Opinion ID: 585576
Heading Depth: 2
Heading Rank: 1

Heading: Medical Improvement and Residual Functional Capacity

Text: 16 According to the regulations, Sparhawk's medical improvement must be manifested in terms of improved signs, symptoms, or laboratory reports before the improvement will strip Sparhawk of her disability status. 20 C.F.R. § 404.1594(b)(1). The ALJ's reliance on the success of the surgery as establishing medical improvement is problematic for two reasons.
17 First, while the surgery did finally effect a solid fusion of Sparhawk's L4-L5 vertebrae, we are hard-pressed to find record evidence indicating that the fusion resulted in identifiable medical improvement, as opposed simply to halting the deterioration in Sparhawk's medical condition. When Sparhawk's condition at the time of the hearing is contrasted with her condition at the time of the initial finding of disability, scant evidence of actual improvement appears. The spondylolysis and spondylolisthesis remain. Indeed, while Dr. Snodgrass characterized Sparhawk's post-fusion impairment as mildly moderate, Dr. Newby, Sparhawk's long-time treating physician, placed her impairment in the moderate category. This represents an increase, rather than a decrease, in the level of severity of Sparhawk's impairment after the successful fusion. 18 Further belying the claim of medical improvement are symptoms, signs, and laboratory findings appearing after the third surgery. While the x-ray indicated a solid fusion of the L4-L5 vertebrae, the September 1987 x-rays also revealed previously undiagnosed minimal movement between the L5 and S1 vertebrae. 19 Likewise, tests of Sparhawk's reflexes and mobility evidenced an overall deterioration in her condition by January 1988. In December 1984, before the successful fusion, tests revealed that Sparhawk's squatting ability was ninety percent of normal; she could lean over until her fingers were eleven inches above the floor; backward bend thirty degrees; bend sideways twenty degrees; rotate twenty-five degrees; bent-leg test at 130 degrees; and straight-leg test at 75 degrees. In January 1988, after the fusion, the only measurements demonstrating improvement were the rotation (now thirty degrees) and arguably the sideways bend (now at 25/20 degrees). All of the other tests revealed less mobility and flexibility. The squat was reduced to fifty percent of normal; when leaning over, fingers came within only fourteen inches of the floor; backward bend extended to only ten degrees; the bent-leg test was at 120 degrees; and the straight-leg test measured at sixty degrees. In addition, Sparhawk had gained twenty-six pounds between the two examinations and, by January 10, 1988, had reached the age of fifty. See Hammock v. Bowen, 879 F.2d 498, 503-04 (9th Cir.1989) (obesity and advanced age must be considered when assessing disability). The record evidence thus suggests that, at most, the successful fusion halted or slowed deterioration in Sparhawk's condition. It does not sustain a finding of actual medical improvement. 20 Furthermore, the ALJ failed to articulate any reasonable basis for preferring the opinion of Dr. Snodgrass to Dr. Newby's diagnosis. While Dr. Snodgrass was a one-time examining physician, Dr. Newby's conclusion that Sparhawk's impairment rose to the moderate level was based on years of experience treating Sparhawk. We have repeatedly instructed that, when the conflict is between the opinions of a treating physician and an examining physician it is the rule in this circuit that '[i]f the ALJ wishes to disregard the opinion of the treating physician, he or she must make findings setting forth specific, legitimate reasons for doing so that are based on substantial evidence in the record.'  Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir.1987) (quoting Murray v. Heckler, 722 F.2d 499, 502 (9th Cir.1983)) (emphasis added); see also Fair v. Bowen, 885 F.2d 597, 604 (9th Cir.1989) (The medical opinion of a treating physician is entitled to special weight.); Burkhart v. Bowen, 856 F.2d 1335, 1339 (9th Cir.1988); Winans v. Bowen, 853 F.2d 643, 647 (9th Cir.1987) (same as Sprague ) (amended opinion); Desrosiers v. Secretary of Health & Human Servs., 846 F.2d 573, 576 (9th Cir.1988). 21 The ALJ offered absolutely no explanation for his decision to adopt Dr. Snodgrass's evaluation of Sparhawk's level of disability over Dr. Newby's. Not only is the opinion devoid of specific, legitimate reasons, but in fact the ALJ misconstrued the evidence by incorrectly labelling Dr. Snodgrass a treating physician and by stating that Dr. Newby considered Sparhawk's impairment to be only mildly moderate after January 1988. 22 The ALJ's excessive focus on the successful fusion, to the exclusion of other objective indicia of no medical improvement, constitutes reversible error. In Patti v. Schweiker, 669 F.2d 582 (9th Cir.1982), the claimant's disability benefits were terminated following back surgery on the ground that she was no longer disabled. We reversed, finding a lack of substantial evidence to support the finding of medical improvement. Id. at 587. We noted that (as in Sparhawk's case) tests of the claimant's nervous system, reflexes, and motor control revealed no significant improvement in abilities between the determination of disability date and the post-surgery termination date. Id. at 586. Test results previously deemed to be consistent with a finding of disability, we stressed, cannot subsequently be treated as evidence that the disability has ceased. See id. The lack of change in the clinical status of the claimant's impairment reinforced our conclusion that substantial evidence did not support the finding of medical improvement. Id. 23 Similarly, in Bellamy v. Secretary of Health & Human Servs., 755 F.2d 1380 (9th Cir.1985), we found a lack of substantial evidence to justify terminating disability benefits where the ALJ selectively credited medical evidence of improvement and discounted significant objective evidence of a continuing impairment. Id. at 1381 (While the Secretary produced some evidence that Bellamy's leg fracture had healed, there has been no clear showing of improvement in her symptoms of dizziness, pain and fainting.). We noted that medical reports corroborated Bellamy's complaints that leg pain kept her from sleeping and that she suffered from dizziness and fainting. Id. at 1382. Yet the ALJ failed to explain adequately his rejection of uncontroverted testimony and significant probative evidence concerning Bellamy's ... impairments. Id.; see also Sprague, 812 F.2d at 1231 (substantial evidence lacking in part because ALJ not only failed to give reasons for disregarding [the treating physician's] opinion, he failed even to mention the other evidence of [impairment]); Gallant v. Heckler, 753 F.2d 1450, 1454 (9th Cir.1984) (ALJ improperly failed to give specific reasons for rejecting medical evidence supporting a finding of impairment). 24 The same errors that warranted reversal in the foregoing decisions reappear in Sparhawk's case. Like Patti, the medical evidence in terms of flexibility and mobility after surgery does not indicate improvement. To the contrary, test results demonstrate decreased mobility in many areas. Also like Patti, the clinical evaluation of her impairment did not improve. Prior to surgery, her impairment was characterized as mildly moderate. After surgery, the evaluation at best remained the same and, in the opinion of Sparhawk's treating physician, actually deteriorated to a moderate impairment. Consistent with Patti, we also hold that the diagnosis of Sparhawk's impairment as mildly moderate cannot be used as evidence of no disability in 1988 when it was considered consistent with disability in 1984. Moreover, the ALJ wholly fails to discuss in his opinion the objective medical tests and reports supporting impairment. While an ALJ is not bound to adopt medical diagnoses and reports, he must give specific reasons for discounting them. See, e.g., Bellamy, 755 F.2d at 1382. The ALJ here offered no such explanation. 25 In sum, the ALJ failed to demonstrate a medical correlation, in terms of signs, symptoms, and laboratory findings, between the successful fusion and actual medical improvement. While the fusion no doubt constituted a proper consideration in assessing improvement, the ALJ was not free to reach its conclusion  'simply by isolating a specific quantum of supporting evidence.'  Gallant, 753 F.2d at 1455 (quoting Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir.1975)). Rather, the ALJ should have considered the whole picture of Anna Sparhawk's condition in January 1988, including the medical indicators of continued impairment, along with the successful fusion. The ALJ's failure to do so and, specifically, his failure to answer the significant medical evidence of no improvement, requires us to reverse for a lack of substantial evidence of medical improvement.
26 The second problem with the ALJ's focus on the success of the 1987 surgery is that nothing in the record connects the attainment of a solid fusion with an increase in Sparhawk's ability to work as a drill bit or moulding machine operator. Disability benefits cannot be terminated unless the claimant's medical improvement is accompanied by an actual increase in residual functional capacity. 20 C.F.R. § 404.1594(b)(2). In other words, the evidence had to show that Sparhawk's medical improvement (if any) is positively related to her ability to work. See id. 27 In this case, nothing in the record indicates that the vertebrae fusion sufficiently alleviated Sparhawk's condition to permit her to sit for six or seven hours a day on a hard stool and pump pedals, which is what she will have to do as a drill bit or moulding machine operator. To the contrary, what evidence does exist on this issue consists of Sparhawk's unrebutted testimony that back, leg, neck, and shoulder pain precludes her from sitting for more than an hour and a half at a time (or for more than twenty minutes at a time on a hard chair). 28 In his opinion, the ALJ states that Sparhawk's improvement related to her ability to work was evidenced in the reports of her treating physicians. 1 However, nothing in the record, and specifically nothing in either Dr. Newby's or Dr. Snodgrass's reports, evaluates Sparhawk's ability after the fusion surgery to sit, stand, walk, lift, pull, or pump pedals. The ALJ cites three exhibits as supporting evidence, but not one of these reports evaluates Sparhawk's capacity to perform job-related functions. They simply discuss the successful fusion and prescribe treatment for Sparhawk's continuing pain. Apparently, the ALJ simply inferred from the evidence of a successful fusion a concomitant increase in Sparhawk's ability to work. The ALJ may not, however, set himself up as an expert on improvement in functional capacity. Cf. Burkhart, 856 F.2d at 1341 (reversible error for ALJ to assume[ ] the role of vocational expert himself). Consequently, we hold that the record lacks substantial evidence to support the ALJ's conclusion that Sparhawk's medical improvement sufficiently increased her residual functional capacity to permit her to work as a drill bit or moulding machine operator.