Court Opinion

ID: 9474617
Source: CourtListenerOpinion
Date Created: 2023-08-05 05:03:17.476127+00
Date Added: 2024-06-11T17:44:12.986673
License: Public Domain

K.K. HALL, Circuit Judge,
dissenting:
Unlike the majority, I conclude that the Appeals Council’s decision to review this case conflicts with at least one portion of *1167this Court’s decision in Parris. To me, the majority in this case and the Court in Kellough, upon which the majority relies, completely misinterpret the standard of review which this Court must follow when the Appeals Council reverses an ALJ for lack of substantial evidence. Accordingly, I dissent.
I.
To reach a proper decision in this case, it is essential to recount in some detail the lengthy history and factual background to the appeal, much of which the majority chooses to ignore.
Gross was born on December 17, 1937, and was forty-four years old at the time of his administrative hearing. He has a seventh-grade education and until 1979 worked for fifteen to twenty years as a truck driver, sometimes as much as fifteen hours a day, six days a week. Claiming that since February, 1979, he had suffered from black out spells, arthritis, ulcers, “nerves,” poor vision, and a heart condition, Gross filed his applications for disability insurance and SSI benefits on February 23, 1981. These applications were denied initially and upon reconsideration.
Following Gross’ request for a hearing, the ALJ concluded that a hearing was unnecessary and awarded claimant benefits on the basis of the exhibits contained in his file. The Appeals' Council reviewed this award and remanded the claim to the AU for resolution of conflicts in the evidence and to obtain further evidence concerning claimant’s alcohol problem. The AU was specifically instructed to obtain a consultative psychiatric examination with psychological testing and a residual functional capacity evaluation. He was also directed to conduct a hearing.
At the administrative hearing, which took place on April 21, 1982, Gross appeared pro se and testified that he has black-out spells, poor eyesight, heart disease, and ulcers. He stated that he also suffers from memory loss, “nerves,” arthritis, and pain in his lower back, left shoulder, and chest. According to Gross, he cannot afford medication or eyeglasses. Claimant told the AU that he had had a “light stroke,” which affects his speech. The AU, describing the speech impediment as “severe,” had difficulty understanding Gross at the hearing. Gross denied being an alcoholic but admitted that he drinks “a good bit of wine” and about three glasses of beer a day. He stated that he drinks whiskey “once a week or once a day,” depending upon how he feels.
The medical evidence presented to the AU documented that in 1978 claimant had been hospitalized for severe degenerative arthritis. Cervical x-rays taken at that time revealed degenerative spurring and encroachment of the cervical spine with severe limitation of motion. Following treatment, Gross was discharged as “much improved.” In another 1978 report, a physician, noting that Gross had a strong odor of ethanol about him and acted drunk, concluded that claimant has a paranoid personality.
In March, 1981, claimant was referred by the Social Security Administration (“SSA”) to A. Neil Johnson, M.D., a specialist in internal medicine and gastroenterology. Dr. Johnson’s report concluded that Gross suffered from a significant restriction of motion of the lumbar spine, mild dextroscoliosis, and mild diffuse osteophyte formation. Dr. Johnson also noted Gross’ “stuttering speech,” for which he recommended a speech pathologist. Dr. Johnson’s impressions were: history of syncope, i.e., temporary loss of consciousness (etiology unknown); chest pains, which were atypical of angina; and chronic lumbar pain.
Lawrence Hoy Mills, M.D., a surgeon and general practitioner, reported in March, 1981, that Gross had all the signs of chronic ethanolism. Dr. Mills stated that he did not believe claimant desired to be cured, arid further that he did not think Gross was disabled.
In February, 1982, Jo Ledwell, Ph.D., a clinical psychologist, evaluated Gross on behalf of the SSA. Dr. Ledwell found no signs of organic brain damage and “[n]o *1168psychomotor disturbances, neurological impairments, or other physical health problems ... except for a mild visual problem.” She found it “mildly difficult” to understand claimant’s speech until his speech pattern was learned. Dr. Ledwell’s tests showed that Gross had a verbal I.Q. of 83, which placed him in the dull-normal range of intelligence, and a memory quotient of 79. Dr. Ledwell stated that Gross denied using any alcohol in the past six months. The psychologist opined that claimant’s judgment was intact when he was not under the influence of alcoholic beverages, and that his insight was quite limited. Dr. Ledwell concluded that Gross was an “old-fashioned somatizer,” 1 who manifests “hyper-sensitivity to minor dysfunction and numerous complaints without adequate physical pathology.” Her diagnostic impression was hypochondriasis.
Gross was also referred to a psychiatrist, David J. Withersty, M.D., for a consultative examination. During his meeting with claimant on April 1, 1982, Dr. Withersty noted a distinct odor of alcohol when Gross spoke and reported that claimant frequently smiled inappropriately throughout the interview. Dr. Withersty observed that Gross’ family history was positive for psychiatric disorders and noted that claimant acknowledged four previous psychiatric-related hospitalizations. According to Dr. Withersty, Gross was limited in a moderate to severe manner in his ability to perform a variety of functions, including understanding instructions, responding appropriately to supervision, co-workers, and work pressures, and performing simple, complex, repetitive, and varied tasks. Dr. Withersty suggested that claimant’s alcohol abuse be given serious consideration, despite Gross’ denials, and that further physiological evaluation and psychological testing, including the Minnesota Multiphasic Personality Inventory (“MMPI”), be conducted.2 The psychiatrist diagnosed a conversion disorder, a term used to connote the transformation of emotions into physical manifestations, and opined that claimant was disabled due to his psychological impairment.
The AU once again found that Gross was disabled and awarded benefits on the basis of Gross’ testimony and the medical evidence of claimant’s alcoholism and combination of impairments. On its own motion, the Appeals Council notified claimant of its intention to reverse the AU’s decision for lack of substantial evidence of a severe impairment. Gross subsequently retained counsel and, in response to the Appeals Council’s invitation to submit additional evidence prior to the final decision, submitted an evaluation by another clinical psychologist, William J. Fremouw, Ph.D.
According to Dr. Fremouw’s report, dated October 21, 1982, Gross admitted to a history of chronic alcohol dependence beginning in 1971, when he was drinking a pint of whiskey every day. Gross further reported to Dr. Fremouw that he had had four psychiatric hospitalizations since 1979 and one eight-day hospitalization in 1982 for alcohol-related treatment. Gross told the psychologist that he had a history of multiple arrests for intoxication and admitted to drinking beer and wine currently on a daily basis. Dr. Fremouw reported a noticeable odor of alcohol on claimant’s breath during the interview and stated that he had to have Gross frequently repeat himself in order to understand him.
Dr. Fremouw’s intelligence testing revealed a memory quotient of 77, a verbal I.Q. of 78, a performance I.Q. of 73, and a full-scale I.Q. of 75, placing Gross in the borderline level of intellectual testing.3 *1169Noting claimant’s vision problems, Dr. Fremouw orally administered the MMPI and concluded that the results were consistent with the previous MMPI scores obtained by Dr. Ledwell. According to Dr. Fremouw, Gross’ responses to the MMPI “were consistent with someone who is experiencing a high degree of psychological distress and who is requesting help” and reveal “the presence of anxiety and depression with long standing physical complaints.”
Dr. Fremouw noted that Gross could understand simple instructions and carry them out under ordinary supervision and, while sober, could relate well to co-workers and supervisors. Dr. Fremouw concluded, however, that Gross’ “ability to meet quality standard and production norms on a sustained basis is impaired by both his daily alcohol dependence, his vision problems, and his symptoms of depression, characterized by fatigue and forgetfulness. This combination of these difficulties would make sustained competitive work very difficult for Mr. Gross to maintain.” Dr. Fremouw’s diagnosis was alcohol dependence and continuous conversion disorder. He concluded that the prognosis for improvement was poor, even with treatment, because of Gross’ lack of insight into his psychological problems and his lack of motivation to alter his drinking.
After considering the entire record in the case, including the post-hearing psychological report of Dr. Fremouw, the Appeals Council reversed the AU, concluding that Gross has no severe impairment. Claimant’s arthritis was dismissed as not disabling, because “there is no medical evidence which shows any further complaints or treatment to his neck” since his 1978 hospitalization, and because recent lumbar x-rays, showing mild degenerative arthritis and limitation of motion, were unaccompanied by any associated neurological, sensory, or reflex abnormalities. The Appeals Council further found that Gross’ visual impairment could be corrected by glasses, that his pain would not interfere with basic work activities, and that his speech problem did not hinder communication.
As for claimant’s alcohol problem, the Appeals Council concluded that at most it was mild and not so involuntary as to preclude sustained work, given the lack of treatment and any specific clinical findings. According to the Appeals Council’s assessment of the psychological reports of Dr. Ledwell and Dr. Fremouw, Gross retained the ability to perform work-related tasks. Dr. Withersty’s conclusion that claimant was disabled was discounted as not consistent with the psychological findings. It was the Appeals Council’s opinion that claimant’s limited daily activities “are indicative of a lifestyle rather than any restriction imposed by an impairment.”
II.
In Parris, this Court considered the provisions of the Secretary’s regulations, which specify the conditions under which the Appeals Council is authorized to review decisions of an AU. Pursuant to 20 C.F.R. § 404.970:
(a) The Appeals Council will review a case if—
(1) There appears to be an abuse of discretion by the administrative law judge;
(2) There is an error of law;
(3) The action, findings or conclusions of the administrative law judge are not supported by substantial evidence; or
(4) There is a broad policy or procedural issue that may affect the general public interest.
(b) If new and material evidence is submitted with the request for review, the Appeals Council shall evaluate the entire record. It will then review the case if it finds that the administrative law judge’s action, findings, or conclusion is contrary to the weight of the evidence currently in the record.
*1170The Parris Court interpreted these provisions to mean that “the Appeals Council does not have unbridled discretion to overturn an ALJ’s decision with which it disagrees, but may only do so if one of these four grounds [enumerated in 20 C.F.R. § 404.970(a) ] is present.” 733 F.2d at 325. If our decision in Parris that the Appeals Council does not have unbridled discretion means anything, then this Court must have the right to review the ALJ’s decision for substantial evidence to determine whether the Appeals Council properly followed the Secretary’s review regulations. Any other interpretation totally insulates the Appeals Council’s decision to review a case from judicial scrutiny and renders meaningless the conclusion reached by the Parris Court on this point.4
Moreover, this approach is entirely consistent with the Court’s responsibility to review other administrative decisions. For example, in Universal Camera Corp. v. NLRB, 340 U.S. 474, 71 S.Ct. 456, 95 L.Ed. 456 (1951), which involved the reversal of a hearing examiner’s decision by the National Labor Relations Board, the Supreme Court made clear that a reviewing court was not barred from setting aside the Board’s final decision when, after reviewing all the evidence in the record, the court could not find substantial evidence to support the Board’s reversal. In so holding, the Supreme Court observed as follows:
We do not require that the examiner’s findings be given more weight than in reason and in the light of judicial experience they deserve. The “substantial evidence” standard is not modified in any way when the Board and its examiner disagree. We intend only to recognize that evidence supporting a conclusion may be less substantial when an impartial, experienced examiner who has observed the witnesses and lived with the case has drawn conclusions different from the Board’s than when he has reached the same conclusion. The findings of the examiner are to be considered along with the consistency and inherent probability of testimony.
Id. at 496, 71 S.Ct. at 469 (emphasis added). Cf Winn-Dixie Stores, Inc. v. NLRB, 448 F.2d 8, 12 (4th Cir.1971) (“The Board can overrule the Trial Examiner, even on findings of fact, but the Examiner’s decision is part of the record which must be considered when determining whether the substantial evidence on the record as a whole supports the findings of the Board.”) Similarly, in a black lung case, this Court recently concluded that the Benefits Review Board erred when it overturned an ALJ’s decision to award benefits, where there was substantial evidence in the record, considered as a whole, to support the original decision. Zbosnik v. Badger Coal Company, 759 F.2d 1187 (4th Cir.1985).5
*1171I can only conclude that in light of the Secretary’s regulations, as interpreted by this Court in Parris, this same standard of review applies when we are confronted with conflicting opinions of an AU and the Appeals Council in a social security case. In this case, as the record clearly demonstrates and as the magistrate specifically noted, there was undoubtedly “substantial evidence from which it could be found that one or more of the plaintiff’s impairments is ‘severe.’ ” Thus, the Appeals Council lacked authority to overturn the AU on these grounds. Here, Gross had been twice found disabled by an AU. Furthermore, the Secretary’s consultative psychiatrist had concluded that claimant was disabled due to his psychological impairment, and the record is replete with documentation of Gross’ long standing alcoholism, as well as his other physical and mental impairments. The fact that Gross cannot afford medical treatment for his impairments does not preclude a finding of disability. See Gordon v. Schweiker, 725 F.2d 231, 237 (4th Cir.1984).
Nor does claimant’s denial of a drinking problem preclude a finding of alcoholism, because such denials from a true alcoholic are typical of the disease and are inherently unreliable. See Swaim v. Califano, 599 F.2d 1309, 1312 (4th Cir.1979); Adams v. Weinberger, 548 F.2d 239, 245 (8th Cir. 1977). Dr. Ledwell’s evaluation, on which the Appeals Council heavily relied, virtually ignores Gross’ alcoholism in drawing the conclusion that Gross was a hypochondriac. Moreover, even Dr. Ledwell conceded that claimant’s insight was limited and that his judgment was intact only when not under the influence of alcohol. Furthermore, Dr. Ledwell’s description of Gross as a somatizer is not inconsistent with Dr. Withersty’s diagnosis of a conversion disorder. The report of Dr. Fremouw, submitted by claimant to the Appeals Council after it announced its decision to review the case, provides further evidence of Gross’ disability due to a conversion disorder and alcoholism and only confirms that the AU’s decision was correct.6
III.
Under the circumstances presented by this case, I would find that the Secretary’s reversal of the AU’s decision for lack of substantial evidence violated the agency’s own review regulations. Consequently, I would reverse the decision of the magistrate affirming the Appeals Council, and would remand the case for an award of benefits to Gross.

. Somatization is defined as a conversion of mental experiences or states into bodily symptoms. Dorland's Illustrated Medical Dictionary, 25th Edition, at 1438 (1974).

. Dr. Withersty was apparently not aware that Dr. Ledwell had administered one version of the MMPI test in February, 1982. The results of this test showed that Gross scored "beyond normal limits.”

. Dr. Fremouw concluded that these results were not inconsistent with Dr. Ledwell's findings because of the difference in tests employed. Dr. Fremouw utilized the 1981 Wechsler Adult Intelligence Scale (“WAIS”) instead of the 1955 WAIS employed by Dr. Ledwell, which Dr. Fre*1169mouw described as obsolete and which tested five to six points higher than the 1981 WAIS edition.

. I cannot accept the Kellough Court's unsupported conclusion that Parris' restriction of the Secretary's reviewing powers under 20 C.F.R. § 404.970 was mere dicta. Nor do I accept the gloss placed upon that portion of Parris by the Kellough Court, which now concludes that “[a]t most, the Parris dicta on this point implies that where the basis for an Appeals Council decision on sua sponte review is demonstrably outside the scope of the grounds specified for § 404.-970(a) review, this might violate the regulation.” Kellough v. Heckler, 785 F.2d 1147 (4th Cir.1986), at 1149-50, n. 2.
Quite simply, Parris does not say what Kellough would have it say. The Court in Parris specifically found that the Appeals Council has limited power to review an ALJ’s decision, but then went on to state in that case that “[o]n the basis of the record before us, we cannot conclude that the Appeals Council failed to follow the Secretary’s own regulations and applied an improper standard of review.” Parris, 733 F.2d at 326 (emphasis added). Perhaps it is impossible to reconcile the conclusion reached by Parris concerning the Appeals Council’s limited review powers with the case’s subsequent conclusion that judicial deference is owed to the Appeals Council. If that is so, however, then the proper way to resolve the matter is through en banc review — not by rewriting a portion of Parris and labeling it as dicta.

. Unlike the Kellough Court, Kellough, at 1150, n. 3, I see no meaningful distinction between the Secretary's regulations in social security cases and the regulations which limit review by the Benefits Review Board of an ALJ’s decision in a black lung case. Cf. 20 C.F.R. § 404.970(a), which we interpreted in Parris to allow Appeals Council review only for abuse of discretion, error of law, lack of substantial evidence, or broad policy or procedural issues, to *117120 C.F.R. § 802.301, governing the Benefits Review Board’s scope of review:
The Benefits Review Board is not empowered to engage in a de novo proceeding or unrestricted review of a case brought before it. The Board is authorized to review the findings of fact and conclusions of law on which the decision or order appealed from was based. Such findings of fact and conclusions of law may be set aside only if they are not, in the judgment of the Board, supported by substantial evidence in the record considered as a whole or in accordance with law.
Thus, I believe that the Court's Zbosnik decision is relevant to our determination in this case.

. In my view, the submission of Dr. Fremouw’s report did not authorize the Appeals Council to conduct a de novo review of the evidence. Under 20 C.F.R. § 404.970(b), if new and material evidence is submitted with a request for review, the Appeals Council will evaluate the entire record. By its own terms, this provision is only triggered where a claimant requests review by the Appeals Council and not, as here, where merely cumulative evidence is provided to clarify or explain evidence already contained in the record. It is not entirely clear whether the Appeals Council conducted its review of these proceedings under a substantial evidence standard or under the broader de novo standard. I would find that under either standard of review the result in this case is the same and that the ALJ’s decision should not have been disturbed.