Opinion ID: 21103
Heading Depth: 2
Heading Rank: 1

Heading: Overview of Legal Principles Applicable

Text: 53 The Social Security Act provides for the payment of insurance benefits to persons who have contributed to the program and who suffer from a physical or mental disability. See 42 U.S.C. § 423(a)(1)(D) (1991). Disability is defined as the inability 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.... 42 U.S.C. § 423(d)(1)(A); Bowen v. Yuckert, 482 U.S. 137, 140 (1987); Anthony v. Sullivan, 954 F.2d 289, 292 (5th Cir. 1992). The Act further provides that an individual is disabled only if his physical and mental impairment or 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 which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work. 42 U.S.C. § 423(d)(2)(A). 54 The Secretary promulgated regulations establishing a five step sequential evaluation process for deciding whether an individual is disabled. See 20 C.F.R. §§ 404.1520, 416.920. The first two steps involve threshold determinations that the claimant is not presently engaged in substantial gainful activity and has an impairment or combination of impairments which significantly limits his physical or mental ability to do basic work activities. See 20 C.F.R. §§ 404.1520, 404.1520(b)-(c), 416.920, 416.920(b)-(c). In the third step, the medical evidence of the claimant's impairment(s) is compared to a list of impairments presumed severe enough to preclude any gainful activity. See 20 C.F.R. pt. 404, subpt. P, App. 1 (pt. A) (1999). If the claimant's impairment matches or is equal to one of the listed impairments, he qualifies for benefits without further inquiry. 16 See 20 C.F.R. §§ 404.1520(d), 416.920(d). If the person cannot qualify under the listings, the evaluation proceeds to the fourth and fifth steps. 17 At these steps, analysis is made of whether the person can do his own past work or any other work that exists in the national economy, in view of his age, education, and work experience. If he cannot do his past work or other work, the claimant qualifies for benefits. See 20 C.F.R. §§ 404.1520(e)-(f), 416.920(e)-(f); Sullivan v. Zebley, 493 U.S. 521, 525-26 (1990); Yuckert, 482 U.S. at 141-42; Anthony, 954 F.2d at 293. 55 In Stone v. Heckler, 752 F.2d 1099 (5th Cir. 1985), this court was confronted with another in a series of cases in which a decisive administrative determination was made against disability at step two on the grounds of non-severity through a literal application of the Secretary's severity or significant limitation regulation. 18 The Stone court pointed out that this Circuit had construed the regulation as setting the following standard in determining whether a claimant's impairment is severe: '[A]n impairment can be considered as not severe only if it is a slight abnormality [having] such minimal effect on the individual that it would not be expected to interfere with the individual's ability to work, irrespective of age, education or work experience.' Stone, 752 F.2d at 1101 (quoting Estran v. Heckler, 745 F.2d 340, 341 (5th Cir. 1984) and citing Martin v. Heckler, 748 F.2d 1027, 1032 (5th Cir. 1984); Davis v. Heckler, 748 F.2d 293, 296 (5th Cir 1984)). 56 In Stone this court explained that a literal application of the regulation would be inconsistent with the Act and its legislative history. See Stone, 752 F.2d at 1104-05. Because the severity regulation defined severe impairment to include far fewer conditions than the statute indicated, we admonished the Secretary not to use the severity regulation to systematically deny benefits to statutorily eligible claimants. See id. at 1105. Although we recognized in Stone that the fact finder is entitled to follow a sequential process that disposes of appropriate cases at an early stage, we also recognized that it is impermissible to conduct the evaluation in such a manner as to deny benefits to individuals who are in fact unable to perform 'substantial gainful activity.' Anthony, 954 F.2d at 293 (quoting Stone, 752 F.2d at 1103). 57 Moreover, the Stone court, in censuring misuse of the severity regulation, forewarned that we would in the future assume that the ALJ and the Appeals Council have applied an incorrect standard to the severity requirement unless the correct standard is set forth by reference to this opinion or another of the same effect, or by an express statement that the construction we give to 20 C.F.R. § 404.1520(c) is used. Stone, 752 F.2d at 1106; see also Anthony, 954 F.2d at 293-94. 58 After the Supreme Court's decision in Bowen v. Yuckert, this court addressed the issue of whether Yuckert had altered the standard we announced in Stone. See Anthony, 954 F.2d at 294. We concluded that it had not: 59 Yuckert simply upheld the facial validity of the severity regulation as an appropriate method of streamlining the review process. Yuckert did not conclude that the severity regulation properly interpreted the statutory requirements, and Yuckert did not purport to state the proper definition of the term severe impairment. Thus, Stone is not inconsistent with the Supreme Court's pronouncement in Yuckert; Stone merely reasons that the regulation cannot be applied to summarily dismiss, without consideration of the remaining steps in the sequential analysis, claims of those whose impairment is more than a slight abnormality. 60 Id. That interpretation of the Stone requirements as being consistent with Yuckert has been recognized continuously as the view of this Circuit. See Spellman v. Shalala, 1 F.3d 357, 364 n.11 (5th Cir. 1993); Frizzell v. Sullivan, 937 F.2d 254, 255 (5th Cir. 1991); Harrell v. Bowen, 862 F.2d 471, 481 (5th Cir. 1988); Rodriguez v. Bowen, 857 F.2d 275, 278 (5th Cir. 1988). Most other Circuits agree that Yuckert does not displace prior limitations on the Secretary's reliance on the severity regulation. See, e.g., Gilbert v. Apfel, 175 F.3d 602, 604 (8th Cir. 1999); Dixon v. Shalala, 54 F.3d 1019, 1030 (2d Cir. 1995); Bailey v. Sullivan, 885 F.2d 52, 56-57 (3d Cir. 1989); Higgs v. Bowen, 880 F.2d 860, 863 (6th Cir. 1988); Yuckert v. Bowen, 841 F.2d 303, 306 (9th Cir. 1988); Gonzalez-Garcia v. Secretary of Health and Human Services, 835 F.2d 1, 2 (1st Cir. 1987); Stratton v. Bowen, 827 F.2d 1447, 1453 (11th Cir. 1987); Brown v. Bowen, 827 F.2d 311, 312 (8th Cir. 1987) (concluding that a majority of the Supreme Court adopted the standard that '[o]nly those claimants with slight abnormalities that do not significantly limit any basic work activity can be denied benefits without undertaking' the subsequent steps of the sequential evaluation process.)(quoting Yuckert, 107 S.Ct. at 2298). 19 61 B. The ALJ's Determination That Mr. Loza's Mental Impairment Was Non-Severe Was Based On An Error Of Law 62 The ALJ's administrative determination that Mr. Loza did not have any mental impairment related disabilities was made at step two on the grounds that his mental impairment was not severe. The ALJ adverted only to the literal terms of 20 C.F.R. § 404.1520(c) as setting forth the criteria for that determination: 63 The second step in the evaluation process is a determination as to whether the claimant has an impairment or combination of impairments which is 'severe.' A severe impairment is defined in the Regulations as one which significantly limits an individual's physical or mental ability to meet the basic demands of work activity. 20 C.F.R. § 404.1520(c). 64 The ALJ based his conclusion that Mr. Loza's mental impairment was non-severe on his finding that between April 27, 1979 and June 30, 1980,...the claimant [was] at most, slightly restricted by his mental impairment in his activities of daily living. Thus, the ALJ did not apply the correct standard as set forth in Stone, which held that an impairment can be considered as not severe only if it is a slight abnormality having such minimal effect on an individual that it would not be expected to interfere with the individual's ability to work, irrespective of age, education or work experience. The ALJ erroneously applied his own standard involving a slight restriction in activities of daily living instead of this court's standard based on a slight abnormality having such minimal effect as would not be expected to interfere with ability to work, irrespective of age, education or work experience. Stone, 752 F.2d at 1101; see also Brown v. Bowen, 864 F.2d 336, 337 (5th Cir. 1988); Hampton v. Bowen, 785 F.2d 1308, 1311 (5th Cir. 1986); Sewell v. Heckler, 764 F.2d 291, 294 (5th Cir. 1985); Martin v. Heckler, 748 F.2d 1027, 1032-34 (5th Cir. 1984). 65 The ALJ did not set forth the standard as it was construed in Stone, refer to Stone or another decision of this court to the same effect, or expressly state that the construction this court gives to 20 C.F.R. § 404.1520(c) was used. Consequently, in accordance with our holding in Stone, we must assume that the ALJ and Appeals Council applied an incorrect standard to the severity requirement, reverse the magistrate's judgment dismissing Mr. Loza's claim, and cause the case to be remanded to the Commissioner for reconsideration. 66 C. The ALJ's Finding That Mr. Loza's Mental Impairment Is Non-Severe Or Insignificant Is Not Supported By Substantial Evidence Based On The Record As A Whole 67 The inquiry here is whether the record, read as a whole, yields such evidence as would allow a reasonable mind to accept the conclusions reached by the ALJ. See Richardson v. Perales, 402 U.S. 389, 401 (1971); Randall v. Sullivan, 956 F.2d 105, 109 (5th Cir. 1992); Rivas, 475 F.2d at 257-58; Ward v. Celebrezze, 311 F.2d 115, 116 (5th Cir. 1963). Written reports by physicians who have examined the claimant setting forth medical data are admissible in evidence in a disability hearing and may constitute evidence supportive of findings by hearing examiners. See Perales, 402 U.S. at 402. Medically acceptable evidence includes observations made by a physician during physical examination and is not limited to the narrow strictures of laboratory findings or test results. Ivy, 898 F.2d at 1048-49. Medical evidence must support a physician's diagnosis, but if it does [t]he expert opinion[] of a treating physician as to the existence of a disability [is] binding on the fact-finder unless contradicted by substantial evidence to the contrary. Bastien v. Califano, 572 F.2d 908, 912 (2d Cir. 1978); see also 20 C.F.R. § 404.1527(d)(2). Evidence includes medical history, statements of the claimant, decisions by any governmental or non-governmental agency, and findings made by the administrative law judge levels. See 20 C.F.R. § 404.1512(b)(1)-(6). However, the determinations of other agencies, while persuasive, do not bind the Social Security Administration. See 20 C.F.R. § 404.1504. [E]stablished policy provides that information may be obtained from family members, friends, and former employers regarding the course of the claimant's condition. Ivy, 898 F.2d at 1049. [N]oncontemporaneous medical records are relevant to the determination of whether onset occurred on the date alleged by the claimant. Id. (citing Basinger v. Heckler, 725 F.2d 1166 (8th Cir. 1984); Soc.Sec.R. 83-20, 1983 CE 109). 68 In determining whether a claimant's physical or mental impairments are of a sufficient medical severity as could be the basis of eligibility under the law, the ALJ is required to consider the combined effects of all impairments without regard to whether any such impairment, if considered separately, would be of sufficient severity. See 20 C.F.R. § 404.1523; Crowley v. Apfel, 197 F.3d 194, 197 (5th Cir. 1999); Anthony, 954 F.2d at 293; Sewell, 764 F.2d at 294; Davis, 748 F.2d at 296; Estran, 745 F.2d at 341. If the ALJ finds a medically severe combination of impairments, the combined impact of the impairments will be considered throughout the disability determination process. 20 C.F.R. § 404.1523. Finally, it is clear that the ALJ must consider all the record evidence and cannot pick and choose only the evidence that supports his position. See Switzer v. Heckler, 742 F.2d 382, 385-86 (7th Cir. 1984); Garfield v. Schweiker, 732 F.2d 605, 609 (7th Cir. 1984); Green v. Shalala, 852 F.Supp. 558, 568 (N.D. Tex. 1994); Armstrong v. Sullivan, 814 F.Supp. 1364, 1373 (W.D. Tex. 1993). 69 A claimant is eligible for benefits only if the onset of the qualifying medical impairment [or combination of impairments] began on or before the date the claimant was last insured. See Ivy, 898 F.2d at 1048 (citing POMS § KI 25501.050(B)(1)). Claimants bear the burden of establishing a disabling condition before the expiration of their insured status. Id. (citing Milam v. Bowen, 782 F.2d 1284 (5th Cir. 1986)). Factors relevant to the determination of the date of disability include the individual's declaration of the date of when the disability began, work history and available medical history. See id. (citing Soc.Sec.R. 83-20, 1983 CE 109)). The claimant's stated onset date of disability is to be used as the established date when it is consistent with available medical evidence and may be rejected only if reasons are articulated and the reasons given are supported by substantial evidence. See Spellman, 1 F.3d at 361; Ivy, 898 F.2d at 1048. 70 The ALJ found that Mr. Loza had been diagnosed with a nonpsychotic brain syndrome due to trauma in April 1974; that a hospital summary report stated that he required follow-up treatment; that he was considered competent to handle funds due him, and a 90 day convalescence was recommended; that he received no further treatment for his mental impairment until October 1980; that there was no record of ongoing medical treatment or therapy for anxiety between April 27, 1979 and June 30, 1980; and that the claimant had recurrent and intrusive recollections of a traumatic experience which were a source of marked distress. From these findings, the ALJ inferred that between April 27, 1979 and June 30, 1980 the claimant suffered from an anxiety related disorder by which he was at most, slightly restricted...in his activities of daily living. The ALJ concluded: Considering all the evidence, the undersigned finds the claimant's mental impairment to be a non-severe impairment. 71 The ALJ's determination that Mr. Loza's mental impairment was non-severe is not supported by substantial evidence because, first, the ALJ did not consider whether the combined effects of all impairments, mental and physical, would be of sufficient severity. See C.F.R. §§ 404.1520(a), 404.1523; Crowley, 197 F.3d at 197; Anthony, 954 F.2d at 293; Sewell, 764 F.2d at 294; Davis, 748 F.2d at 296; Estran, 745 F.2d at 341; second, the ALJ did not take into account: (1) the VA's determination that Mr. Loza had a service connected 100 percent disability rating prior to and during the relevant period of April 27, 1979 through June 30, 1980; (2) Dr. Reveley's determination on April 25, 1974 that Mr. Loza cannot return to full employment[,] which has not been changed by Dr. Reveley or any other physician; (3) the consistent diagnosis and treatment of Mr. Loza's mental impairment as Organic Brain Syndrome, Chronic Brain Syndrome, or Post Traumatic Stress Disorder by several VA treating physicians from 1974, during the relevant period, and up to the date of the ALJ hearing; (4) the VA treating physicians' regular prescription of powerful antipsychotic and antidepressant drugs for Mr. Loza's mental impairment that began in 1974 and continued through the relevant period and the date of the ALJ hearing; (5) the overwhelming evidence of Mr. Loza's inability to maintain social interactions and other pertinent evidence of combined mental and physical impairments contained in Mr. Loza's medical records. 72 (1) Veterans' Administration Determination 73 In 1973 or 1974, the Veterans' Administration determined that Mr. Loza was 100 percent permanently disabled in connection with military service as the result of his Vietnam War combat wounds and experiences. A VA rating of 100 percent service connected disability is not legally binding on the Commissioner, but it is evidence that is entitled to great weight and should not have been disregarded by the ALJ. See Latham v. Shalala, 36 F.3d 482, 483 (5th Cir. 1994); Rodriguez v. Schweiker, 640 F.2d 682, 686 (5th Cir. 1981); Epps v. Harris, 624 F.2d 1267, 1274 (5th Cir. 1980); DePaepe v. Richardson, 464 F.2d 92, 101 (5th Cir. 1972). The record demonstrates that the VA 100 percent disability rating had not changed at the time of the ALJ hearing and was in effect between April 27, 1979 and June 30, 1980. In Rodriguez, 640 F.2d at 686, this court stated that [a]lthough the ALJ mentioned the Veteran's Administration disability rating on Rodriguez, he obviously refused to give it much weight....A VA rating of 100% disability should have been more closely scrutinized by the ALJ. In the present case, the ALJ did not mention or scrutinize Mr. Loza's VA rating of 100 percent disability. 74 (2) Determinations of Treating Physicians 75 On April 25, 1974, when Mr. Loza was transferred from the VA hospital psychiatric ward to VA therapy, Dr. Reveley, his treating physician, specifically determined that Mr. Loza cannot return to full employment. In addition to Dr. Reveley, Dr. Gaylord, Dr. Flore, Dr. Cooney and Dr. Michals diagnosed Mr. Loza as having OBS and treated him for this condition from April 1974 through the date of the ALJ hearing. There is no evidence that Dr. Reveley or any of the other treating physicians have ever changed the diagnosis of Mr. Loza's medical conditions, his inability to work or his 100 percent service connected permanent disability status. 76 This court has repeatedly held that ordinarily the opinions, diagnoses and medical evidence of a treating physician who is familiar with the claimant's injuries, treatment, and responses should be accorded considerable weight in determining disability. Scott v. Heckler, 770 F.2d 482, 485 (5th Cir. 1985) (citing Barajas v. Heckler, 738 F.2d 641, 644 (5th Cir. 1984); Smith v. Schweiker, 646 F.2d 1075, 1081 (5th Cir. 1981); Perez v. Schweiker, 653 F.2d 997, 1001 (5th Cir. 1981); Fruge v. Harris, 631 F.2d 1244, 1246 (5th Cir. 1980)). The ALJ may give less weight to a treating physician's opinion when 'there is good cause shown to the contrary[.]' Scott, 770 F.2d at 485 (citing Perez, 653 F.2d at 1001; Smith, 646 F.2d at 1081; Fruge, 631 F.2d at 1246); accord Newton v. Apfel, 209 F.3d 448, 455-56 (5th Cir. 2000); Leggett v. Chater, 67 F.3d 558, 566 (5th Cir. 1995); Greenspan, 38 F.3d at 237; Moore v. Sullivan, 919 F.2d 901, 905 (5th Cir. 1990). 77 In his opinion, the ALJ did not consider Dr. Reveley's determination on April 25, 1974 that Mr. Loza could not return to full employment. Similarly, the ALJ did not advert to the treating physicians' continuing diagnoses of OBS and PTSD and treatment of Mr. Loza for those conditions before, during and after his period of eligibility. No good cause appears in the ALJ opinion or in the record to justify the ALJ's failure to give considerable weight to the treating doctors' medical evidence. See Scott, 770 F.2d at 485. The ALJ cannot reject a medical opinion without an explanation. See Strickland v. Harris, 615 F.2d 1103, 1110 (5th Cir. 1980); Goodley v. Harris, 608 F.2d 234, 236 (5th Cir. 1979). The ALJ is not at liberty to make a medical judgment regarding the ability or disability of a claimant to engage in gainful activity, where such inference is not warranted by clinical findings. See Spencer v. Schweiker, 678 F.2d 42, 45 (5th Cir. 1982). Consequently, the ALJ and the Commissioner committed reversible error by failing to accord great weight to the medical reports of the treating physicians. See Fraga v. Bowen, 810 F.2d 1296, 1304 n.8 (5th Cir. 1987); Fruge, 631 F.2d at 1246. 78 (3) Prospective And Retrospective Effects Of Diagnoses Of Conditions 79 Further, [o]nce evidence has been presented which supports a finding that a given condition exists it is presumed in the absence of proof to the contrary that the condition has remained unchanged. Rivas, 475 F.2d at 258 (citing Hall v. Celebrezze, 314 F.2d 686, 688 (6th Cir. 1963)); Byerly v. Heckler, 744 F.2d 1143, 1144 (5th Cir. 1984); Taylor v. Heckler, 742 F.2d 253, 254 (5th Cir. 1984); Richardson v. Heckler, 750 F.2d 506, 509 (6th Cir. 1984)(medical evidence of Korean War related PTSD available in 1953 supported a finding of disability and presumption of its continuance which the Secretary failed to overcome with evidence of improvement in claimant's condition); Dotson v. Schweiker, 719 F.2d 80, 82 (4th Cir. 1983); Kuzmin v. Schweiker, 714 F.2d 1233, 1237 (3d Cir. 1983); Schauer v. Schweiker, 675 F.2d 55, 59 n.4 (2d Cir. 1982); accord Prevette v. Richardson, 316 F.Supp. 144, 146 (D.S.C. 1970). The record as a whole shows no genuine improvement in Mr. Loza's mental and physical impairments. The ALJ's findings suggesting the contrary are not supported by substantial evidence on the record as a whole for the reasons already stated and those to be given later. 80 On the other hand,'[s]ubsequent medical evidence is [also] relevant...because it may bear upon the severity of the claimant's condition before the expiration of his or her insured status.' Ivy, 898 F.2d at 1049 (citing Basinger, 725 F.2d at 1169; Parsons v. Heckler, 739 F.2d 1334 (8th Cir. 1984)). Retrospective medical diagnoses of PTSD, even if uncorroborated by contemporaneous medical reports but corroborated by lay evidence relating back to the claimed periods of disability, can support a finding of past impairment. See Likes v. Callahan, 112 F.3d 189, 190 (5th Cir. 1997)('PTSD is an unstable condition that may not manifest itself until well after the stressful event which caused it, and may wax and wane after manifestation.' Id. at 191 (quoting and adopting the rule of Jones v. Chater, 65 F.3d 102, 103 (8th Cir. 1995)). In addition to the primary medical evidence, the record contains reports by family members, therapists and counselors of Mr. Loza's hallucinations, social withdrawal and other symptoms of PTSD and OBS before and after his insured status had lapsed. The ALJ's failure to recognize the existence and significance of this cogent evidence further demonstrates that the administrative determination is not supported by substantial evidence on the record as a whole. 81 (4) Antipsychotic and Antidepressant Medications 82 The ALJ did not take into account the evidence concerning the nature and quantity of medications that Mr. Loza's treating physicians prescribed for his mental impairment and disability before, during and after the period in question. The ALJ neither elicited testimony nor made any findings regarding the timing, purpose or effect of the antipsychotic drugs and other medicines that were prescribed for Mr. Loza between 1974 and the date of the ALJ hearing. Mr. Loza was placed on Haldol 20 by Dr. Reveley during his April 1974 confinement at the Olin R. Teague Center. On November 22, 1974, February 7, 1975 and June 26, 1975 Dr. Reveley prescribed Darvon 21 and Haldol. Dr. Johnson prescribed acetaminophen 22 on April 8, 1977. A medical doctor whose name is not clear from the record prescribed Haldol and Ascriptin 23 on July 23, 1978 and September 17, 1979. On April 7, 1980, October 8, 1980, and February 10, 1981, Dr. Flore, M.D., prescribed Ascriptin, Stelazine 24 and Benadryl 25 . Stelazine was prescribed by Dr. Flore on August 28, 1981, and he prescribed Stelazine and Ascriptin on December 23, 1981. On June 28, 1982, Mr. Loza was taken off Stelazine by Dr. Lipt and placed on Ascriptin and Vistaril 26 . Dr. Lipt prescribed Vistaril on September 22, 1982, and both Vistaril and Ascriptin on December 16, 1982, June 22, 1983, December 14, 1983, June 1, 1984, September 4, 1984, February 5, 1985, August 20, 1985, March 13, 1986 and September 22, 1986. On March 3, 1987 Dr. Lipt prescribed only Vistaril for Mr. Loza. Dr. Gaylord prescribed Allopurinol 27 on June 22, 1987, presumably to lower the uric acid levels in the claimant's blood. Mr. Loza received Motrin and Tylenol from Dr. Gaylord, and Vistaril from Dr. Lipt on September 1, 1987. A medical doctor with an illegible signature prescribed Vistaril on March 1, 1988. Dr. McCormick refilled Mr. Loza's Hydroxyzine (presumably Stelazine) prescription on August 30, 1989 to help the claimant rest. However, Dr. McCormick canceled the Hydroxyzine prescription on November 13, 1989 and prescribed Ibuprofen and Diphenhydramine 28 (the antihistamine present in Benadryl). Dr. McCormick issued another prescription for Ibuprofen and Diphenhydramine on August 8, 1990. After a Motrin prescription from a medical doctor with an illegible signature on March 4, 1992, Mr. Loza was placed on Nortriptyline 29 by another doctor on November 23, 1992. Dr. Michals prescribed Nortriptyline on December 28, 1992 and subsequently canceled the prescription on February 19, 1993. On October 29, 1993 Dr. Michals started Mr. Loza on Sertraline. 30 An unidentified medical doctor prescribed Verapamil to control blood pressure on November 22, 1993, March 2, 1994 and September 30, 1994. Sertraline dosage was decreased by Dr. Michals on November 30, 1993 but returned to earlier levels at Mr. Loza's request on December 30, 1993. 83 The history of Mr. Loza's extensive medical treatment with antipsychotic and other mood altering medications not only indicates the presence of a disabling mental illness but also the possibility of medication side effects that could render a claimant disabled or at least contribute to a disability. See Cowart v. Schweiker, 662 F.2d 731, 737 (11th Cir. 1981)(citing 20 C.F.R. Pt. 404, Subpart P, App. 1, § 11.00 (1981); Figueroa v. Secretary of HEW, 585 F.2d 551 (1st Cir. 1978)). The lack of consideration of the antipsychotics, antidepressants, and other medications administered to Mr. Loza before, during and after the period of April 27, 1979 to June 30, 1980 as evidence of mental impairment and disability further demonstrates that the ALJ's findings of fact are not substantially supported by the record when viewed as a whole. 84 (5) ALJ's Findings Contrary to Overwhelming Evidence of Mr. Loza's Inability to Maintain Social Functioning; Disregard of Other Pertinent Evidence in Medical Record 85 The ALJ found that [T]he claimant's ability to maintain social functioning was only slightly limited by his mental impairment....There is nothing in the medical record to suggest that the claimant was socially inhibited by his mental impairment. The ALJ's finding is fundamentally at odds with the evidence. Dr. Reveley on April 9, 1974 noted Mr. Loza's phobic trends and his refusal to enter a theater with other people present. Dr. Reveley also recognized Mr. Loza's adjustment reaction of adult life with marital conflicts. Moreover, Mr. Loza's testimony before the ALJ reveals his social impoverishment: I can't be around -- I get nervous around a lot of people. For a long time I couldn't even go into a movie theater because I couldn't have nobody sitting behind me. Mr. Loza's former wife Janie in her letter also describes his paranoia and fear of crowds. After years of marital problems, she divorced him in 1990. On June 28, 1982 Mr. Loza confided to Dr. Cooney his suicide attempt after an argument with his wife. An August 9, 1989 medical report completed by Dr. McCord makes reference to the misbehavior of Mr. Loza's daughter and his dysfunctional relationship with her. Finally, on February 26, 1993, Mr. Loza admitted striking his son the previous evening. 86 Doctors observed that Mr. Loza appeared unwilling or unable to participate in group therapy from 1982 to 1983, and, consequently, he was removed to individual therapy. On November 23, 1992, Dr. George Clay commented that Mr. Loza tends to isolate. Mr. Loza testified that he only has one friend, his neighbor. In a disability report he filled out for the SSA, he described his social contacts as one friend he fished with and his mother. The available medical records show he has two brothers and seven sisters in south Texas. Yet the evidence indicates that Mr. Loza has withdrawn from a social relationship with them. 87 The ALJ also did not indicate that he had given consideration to Mr. Loza's tinnitus, hearing loss, inability to concentrate, abdominal wall impairment, lumbosacral strain, hallucinations, and other mental and physical impairment symptoms. 88 (6) Summary 89 The ALJ found that between April 27, 1979 and June 30, 1980, Mr. Loza was at most, slightly restricted by his mental impairment in his activities of daily living. In making this determination the ALJ did not consider the totality of the evidence relevant to Mr. Loza's mental and physical impairments, including the VA determination of 100 percent disability; Dr. Reveley's determination that Mr. Loza could not return to full employment; the repeated diagnoses of Mr. Loza's PTSD and OBS; the prospective and retrospective significance of determinations by treating physicians and therapists of Mr. Loza's PTSD and OBS; the nature and quantity of the treating physicians' administration of antipsychotics, antidepressants, and other medications; and the claimant's wounded and weakened abdominal wall and back, back pain, acute back sprain, headaches, depression, hallucinations, nightmares, insomnia, tinnitus, hearing loss, memory loss, concentration loss, difficulties in anger management and social isolation. Consequently, the record viewed as a whole does not contain substantial evidence supporting an administrative determination that the combination of Mr. Loza's mental and physical impairments did not exceed the level of a slight abnormality [having] such minimal effect...that it would not be expected to interfere with the individual's ability to work, irrespective of age, education or work experience. Stone, 752 F.2d at 1101 (internal quotes and citations omitted). 90 D. The ALJ's Use of the Medical-Vocational Guidelines Was Improper And Must Be Reconsidered 91 After considering Mr. Loza's physical impairments, the ALJ concluded that [b]ased on exertional capacity for medium work, and the claimant's age, education and work experience, Section 404.1569 and Rule 203.28, Appendix 2, Subpart P, Regulations No. 4, directs a conclusion of 'not disabled'. However, based on the record as a whole, it cannot be said that the ALJ's reliance solely on the Medical-Vocational Guidelines at the fifth level in this case was a correct application of the proper legal standards. Use of the 'Grid Rules' is appropriate when it is established that a claimant suffers only from exertional impairments, or that the claimant's nonexertional impairments do not significantly affect his residual functional capacity. Crowley, 197 F.3d at 199. Moreover, the Secretary bears the burden at the fifth step of establishing that the claimant is capable of performing work in the national economy. See Leggett, 67 F.3d at 565 n.11; Greenspan, 38 F.3d at 236. 92 We have determined that the ALJ's finding that Mr. Loza's mental impairment was non-severe was not reached through the application of the proper legal standard and was not supported by substantial evidence on the record. Accordingly, if it should be determined on remand that Mr. Loza's non-exertional mental impairments during the period of disability were not merely a slight abnormality of minimal effect on ability to work, the ALJ's reliance on the Grid Rules at the fifth level also constitutes error and must be reconsidered. See Newton, 209 F.3d at 458; Crowley, 197 F.3d at 199; Fraga, 810 F.2d at 1304; Dellolio v. Heckler, 705 F.2d 123, 127-28 (5th Cir. 1983); Thomas v. Schweiker, 666 F.2d 999, 1004 (5th Cir. 1982). 93 E. Failure to Employ Proper Legal Standards By Not Considering the Combined Effects of Impairments 94 The ALJ erred by separately evaluating the consequence of Mr. Loza's mental and physical impairments and by not considering their combined effects. The law of this Circuit requires consideration of the combined effect of impairments: The well-settled rule in this Circuit is that in making a determination as to disability, the ALJ must analyze both the 'disabling effect of each of the claimant's ailments' and the 'combined effect of all of these impairments.' Fraga, 810 F.2d at 1305 (citing Dellolio, 705 F.2d at 128). 95 The ALJ's disposition of the present case bears a strong resemblance to the situation encountered by this court in Strickland v. Harris: 96 The ALJ failed to address at all a fact issue raised herein which was essential to a conclusion of no disability, namely, the degree of impairment caused by the combination of physical and mental medical problems. Dodsworth v. Celebrezze, 349 F.2d 312 (5th Cir. 1965). The ALJ addressed certain of the claimant's complaints separately, tending to minimize them (sometimes despite quite strong evidence to the contrary, see note 4 supra), but he devoted no discussion and made no factfindings as to disability indicated as arising from the interaction or cumulation of even those medical problems whose existence he acknowledged or did not rule out. 97 Strickland, 615 F.2d at 1110; see also, e.g., Scott, 770 F.2d at 487 (Although the ALJ stated that he had 'carefully considered the entire record in this case,' his 'evaluation of the evidence' addresses each impairment separately and does not specifically discuss the interaction or cumulation of all of the claimant's medical problems.). Thus, the interaction or cumulation of all of Mr. Loza's mental and physical medical problems and impairments also must be addressed on remand.