Bell v. Bowen

• Decision Date: 14 August 1986
• Docket Number: No. 85-3543,85-3543
• Citation: 796 F.2d 1350
• Parties: , Unempl.Ins.Rep. CCH 16,918 Noah C. BELL, Jr., Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee. Non-Argument Calendar.
• Court: U.S. Court of Appeals — Eleventh Circuit

Page 1350

796 F.2d 1350

14 Soc.Sec.Rep.Ser. 284, Unempl.Ins.Rep. CCH 16,918

Noah C. BELL, Jr., Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services Defendant-Appellee.

No. 85-3543

Non-Argument Calendar.

United States Court of Appeals Eleventh Circuit.

August 14, 1986.

William C. Davis, Jr., Jacksonville, Fla., for plaintiff-appellant.

Dorothea Beane, Asst. U.S. Atty., Jacksonville, Fla., for defendant-appellee.

Appeal from the United States District Court for the Middle District of Florida.

Before FAY, JOHNSON and CLARK, Circuit Judges.

PER CURIAM:

In this Social Security disability case, we review the district court's conclusion that the administrative law judge and appeals counsel did not err in concluding that appellant is not disabled. This is a troubling case in which the claimant's treating physician concluded that the claimant is totally disabled because of massive heart enlargement while the ALJ relied upon a consulting physician's single examination and the report of the agency's medical consultant that the claimant retained the ability to perform a full range of sedentary activities.

Bell was born May 24, 1928, has a college degree, and had performed clerical functions essentially sedentary in nature until he stopped working April 16, 1982. It is undisputed that Bell has a severe cardiac problem, probably congenital having its origin in rheumatic fever and resulting in cardiac irregularities, fatigue, and shortness of breath. The claimant's physician who had treated him at least ten years concluded from various tests that Bell had a gross enlargement of the right atrium and right ventricle, as well as apparent mitral and tricuspid prolapse.

There is no dispute that Bell's condition constitutes a severe impairment. The inquiry is whether Bell's impairment meets or equals a listed impairment which would qualify him for a disability rating. See 20 C.F.R. Sec. 404.1520(d) and app. 1 to pt. 404 (list of various impairments based on certain objective symptomatology). Bell's impairment relates to category 4.01, Cardiovascular System. If Bell's impairment does not qualify him for a disability rating, he could still qualify for such a rating if he could prove that his illness prevents him from performing his past work or any other work. Bell failed to establish disability under any of these methods of qualifying.

Three doctors presented evidence for consideration by the ALJ, all in memorandum or letter form. Dr. John J. Rahaim is Bell's regular physician and has treated Bell since 1971. Dr. Rahaim's letter (Record at 99) describes Bell's history, medications, and the results of an echocardiogram. After describing the damage to Bell's heart, Dr. Rahaim concludes: "His condition will not improve and he will continue to suffer from severe disability."

Dr. A.E. Anderson examined Bell at the request of the agency and gave the following diagnosis and comment:

DIAGNOSIS: Probable rheumatic heart disease with severe cardiomegaly, probable mitral insufficiency, right bundle branch block, AV heart block, ST segment T-wave abnormalities and PAC's. Class II, C.

COMMENT: Although there was no evidence of congestive heart failure, this patient is felt to be restricted to a program of light physical activity by his cardiac difficulty.

Record at 87.

Dr. Sanford Cobb, a regular employee of the agency, reviewed Bell's file, including In light of this medical evidence and Bell's education and work history, the ALJ found that Bell "has the residual functional capacity to perform essentially a full range of 'sedentary work' activities as defined by the applicable Social Security Regulations."

the medical reports of Dr. Rahaim and Dr. Anderson. He concluded that Bell had a severe cardiac problem, probably congenital in origin and, while concluding that Bell had a severe impairment, he found him not to have congestive heart failure. See category 4.02, app. 1 to pt. 404 in 20 C.F.R. Dr. Cobb concluded that Bell could do sedentary work, but that he should not stand or walk as much as 6 hours a day.

Appellant contends that this finding is not supported by substantial evidence since the ALJ did not give proper weight to the opinion of Bell's treating physician. ¹ We have held that good cause must be shown if the opinion of the treating physician is discounted. We have further held that a non-examining physician's opinion is entitled to little weight if it is contrary to the opinion of the claimant's treating physician. See Broughton v. Heckler, 776 F.2d 960 (11th Cir.1985), for a discussion of these principles. In this case we do not find any particularized difference, let alone actual conflict, in the medical diagnoses of the three physicians. The variance among them is largely a matter of expression, as neither Dr. Rahaim nor Dr. Anderson described Bell's impairment in terms of the detailed objective symptoms of cardiovascular impairment set out in the Regulations. All three opinions reach about the same medical conclusion. They only diverge with respect to disability to work, but that divergence is not sufficiently articulated in Bell's behalf to warrant a reversal that Bell could not do a full range of sedentary work. Consequently, we conclude that the ALJ's finding that Bell is not unable to engage in substantial gainful activity is supported by substantial evidence. The treating physician's opinion on disability was properly discounted here. ²

The decision of the district court is AFFIRMED.

APPENDIX A

In an attempt to explain our consideration of Dr. Rahaim's diagnosis, we will elaborate on our opinion. All doctors who have examined Bell, the ALJ, and all judges who have reviewed the case conclude that Bell has a severe cardiac problem and impairment. However, the issue is whether Bell is unable "to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment." 42 U.S.C. Sec. 423(d)(1)(A).

Appellant argues (1) that claimant's severe impairment met or equalled the Secretary's listed impairments (2) that the evidence established claimant could not perform his past relevant work and (3) that the ALJ applied the incorrect legal standard in evaluating claimant's subjective complaints of disability. See supra note 3.

The appellant and the dissent miss the mark if they believe Dr. Rahaim's medical opinion and conclusions meet the requirements of Sec. 404.1520(d) of the regulations which provides, "if you have an impairment which meets the duration requirement and is listed in Appendix 1, or we determine that the impairment is equal to one of the listed impairments, we will find you are disabled without considering your age, education, and work experience." We include in the Appendix B 20 C.F.R. Sec. 401, pt. 404, subpt. P, app. 1 which describe the listed impairments that detail various types of cardiovascular diseases and the objective At no point in his opinion, did Dr. Rahaim compare his objective findings with respect to Bell's illness with the listed objective findings under subsection 4.02 and conclude that Bell met the listed impairments. In fact Dr. Rahaim does not mention the regulations or the listed impairments. Nor does Dr. Rahaim state that Bell has an impairment that is equal to one of the listed impairments as required by the regulation. Nor does Dr. Rahaim state that Bell had several different impairments which in combination would prevent Bell from engaging in substantial gainful activity.

symptoms which must be found to support a finding of disability under regulation 404.1520(d) and subsection 4.02. The type of cardiac illness suffered by Bell comes within the purview of subsection 4.02, congestive heart failure. Dr. Cobb was of the opinion that his condition is cor pulmonale, listed under paragraph D.

We hold that when a claimant contends that he has an impairment meeting the listed impairments entitling him to an adjudication of disability under regulation 404.1520(d), he must present specific medical findings that meet the various tests listed under the description of the applicable impairment or, if in the alternative he contends that he has an impairment which is equal to one of the listed impairments, the claimant must present medical evidence which describes how the impairment has such an equivalency. See 20 C.F.R. Secs. 404.1525 and 404.1526. Dr. Rahaim's conclusion that Bell is "totally disabled," and that "[h]is condition will not improve and he will continue to suffer from severe disability" is not sufficient. Bell has not met the burden of furnishing the medical findings which would permit a determination of disability under regulation 404.1520(d).

Appellant next argues that the Secretary erred in finding that he could perform his past relevant work. We have stated that the ALJ was correct in concluding that Bell did not have an impairment listed in Appendix 1 or an impairment equivalent to such an impairment. Regulation 404.1520(e) provides, "If we cannot make a decision based on current activity or on medical facts alone, and you have a severe impairment(s), we then review your residual functional capacity and the physical and mental demands of the work you have done in the past. If you can still do this kind of work, we will find that you are not disabled." Dr. Rahaim's opinion was dated July 16, 1982. He wrote in reference...