A dm i ni str ati on f oraddit i onalpro ce eding s co ns i st en t wi ththi s o pi ni o n.

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