Opinion ID: 168285
Heading Depth: 4
Heading Rank: 1

Heading: Post-Traumatic A rthritis

Text: The ALJ found that M r. Blea did not prove he suffered from post-traumatic arthritis prior to December 31, 1998, relying primarily on three inferences he made from the medical evidence in the record. First, at a M arch 1998 visit with a specialist, M r. Blea indicated that he was not interested in further surgery. “It is reasonable to infer then, that he was at least partially satisfied with the result of the surgery he had before.” Aplt’s App. vol. I, at 22. Second, with respect to M r. Blea’s June 1998 visit to a doctor for treatment after stubbing his toe while carrying his child, the ALJ determined that “it is apparent that at that time, he was able to ambulate effectively enough to feel comfortable carrying his baby.” Id. 2 W e need not scrutinize M r. Blea’s ancillary argument that the Appeals Council erred by not analyzing new evidence from one of M r. Blea’s treating physicians. In denying review of the ALJ’s decision, the Appeals Council stated “we considered the additional evidence listed. . . . W e found that this information does not provide a basis for changing the Administrative Law Judge’s decision.” Aplt’s App. vol. I at 6-7. The Social Security Administration’s regulations “require[] the Appeals Council to consider evidence submitted with a request for review.” Threet v. Barnhart, 353 F.3d 1185, 1191 (10th Cir. 2003). However, where as here, the Appeals Council states that it has considered the additional evidence, “our general practice, which we see no reason to depart from here, is to take a lower tribunal at its word when it declares that it has considered a matter.” Hackett v. Barnhart, 395 F.3d 1168, 1173 (10th Cir. 2005). Because we remand this case to the ALJ, we need not determine whether the medical evidence here is so strong as to require a change in our general practice. 18 Third, with respect to the gap in medical evidence from June 1998 to January 2000, the A LJ stated that “[i]t stands to reason that if the claimant’s pain w as so severe as to be completely debilitating as alleged, he would have sought medical attention throughout this period.” Id. These inferences are not reasonable because they do not necessarily flow from the facts. First, it is equally reasonable to think that M r. Blea declined further surgery because he did not wish to endure another painful process–an eighth surgery–as 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 necessity–not 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 M r. 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. M r. 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 w hen onset must be inferred,” the ALJ made negative inferences against M r. 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 19 medical advisor be consulted prior to inferring an onset date is merely a variation on the most pervasive theme in administrative law–that substantial evidence support an agency’s decisions.” Bailey, 68 F.3d at 80. In this regard, we find the Fourth Circuit’s opinion in Bailey v. Chater, 68 F.3d 75, particularly instructive. In Bailey, a claimant had a number of ailments that he acquired over a few years, including diabetes, anxiety, high blood pressure, and allergies. The A LJ had fixed the claimant’s onset date two years after the date on which she had asserted her disability began. The Fourth Circuit reversed and remanded with instructions for the ALJ to call a medical advisor pursuant to SSR 83-20 because the “evidence regarding the onset date is ambiguous. . . . In the absence of clear evidence documenting the progression of [the claimant’s] condition, the ALJ did not have the discretion to forgo consultation with a medical advisor.” Id. at 79. As in Bailey, the ALJ lacked “clear evidence documenting the progression” of M r. Blea’s post-traumatic arthritis. Id. In June 1998, six months before his last-insured date, M r. Blea appeared not to be experiencing a significant amount of pain; however, by January 2000, approximately one year after his last-insured date, M r. Blea exhibited symptoms, including complaints of pain, difficulty walking, and degenerative changes present on x-rays. The condition was advanced enough by February 2000 to permit a treating physician to diagnose him with “significant post-traumatic arthritis.” Aplt’s App. vol. I, at 150. W ith respect 20 to the critical time, June 1998 to December 1998, however, the medical record before the ALJ was silent. Therefore, the ALJ should have called a medical advisor to assist in making reasonable inferences. W e note that on appeal, we have the benefit of a letter from Dr. Schenck, one of M r. Blea’s treating physicians. See O’Dell, 44 F.3d 859 (holding that any new evidence submitted to the Appeals Council on review “becomes part of the administrative record to be considered when evaluating the Secretary’s decision for substantial evidence.”) In this letter, w hich was provided only to the Appeals Council, not to the ALJ, Dr. Schenck opines that “it is reasonable to assume that M r. Blea’s post-traumatic arthritis with constant pain was present between June 1998 and January 2000.” Aplt’s App. vol. I at 309. This letter further undermines the ALJ’s decision because “[a]n ALJ is required to give controlling weight to a treating physician’s well-supported opinion, so long as it is not inconsistent with other substantial evidence in the record.” Drapeau v. M assanari, 255 F.3d 1211, 1213 (10th Cir. 2001). On remand, the A LJ must address Dr. Schenck’s opinion, as it is now part of the medical record.