Opinion ID: 4561261
Heading Depth: 3
Heading Rank: 1

Heading: Pain and Disability

Text: The central issue in this case is whether Jordan’s complaints of pain described a covered disability. The LHWCA defines “disability” as the “incapacity because of injury to earn the wages which the employee was receiving at the time of injury in the same or other employment.” 33 U.S.C. § 902(10). We have occasionally alluded to the effect of pain on a claimant’s ability to do work and earn wages. The claimant in Carrion v. SSA Marine Terminals, LLC, 821 F.3d 1168 (9th Cir. 2016), for example, “had endured decades of 10 JORDAN V. SSA TERMINALS persistent [knee] pain without any actual or expected improvement.” Id. at 1170. We said that “[w]ithout doubt, he is disabled.” Id. In Container Stevedoring Co. v. Director, Office of Workers Compensation Programs, 935 F.2d 1544 (9th Cir. 1991), we upheld the ALJ’s finding that the claimant’s post-injury wages did not reflect his earning capacity because he was able to work after his injury only with “pain and limitations.” Id. at 1550. Other circuit courts have been more explicit that pain can be disabling. See, e.g., Bath Iron Works Corp. v. White, 584 F.2d 569, 575 (1st Cir. 1978) (“[A]n employee need not be in pain, nor is he required, after injury, to continue in employment which is medically contraindicated until his condition and pain render it impossible for him to work at all.”). Perhaps the clearest statement comes from the Fifth Circuit: “Even if able to work, [a claimant] may be found to be totally disabled if he is working with extraordinary effort and in excruciating pain.” La. Ins. Guar. Ass’n v. Bunol, 211 F.3d 294, 297 (5th Cir. 2000). The BRB has itself endorsed a virtually identical formulation: “An employee may be found to be totally disabled despite continued employment if he works only through extraordinary effort and in spite of excruciating pain, or is provided a position only through employer’s beneficence.” Ramirez v. SeaLand Servs., Inc., 33 BRBS 41, 1999 WL 284793, at  (BRB Apr. 20, 1999); see also Haughton Elevator Co. v. Lewis, 572 F.2d 447, 451 (4th Cir. 1978) (Winter, J., concurring) (“I agree with the Board that ‘it would be unfair to penalize [the claimant] by denying him compensation for permanent total disability because he made an extraordinary effort to keep working” and that a man “having a severe physical disability as a result of an employment-related injury should not be required to continue enduring JORDAN V. SSA TERMINALS 11 excruciating pain and subjecting himself to the possibility of further injury . . . .”). SSA and Homeport do not dispute the idea that pain can be disabling, but point out that the complaints of pain must be credible. We agree. We hold, as a matter of first impression, that credible complaints of severe, persistent, and prolonged pain can establish a prima facie case of disability, even if the claimant can literally perform his or her past work. See, e.g., Bunol, 211 F.3d at 297. Our holding should not be taken to mean that any amount of pain is per se disabling. As the Sixth Circuit observed in Paducah Marine Ways v. Thompson, 82 F.3d 130 (6th Cir. 1996), there are some “aches and pains that are not disabling and thus not compensable” under the LHWCA. Id. at 134. Even judges must endure some degree of physical discomfort inherent in their work. On the other hand, a claimant need not experience excruciating pain to be considered disabled. According to one reputable dictionary, “excruciating” is defined as “so intense as to cause great pain or anguish,” Webster’s Third New International Dictionary 794 (2002), and is synonymous with “agonizing, harrowing, racking, raging, tormenting, torturing, torturous [and] wrenching,” MerriamWebster Online, https://merriam-webster.com/dictionary/ excruciating (last visited Aug. 21, 2020). Torture should not be the benchmark for disability under the LHWCA, a statute which “is to be liberally construed in favor of injured employees.” Saipan Stevedore Co. v. Dir., Office of Workers’ Comp. Programs, 133 F.3d 717, 722 (9th Cir. 1998) (citing Voris v. Eikel, 346 U.S. 328, 333 (1953)). 12 JORDAN V. SSA TERMINALS Moreover, although the Fifth Circuit and the BRB have made reference to the term, neither has suggested that “excruciating” is the threshold for disabling pain. Both the circuit court and the agency simply rejected the proposition that continued employment precluded a finding of disability in the face of evidence that the work subjected the claimant to such extreme pain. See Bunol, 211 F.3d at 297; Ramirez, 1999 WL 284793, at  n.5. Indeed, the Fifth Circuit has elsewhere acknowledged that the LHWCA does not “require[] that a longshoreman be bed-ridden before he is considered totally disabled.” Watson v. Gulf Stevedore Corp., 400 F.2d 649, 654 (5th Cir. 1968); see also John W. McGrath Corp. v. Hughes, 289 F.2d 403, 405 (2d Cir. 1961) (noting that, under the LHWCA, “[a] person may be permanently totally disabled in an economic sense and still be ambulatory”). Between the poles of “any” pain (which is not sufficient), see Paducah Marine Ways, 82 F.3d at 134, and “excruciating” pain (which is not necessary to show), see Bunol, 211 F.3d at 297, lies a considerable range. There is, in other words, a vast middle ground between occasional discomfort and torture. Although the cases have not clearly identified the quantum of pain that is sufficient to create a disability under the LHWCA, the statute’s definition of “disability” and the case law in this area support our holding that the level of pain must be sufficiently severe, persistent, and prolonged to significantly interfere with the claimant’s ability to do his or her past work. See id. (upholding disability benefits based on testimony that the claimant worked only with “substantial” and “constant pain”); see also Mijangos v. Avondale Shipyards, Inc., 948 F.2d 941, 944–45 (5th Cir. 1991) (reinstating disability award when “there was much expert testimony indicating that [the claimant] could physically perform certain jobs” but “[t]here JORDAN V. SSA TERMINALS 13 was also testimony indicating that [the claimant] would have constant pain in any of these jobs”); see also Nardella v. Campbell Mach., Inc., 525 F.2d 46, 49 (9th Cir. 1975) (“Even a relatively minor injury must lead to a finding of total disability if it prevents the employee from engaging in the only type of gainful employment for which he is qualified.”). We leave it to ALJs to determine, based on consideration of all the facts and circumstances of a particular case, whether a claimant’s complaints of pain are (1) credible and (2) if so, whether the level of pain described is so severe, persistent, and prolonged that it significantly interferes with the claimant’s ability to do his or her past work. Although we do not attempt an across-the-board definition of disabling pain, we offer the following guideposts. First, the pain must relate to an injury “arising out of and in the course of employment.” 33 U.S.C. § 902(2); see also Kalama Servs., Inc. v. Office of Workers’ Comp. Programs, 354 F.3d 1085, 1091 (9th Cir. 2004). Pain unrelated to such an injury will not suffice. In addition, the pain must be sufficiently severe, persistent, and prolonged to adversely impact the claimant’s ability to do his or her job in some significant way. This certainly includes impossibility; an injury might make an activity so painful that the employee literally cannot do it, “render[ing] it impossible for him to work at all.” See White, 584 F.2d at 575. It would also cover a situation in which the employee can perform a task only by enduring extreme or “excruciating” pain. Bunol, 211 F.3d at 297. But it might also impact the employee’s ability to perform the activity over a full workday. See Eller & Co. v. Golden, 620 F.2d 71, 72 (5th Cir. 1980) (upholding a disability benefits award when, among other things, the claimant credibly testified 14 JORDAN V. SSA TERMINALS that he could “not continue to work beyond four hours due to pain in his lower back and the ‘giving way’ of his left knee which caused him to fall when he attempted to lift cargo”). Or it might simply cause the severe, persistent, and prolonged pain that would make a reasonable employee stop doing the activity. See Bunol, 211 F.3d at 297 (upholding disability benefits based on “substantial” and “constant pain”); Mijangos, 948 F.2d at 944–45 (5th Cir. 1991) (reinstating disability award based on “constant pain”). In other words, whatever the level of pain, the employee need not make an “extraordinary effort” to overcome it and should not be penalized if he or she does so. Bunol, 211 F.3d at 297. Relatedly, and although somewhat distinct from the issue of the required quantum of pain, an employee need not perform work that, according to the medical evidence, will exacerbate his or her injury to a degree that significantly impedes the claimant’s ability to perform his or her past work. As the First Circuit explained in Bath Iron Works, a claimant is not “required, after injury, to continue in employment which is medically contraindicated until his condition and pain render it impossible for him to work at all.” 584 F.2d at 575; see also Container Stevedoring, 935 F.2d at 1550 (upholding an award of disability benefits based in part on a treating physician’s view that continuing to work would “lead to worsening symptoms and worsening disability” for the claimant) (quotations omitted); Haughton Elevator Co., 572 F.2d at 451 (Winter, J., concurring) (agreeing that, under the LHWCA, a claimant “should not be required to continue enduring excruciating pain and subjecting himself to the possibility of further injury”); Care v. Wa. Metro. Area Transit Auth., 21 BRBS 248, 251 (1988) (“A doctor’s opinion that [a claimant’s] return to his usual work would aggravate his condition may support a finding of total disability.”); Lobue v. Army & Air Force Exch. Serv., JORDAN V. SSA TERMINALS 15 15 BRBS 407, 408–09 (1983) (affirming an ALJ’s finding that the claimant was disabled based on a physician’s statement that continued work would “aggravate” the claimant’s spondylolisthesis); cf. Haw. Stevedores, Inc. v. Ogawa, 608 F.3d 642, 653 (9th Cir. 2010) (affirming ALJ’s consideration of work restrictions that would allow claimant to “avert more pronounced cognitive difficulties”).