Court Opinion

ID: 2963859
Source: CourtListenerOpinion
Date Created: 2015-09-21 21:16:20.967683+00
Date Added: 2024-06-11T11:42:47.297978
License: Public Domain

USCA1 Opinion

	

                            UNITED STATES COURT OF APPEALS
                                FOR THE FIRST CIRCUIT

                           
                                 ____________________

        No. 95-1241 

                               VICTORIA MANSO-PIZARRO,

                                Plaintiff, Appellant,

                                          v.

                       SECRETARY OF HEALTH AND HUMAN SERVICES,

                                 Defendant, Appellee.

                                 ____________________

                     APPEAL FROM THE UNITED STATES DISTRICT COURT

                           FOR THE DISTRICT OF PUERTO RICO

                   [Hon. Salvador E. Casellas, U.S. District Judge]
                                               ___________________

                                 ____________________

                                        Before

                                Torruella, Chief Judge,
                                           ___________
                           Selya and Lynch, Circuit Judges.
                                            ______________

                                 ____________________

            Raymond Rivera Esteves and Juan A.  Hernandez Rivera on brief  for
            ______________________     _________________________
        appellant.
            Guillermo Gil,  United  States  Attorney,  Maria  Hortensia  Rios-
            _____________                              _______________________
        Gandara,  Assistant United  States  Attorney, and  Donna C.  McCarthy,
        _______                                            __________________
        Assistant Regional  Counsel, Department of Health  and Human Services,
        on brief for appellee.

                                 ____________________

                                   February 8, 1996
                                 ____________________

                      Per  Curiam.   Claimant Victoria  Manso-Pizarro was
                      ___________

            fifty-eight years  old when  she applied for  social security

            insurance  benefits on September 5, 1991.  She alleged that a

            heart condition, high blood  pressure and bad circulation had

            disabled  her  from working  since June  24,  1991.   After a

            hearing,  an Administrative  Law Judge  (ALJ) concluded  that

            claimant   suffered  from  hypertension,  obesity,  and  mild

            anxiety, but that she could  still perform her last  previous

            job.   Upon judicial  review, a magistrate  judge recommended

            affirming  the ALJ's  decision.   The district  court agreed.

            The claimant  appeals.   We  vacate  and remand  for  further

            proceedings.

                                          I.
                                          _

                      We  must   uphold  a  denial  of   social  security

            disability  benefits  unless "the  Secretary has  committed a

            legal  or factual  error in  evaluating a  particular claim."

            Sullivan  v.  Hudson,  490  U.S.   877,  885  (1989).     The
            ________      ______

            Secretary's findings  of fact are conclusive  if supported by

            substantial  evidence.   See  42  U.S.C.    405(g);  see also
                                     ___                         ___ ____

            Richardson v. Perales, 402 U.S. 389, 401 (1971).
            __________    _______

                      There is substantial  record evidence that claimant

            met her  initial burden  to provide enough  information about

            the  activities  her  usual   work  required  and  how  those

            activities were  compromised by her  functional inability  to

            perform that  work.   Claimant has a  twelfth-grade education

            and  worked for  twenty-two years  as a  kitchen helper  in a

            public  school  cafeteria.    Her  duties   included  serving

            children, preparing  milk, washing dishes  and trays, helping

            the cook, and  cleaning the floor.   The job required  her to

            stand or  walk for six hours a day, to sit for one-half hour,

            and  to lift  and carry  up to  thirty pounds  (including, on

            occasion, lifting and carrying large, hot cooking pots).  She

            described  her work as fairly heavy and stated that she could

            no longer perform  it because:   she lacked  the strength  to

            lift  anything  heavy; she  had limited  ability to  lift and

            carry because her  hands cramped due to bad  circulation; she

            had  blurry vision  and became  dizzy when  bending; and  she

            could not  stand for very long  due to pain on  her left side

            and in her feet.   Upon this foundation, the  ALJ supportably

            concluded that claimant's past relevant  work involved medium

            physical exertion,  and required  her alternately to  walk or

            stand for six hours, to lift or carry up to thirty pounds.

                      This   finding   implicated   step  four   of   the

            Secretary's sequential  evaluation process.  See  20 C.F.R.  
                                                         ___

            404.1520(e).    At step  four the  initial  burden is  on the

            claimant  to show that she  can no longer  perform her former

            work because  of her impairments.  See  Santiago v. Secretary
                                               ___  ________    _________

            of HHS, 944 F.2d 1,  5 (1st Cir. 1991).   At that point,  the
            ______

            ALJ must compare the physical and mental demands of that past

            work  with current functional capability.   See id.; see also
                                                        ___ ___  ___ ____

                                         -3-

            20  C.F.R.   404.1560(b).   In making a  step four appraisal,

            the ALJ is entitled to credit a claimant's own description of

            her former  job duties  and functional limitations,  see id.,
                                                                 ___ ___

            but has some burden independently to develop the record.  See
                                                                      ___

            id. at 5-6.
            ___

                      In  this instance,  the ALJ  decided that  claimant

            retained the  residual functional  capacity (RFC)  to perform

            her  past relevant  work as  a cook's  helper.   In comparing

            claimant's  retained capacities with  the mental and physical

            demands of her prior work, the ALJ concluded that because the

            record  indicated  no  physical  restrictions   limiting  her

            ability to alternately  walk or  stand for six  hours, or  to

            lift up  to thirty pounds, claimant's RFC  coincided with her

            past relevant work activities.1   The claimant argues that in
                                          1

            making this RFC assessment, the ALJ impermissibly interpreted

            raw medical evidence, and instead should have obtained an RFC

            assessment  by a physician.   The  Secretary disagrees.   She

            contends  that  the  non-severity of  claimant's  impairments

            entitled the ALJ  to make  a commonsense  RFC assessment  and

            that  the ALJ, in finding  that claimant retained  the RFC to

            perform medium-level exertion, did not overstep the bounds of

            lay competence.

                                
            ____________________

               1The  ALJ deemed it "advisable" to limit the claimant to a
               1
            medium work level  of exertion.   See generally  20 C.F.R.   
                                              ___ _________
            404.1567(c)  (medium work  involves lifting  no more  than 50
            pounds at a time with frequent carrying or lifting of objects
            weighing up to 25 pounds).

                                         -4-

                                         II.
                                         __

                      With a few exceptions  (not relevant here), an ALJ,

            as a lay person, is not  qualified to interpret raw data in a

            medical record.  See Perez v. Secretary of HHS, 958 F.2d 445,
                             ___ _____    ________________

            446  (1st Cir. 1991); Gordils  v. Secretary of  HHS, 921 F.2d
                                  _______     _________________

            327,  329  (1st Cir.  1990).   Of  course, where  the medical

            evidence shows relatively little  physical impairment, an ALJ

            permissibly  can   render   a  commonsense   judgment   about

            functional  capacity even  without a  physician's assessment.

            See, e.g., id.  But when, as now, a claimant has sufficiently
            ___  ____  ___

            put her  functional inability  to perform her  prior work  in

            issue, the ALJ must measure the claimant's capabilities, and

                      to make that measurement, an expert's RFC
                      evaluation is ordinarily essential unless
                      the  extent of  functional loss,  and its
                      effect  on  job  performance,   would  be
                      apparent even to a lay person.

            Santiago, 944 F.2d at 7.
            ________

                      Here, the record contains no analysis of functional

            capacity  by a physician or other expert.  Thus, the question

            whether substantial  evidence supports the ALJ's finding that

            claimant retains  the functional capacity to  do medium-level

            work and  otherwise perform  her prior  vocational activities

            depends on  a qualitative assessment of  the medical evidence

            that  was  before  the ALJ.    If  that  evidence suggests  a

            relatively   mild   physical   impairment  posing,   to   the

            layperson's eye, no significant exertional restrictions, then

                                         -5-

            we must uphold the ALJ's finding; elsewise, we cannot (in the

            absence of an expert's opinion).  See Perez, 958 F.2d at 446-
                                              ___ _____

            47; Gordils, 921  F.2d at 329.  It is  to that  perscrutation
                _______

            that we now turn.

                                         III.
                                         ___

                      On  June 27,  1991,  three days  after she  stopped

            working, claimant saw  Dr. Ruiz for chest pain, dizziness and

            palpitations.   Dr. Ruiz  diagnosed her as  having high blood

            pressure  and  premature ventricular  contractions.2 Although
                                                               2

            he prescribed medication,  the claimant's condition  worsened

            and  he hospitalized her  on July 6.   She was  placed in the

            intensive care  unit.   Tests showed ventricular  tachycardia

            (an   abnormally  rapid  ventricular  rhythm,  most  commonly

            associated with atrioventricular dissociation, see Dorland's,
                                                           ___

            supra,   at   1655),   frequent  PVCs,   premature   arterial
            _____

            contractions,   and  some   evidence  of   paroxysmal  atrial

            tachycardia (a condition marked by sudden onset and cessation

            of rapid  cardiac rate in the atrial locus, Dorland's, supra,
                                                                   _____

            at   655).3     The  principal   diagnosis   was  ventricular
                      3

            tachycardia.      Coexisting  admission   diagnoses  included

            premature ventricular beats, hyperthyroidism,  excess calcium

                                
            ____________________

               2Premature  ventricular  contractions  (PVCs)  are  "often
               2
            indicative of organic heart disease."   Dorland's Illustrated
                                                    _____________________
            Medical Dictionary 363 (28th ed. 1994).
            __________________

               3Several other entries in the record are illegible.
               3

                                         -6-

            and uric acid  in the  blood, moderate  dehydration, and  two

            other illegible conditions.

                      During  the  claimant's  twelve-day hospital  stay,

            seven  electrocardiograms combined conclusively to show sinus

            tachycardia.   Two chest  x-rays revealed an  enlarged heart.

            No  fewer than  five physicians  were asked  to consult.4   A
                                                                    4

            July 8 consultation report related a diagnostic impression of

            sinusal tachycardia and a history of arterial hypertension.

                      The discharge  summary  is mostly  unreadable.   It

            indicates, however,  that the claimant's laboratory, chemical

            profile, and  radiology tests were not  within normal limits.

            The prognosis was described as "fair."  Claimant was released

            on  a regime  of  medication and  extremely limited  physical

            activity.

                      Dr. Ruiz saw the claimant as an out-patient in July

            and  August, and  again in  January of  1992.  At  the August

            visit,  he  found  her  chest  pain  to  be  precipitated  by

            hyperthyroidism   with   supraventricular   tachycardia   and

            occasional episodes of ventricular tachycardia.  He diagnosed

            her   as  suffering  from   hyperthyroidism  with  associated

            hypertensive cardiovascular disease,  ventricular and  atrial

            tachycardia, and  PVCs.   He noted other  adverse conditions,

                                
            ____________________

               4Four of  the consulting physicians' reports (Dr. Gonzalez
               4
            -July 7;  Dr. Guerra - July  8; Dr. Rodriguez -  July 10; and
            Dr. [illegible]  -  July  11)  are, like  many  other  record
            entries, inscrutable not because  of copy quality but because
            the handwriting is not intelligible.

                                         -7-

            but  they  are  unreadable.    During that  same  month,  the

            claimant  was also  evaluated  at the  State Insurance  Fund.

            Tests  showed   cardiomegaly,  an  elongated   aorta  with  a

            calcified knob, and multifocal PVCs.

                      On November 26, 1991, the claimant was seen  by Dr.

            Medina-Ruiz,  the  Secretary's consulting  cardiologist.   At

            that  point,  the claimant's  chief complaints  were fatigue,

            lack  of  energy,  cramping  of the  legs,  palpitations  and

            numbness.   The  physical  examination and  associated  tests

            revealed  many  of  the  same heart-related  problems.    Dr.

            Medina-Ruiz's  diagnostic impression  included  a finding  of

            hypertensive cardiovascular disease.

                      On June 13, 1992, the claimant was hospitalized for

            three days due to high blood pressure, headaches  and blurred

            vision.   The  diagnosis  was hypertensive  crisis and  renal

            insufficiency.     She  improved  with   medication  and  was

            discharged with a one-week restriction of activities. 

                                         IV.
                                         __

                      Putting aside  the many  unreadable entries  in the

            medical  evidence,5  those  reports  otherwise  unambiguously
                              5

            indicate    the   existence   of   medical   conditions   and

            symptomatology that  do not appear, at  least without further

                                
            ____________________

               5In  this  case,  the  unreadable entries  may  have  some
               5
            import.  We think that it is  the duty of the ALJ, on remand,
            to make some effort to decipher them.

                                         -8-

            evaluation by an expert, to be so mild as to  make it obvious

            to a  layperson that  the claimant's ability  to perform  her

            particular  past work as a cook's helper was unaffected.  The

            Secretary   acknowledges  that   the  record   shows  cardiac

            abnormalities and other serious conditions.   Even if we were

            to conclude that substantial evidence documented no more than

            mild  physical  impairments  with   relatively  insignificant

            exertional  loss,  the record  here is  sufficiently ramified

            that understanding it requires more than a layperson's effort

            at  a  commonsense  functional  capacity  assessment.     See
                                                                      ___

            Gordils,  921  F.2d  at  329 (limiting  ALJ's  assessment  of
            _______

            claimant's functional  capacity to sedentary  work activities

            only).   To sum  up,  given the  illegibility of  non-trivial

            parts  of  the  medical reports,  coupled  with  identifiable

            diagnoses  and symptoms that seem to  indicate more than mild

            impairment, we believe that the record alerted the ALJ to the

            need  for  expert  guidance   regarding  the  extent  of  the

            claimant's  residual  functional   capacity  to  perform  her

            particular  past  employment.   See Perez,  958 F.2d  at 447;
                                            ___ _____

            Santiago, 944 F.2d at 4; Gordils, 921 F.2d at 329.
            ________                 _______

                      We need go no further.   Since the ALJ's conclusion

            that the  claimant can continue to do  her prior medium-level

            work is not readily verifiable on the record as it stands, we

                                         -9-

            think that the  case must  be remanded to  the Secretary  for

            additional evidence of functional ability.6
                                                      6

                      The judgment  of the district court  is vacated and
                                                              _______

            the  case  is  remanded  with  directions  to  remand  to the
                           ________

            Secretary  for  further  proceedings  consistent   with  this

            opinion.

                                
            ____________________

               6Because we remand for  further development of the record,
               6
            we  do not reach the other arguments advanced by the claimant
            on appeal.

                                         -10-