Source: http://ca10.washburnlaw.edu/cases/2006/10/05-2246.htm
Timestamp: 2019-01-17 19:04:14
Document Index: 513205066

Matched Legal Cases: ['§ 405', '§ 1291', '§ 404', '§ 404', '§ 1', '§ 636', '§ 423', '§ 423', '§ 423', '§ 402', '§ 402']

05-2246 -- Blea v. Barnhart -- 10/23/2006
| Keyword | Case | Docket | Date: Filed / Added | (90735 bytes) (68055 bytes)
NICK L. BLEA,
(D.C. No. 04-1149-LCS)
Linda H. Green, Assistant Regional Counsel, United States Social Security Administration, Dallas, Texas (David C. Iglesias, United States Attorney, Cynthia L. Weisman, Assistant United States Attorney, and Tina M. Waddell, Chief Counsel, Region VI with her on the brief) for Defendant-Appellee.
Claimant Nick L. Blea appeals from a magistrate judge's order affirming the Commissioner's denial of his application for disability insurance benefits under Title II of the Social Security Act. Mr. Blea contends that the magistrate judge erred in upholding the administrative law judge (ALJ)'s decision, where the ALJ failed to: (1) utilize Social Security Ruling (SSR) 83-20 to determine the onset date of Mr. Blea's disabilities, and (2) confront or address lay witness testimony pursuant to Social Security Rulings 83-20 and 85-16. We hold the onset date of Mr. Blea's disabilities was ambiguous, that the ALJ erred by failing to utilize SSR 83-20 to infer an onset date, and that the ALJ should have addressed lay witness testimony in his written decision. Therefore, exercising jurisdiction pursuant to 42 U.S.C. § 405(g) and 28 U.S.C. § 1291, we reverse and remand for further proceedings consistent with this opinion.
At the January 2000 visit, Dr. Ritchie noted that the wounds from surgery and the injury itself were "well healed." Id. at 153. The x-rays showed "some degenerative changes" in Mr. Blea's foot; however, "no acute changes [were] noted." Id. He recommended that Mr. Blea see Dr. Mitchell again. But, at his February 2000 visit, Dr. Mitchell diagnosed Mr. Blea with "significant post-traumatic arthritis with constant pain." Id. at 150. She discussed the possibility of a Syme's amputation ­ an amputation of the entire foot at the ankle ­ with Mr. Blea at this visit. Further, in February 2002, Mr. Blea saw Dr. Robert C. Schenck, M.D., who indicated that Mr. Blea's x-rays "reveal[ed] fairly significant midfoot and forefoot arthritis." Id. at 197. Dr. Schenck also recommended that Mr. Blea apply for social security benefits: "in my opinion, he is permanently fully disabled and unemployable." Id. at 198.
After the denial of his claim for disability insurance benefits, Mr. Blea requested a hearing before an ALJ, which was held in September 2003. During the hearing, Mr. Blea testified about the effects of having been shot in the foot. Mrs. Blea also testified. She reported that after the gunshot injury and for months thereafter, her husband talked about suicide. Even recently, she testified, "he talks about it probably at least two to three times a week . . . he says that the pain is too much to bear." Id. at 333. She also explained that since the gunshot injury, Mr. Blea has rarely left the house due to pain and anxiety, and has also been unable to sleep comfortably. At the close of the evidence, Mr. Blea's attorney asked that the ALJ call a medical expert to assist the ALJ in reviewing the medical evidence. The ALJ denied this request because he found "no medical ­ or no psychiatric evidence relating to [the time before Dec. 31, 1998] which [he] feel[s] warrants that review." Id. at 342.
In November 2003, the ALJ denied Mr. Blea's claim for disability insurance benefits because he decided that Mr. Blea had not been disabled as of the date he last was eligible for disability benefits, December 31, 1998. The ALJ did not, however, determine an exact onset date. Rather, the ALJ applied the five-part sequential analysis mandated by 20 C.F.R. §§ 404.1520 and 416.920, and determined that because Mr. Blea retained the capacity for sedentary work as of December 31, 1998, he could not have been disabled.
With respect to his post-traumatic arthritis, the ALJ applied the five-step sequential analysis pursuant to 20 C.F.R. §§ 404.1520 and 416.920 to determine whether Mr. Blea was disabled as of that date. Mr. Blea carried the burden of proof with respect to the first four parts of the test. The first part inquires whether the claimant has performed substantial gainful activity since the alleged onset date; if he has, he is not disabled. The ALJ found that Mr. Blea had not performed substantial gainful activity since the gunshot wound. The second part asks whether the claimaint's impairments are severe, which they must be if he is to be found disabled. The ALJ found that Mr. Blea's impairment due to post-traumatic arthritis was severe.
If the claimant has not performed gainful activity and his impairments are severe, then the ALJ must determine whether his impairments are listed in the Regulations. If the impairments are listed, then the ALJ must find the claimant disabled without further inquiry. At this step, the ALJ determined that "[t]he claimant's musculoskeletal impairments did not approach the severity required to meet listings, § 1.00 prior to December 1998. Mr. Blea retained the ability to ambulate effectively . . . ." Aplt's App. at 21. Thus, the ALJ proceeded to the fourth step of the inquiry, whether the impairments prevent Mr. Blea from performing his past relevant work. The ALJ found that after the gunshot injury, Mr. Blea could no longer perform his relevant past work, even before December 31, 1998.
Mr. Blea appealed the ALJ's decision to the federal district court, arguing that the ALJ erred by not applying SSR 83-20 to determine the onset date of his disabilities. He also contended that the ALJ's failure to address the evidence provided by lay witnesses constituted reversible error. A magistrate judge issued judgment pursuant to 28 U.S.C. § 636(c), holding that the ALJ's decision was supported by substantial evidence. This appeal followed.
Application of SSR 83-20
To qualify for disability benefits, a claimant must establish that he is "disabled" under the Social Security Act, 42 U.S.C. § 423(a)(1)(E) (the "Act"). The Act states that "disability" is the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which . . . has lasted or can be expected to last for a continuous period of not less than 12 months." Id. § 423(d)(1)(A). It is not disputed that Mr. Blea is currently disabled under the Act. What is in dispute is when Mr. Blea became disabled. This is problematic for Mr. Blea because he only qualifies for disability benefits if he can show that he was disabled prior to his last insured date ­ December 31, 1998. See id. § 423(c).
On appeal, Mr. Blea presents two arguments regarding why the ALJ should have applied SSR 83-20 to determine the onset date of his disabilities. First, Mr. Blea contends that his post-traumatic arthritis is of traumatic origin under SSR 83-20 because it was caused by the gunshot wound and presented within twelve months of the gunshot incident, thereby making the onset date of his disability June 1997 ­ the date of the gunshot injury. Alternatively, he argues that even if his post-traumatic arthritis and dysthymia are not of traumatic origin, the ALJ committed reversible error by failing to follow SSR 83-20's provisions for calling a medical advisor. Before addressing Mr. Blea's arguments, we examine SSR 83-20 and discuss what it requires of an ALJ.
SSR 83-20 is "binding on all components of the Social Security Administration," including ALJs, 20 C.F.R. § 402.35(b)(1), and sets forth an analytical framework for assessing the date of onset for a disability of traumatic or non-traumatic origin. It provides that a disability is of "traumatic origin," where after the date of injury, "the individual is thereafter expected to die as a result or expected to be unable to engage in substantial gainful activity (SGA) (or gainful activity) for a continuous period of at least 12 months." SSR 83-20, at 2. Where a disability is of traumatic origin, the date of onset is the date of the traumatic injury. Id.
SSR 83-20 also provides that, when medical evidence does not establish the precise onset date, the ALJ may have to "infer the onset date from the medical and other evidence that describe the history and symptomatology of the disease process." Id. at 2. The regulation provides two examples of situations where it may be necessary to infer an onset date: (1) in the case of a slowly progressing impairment, "when, for example, the alleged onset and the date last worked are far in the past and adequate medical records are not available," and (2) when "onset of a disabling impairment(s) occurred some time prior to the date of the first recorded medical examination."(1) Id. at 3. "At the hearing, the [ALJ] should call on the services of a medical advisor when onset must be inferred." Id.
Traumatic Origin Provisions of SSR 83-20
Although Mr. Blea still suffered from pain, by January 1998, seven months after the injury, he was "able to ambulate with minimal restrictions." Aplt's App. vol. I at 161. In March 1998, he sought the advice of a foot and ankle specialist, who prescribed a new orthotic to assist Mr. Blea in walking. The specialist's notes state that, besides some numbness, Mr. Blea was "doing well and is not interested in any further surgery." Id. at 156. Finally, a doctor's notes from June 1998 indicate that Mr. Blea had "no pain proximally where he had the previous bone graft," supporting the ALJ's conclusion that Mr. Blea was not exhibiting symptoms of post-traumatic arthritis at that visit. Id. at 154. Therefore, we conclude that the ALJ's decision not to use the date of the gunshot as the onset date did not conflict with SSR 83­20, and that it was supported by substantial evidence.
Provisions of SSR 83-20 Relating to Slowly Progressing Impairments
We begin by rejecting the Commissioner's position because it fails to address the crux of the issue. The ALJ's finding of residual functional capacity at step five does not mean that the ALJ can ignore the clear directives of SSR 83-20, which is "binding on all components of the Social Security Administration." 20 C.F.R. § 402.35(b)(1).
Thus, the issue of whether the ALJ erred by failing to call a medical advisor turns on whether the evidence concerning the onset of Mr. Blea's disabilities was ambiguous, or alternatively, whether the medical evidence clearly documented the progression of his conditions. Below, we examine the medical record with respect to both of Mr. Blea's disabilities. We conclude that Mr. Blea's medical record was ambiguous, did not clearly document the progression of his impairments, and presented a situation where the ALJ needed to infer an onset date both for Mr. Blea's dysthymia and post-traumatic arthritis.
Therefore, we remand this case to the ALJ with instructions to follow the provisions of SSR 83-20 and call a medical advisor.(2)
These inferences are not reasonable because they do not necessarily flow from the facts. First, it is equally reasonable to think that Mr. Blea declined further surgery because he did not wish to endure another painful process­an eighth surgery­as it is to think that he was not interested in surgery because he was fully recovered. Second, although he carried his child, he may have done so out of necessity­not because he was fully recovered. Third, as other evidence suggested, it is also reasonable to infer that the gap in medical treatment occurred, not because Mr. Blea felt better, but because he was dysthymic and dependent on alcohol.
Thus, we find these inferences insufficient to support the ALJ's decision in light of the requirements of SSR 83-20. Mr. Blea's medical record is indisputably incomplete during a pertinent time period, June to December 1998. But, rather than "call[ing] on the services of a medical advisor when onset must be inferred," the ALJ made negative inferences against Mr. Blea due to the gap in the medical record. SSR 83-20 at 3. An ALJ may not make negative inferences from an ambiguous record; rather, it must call a medical advisor pursuant to SSR 83-20. Reid, 71 F.3d at 374. "The requirement that, in all but the most plain cases, a medical advisor be consulted prior to inferring an onset date is merely a variation on the most pervasive theme in administrative law­that substantial evidence support an agency's decisions." Bailey, 68 F.3d at 80.
Failure to Consider Lay-Witness Testimony
URL: http://ca10.washburnlaw.edu/cases/2006/10/05-2246.htm.