1

The Honorable Donovan W. Frank, United States District Judge for the

District of Minnesota, sitting by designation.

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United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 02-2105

___________

Jack Dixon, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the Eastern 

* District of Arkansas.

JoAnne B. Barnhart, Commissioner *

of Social Security, *

Appellee. *

*

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Submitted: November 7, 2002

Filed: April 4, 2003

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Before MURPHY, and MELLOY, Circuit Judges, and FRANK1

 District Judge.

___________

MELLOY, Circuit Judge.
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Appellant Jack Dixon appeals the district court’s affirmance of his termination

of disability benefits. We reverse and remand for further development of the factual

record.

I.

Appellant Jack Dixon was born on August 21, 1948. He received a ninth grade

education and worked as a truck driver and heavy equipment operator. Dixon

suffered a job related injury on January 9, 1989, when he fell off a loading dock and

injured his tail bone, resulting in an L1 vertebral body compression fracture,

paralumbar muscle strain, myositis with myospasticity, and a coccygeal contusion.

Dr. Hermie Plunk, a primary care physician, was Dixon’s treating physician. Dr.

Plunk has continued to treat Dixon throughout this appeal. Dixon also had trouble

with his vision for a number of years. Dixon received treatment for his vision

problems from Dr. Roger Baker, an ophthalmologist. Dr. Baker concluded Dixon had

only hand motion vison in the right eye, and 20/25 vision in the left eye.

In June of 1989, Dixon filed an application for disability insurance benefits and

for supplemental security income benefits alleging a disability onset date of January

9, 1989, due to an injured tail bone and poor vision. On May 3, 1990, Dixon was

awarded benefits on his claim with an onset date of January 9, 1989.

In 1994, while Dixon was still receiving disability benefits based on his back

and vision problems, he began to have heart problems. Dr. Fraser Richards

successfully performed coronary artery bypass surgery on Dixon on June 1, 1994.

Dixon continued to see his primary care physician, Dr. Plunk, for cardiac problems,

hypertension, and anxiety, while also seeing Dr. Richards for his cardiac problems.

From June 21, 1994, through December 17, 1996, Dr. Plunk saw Dixon a number of

times for cardiac and non-cardiac symptoms and for medication management.

Dixon was admitted to the hospital on May 24, 1997, for chest pain. While in

the hospital, a cardiac catheterization revealed coronary atherosclerotic disease
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At the request of the Social Security Administration, Dr. Robert Redd

evaluated the medical records of Dixon.

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ranging from mild stenosis in some arteries to severe stenosis or total occlusion in

others. Tests performed on Dixon revealed he had sinus bradycardia. He was

diagnosed with non-cardiac chest pain, coronary artery disease, hypertension, and a

history of tobacco abuse. Dixon was discharged on May 26, 1997, with a medication

regime that included Ecotrin, Nitroglycerin, Norvasc, and Xanax. The medication

regime was altered throughout 1997 by Dr. Plunk and Dr. Richards as Dixon

continued to experience symptoms. A June 13, 1997, stress test revealed that Dixon

failed to achieve the target heart rate and that he had abnormal blood pressure.

The Social Security Administration continued to review Dixon’s disability

award through the continuing disability review process. A March 17, 1998, report

by Dr. Plunk, performed at the request of the Social Security Administration, stated

that Dixon’s physical ability to perform activities of daily living were limited by

coronary artery disease, post CASG triple bypass surgery, unstable angina,

hypertension, hystoplasmosis, hiatal hernia, difficulty hearing, and decreasing vision.

Dr. Richards, Dixon’s treating cardiac surgeon, gave no opinion on Dixon’s workrelated or daily living activities.

In a letter dated April 26, 2000, Dr. Plunk reiterated her previous diagnosis and

concluded: “[Dixon’s] overall health condition at this time is weakened yet stable

with medication. He cannot work in extreme heat or cold. He cannot lift over ten

pounds. He cannot return to his previous occupation in construction as a heavy

equipment operator nor truck driver. I do not expect his condition to improve.”

On May 3, 1998, Dr. Robert Redd reviewed the medical evidence in Dixon’s

record to make a capacity assessment2

. Dr. Redd did not treat nor did he examine
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Dixon. Dr. Redd did not have the statements of Dr. Plunk or Dr. Swingle regarding

Dixon’s work limitations. Dr. Redd concluded that Dixon had a medium level

residual functional capacity (RFC) reduced by vision-related limitations.

Dixon also underwent, at the request of the Social Security Administration, a

consultative examination performed by Dr. Charles Swingle on May 5, 1998. Dr.

Swingle diagnosed Dixon with post-bypass coronary artery disease, hypertension,

blindness in the right eye, hiatal hernia, and histoplasmosis. Dr. Swingle stated that

Dixon was “probably unable to be gainfully employed due to the severity of [coronary

artery disease] and blindness in [the] right eye.”

Dr. F. Joseph George, with the Jonesboro Eye Clinic, also treated Dixon in

1998 and 1999. Dr. George concluded that Dixon’s best corrected central visual

acuity was the ability to count fingers with the right eye and 20/20 vision in the left

eye. This represented a slight improvement in Dixon’s left eye vision. Dr. George

did not believe that the poor vision in the right eye could be improved with treatment.

Dr. George did note early cataract changes in each eye.

Pursuant to the continuing disability review process, Dixon received a notice

of disability cessation on May 18, 1998. The communication notified Dixon that he

was no longer disabled as of May 1, 1998, and that his final benefits payment would

be made on July 31, 1998. This decision was affirmed on reconsideration before a

disability hearing officer on June 24, 1999. On June 27, 2000, an ALJ upheld the

determination that Dixon was no longer disabled within the meaning of the Social

Security Act. Dixon was not represented by counsel at the hearing. The Appeals

Council declined to review the decision. After retaining counsel, Dixon sought

judicial review of the ALJ’s final decision and on March 28, 2002, a United States

Magistrate Judge affirmed the ALJ’s determination that Dixon was no longer

disabled. On appeal, Dixon contends the ALJ’s decision was not supported by

substantial evidence.
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II.

We review the denial of benefits pursuant to the continuing disability review

process for substantial record evidence to support the ALJ’s decision. See Muncy v.

Apfel, 247 F.3d 728, 730 (8th Cir. 2001). Substantial evidence is relevant evidence

that reasonable minds might accept as adequate to support the decision. Hunt v.

Massanari, 250 F.3d 622, 623 (8th Cir. 2001). Therefore, the narrow issue on appeal

is whether there is substantial record evidence to support the ALJ’s determination that

Dixon could perform medium work. 

The continuing disability review process is a sequential analysis prescribed in

20 C.F.R. § 404.1594(f). The regulations for determining whether a claimant’s

disability has ceased may involve up to eight steps in which the Commissioner must

determine (1) whether the claimant is currently engaging in substantial gainful

activity, (2) if not, whether the disability continues because the claimant’s

impairments meet or equal the severity of a listed impairment, (3) whether there has

been a medical improvement, (4) if there has been medical improvement, whether it

is related to the claimant’s ability to work, (5) if there has been no medical

improvement or if the medical improvement is not related to the claimant’s ability to

work, whether any exception to medical improvement applies, (6) if there is medical

improvement and it is shown to be related to the claimant’s ability to work, whether

all of the claimant’s current impairments in combination are severe, (7) if the current

impairment or combination of impairments is severe, whether the claimant has the

residual functional capacity to perform any of his past relevant work activity, and (8)

if the claimant is unable to do work performed in the past, whether the claimant can

perform other work. 20 C.F.R. § 404.1594(f).

The ALJ first determined that Dixon had not been engaged in substantial

gainful work activity. In the next step, the ALJ concluded that “[w]hile the claimant’s

current conditions and/or impairments . . . are potentially severe within the meaning
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“Medium work involves lifting no more than 50 pounds at a time with frequent

lifting or carrying of objects weighing up to 25 pounds.” 20 C.F.R. § 404. 1567(c).

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of the Regulations, there is no evidence in this claim to show that they have been so

pervasive and/or severe as to meet or medically equal one of the impairments listed

in Appendix 1, Subpart P, Regulations No. 4.” ALJ Decision, July 27, 2000, at 3.

The ALJ continued in the sequential analysis and determined that there was medical

improvement in Dixon’s impairments. Next, the ALJ found that Dixon’s medical

improvement was related to his ability to do work and his RFC had increased to at

least the medium duty level3

. The ALJ then determined that Dixon’s current

impairments were still severe, but that he had the RFC to perform medium work.

Specifically, the ALJ concluded:

In assessing the claimant’s residual functional capacity consideration is

given to the above factors regarding the wide range of daily activities

performed by him including driving, gardening, mowing, shopping, and

reading which discredit the assessment reached by Dr. Plunk in his April

26, 2000 correspondence. Testimony disclosed he rarely experiences

back discomfort and treatment notes disclose a negative cardiolite study

in July 1999. Based upon these considerations he is assessed residual

functional capacity to lift/carry 50 pounds occasionally and 25 pounds

frequently; stand/walk 6 hours in an 8 hour day; sit 6 hours in an 8 hour

day; and push/pull using the upper and lower extremities.

ALJ Decision, July 27, 2000, at 5. Finally, the ALJ determined that Dixon could not

perform his past relevant work, but, according to testimony from a vocational expert,

there were jobs within the economy which Dixon could perform.

The ALJ based his decision on three principal factors. First, the ALJ correctly

noted that Dixon’s back pain had improved and that Dixon rarely experienced back

discomfort. Second, the ALJ found persuasive the fact that Dixon was able to engage

in a wide range of certain daily activities, such as driving, gardening, mowing,
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shopping, and reading. The ALJ believed these activities discredited the assessment

reached by Dixon’s treating physician, Dr. Plunk, and his examining physician, Dr.

Swingle. Third, the ALJ relied on the negative cardiolite study in 1999 to support his

determination that Dixon could perform medium work. We address these factors in

turn.

The ALJ determined that Dixon rarely experienced back discomfort. It is

undisputed that Dixon’s back problems have improved and we agree there is

substantial record evidence to support that determination. However, the mere fact

that Dixon’s back problems have improved does not mean, in and of itself, that Dixon

can do medium work. Dixon still suffers from poor vision and the record indicates

a significant history of cardiac problems since the initial onset of his disability and

during his award period. While the record was well-developed regarding Dixon’s

back pain, we find the record insufficiently developed regarding Dixon’s cardiac

problem and the impact it has on his ability to work.

In finding Dixon capable of performing the exertional tasks of medium work,

the ALJ relied on the statements in the record that Dixon engaged in daily life

activities of driving, gardening, mowing, shopping, and reading. The ALJ believed

these activities discredited the assessment reached by Dr. Plunk, Dixon’s treating

physician, that Dixon had a lifting limitation of ten pounds. However, the record

pertaining to Dixon’s daily activities was not fully developed. There is nothing in the

record to support the conclusion that because Dixon can perform certain daily life

activities, he can also perform the exertional tasks of medium work. “This court often

has noted . . . that a claimant’s ability to perform household chores does not

necessarily prove that claimant capable of full-time employment.” See Ekeland v.

Bowen, 899 F.2d 719, 722 (8th Cir. 1990) (citing Easter v. Bowen, 867 F.2d 1128,

1130 (8th Cir. 1989)). The fact that Dixon usually walks two miles a day at a slow

pace does not, in itself, mean Dixon can perform medium work. The ALJ failed to
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explain how Dixon’s daily life activities translate to an ability to perform the

exertional tasks required in medium work. 

The Commissioner contends that the ALJ adopted most of Dr. Plunk’s

assessment, but did not agree with the ten pound limitation because the results of his

cardiolite test do not support that conclusion. The ALJ did not explain the

significance of the negative cardiolite test, nor is its significance developed in the

record. The test is mentioned in the cardiologist’s report without any explanation of

its implications. The record needs to be more fully developed regarding what

specifically the cardiolite test results, among other information, means relative to

Dixon’s ability to work, and how those particular test results may conflict with other

tests in Dixon’s medical records. Absent that information, it is not possible to

ascertain Dixon’s ability to work without engaging in medical conjecture. See

Nevland v. Apfel, 204 F.3d 853, 858 (8th Cir. 2000) (“‘An administrative law judge

may not draw upon his own inferences from medical reports.’” (quoting Lund v.

Weinberger, 520 F.2d 782, 785 (8th Cir. 1975)). On the record as it stands, the

results of the cardiolite test provide no basis for rejecting the recommendations of Dr.

Plunk and Dr. Swingle.

Finally, we find merit in Dixon’s contention that the ALJ relied too heavily on

the opinion of the Social Security Administration’s reviewing physician, Dr. Redd.

While the ALJ’s decision does not mention Dr. Redd’s recommendation, it is record

evidence. Dixon contends Dr. Redd’s report is the only evidence in the record which

supports the ALJ’s RFC determination that Dixon can perform medium work. Dr.

Redd never examined Dixon and provided his RFC opinion based solely on Dixon’s

medical records. See Nevland, 204 F.3d at 858 (relying upon non-examining, nontreating physicians to form an opinion on a claimant’s RFC does not satisfy the ALJ’s

duty to fully and fairly develop the record). The record indicates that Dr. Redd did

not have Dr. Plunk’s or Dr. Swingle’s recommendations and statements to inform his

RFC recommendation. We have previously stated that “[a] treating physician’s
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opinion should be accorded substantial weight.” Prince v. Bowen, 894 F.2d 283, 285

(8th Cir. 1990) (citations omitted). Dixon’s treating physician and the state’s

examining physician concluded that Dixon had, at a minimum, more severe work

restrictions than what the ALJ determined. Dr. Redd concluded that Dixon could

perform medium work. Given the contradicting recommendations in the record and

the insufficiently developed record surrounding Dixon’s cardiac problems, Dr. Redd’s

opinion does not constitute substantial record evidence that Dixon can perform

medium work. See Nevland, 204 F.3d at 858 (“The opinions of doctors who have not

examined the claimant ordinarily do not constitute substantial evidence on the record

as a whole.”).

The ALJ’s conclusions were not supported by substantial record evidence.

Specifically, the record is undeveloped regarding: Dixon’s daily life activities and

how those activities relate to his ability to work; the significance of certain test results

relied upon by the ALJ; and, what specifically Dixon’s treating and examining

physicians recommend in terms of his RFC. A more complete record needs to be

developed to ascertain what level of work, if any, Dixon is able to perform.

Accordingly, we remand the case for further proceedings to more fully develop the

record.

A true copy.

Attest:

CLERK, U.S. COURT OF APPEALS, EIGHTH CIRCUIT.