Court Opinion

ID: 9484025
Source: CourtListenerOpinion
Date Created: 2023-08-05 09:38:35.845964+00
Date Added: 2024-06-11T17:49:58.620661
License: Public Domain

*817HEANEY, Senior Circuit Judge,
dissenting.
Counsel for the Secretary stated at oral argument that the critical issue in this case is whether Marcia Reed’s obesity is controllable by her.3 Counsel thereby implicitly conceded that Reed cannot presently engage in substantial gainful activity as a sedentary employee because of her obesity, a concession which the record requires. The question thus becomes, is there substantial evidence in this record that Marcia Reed can reasonably control her obesity? The answer is clearly no. The AU, however, made no effort to obtain an answer; he simply assumed that she could. I do not have sufficient information to know whether this assumption reflects a policy of the Secretary,4 or whether the decision simply reflects the view of one AU.5 This circuit’s position is clear:
The [social security] agency is certainly not entitled to presumptions that obesity is remediable or that an individual’s failure to, lose weight is “wilful.” The notion that all fat people are self-indulgent souls who eat more than anyone ought appears to be no more than the baseless prejudice of the intolerant svelte....
... The proper question for the- agency is not whether [the claimant’s] obesity is in some clinical sense remediable, but whether her obesity is the sole or major cause of her disabilities, and, if so, whether her obesity is reasonably remediable by her. The answers to these questions must, of course, be supported by substantial evidence.
Stone v. Harris, 657 F.2d 210, 212 (8th Cir.1981).
In addition to the Eighth Circuit, other circuits have addressed this issue, including the Fifth, Sixth, Ninth, and Eleventh Circuits. In Lovelace, the male claimant was 5'11" and weighed 252 pounds. In addition to obesity, he suffered from hypertension, arthritis, and back trouble. The court remanded for an individualized determination of his ability to remedy his obesity, faulting the Secretary for failing to make the necessary findings:
In like disregard of reality, the Secretary continues to hold that a person who is disabled because of obesity has a condition that is per se remediable, without examining the medical condition and personal factors that might make it possible or impossible for a particular disabled person to remedy his obesity.
Lovelace, 813 F.2d at 59; see also Scott v. Heckler, 770 F.2d 482, 486-487 (5th Cir.1985).
In Johnson v. Sec’y of Health & Human Servs., 794 F.2d 1106 (6th Cir.1986), the male claimant was 5'9" and weighed 314 pounds. The Sixth Circuit thoroughly reviewed the regulations and decisions relating to obesity:
The- introductory material [in section 10.10 of the Social Security regulations] *818is instructive. It indicates that obesity-caused disorders are within the contemplation of the Act’s coverage and that the Secretary recognizes that obesity by its nature can be expected to result in various restrictions and health problems:
Long-term obesity will usually be associated with disorders in the musculo-skeletal, cardiovascular, peripheral vascular, and pulmonary systems and the advent of such disorders is the major cause of impairment. Extreme obesity results in restrictions imposed by body weight and the additional restrictions imposed by disturbances in other body systems.
[20 C.F.R.] Pt. 404, Subpt. P, App. 1, § 10.00(B)_ We further note that section 10.10 makes no distinction between obesity that is the result of simple overeating and obesity that is caused by a physiological disorder or other problem.
... It would not make sense for the regulatory scheme to include a specific regulation on obesity if a general regulation on treatment could entirely negate it, and we must attempt to construe the regulations so that they make sense.... Few if any claimants could satisfy section 10.10 if the mere possibility of losing weight, however remote or theoretical, could render the claimant ineligible.... Furthermore, this court has stated that physicians’ recommendations to lose weight do not necessarily constitute a prescribed course of treatment, nor does a claimant’s failure to accomplish the recommended change constitute a refusal to undertake treatment....
... The Secretary must show that the disability is clearly treatable. In the absence of such findings, we are unable to agree with the government’s post hoc rationale based on treatability.
Id. at 1112-13. The court remanded to the Secretary for consideration in light of its opinion.
In Hammock v. Bowen, 879 F.2d 498 (9th Cir.1989), the Ninth Circuit followed Lovelace and Johnson with respect to a 5'3" female claimant who weighed between 236 and 273 pounds. She submitted evidence of obesity, degenerative spine disease, hypertension, arthritis, hearing loss, ulcers, and a rash. There was no testimony from a vocational expert. The court stated that “while a claimant’s impairments can be improved by simply following a doctor’s orders to lose weight, losing weight is a task which is not equivalent to taking pills or following a prescription.” Id. at 503-04. It remanded to the Secretary with directions to take further evidence on the question of whether her obesity was reasonably controllable.
In McCall v. Bowen, 846 F.2d 1317 (11th Cir.1988), the claimant was 5'2V2" and weighed 173 pounds. She complained of arthritis, back, and heart problems. The Eleventh Circuit remanded for further findings:
Admittedly, plaintiff’s physicians advised her to lose weight, and the record clearly indicates her condition would improve if she did so, but no evidence has been presented suggesting that plaintiff has refused to follow a plan of prescribed treatment. A physician’s recommendation to lose weight does not necessarily constitute a prescribed course of treatment, nor does a claimant’s failure to accomplish the recommended change constitute a refusal to undertake such treatment. McCall’s obesity, of itself, does not justify the conclusion that she has refused treatment nor the consequent denial of disability benefits. Further findings of fact and conclusions of law are required before the Secretary may determine that a claimant has refused treatment.
Id. at 1319 (citations omitted). These decisions are instructive and well-reasoned, and I therefore find them persuasive in reaching my decision.
The law of this circuit on the issue of obesity, together with that of other circuits, requires us to remand this case to the Secretary for a further hearing. At this hearing, medical testimony must be obtained to establish whether Marcia Reed’s obesity is reasonably remediable in *819the light of her other disabilities. If it is, the cost of the program,6 and the length of time it will take to complete it must be determined. If the time is expected to exceed twelve months, then Marcia Reed is entitled to disability benefits for as long as it takes to complete the program. If Reed refuses to participate in prescribed treatment, then she will not be entitled to benefits unless the costs of participation are beyond her personal means and no governmental resources are available to pay for the treatment.
In view of the fact that a remand is required on the obesity issue, there are additional errors by, the AU that are important to point out so that they will not be repeated. First, the AU considered an impermissible factor in determining whether Reed was disabled:
[Reed] has a spotty and irregular work history with erratic earnings. Her work record does not reflect qualities of dedication or the desire to regularly engage in competitive employment. She and her family receive public assistance of $1,140 a month. There are clear indications of secondary gain in this case.
Decision of Administrative Law Judge, Frank C. Mansfield, at 3 (July 2, 1990). Whether Reed, her children, or her husband receive public benefits is irrelevant to the question of whether she is eligible to receive SSI benefits. What is relevant, however, is whether her income and resources exceed the maximum provided by the Social Security regulations. See 20 C.F.R. § 416.202 (1990). Counsel for the Secretary conceded this fact at oral argument.7 If Reed is awarded SSI benefits, then there may be adjustments in other public benefits she and her family might receive and rightly so, but this is a decision to be made by the appropriate authorities if Reed is found eligible for SSI benefits.
Second, the AU erred in using the guidelines to determine that Reed was not disabled. The Guidelines can only be used where nonexertional impairments are present “if the AU finds, and the record supports the finding, that the nonexertional impairments do not diminish the claimant’s residual functional capacity to perform the full range of activities listed in the Guidelines.” Thompson v. Bowen, 850 F.2d 346, 349-50 (8th Cir.1988) (emphasis added). The record in this case, establishes that Reed’s nonexertional impairments diminish her capacity to engage in the full range of activities of a sedentary employee. This fact was recognized by the AU as he found that Reed could not return to her work as a chicken deboner, clearly a sedentary occupation.8 The question thus becomes whether there are other sedentary jobs that Reed can perform in light of her several nonexertional impairments. A vocational expert is required to answer this question.9 Perhaps a vocational expert *820would find that even though her abilities were diminished, she can still engage in substantial gainful employment as a sedentary worker, perhaps not.
Third, the AU erred in discounting Reed’s complaint of headaches:
There is no documentation in the record that [Reed] complained to physicians of headaches five out of seven days a week lasting for almost a whole day, and no physician noted any significant impairment in her ability to concentrate. Surely, if her headaches were that bad, she would have sought medical intervention.
Decision of AU at 3. The facts are that Reed has been taking prescribed medicines for headaches on a regular basis from 1988 through 1990. These prescribed medicines include Tylenol with codeine and Fiorinal. Moreover, numerous medical reports document the fact that Reed has a long history of migraine headaches.10
Fourth, the AU stated that one reason for rejecting the claimant’s testimony was her conduct and demeanor at the hearing. Decision of AU at 4. He gave no explanation in his report as to what there was about her conduct and demeanor that reflected on her credibility. This being the case, I have no way of knowing whether he was applying the “sit-and-squirm” test that we have rejected in Reinhart v. Sec’y of Health & Human Servs., 733 F.2d 571, 573 (8th Cir.1984), and Cline v. Sullivan, 939 F.2d 560, 567-68 (8th Cir.1991), or some other factor that this court has considered inappropriate. See Bishop v. Sullivan, 900 F.2d 1259, 1263 (8th Cir.1990).
Fifth, the AU stated that “[Reed] engages in the performance of household tasks, cooks, helps her children get ready for school, watches television, does some sewing, used to do some painting as a hobby, and occasionally takes walks.” Decision of AU at 4. He decided that these activities indicate Reed is capable of performing sedentary work. This court has consistently held that the ability to do the listed activities is not evidence of one’s “ability to perform as required on a daily basis in the ‘sometimes competitive and stressful’ environment of the working world.” Easter v. Bowen, 867 F.2d 1128, 1130 (8th Cir.1989) (citation omitted). Something more than this is required. See also Ghant v. Bowen, 930 F.2d 633, 638-39 (8th Cir.1991).
CONCLUSION
The case law of this circuit requires that this matter be remanded to the Secretary to determine whether Reed’s obesity can be remedied by reasonable actions on her part. The case law also requires that on remand the AU determine whether Reed’s ability to engage in substantial gainful activity is diminished by her nonexertional impairments. If so, he must call a vocational expert to determine if, in light of these nonexertional limitations, there is work in the national economy that she can perform. Because the majority rejects established case law, I respectfully dissent.

. Counsel made the following statement at oral argument:
You know what I think we’re seeing here today ... more and more people are going to say, well, I’m obese, therefore you ought to per se find a nonexertional impairment. I don’t think this court’s ever found that. I think what they have found is that you must ask the next question ... is it controllable? Because if you get to the question of is it controllable, and the answer is yes, it is up to the patient, and the patient chooses not to control it; to me that should be the distinction.

. See Lovelace v. Bowen, 813 F.2d 55, 59 (5th Cir.1987) (the Fifth Circuit faulted the Secretary for its policy of finding obesity per se remediable).

. Reed may, in fact, be eligible for SSI benefits by having a listed impairment. To satisfy the listed impairment entitled "obesity,” Reed must meet two requirements. First, she must meet the weight requirement for her height. Because her height is 5'2" and her weight is approximately 293 pounds, she substantially exceeds the listed standard of 242 pounds (as well as the 258-pound standard set forth in the 1992 regulations). See 20 C.F.R. Part 404, Subpt. P, App. 1, Table II (1990). Second, she must satisfy one of five other listed requirements, two of which are relevant to this case: (a) history of pain and limitation of motion in any weight-bearing joint or spine (on physical examination) associated with x-ray evidence of arthritis in a weight-bearing joint or spine; or (b) hypertension with diastolic blood pressure persistently in excess of 100 mm. Hg measured with appropriate size cuff. See 20 C.F.R. Part 404, Subpt. P, App. 1 § 10.10 (1990).

. If a disability benefits claimant cannot afford prescribed treatment or medicine, and can find no way to obtain it, the condition that is disabling in fact continues to be disabling in law. Lovelace, 813 F.2d at 59; see also Dover v. Bowen, 784 F.2d 335, 337 (8th Cir.1986); Ludden v. Bowen, 888 F.2d 1246 (8th Cir.1989).

. Counsel acknowledged that the ALJ’s error:
There are a couple of things I think in this case that perhaps are a little unusual and Judge Heaney has hit on one of them at least. That is the choice of the AU to go off on the really non-medical issue of the fact that this is a family that exists on welfare. Perhaps we might wish [the AU] had chosen not to do that. But, I don’t think that that is something that the court should essentially hold against the AU....
This error raises the question of whether this matter should be remanded to the AU who initially heard the case. I leave it to the Secretary to determine whether the AU can overcome his apparent bias.

. The AU does not state why Reed cannot work as a chicken deboner but can perform other sedentary work. A poultry boner is defined as one who
[c]uts, scrapes and pulls meat from cooked poultry carcasses, using fingers and boning knife: Pulls wings and drumsticks from carcasses. Cuts along each side of breast plate, using knife, and peels meat from breast, using hands. Pulls and scrapes meat from rest of carcass, using knife and hands. Segregates light and dark meat into separate piles. Discards wastes, such as skin, bones, and gristle, into waste containers.
Dictionary of Occupational Titles 347 (4th ed. 1977).

. See Dover, 784 F.2d at 337-38 ("on remand, assuming the evidence as developed does not *820conclusively establish that appellant is disabled, we believe that vocational expert testimony is needed to satisfy the Secretary’s burden [when the AU concludes that a claimant cannot return to previous work] of demonstrating the availability of jobs in the national economy that appellant could perform”).

. See Adm.Rec. at 121, 195, 246, 257, 261, 265, 274, 279, 281, 284, 311, 317, 322.