Court Opinion

ID: 2964119
Source: CourtListenerOpinion
Date Created: 2015-09-21 21:20:51.936149+00
Date Added: 2024-06-11T11:42:50.932207
License: Public Domain

USCA1 Opinion

	

          J       u       n       e   6       ,   1       9       9       6
                            UNITED STATES COURT OF APPEALS
                                FOR THE FIRST CIRCUIT

                                   _______________

          No.  95-2300

                                  GEORGE RICE, JR.,
                                Plaintiff, Appellant,

                                          v.

                                  SHIRLEY S. CHATER,
                           Commissioner of Social Security,
                                 Defendant, Appellee.

                                _____________________

                                     ERRATA SHEET

                    The opinion of  this Court  issued on May  29, 1996  is
          amended as follows:

               On  the cover  sheet,  the district  court  judge should  be
          changed  from [Hon. Francis J. Boyle, Senior U.S. District Judge]
                                                __________________________
          to  [Hon. Robert W. Lovegreen, U.S. Magistrate Judge].
                                         _____________________

                                                    

                            UNITED STATES COURT OF APPEALS
                                FOR THE FIRST CIRCUIT

                                 ____________________

        No. 95-2300

                                  GEORGE RICE, JR.,

                                Plaintiff, Appellant,

                                          v.

                                  SHIRLEY S. CHATER,
                           Commissioner of Social Security,

                                 Defendant, Appellee.

                                 ____________________

                     APPEAL FROM THE UNITED STATES DISTRICT COURT

                           FOR THE DISTRICT OF RHODE ISLAND

                  [Hon. Robert W. Lovegreen, U.S. Magistrate Judge]
                                             _____________________

                                 ____________________

                                        Before

                                Torruella, Chief Judge,
                                           ___________
                            Cyr and Stahl, Circuit Judges.
                                           ______________

                                 ____________________

            Gretchen Bath on brief for appellant.
            _____________
            Sheldon  Whitehouse, United  States Attorney,  Anthony C. Digioia,
            ___________________                            __________________
        Assistant U.S.  Attorney, and  Gerald Luke, Attorney,  Social Security
                                       ___________
        Administration, on brief for appellee.

                                 ____________________

                                     May 29, 1996
                                 ____________________

                      Per Curiam.  Appellant George Rice appeals from the
                      __________

            district court's decision affirming the termination of Rice's

            disability benefits  by the Commissioner  of Social  Security

            ("Commissioner").  We vacate the decision and remand.  

                      1.  Erroneous Legal Standard Applied
                          ________________________________

                      Rice was  determined to  be disabled as  of January

            1976 because he was found to have a urinary-kidney impairment

            which met or equalled then Listing 6.04.  Under that listing,

            claimants with a permanent urinary diversion  and progressive

            bilateral  hydronephrosis were  considered  disabled.1    The
                                                                 1

            administrative  law  judge  ("ALJ")  determined  that  Rice's

            impairment had medically improved by October 1990, justifying

            termination of his disability benefits.  

                      Under  the  regulations,  medical   improvement  is

            defined  as "any  decrease  in the  medical  severity" of  an

            impairment,  and any such decrease  "must be based on changes

            in the symptoms, signs and/or laboratory findings" associated

            with   the  claimant's   impairment.     See   20  C.F.R.    
                                                     ___

            404.1594(b)(1).      To   find   medical   improvement,   the

            Commissioner  must  compare  the prior  and  current  medical

            evidence  to  determine  whether  there have  been  any  such

            changes  in  the  signs,  symptoms  and  laboratory  findings

            associated  with  the  claimant's  impairment.   Id.  (b)(7),
                                                             ___

                                
            ____________________

               1As the Commissioner argues, there is substantial evidence
               1
            to  support  the  determination  below  that  the  applicable
            listing was Listing 6.04.

                                         -3-

            (c)(1).   The  ALJ did  not make  this comparison  in finding

            medical improvement in Rice's impairment, but focused instead

            on the question  whether Rice continued to  meet Listing 6.04

            in 1990.  In doing so, he erred.2  
                                            2

                      2.  Lack of Medical Improvement
                          ___________________________

                      Rice argues that the symptoms, signs and laboratory

            findings associated  with his impairment did  not change from

            1976,  when he was found disabled, to 1990, when his benefits

            were  terminated, precluding termination  of his  benefits on

            the basis of medical improvement.  We agree.

                      The  laboratory  findings  evidencing Rice's  renal

            functioning  in 1990  and thereafter  were comparable  to the

            pre-1976 laboratory  findings.   Creatinine in 1990  was 2.6,

            comparable  to the  1969 creatinine  of 2.84  and within  the

            other   pre-1976   creatinine  values   of   1.0   and  3.8.3
                                                                        3

            Creatinine after  1990 continued to come  within the pre-1976

                                
            ____________________

               2The  regulations  clearly  require  the  Commissioner  to
               2
            compare a  claimant's current and prior   symptoms, signs and
            laboratory findings in determining medical improvement.  Only
            if  those  indicia of  the  severity  of an  impairment  have
            changed, i.e.,  improved, may  benefits be terminated  on the
            _______         ________
            basis  of medical improvement.  The  question whether a prior
            listing  continues to be met plays at best a subordinate role
            in determining medical improvement  and is not determinative.
            Once medical improvement has been shown, a claimant's failure
                                     ___ ____ _____
            to  meet  a  prior  listing  suffices  to show  that  medical
            improvement is  related to ability to work,  a separate issue
                        __  _______ __ _______ __ ____
            which is  not even  considered until medical  improvement has
            been established,  as provided  in the  regulations.   See 20
                                                                   ___
            C.F.R.    404.1594(b)(1), (c)(1), (c)(3)(i), (f)(3) & (4).

               3The record indicates that creatinine levels greater  than
               3
            1.5 mg./dec. are considered abnormal.

                                         -4-

            figures,  ranging from  2.6  to 3.3.    In 1990,  blood  urea

            nitrogen  was 18, a value which was within the pre-1976 range

            of 12 to 47.4  After  1990, blood urea nitrogen also remained
                        4

            within the  range of pre-1976 values,  fluctuating between 29

            and 45.   Rice's precise renal status was unknown as of 1990.

            But, in 1992, he  was diagnosed with renal failure as  he had

            been  in   1973;  he   was  also   found  to  have   advanced

            hydronephrosis and a markedly hydronephrotic  kidney, similar

            to the 1968 and  1969 characterizations of his hydronephrosis

            as marked or severe.  When questioned as to what the clinical

            findings showed about  Rice's impairment, the  medical expert

            answered  that  he found  no  evidence  of change  in  Rice's

            condition from  January 1976  to the  fall of 1990.   On  the

            basis  of the  above,  it seems  evident  that there  was  no

            medical improvement in Rice's condition from 1976 to 1990, as

            that term  is defined  in the regulations.   See 20  C.F.R.  
                                                         ___

            404.1594(b)(1) & (7).  

                      Under  the  circumstances  present  in  this  case,

            Rice's failure to  seek treatment  from 1973 to  1990 is  not

            evidence of medical improvement.  As noted, changed symptoms,
                                                        _______ ________

            signs and  laboratory findings are the  only relevant indicia
            _____      __________ ________

            of  medical  improvement  under   the  regulations.    Id.   
                                                                   ___

            404.1594(b)(1) & (7),  (f)(3).  While the  medical expert may

                                
            ____________________

               41976 Listing 6.02A indicates  that blood urea nitrogen of
               4
            30 mg./100 ml. or greater would be considered abnormal.

                                         -5-

            have  speculated  that  a failure  to  seek  treatment for  a

            deteriorating impairment could denote medical improvement, on

            the basis of the  actual clinical findings in the  record, he

            stated  only  that Rice's  condition  had  remained the  same

            (i.e., not changed) from 1976 to 1990.  Moreover, Rice sought

            no treatment for his impairment for the two-and-one-half year

            period preceding  the January  1976 finding of  disability, a
                   _________

            factor never taken into account by the ALJ and ignored by the

            Commissioner  on  appeal.    Given  Rice's  failure  to  seek

            treatment  for a  substantial  period of  time preceding  the

            determination that he was disabled, his continuing failure to
                                                    __________

            seek treatment  is not evidence  of change or  improvement in
                                                ______     ___________

            his  impairment.     See  20  C.F.R.      404.1594(b)(7)  (in
                                 ___

            determining  medical  improvement,  the   claimant's  current

            condition  is compared with his  condition as of  the date of

            the original disability decision);  Bosley v. Shalala, 879 F.
                                                ______    _______

            Supp. 296, 304 (W.D.N.Y.  1995) (improvements in a claimant's

            condition which precede the date on which disability is found

            cannot be used  as evidence  that the  disability has  ceased

            since the  regulations require  comparison of  the claimant's

            current  condition   with  his  condition  as   of  the  date

            disability  was found);  accord Fleming  v. Sullivan,  806 F.
                                     ______ _______     ________

            Supp. 13, 15 (E.D.N.Y. 1992).

                      Furthermore, because Rice's creatinine  levels from

            1990  and from  1992-93 were  commensurate with  his pre-1976

                                         -6-

            creatinine, i.e., had  not changed, they  cannot be cited  as

            evidence of  medical  improvement.   The Commissioner  argues

            that  the  stability  of  creatinine  levels  shows   medical

            improvement  because  Rice's condition  was  deteriorating in

            1976.   We see two problems with her argument.  First, she is

            essentially arguing  only that Rice's prognosis  had improved

            as  of 1990 since his  condition did not  continue to worsen.

            But the regulations require  actual physical improvement in a

            claimant's  impairment,  not  merely an  improved  prognosis.

            Second, her claim that  Rice's condition was deteriorating in

            1976,  when he was found disabled, seems doubtful.  As noted,

            Rice  sought no  medical treatment  from mid-1973  to January

            1976.   In  addition, the medical  expert testified  that the

            medical records indicated that  Rice's condition had remained

            stable  from before 1976 to 1990.  The medical expert further

            stated that there was nothing in the record by which he could

            judge whether  Rice had progressive  hydronephrosis in  1976.
                                                                __  ____

            The   last    medical   records   suggesting    that   Rice's

            hydronephrosis was  increasing dated  from 1969, seven  years

            before he was found disabled.5
                                         5

                                
            ____________________

               5Thus,  the  ALJ's approach  in  this  case was  not  only
               5
            legally  erroneous, but it  was flawed  for other  reasons as
            well.  Unless Rice actually had progressive hydronephrosis in
            1976, it  is not at  all clear how  the fact that  he did not
            have  it in 1990 could evidence medical improvement.  Yet the
            ALJ  never examined  the evidence  to determine  whether Rice
            actually   had  progressive   hydronephrosis  in   1976,  but
            apparently assumed that the  1976 determination that Rice met
            Listing 6.04, which required progressive hydronephrosis, must

                                         -7-

                      3.  Remand
                          ______

                      Given the  lack  of medical  improvement in  Rice's

            impairment, the Commissioner could not terminate his benefits

            without showing application of an exception under 20 C.F.R.  

            404.1594(d)  or  (e), see  42 U.S.C.     423(f); 20  C.F.R.  
                                  ___

            404.1594(a), (f)(3), (5), a question which was not considered

            below and  has not  been argued on  appeal.   On remand,  the

            Commissioner may wish to consider that question.

                      The decision  of the district court is vacated.  We
                      ___________________________________________________

            remand to the  district court with  directions to remand  the
            _____________________________________________________________

            case to the  Commissioner for further  proceedings consistent
            _____________________________________________________________

            with this opinion. 
            __________________

                                
            ____________________

            be correct.

                                         -8-