Source: https://law.justia.com/cases/federal/appellate-courts/F2/964/524/341450/
Timestamp: 2019-07-22 16:44:43
Document Index: 779869252

Matched Legal Cases: ['§ 405', '§ 423', '§ 423', '§ 423', '§ 200', '§ 404', '§ 404', '§ 404', '§ 636']

Elizabeth L. Cohen, Appellant, v. Secretary of Department of Health and Human Services, Appellee, 964 F.2d 524 (6th Cir. 1993) :: Justia
Justia › US Law › Case Law › Federal Courts › Courts of Appeals › Sixth Circuit › 1993 › Elizabeth L. Cohen, Appellant, v. Secretary of Department of Health and Human Services, Appellee
Elizabeth L. Cohen, Appellant, v. Secretary of Department of Health and Human Services, Appellee, 964 F.2d 524 (6th Cir. 1993)
U.S. Court of Appeals for the Sixth Circuit - 964 F.2d 524 (6th Cir. 1993)
Argued April 3, 1992. Decided May 7, 1992. As Amended on Denial of RehearingJune 12, 1992. Second Rehearing Denied June 30, 1992. Rehearing Denied May 20, 1993
Dr. Neil Johnson, an internist, examined Cohen on September 14, 1988. He diagnosed Chronic Epstein-Barr virus infection, but stated that " [t]here is no localizing motor weakness. Gross neurological functions are intact. I would be unable to detect minor neuropsychiatric deficiencies in this patient. She is very intelligent and even a decrease in function leaves her well above average." Dr. Johnson, however, recommended a neuropsychological evaluation, which "would likely document various mental neurological deficiencies." He further reported that marked fatigue and the development of mental deficiencies were major problems and that it "appears that this illness is most disabling to this individual."
In July 1989, Cohen also was examined by Dr. Tarras Onischenko, a licensed practicing psychologist, who performed a battery of neuropsychological tests, including a WAIS-R IQ test and the Halstead-Reitan Neuropsychological test battery, to evaluate Cohen's "high order" brain function. Dr. Onischenko found that, although Cohen's performance on the WAIS-R IQ test--test result of 112, with performance and verbal scores of 104 and 109, respectively--still placed her in the "high average" range of intellectual ability, the difference between her Verbal IQ and Performance IQ scores "suggested that [Cohen's] right cerebral hemisphere is more compromised than the contralateral cortical region. In terms of functional considerations, the identified areas of deficit performance suggest that [Cohen] will experience problems managing daily activities which are dependent to a large extent on the identified cognitive skill areas." Dr. Onischenko concluded that the test results "suggested that the client is currently manifesting certain dysfunctions of her highest-order brain-behavior relationships that will debilitate her daily functional status ... [and] suggest [ed] that Ms. Cohen will experience major obstacles in accomplishing many of her goals at a level of performance that was characteristic of her pre-morbid functional status."
We are mindful that, pursuant to 42 U.S.C. § 405(g), we are confined to determining whether the district court erred in concluding that there is substantial evidence to support the Secretary's decision. Duncan v. Secretary of Health & Human Servs., 801 F.2d 847, 851 (6th Cir. 1986); Murphy v. Secretary of Health & Human Servs., 801 F.2d 182, 184 (6th Cir. 1986); see also Garner v. Heckler, 745 F.2d 383, 387 (6th Cir. 1984) (In a social security case, a circuit court "may not try the case de novo, nor resolve conflicts in evidence, nor decide questions of credibility."). "Substantial evidence is more than a scintilla of evidence but less than a preponderance...." Brainard v. Secretary of Health & Human Servs., 889 F.2d 679, 681 (6th Cir. 1989).
To qualify for disability insurance payments, a claimant must establish that she is disabled within the meaning of the Social Security Act. 42 U.S.C. § 423(a) (1) (D) (1988). A claimant is entitled to receive disability insurance benefits "only if [the claimant's] physical or mental impairment or impairments are of such severity that [she] is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." 42 U.S.C. § 423(d) (2) (A) (1988); King v. Heckler, 742 F.2d 968, 972-73 (6th Cir. 1984). In determining whether a claimant is entitled to disability insurance payments, medical opinions and diagnoses of treating physicians are entitled to great weight, and if uncontradicted, are entitled to complete deference. King, supra, 742 F.2d at 973. The ALJ, however, is not bound by conclusory statements of doctors, particularly where they are unsupported by detailed objective criteria and documentation. Id.; Duncan, supra, 801 F.2d at 855.
We recognize that " [a]n individual's statement as to pain or other symptoms shall not alone be conclusive evidence of disability." 42 U.S.C. § 423(d) (5) (A) (1988) (emphasis added). A claimant, however, may rely in part on her own testimony in combination with objective medical evidence in order to establish that she is disabled. To qualify for disability payments under the Act, Cohen must show that she has a medically ascertainable condition that reasonably could be expected to cause her symptoms. Foster v. Heckler, 780 F.2d 1125, 1129 (4th Cir. 1986). Cohen, however, is not required to prove the exact cause of her condition. Sparks v. Bowen, 807 F.2d 616, 617-18 (7th Cir. 1986). Indeed, because the exact nature and causes of chronic fatigue syndrome still are being explored, it perhaps would be impossible for Cohen to identify the exact cause of her condition. The mere fact that the medical community is still exploring the contours of chronic fatigue syndrome, however, does not make Cohen's symptoms any less disabling. Cf. id. at 618.
Nonetheless, the debilitating fatigue described by Cohen to her doctors and to the ALJ is not readily reduced to objective medical criteria, and the ALJ was not bound to accept as credible Cohen's own testimony regarding her symptoms. Gooch v. Secretary of Health & Human Servs., 833 F.2d 589, 592-93 (6th Cir. 1987), cert. denied, 484 U.S. 1075, 108 S. Ct. 1050, 98 L. Ed. 2d 1012 (1988). The ALJ properly considered the extent of Cohen's activities in determining the credibility of her assertions of fatigue. Siterlet v. Secretary of Health & Human Servs., 823 F.2d 918, 921 (6th Cir. 1987). The ALJ's credibility determinations are entitled to great weight. King, supra, 742 F.2d at 974.
We believe that the level of activity maintained by Cohen since she began suffering from the Chronic Epstein-Bar virus and the associated chronic fatigue syndrome is a tribute to her courage and determination in refusing to surrender to the debilitating effects of her illness. Her activities do not, however, warrant a finding that Cohen maintained the residual functional capacity to perform her previous work at Wayne State University or to maintain substantial gainful employment in the national economy. Cf. Wilcox v. Sullivan, 917 F.2d 272, 277 (6th Cir. 1990) (" [C]laimant should not be penalized because he had the courage and determination to continue working despite his disabling condition."). The issue here is whether, despite her illness, Cohen had the residual functional capacity to maintain substantial gainful employment during the period for which she now seeks disability benefits. Residual functional capacity is defined as the "maximum degree to which the individual retains the capacity for sustained performance of the physical-mental requirements of jobs." 20 C.F.R. Pt. 404, Subpt. P, App. 2 § 200.00(c) (1989) (emphasis added). In determining a claimant's physical abilities, we must "assess the severity of [claimant's] impairment(s) and determine [claimant's] residual functional capacity for work activity on a regular and continuing basis." 20 C.F.R. § 404.1545(b) (1989) (emphasis added).
In Parish v. Califano, 642 F.2d 188 (6th Cir. 1981), we recognized that " [a]ttending college on a part-time basis is not the equivalent of being able to engage in substantial gainful activity. Seven or eight classroom hours are a lot less demanding than full-time remunerative work." Id. at 191. This is so, in part, because "one may miss occasional classes without penalty, and homework may be scheduled for those times when the student feels his or her best." Id. at 192; see also Davis v. Califano, Unempl.Ins.Rep. (CCH) para. 16,779 (S.D.N.Y. 1979) (" [E]vidence of the limited ability to perform some physical acts on an occasional basis is inadequate to support a reasonable conclusion of ability to engage in substantial gainful activity.").
While we recognize that the ALJ's credibility determinations are entitled to deference, Garner, supra, 745 F.2d at 387; Houston v. Secretary of Health & Human Servs., 736 F.2d 365, 367 (6th Cir. 1984), we are convinced that the ALJ's emphasis on Cohen's ability to pass her law school examination was misplaced. The medical evidence, as well as her own testimony, show that Cohen maintained an above average level of intelligence despite the cognitive dysfunction that she had been experiencing. The issue, however, is not whether Cohen maintained the intelligence to continue substantial gainful employment; rather, the issue is whether Cohen has been rendered disabled by the chronic fatigue syndrome and other symptoms associated with her illness. Her ability successfully to attend law school on a part-time basis (Cohen completed one year of law school over the course of three calendar years), while probative of whether she was capable of engaging in substantial gainful activity, in view of the nature of Cohen's illness, does not provide substantial basis for the ALJ's conclusion that Cohen had the residual capacity to engage in substantial gainful employment.
We acknowledge that this is a close case, as borne out by the swinging back and forth between the ALJ, the Secretary, the Magistrate, the district court and now our Court. In a close case, it is well to bear in mind that " [t]he Social Security Act is a remedial statute which must be 'liberally applied'; its intent is inclusion rather than exclusion." Marcus v. Califano, 615 F.2d 23, 29 (2d Cir. 1979), and cases cited. We hold that the district court erred in rejecting the Magistrate's recommendation and determining that the ALJ's decision to deny Cohen disability insurance benefits for the period from October 4, 1984 to June 29, 1988 was supported by substantial evidence.
This is an action timely filed under 205(g), as amended, 42 U.S.C. 405(g), to review a final decision of the Secretary of Health and Human Services denying plaintiff's application for disability insurance benefits. The initial application was denied. Plaintiff exhausted available administrative remedies including a hearing before an Administrative Law Judge (ALJ), and thereafter filed suit in this court. The issue before this court is whether there is substantial evidence in the record to support the Secretary's determination. Gibson v. Secretary of Health, Education and Welfare, 678 F.2d 653, 654 (6th Cir. 1982).
Substantial evidence has been defined as such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Richardson v. Perales, 402 U.S. 389, 401 [91 S. Ct. 1420, 1427, 28 L. Ed. 2d 842] (1971). The claimant has the burden of showing by a preponderance of the evidence, inability to perform his/her former work. Allen v. Califano, 613 F.2d 139, 145 (6th Cir. 1980). Once that claimant has established this prima facie case, the burden should shift to the Secretary to show by expert vocational testimony or otherwise that there exists other substantial gainful employment in the national economy which the claimant is capable of performing. Young v. Califano, 633 F.2d 569, 570 (6th Cir. 1980). Upon appellate review, the court may not try the case de novo, nor resolve conflicts in evidence, nor decide questions of credibility, Meyers [Myers] v. Richardson, 471 F.2d 1265, 1267 (6th Cir. 1972). Even if this court might arrive at a different factual conclusion, the decision must be affirmed if it is supported by substantial evidence. Lane v. Gardner, 374 F.2d 616 (6th Cir. 1967).
In order to be entitled to disability insurance benefits under the Social Security Act, plaintiff must meet a two fold test. First, there must be a medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than twelve (12) months; and second, the impairment must render the plaintiff unable to engage in any substantial employment. 42 U.S.C. 423(d) (1) (A); 1382(a) (3) (A) (B). Substantial gainful activity is defined as work activity which involves doing significant physical and mental activities that are performed for pay or profit. 20 C.F.R. § 404.1572(a) (b) 416.972(a) (b). Furthermore, Social Security Regulations provide that all symptoms, including pain be corroborated by objective clinical signs and laboratory findings which can be shown to be the cause of the symptoms. 20 C.F.R. § 404.1529. Where plaintiff has the ability to perform past relevant work, or other work that exists in significant numbers, a finding must be made that he/she is not disabled.
In Duncan v. Secretary of Health and Human Services, 801 F.2d 847, 853 (6th Cir. 1986) the Sixth Circuit Court of Appeals set forth the analysis to be used in applying the standard for the evaluation of pain. First, the Secretary must determine that there is objective medical evidence of an underlying medical condition. If there is such evidence, the Secretary must determine: 1) whether the objective medical evidence confirms the alleged severity of the pain arising from the condition or 2) whether the established medical condition is of such a level of severity that can reasonably be expected to produce the alleged severe pain and other functional limitations. It is unnecessary to meet both requirements of the second prong. The Duncan Test continues to be the law of the Sixth Circuit. McCormick v. Secretary of Health and Human Services, 861 F.2d 998, 1003 (6th Cir. 1988).
The parties are hereby informed that objections may be filed to this Report and Recommendation within ten days after being served with a copy thereof as provided for in 28 U.S.C. § 636(b) (1) (C) and Local Rule C-4 and that failure to file objections may constitute a waiver of any further right of appeal. United States v. Walters, 638 F.2d 947 (6th Cir. 1981). See also, Thomas v. Arn, 474 U.S. 140, 106 S. Ct. 466 [88 L. Ed. 2d 435] (1985).
The Administrative Law Judge found that " [t]he claimant's subjective complaints were not completely credible given her activities," but he made no specific findings on the actual extent of Dr. Cohen's fatigue. " [T]he best way to document the nature and severity of this fatigue syndrome," according to Dr. Cheney, lies in " [o]bjective findings of immune system abnormalities and the elevation of lymphocyte secreted cytokines." I cannot tell, from this record, to what extent Dr. Cohen's immune system abnormalities have been objectively verified. Neither can I tell what her laboratory reports show about "the elevation of lymphocyte secreted cytokines"--and the decision issued by the ALJ suggests that he may have been no better informed on these matters than I am. Under the circumstances, it seems to me, the appropriate course would be to remand the case to the agency for specific findings on the significance of the laboratory reports and on whether Dr. Cohen simply lacked the stamina necessary to engage in substantial gainful employment. For us to make such findings ourselves, in my view, is to undertake a task that is outside our province.