Source: https://law.justia.com/cases/federal/appellate-courts/F2/755/141/52630/
Timestamp: 2020-02-25 19:59:34
Document Index: 530895938

Matched Legal Cases: ['§ 405', '§ 423', '§ 1382', '§ 423', '§ 405', '§ 423', '§ 423', '§ 1382', '§ 423', '§ 1382', '§ 423', '§ 2106']

8 Soc.sec.rep.ser. 343, Unempl.ins.rep. Cch 15,881gene Knipe, Plaintiff-appellant, v. Margaret M. Heckler, Secretary, Department of Health Andhuman Services, Defendant-appellee, 755 F.2d 141 (10th Cir. 1985) :: Justia
Justia › US Law › Case Law › Federal Courts › Courts of Appeals › Tenth Circuit › 1985 › 8 Soc.sec.rep.ser. 343, Unempl.ins.rep. Cch 15,881gene Knipe, Plaintiff-appellant, v. Margaret M. He...
8 Soc.sec.rep.ser. 343, Unempl.ins.rep. Cch 15,881gene Knipe, Plaintiff-appellant, v. Margaret M. Heckler, Secretary, Department of Health Andhuman Services, Defendant-appellee, 755 F.2d 141 (10th Cir. 1985)
US Court of Appeals for the Tenth Circuit - 755 F.2d 141 (10th Cir. 1985) Feb. 13, 1985
Knipe sought benefits alleging that he had essentially four impairments. First, he complained of his bad back and the pain related to it. His back injuries had required his hospitalization on at least two occasions. In February 1980, X-rays showed significant narrowing of the intervertebral disc at the lumbrosacral junction, indicating probable disc degeneration or herniation. Brief for Appellee 3. Surgery was not performed because Mr. Knipe was a diabetic with high blood pressure and extensive heart disease. Because of these other health problems, one physician commented that " [n]o neurosurgeon in his right mind will operate on this patient." II R. 273. He was given conservative treatment including local heat, massage, II R. 153, traction and exercise, the latter two to be continued at home. II R. 189. This treatment did provide him with some relief from the pain. II R. 296, 298.
Further compounding the above health problems is Mr. Knipe's mental impairment which he alleges is attributable to brain damage from one of his heart attacks. II R. 13. Although it is unclear whether Knipe explicitly asserted that this was a separate impairment before the ALJ, the ALJ did refer to a psychological evaluation of Mr. Knipe. II R. 28. This evaluation stated that "with regard to [Mr. Knipe's] neuropsychological status, test data (the Hain scored Bender Gestalt) is indicative of organic impairment. The difficulty which Mr. Knipe seems to experience in putting both conceptual and concrete things together ... could well be a reflector of this type impairment." II R. 285. The evaluation also found that Knipe had a verbal I.Q. of 82, a performance I.Q. of 76, and a full scale I.Q. of 78. II R. 285. He had an eighth grade reading level, a sixth grade spelling level, and a third grade arithmetic level. Id.6 The evaluation did find that Knipe was "socially sensitive" and that his strengths were his "common sense" and his "facility with the English language." However, his " [w]eaknesses were apparent in his ability to think and reason abstractly as well as his visual-motor coordination in both familiar and unfamiliar settings. He has difficulty putting concrete things together with his hands as well as generalizing from his knowledge of concepts." II R. 285.
The ALJ stated that the issues were whether Knipe "is entitled to a period of disability and to disability insurance benefits under Sections 216(i) and 223 respectively of the Social Security Act; and whether the claimant is disabled under Section 1614(a) (3) of the Social Security Act." II R. 22. The ALJ found that the claimant had "the following impairments: ischemic heart disease, controlled diabetes mellitus, controlled herniated intervertebral disc, L4, right, treated conservatively." II R. 32.
The district court affirmed and entered summary judgment for defendant. The court reasoned that the finding of the Secretary and the inferences based on those findings cannot be disturbed if supported by substantial evidence. I R. 75; see 42 U.S.C. § 405(g). The court said that the record reflected that Knipe had a twelfth grade education with work experience as a truck driver, salesman, security guard, and sheriff's deputy; that he had testified that his daily activities consisted of limited lawn mowing and sitting around his mother's house; and that Knipe stated he could walk two or three blocks and drive an automobile short distances. I R. 77. The court concluded that the decision was supported by substantial evidence and that the "evidence clearly reflect [ed]" that Knipe had a residual functual capacity to do light work. I R. 77, 78.7
Mr. Knipe applied for disability insurance benefits, 42 U.S.C. § 423(a) (1), and supplemental security income benefits. 42 U.S.C. § 1382(a) (1). Under each, a claimant must be disabled to qualify for benefits. See, e.g., 42 U.S.C. §§ 423(a) (1), 1382(a) (1). Our scope of review of a disability award determination is restricted. We must uphold the decision if it is supported by substantial evidence. See 42 U.S.C. § 405(g); Tillery v. Schweiker, 713 F.2d 601, 603 (10th Cir. 1983); see also Bowen v. Heckler, 748 F.2d 629, 634 (11th Cir. 1984).
Substantial evidence is "defined as 'such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.' It must be 'more than a mere scintilla.' " Broadbent v. Harris, 698 F.2d 407, 414 (10th Cir. 1983) (per curiam) (quoting Richardson v. Perales, 402 U.S. 389, 401, 91 S. Ct. 1420, 1427, 28 L. Ed. 2d 842 (1971)). This oft-cited language is not a talismanic formula for adjudication; the determination is not merely a quantitative exercise. Evidence is not substantial "if it is overwhelmed by other evidence--particularly certain types of evidence (e.g., that offered by treating physicians) or if it really constitutes not evidence but mere conclusion." Kent v. Schweiker, 710 F.2d 110, 114 (3d Cir. 1983).
Sections 423(d) (1) and 1382c(a) (3) (A), 42 U.S.C., define a disabled individual as one who is unable "to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." Under these sections a claimant is determined to be "under a disability only if" his physical or mental impairments are of such severity that he is not only unable to do his previous work, but cannot, considering his age, education, and work experience, engage in "any other kind of substantial gainful work" existing in the national economy. 42 U.S.C. §§ 423(d) (2) (A), 1382c(a) (3) (B).
The Regulations provide that if the severity of a claimant's impairment meets or exceeds that found in the Listing of Impairments, he will be found "disabled without considering [his] age, education, and work experience." 20 C.F.R. Sec. 404.1520(d) (1982). The Regulations describe the disabilities in the Listing of Impairments as "impairments which are considered severe enough to prevent a person from doing any gainful activity." 20 C.F.R. Sec. 404.1525(a) (1982). As the Supreme Court noted, " [t]he regulations recognize that certain impairments are so severe that they prevent a person from pursuing any gainful work." Heckler v. Campbell, 461 U.S. 458, 460, 103 S. Ct. 1952, 1954, 76 L. Ed. 2d 66 (1983). When a claimant's disability is equal to or more severe than an impairment in the Listing of Impairments, he is per se disabled. See, e.g., Chico v. Schweiker, 710 F.2d 947, 951 (2d Cir. 1983); Jackson v. Schweiker, 696 F.2d 630, 632-33 (8th Cir. 1983); see also Davis v. Heckler, 748 F.2d 293, 294 n. 4 (5th Cir. 1984); Tillery v. Schweiker, 713 F.2d 601, 602 (10th Cir. 1983).9
Section 4.00 of the Listing of Impairments deals with impairments of the cardiovascular system. Under Sec. 4.04 and Sec. 4.04(D), a claimant is disabled if he has " [i]schemic heart disease with chest pain of cardiac origin as described in 4.00E. With ... Left ventricular ejection fraction of 30 percent or less measured at cardiac catheterization or by echocardiography." The ALJ found that Mr. Knipe suffers from ischemic heart disease, II R. 32, and the evidence is uncontroverted that Mr. Knipe's left ventricular ejection fraction at cardiac catheterization is below 30 percent. See II R. 261 (25%); II R. 264 (22%); II R. 265 (22%).
To conclude that Mr. Knipe did not have chest pain of cardiac origin, it appears that the ALJ relied on three physicians' reports. The first reported that Mr. Knipe had no chest pain during a stress test in which he stopped with fatigue. II R. 261, 266. The second was a report of Dr. Kearns in which he said that Mr. Knipe "did have chest pain in the hospital which I believe was musculoskeletal rather than anginal type pain." II R. 267. The third was a report of Dr. Barnes in which he said that " [a]t the present time, [Knipe] has no significant dyspnea on exertion nor any chest pain." II R. 305.11 Considering these reports and the record as a whole, however, there is not substantial evidence to support a finding that Mr. Knipe does not have chest pain of cardiac origin as defined in Sec. 4.00E.
To establish that chest pain of cardiac origin is present, the pain need not occur during a stress test, see Jackson v. Schweiker, 696 F.2d 630, 632 (8th Cir. 1983); nor must it occur at any threshold level of frequency or duration. See Blumberg v. Heckler, 598 F. Supp. 1250, 1261 (S.D. Fla. 1984). For example in Jackson the claimant had ischemic heart disease. The results of her stress test demonstrated that her heart was sufficiently impaired under Sec. 4.04(A) (1) of the Listing of Impairments so that she would be disabled if she also experienced chest pain of cardiac origin. In concluding that such chest pain was not present, the ALJ apparently relied upon a doctor's statement that the claimant had no chest pain during the stress test. Jackson, 696 F.2d at 631-32. The Eighth Circuit reversed, concluding that although the absence of pain during a stress test could be an important factor, it was not determinitive "because of the undisputed evidence elsewhere in the record that [the claimant] experienced frequent chest pain." Id. at 632.
Similarly, in Blumberg v. Heckler, 598 F. Supp. 1250 (S.D. Fla. 1984), a claimant had sufficiently severe ischemic heart disease so that he would be automatically disabled under Sec. 4.04(A) (1) if he also had chest pain of cardiac origin. The ALJ had denied benefits. He had found that the claimant's "allegations of constant or severe chest pains are clearly not supported by the evidence of record, the claimant's own testimony or the Administrative Law Judge's observation at the hearing, and are not credible to the degree alleged." Id. at 1255-56. The court relied on numerous medical reports that the claimant had chest pain of cardiac origin, and concluded that the ALJ's decision was not supported by substantial evidence.
To support its conclusion, Blumberg noted that Section 4.00D of the Listing of Impairments indicates that a claimant has ischemic heart disease if he experiences chest pain of cardiac origin and there is objective medical evidence, such as a positive treadmill test, which supports the clinical impression of chest pain. "It does not require the chest pain of cardiac origin to occur at any designated minimal level of frequency or duration.... Rather in order to support an automatic finding of disability according to the literal, textual language of Sec. 4.04(A) (1), an individual must merely demonstrate an objective test consistent with the requirements, and experience chest pain of cardiac origin." Blumberg, 598 F. Supp. at 1261 (emphasis added).
Mr. Knipe testified that he had chest pain on exertion. The ALJ did not find that Mr. Knipe's testimony on this point was not credible; rather the ALJ never discussed this testimony. In response to questioning from his attorney, Mr. Knipe related that " [e]very once in a while, whenever I over-exert myself or something like that you know, I'll have some chest pains." II R. 64. If Mr. Knipe "tr [ies] to do exercise or mow the lawn" he has "heart pain." II R. 66-67. He also testified that his condition, including his other impairments, is worsening. II R. 66.13
In addition, it is undisputed that Mr. Knipe takes nitro-bid for his heart pain. II R. 58, 64-65, 134. In fact, the ALJ noted in his opinion that during an 11-day hospitalization in February 1982 for low back and knee pain, an electrocardiogram showed tachycardia and an apparent previous anterior myocardial infarction and Knipe was "continued on Nitrobid and Lasix, 40 mg. daily." II R. 29. Nitro-bid is a brand name for nitroglycerin. See J. Long, The Essential Guide to Prescription Drugs 460 (rev. ed. 1980). Nitroglycerin is one of the drugs which Sec. 4.00E of the Listing of Impairments describes as "promptly reliev [ing]" chest pain of cardiac origin. See Listing of Impairments Sec. 4.00E (chest pain of cardiac origin promptly relieved by "sublingual nitroglycerin or rapid-acting nitrates or rest"). Mr. Knipe's uncontradicted testimony establishes that he takes an extra nitrobid when he has chest pains. II R. 64-65. This further dictates the conclusion that Mr. Knipe has chest pain of cardiac origin.14 See Blumberg, 598 F. Supp. at 1260 (court notes that claimant takes a prescribed nitrate and that nitrates are one of relief-causing agents under Sec. 4.00E for chest pain of cardiac origin).15
Mr. Knipe applied for disability insurance benefits, 42 U.S.C. § 423(a) (1), and supplemental security income benefits, 42 U.S.C. § 1382(a) (1). Under Sec. 423(a) (1) an individual is entitled to disability insurance benefits if he is so insured; he has not attained retirement age; he has filed an application for such benefits; and he is under a disability. We have held that Knipe is disabled, and there is no dispute that he meets the other requirements to be entitled to social security disability insurance benefits.17 Therefore, we hold that Knipe was entitled to disability insurance benefits, 42 U.S.C. § 423, as of May 1, 1981, the date he alleged that he became disabled.
As to eligibility for supplemental security income, 42 U.S.C. § 1382(a) (1) defines an eligible individual as an "aged, blind or disabled individual who does not have an eligible spouse and" whose income and resources are below a specified level. Although we can say that Mr. Knipe is disabled under Sec. 1382(a) (1), and the record does indicate that he has no income, II R. 26, we are unable to determine from the record if he also has resources as defined by the Act below the statutory limit. We must remand to the Secretary to determine if Knipe's resources and income are below the statutory maximum. We hold that if the Secretary determines that Knipe's resources and income do not exceed the limit, he was eligible for supplemental security income benefits as of May 1, 1981.
In determining whether an individual is disabled, "the relevant law and regulations governing a claim for disability benefits are identical to those governing a claim for supplemental income benefits, [and] we treat the two claims together." Davis v. Heckler, 748 F.2d 293, 294 n. 2 (5th Cir. 1984); see also Rivers v. Schweiker, 684 F.2d 1144, 1146 n. 1 (5th Cir. 1982); compare 20 C.F.R. Secs. 404.1520-404.1525 (1984) with 20 C.F.R. Secs. 416.920-416.925 (1984). Although the law regarding when an individual is disabled is virtually identical for disability insurance benefits and supplemental income benefits, other eligibility requirements do differ. Accordingly in Part III of this opinion we separately discuss Mr. Knipe's entitlement to disability insurance benefits and supplemental income benefits
The ALJ stated that " [i]schemic heart disease may result in a severe impairment due to chest pain. At the present time, the claimant has no significant dyspnea on exertion nor any chest pain." II R. 31; see also id. at 28. Prior to the hearing before the ALJ, the Secretary also concluded that Knipe did not have chest pain. II R. 102, 104
Section 404.1525(a), 20 C.F.R., states that " [m]ost of the listed impairments are permanent or expected to result in death, or a specific statement of duration is made." There is no specific statement of duration pertaining to ischemic heart disease. Furthermore, there is evidence in the record that indicates that Mr. Knipe's condition has lasted or is expected to last for a continuous twelve month period. In April of 1980, Mr. Knipe had chest pain while doing Dr. Paul Williams' exercises for his back. II R. 146. In August 1981, Mr. Knipe was described as having "only minimal chest pain," in connection with his "congestive failure, left ventricular decompensation." II R. 297. In May 1982 Mr. Knipe testified before the ALJ that he had chest pain, II R. 64-67, and that his condition is worsening. II R. 66. All of the above taken together is more than enough to conclude that Mr. Knipe's impairment has lasted or is expected to last for a continuous period of twelve months.
We note that the intended therapeutic effect of nitroglycerin is " [r]eduction in the frequency and severity of pain associated with angina pectoris (coronary insufficiency)." J. Long, The Essential Guide to Prescription Drugs 460 (rev. ed. 1980)
We reject the Secretary's argument. First, neither the ALJ, nor the Appeals Council cited this as a reason for denying benefits to Knipe, and we therefore should not uphold the agency's denial of benefits on this basis. See, e.g., Dong Sik Kwon v. INS, 646 F.2d 909, 916 (5th Cir. 1981) (en banc) (in reviewing order of Board of Immigration Appeals, court is not permitted to consider reasons not advanced by Board); Mercantile Texas Corp. v. Board of Governors of the Federal Reserve System, 638 F.2d 1255, 1260 (5th Cir. 1981), (decision cannot be affirmed on basis of appellate counsel's post hoc rationalizations for agency action). Second, there is evidence in the record indicating that Knipe stopped taking his medications because he lacked the financial resources to purchase them. See II R. 63, 273, 278. Third, there is evidence that Knipe has significantly cut back his smoking as a result of medical advice. II R. 281.
The ALJ noted that Knipe was "fully insured" on May 1, 1981, the alleged onset date, and continues to meet the work requirements for disability purposes at least through September 30, 1986. II R. 30; II R. 32. Knipe's forty-five years are below retirement age. See 42 U.S.C. §§ 423(a) (1) (B), 416(l) . Knipe also filed an application for benefits. II R. 22
A remand directly to the Secretary for such relief is appropriate. See Dorsey v. Heckler, 702 F.2d 597, 609 (5th Cir. 1983); Broadbent v. Harris, 698 F.2d 407, 414 (10th Cir. 1983) (per curiam); 28 U.S.C. § 2106