Court Opinion

ID: 9467759
Source: CourtListenerOpinion
Date Created: 2023-08-05 01:56:06.443178+00
Date Added: 2024-06-11T17:40:30.982670
License: Public Domain

OAKES, Circuit Judge (dissenting):
I dissent.
*125Hanna Miles, a woman forty-seven years old at the time of the hearing before the Administrative Law Judge (ALJ), had previously been found disabled, as of March 1974, as the result of a serious back impairment, following surgical intervertebral disc removal. The issue before the ALJ was whether her disability ceased in September 1977, with her last entitlement to Social Security disability benefits in November 1977. Finding against her, the ALJ reached this conclusion, as I read his decision, on the following bases: (1) the ALJ’s own medical opinion that “continuous, severe, and intractable pain must, and does, leave its stigmata,” in conjunction with his observation of Mrs. Miles at the hearing that she exhibited no such “stigmata”; (2) a consultative orthopedic examination by Dr. Elstein that indicated that the claimant’s pain was “mild” and that there was no “severe restriction” on the range of motion of her back; (3) the fact that at the time of the hearing she was working as a short-order cook and cashier at a coffee shop and that this job, in addition to her “daily prescribed exercises of walking,” was inconsistent with her allegations of -severe and intractable pain. In my view each of these bases either lacks support in the record or is so inconsistent with the weight of the evidence as to require the ALJ at least to elaborate further his reasons for disregarding contrary evidence.
With respect to the first point, the ALJ’s medical assumptions as to the “stigmata” of pain are simply not supported by the evidence and constitute an unsubstantiated medical assumption which a lay person is not qualified to make. See Wilson v. Califano, 617 F.2d 1050, 1054 (4th Cir. 1980); Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975). While an administrative fact-finder, like any other factfinder, may rely upon his observations in determining credibility, he is not entitled to make assumptions as to what he should expect to see, given a particular set of medical findings, absent medical support therefor, unless the medical assumption he makes is so well established as to permit of judicial notice. That pain produces “stigmata” is not so well established. The evidence in the record was that Mrs. Miles had a restricted range of motion, a forward list in her posture, difficulty in walking, and a slight limp.
Regarding the observations of the consultant, Dr. Elstein, they were based upon one examination taking an amount of time undisclosed by the record, and are totally inconsistent with numerous, extensive observations made before and after his single examination by the long-time treating physician, Dr. Delahanty. During Dr. Elstein’s examination on September 28, 1977, he found straight-leg-raising in the supine position to 90 degrees on the left and 80 degrees on the right, and felt that Mrs. Miles was capable of sitting and standing for four hours, that her pain was mild and her range of motion not restricted. He further noted that she “stands erect.” Within a very few days thereafter, however, Mrs. Miles was admitted to the Auburn Memorial Hospital because of severe back pain with sciatic radiation. There she was treated conservatively with bed rest, traction, heat, and ultrasound, and was able eventually to walk using crutches. Dr. De-lahanty noted at this time — in total inconsistency with Dr. Elstein’s report — that Miles “has a forward list at about 20 degrees,” that she “can bend only forward to reach partway to her knees and has severe pain in doing this,” and that “[i]n the supine position the straight leg raising test is positive on the right at about 20 degrees and on the left at about 60 degrees causing severe back pain.” The importance of these findings on this well-known and generally utilized straight-leg-raising or Lasegue test cannot be overestimated, since along with the claimant’s list this test tends objectively to demonstrate a serious back condition. See 1 Lawyers’ Medical Cyclopedia §§ 7.10-.11 (1966 & Supp. 1968). The absence of such findings in Dr. Elstein’s report and their presence in Dr. Delahanty’s is simply unexplained. Dr. Delahanty’s report added that leaning to the right and left more than 10 degrees increases her difficulty, that she has “advanced degenera*126tive arthritic changes” of the L5 lumbar space observable by X-ray, and that she has had continuing treatments including two laminectomies — serious back operations used only as a last resort in herniated disc cases. Dr. Delahanty found Mrs. Miles’s standing capacity to be one hour, her walking capacity one block, her sitting capacity one hour, and her bending capacity “to minimal degree.”
In light of the claimant’s past history, the previous finding of disability, and the diagnosis made during the twelve-day stay at the Auburn Memorial Hospital, which occurred within a matter of days after her examination by Dr. Elstein, one has to wonder how the AU could conceivably have relied upon Dr. Elstein’s report to the exclusion of the other evidence. See Bastien v. Califano, 572 F.2d 908, 912 (2d Cir. 1978) (“[t]he expert opinions of a treating physician as to the existence of a disability are binding on the factfinder unless contradicted by substantial evidence to the contrary”); Vitek v. Finch, 438 F.2d 1157, 1160 (4th Cir. 1971) (“the opinion of a claimant’s treating physician is entitled to great weight, for it reflects an expert judgment based on a continuing observation of the patient’s condition over a prolonged period of time”); Selig v. Richardson, 379 F.Supp. 594, 601 (E.D.N.Y.1974) (“once it is determined that an impairment exists, the opinions of the treating physician are entitled to substantially greater weight than the impressions of a doctor who sees the claimant only once . .., especially where [the treating physician] has treated the claimant over a substantial period of time”). In any event, I do not believe that the ALJ’s decision can be accepted without an explanation on his part of the inconsistencies involved here. See Day v. Weinberger, 522 F.2d at 1156; Vitek v. Finch, 438 F.2d at 1160; Chiappa v. Secretary of Department of Health, Education and Welfare, 497 F.Supp. 356, 360 & n.3 (S.D.N.Y.1980).
Finally, on the ALJ’s third point, Mrs. Miles’ “work-related activities,” it is true that she took a part-time job as a short-order cook and cashier at a coffee shop. However, the ALJ did not discuss the facts that this work involved only eight hours per week with a weekly gross of $20, that it was done by Mrs. Miles without the knowledge or approval of her treating physician, Dr. Delahanty, and that after working even this little bit, with freedom to take breaks and sit down, she felt “not too good” and had “very, very severe” pain. To be sure, Mrs. Miles testified that she did a little of her own housework, but this consisted of making breakfast and straightening up her room. She said that she could do housework, laundry, and shopping, but only “when I’m good.” As for the ALJ’s statement that “her daily prescribed exercises of walking” were inconsistent with her allegations as to pain, the ALJ failed to consider that this was a prescription that the doctor hoped Mrs. Miles could work up to; it was not something that she was able to do. In response to the question “[h]ow many blocks can you comfortably walk?” her answer was “[m]aybe a block and a half,” an answer which was completely consistent with Dr. Delahanty’s finding that at the time of her November hospitalization at Auburn Memorial her capacity for walking was “one block.” The ALJ evidently equated the doctor’s prescription with her actual physical capacity and this was erroneous.
It is true that the claimant has filed a new application for Social Security benefits, but this application is limited to a period of disability beginning July 31, 1978, and does not cover the period between September 1977 and July 31, 1978. The present case, therefore, has considerable importance. Although there are several other defects in this record, the foregoing will suffice to state my view that, in addition to failing to consider important evidence, the ALJ has simply not given us a rational decision explaining the inconsistencies between his findings and what seems to me the overwhelming weight of the evidence. I think he is required to provide such an explanation, especially in a cessation proceeding as opposed to an initial determination of disability. Accordingly, I would remand to the Secretary for reconsideration and further findings.