868 F.2d 323 (9th Cir. 1989), 85-2867, Davis v. Heckler
|Citation:||868 F.2d 323|
|Party Name:||Jacqueline W. DAVIS, Plaintiff-Appellant, v. Margaret M. HECKLER, Defendant-Appellee.|
|Case Date:||February 13, 1989|
|Court:||United States Courts of Appeals, Court of Appeals for the Ninth Circuit|
Argued and Submitted April 11, 1988.
Abraham Virdeh, Virdeh & Virdeh, Santa Rosa, Cal., for plaintiff-appellant.
Michael R. Power, U.S. Dept. of Health & Human Services, San Francisco, Cal., for defendant-appellee.
Appeal from the United States District Court for the Northern District of California.
Before FERGUSON and LEAVY, Circuit Judges, and WILSON, 1 District Judge.
WILSON, District Judge:
Jacqueline Davis appeals from the denial of disability insurance benefits contending that the Administrative Law Judge ("ALJ") improperly rejected the opinion of her treating physician. We agree and reverse. In the process we take the opportunity to clarify the legal standard for rejecting the opinion of a treating physician, as well as to explain the claimant's evidentiary burden in establishing a prima facie case of disability.
FACTS AND PROCEEDINGS BELOW
Davis alleged disability commencing December 30, 1981 due to heart disease. On December 30, 1981, Davis sought medical treatment in response to swelling in her ankles and extreme shortness of breath. Dr. Paul Umino, a general practitioner and Davis's family physician, diagnosed her condition as congestive heart failure secondary to arteriosclerotic heart disease. A chest X-ray on January 3, 1982 revealed a moderately enlarged heart. The radiologist diagnosed her condition as "mild" congestive heart failure with no evidence of focal pulmonary disease. Dr. Umino placed claimant on medication, and, on a follow-up visit on January 9, 1982, reported marked improvement in her symptoms. A cardiogram taken at this follow-up session revealed sinus tachycardia (irregular heart beats) and ST-T wave changes consistent with "acute myocardial failure" and "severe" heart disease, but there was no indication of acute myocardial infarction.
Dr. Umino termed the prognosis "fair," but noted that due to her shortness of breath and congestive heart failure, she could not perform sustained work. He concluded, "Because of her shortness of breath, I consider her basically totally disabled because of this condition."
There is very little evidence of Davis's heart condition after January 9, 1982. The evidence consists of five treatment notes from Dr. Umino and the records of one visit to the Emergency Room at Petaluma Valley Hospital. The treatment notes are largely illegible, but variously indicate
Davis denied shortness of breath and complained of tiredness and chest pains. The records from the Emergency Room provide further inconclusive medical evidence. Davis came to the Emergency Room on August 20, 1982, complaining of extreme shortness of breath and reporting chest pain with activity. An electrocardiogram revealed the following abnormalities: few atrial premature contractions; a brief run of atrial fibrillation with ventricular response of approximately 120 per minute vs. sinus tachycardia seen on the rhythm strip; and ST-T changes consistent with ischemia and/or Digitalis effect since 3/4/78. The chest X-rays, however, showed no obvious abnormalities. Claimant's heart rate was regular with no murmur noted. Her breathing was impaired by only a "few wheezes," and she presented no pedal edema. The diagnosis was acute alcohol intoxication.
At the administrative hearing on June 6, 1983, the ALJ stated: "There's very little, as I recall, very little medical at all ... There's not enough in there to show a severe impairment." Davis's counsel agreed stating that Exhibit 17 (Dr. Umino's conclusion that claimant was incapable of working) constitutes "an opinion, there's no medical support for it." Davis's counsel stated that this lack of medical support for his client's claim was the reason he had arranged for claimant to be examined by Dr. Blackard, a cardiologist in San Francisco, on August 4, 1983.
The ALJ agreed to leave the record open for sixty days after the hearing to allow claimant to obtain the consultative cardiological report of Dr. Blackard. On June 23, 1983, before the report was obtained, Davis suffered a disabling stroke. No report from Dr. Blackard was submitted.
At the direction of the Secretary, Davis was examined by Dr. Mohinder P.S. Ahluwalia on December 8, 1983. Davis informed the doctor that she had no history of chest pain, but experienced a cough, sputum production, asthmatic bronchitis and wheezing for the preceding twenty years. She had smoked two packs of cigarettes per day for forty years until her stroke in June 1983. Dr. Ahluwalia examined Davis, reviewed medical records and offered his impressions of right cerebrovascular accident with left hemiparesis, status...
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