Cline v. Sullivan

Decision Date19 July 1991
Docket NumberNo. 90-1570SI,90-1570SI
Citation939 F.2d 560
Parties, Unempl.Ins.Rep. CCH 16204A Sigrid R. CLINE, Appellant, v. Louis W. SULLIVAN, Appellee.
CourtU.S. Court of Appeals — Eighth Circuit

Paul A. Zoss, Des Moines, Iowa, for appellant.

Richard L. Richards, argued (Gene W. Shepard, on brief), Des Moines, Iowa, for appellee.

Before ARNOLD and MAGILL, Circuit Judges, and BATTEY, * District Judge.

BATTEY, District Judge.

Appellant Sigrid R. Cline appeals from the judgment of the district court affirming the decision of the Secretary of Health and Human Services (Secretary) denying her claim for disability benefits. Because the Secretary's denial is not supported by substantial evidence, we reverse.


At issue in this appeal is the question of whether the district court erred in affirming the administrative law judge's (ALJ) decision to deny appellant supplemental security income (SSI) benefits for the period of October 1986 to November 1988. Appellant filed her first application for SSI benefits on October 14, 1986. An administrative hearing was held almost one year later on October 1, 1987. A Notice of Decision denying appellant's application was filed November 30, 1987, which decision appellant appealed to the Appeals Council and to the district court upon rejection of the appeal by the Appeals Council. While appellant's action was still pending in the district court, appellant filed a second SSI application on November 28, 1988, and was awarded benefits as of that date based upon appellant's advanced age and new evidence indicating a deterioration in her condition. This appeal thus concerns only the two-year period from the time of appellant's initial application to the period when plaintiff was awarded benefits in November of 1988.

At the time appellant filed her initial claim in October of 1986 she was 48 years old. She has a high school education and has worked as a waitress and a rooming house manager in recent years. Appellant first experienced depression and back pain in the 1970s. X-rays taken in 1979 showed total disintegration of her right hip joint. Appellant underwent a total hip replacement in January of 1980.

Appellant obtained no significant medical treatment again until 1985 when Dr. W.C. Dannenmaier examined appellant for hand numbness and pain in the groin, right leg, elbows, feet, and left wrist. Dr. Dannenmaier concluded that appellant had excellent range of motion without pain in the hips, that the pain in appellant's right foot was caused by Morton's neuroma, and appellant's wrist pain was possible carpal tunnel syndrome and/or ulnar nerve compression. X-ray examination of the right hip showed a loosened line in the artificial hip. Dr. Dannenmaier recommended use of a splint on the wrist, flat and softly padded footwear, and use of a cane to decrease weight bearing on appellant's hip as much as possible.

Dr. Kevin Crowley first examined appellant in 1986. In his medical report Dr. Crowley expressed the opinion that appellant suffered from severe degenerative arthritis with right hip replacement and hypertension. Appellant was regularly taking Diazide and Aldomat for hypertension, and Centrax, Nalfon, and Tagomet on an as-needed basis to control nervousness, inflammation, and a peptic ulcer.

In November of 1986, Dr. Gary DeVoss conducted a social security disability examination of appellant. Dr. DeVoss reported that appellant complained of pain in her hands, elbows, knees, and feet and noted that her range of motion was normal and her grip strength fairly good. X-rays of the right hip showed minimal dystrophic calcification superiorly over the greater trochanter. Dr. DeVoss diagnosed a history of osteoarthritis, moderately symptomatic with minimal destructive changes noted, history of total right hip replacement with mild residual dysfunction, and hypertension under good control.

Upon referral by Dr. Crowley, appellant was seen in the general medicine clinic at the University of Iowa in February of 1987. Dr. Mark Armstrong evaluated appellant for chronic pain in her hands, elbows, knees, and feet, and for left chest and shoulder pain with shortness of breath. Dr. Armstrong reported that appellant has an active arthritic process versus fibrositis with tender points and probable carpal tunnel syndrome. Dr. Armstrong noted that appellant had a history of active inflammation and laboratory results were within normal limits.

Dr. Stanley Naides examined appellant in the rheumatology clinic at the University of Iowa in March of 1987. Dr. Naides noted that appellant reported no improvement, and continued to complain of hand numbness, and a constant, dull, aching pain in her entire body, worse in the feet wrists, and hands. Laboratory results were normal and the general physical examination, as well as X-rays of the chest, left elbow, and shoulder were unremarkable. Dr. Naides reported "no evidence of active arthritis" or "rheumatological disorder at present." Dr. Naides increased appellant's Clinoril dosage to control inflammation and ordered additional laboratory tests as well as hand, hip, and pelvic X-rays. Dr. Naides also recommended an evaluation by the neurology team. In an addendum to his report, Dr. Naides indicated that the hip X-ray indicated a possible loosening of the hip prosthesis and that an orthopedic consultation had been requested. The report of appellant's March 1987 neurological examination indicated that she complained of chronic pain occurring daily. No evidence or peripheral neuropathy was found, but Amitriptyline was prescribed for pain and headache.

In May of 1987 appellant was examined by Dr. C.R. Clark in the orthopedics clinic. Dr. Clark reported that appellant had a two centimeter leg length discrepancy, but had excellent full range of motion and absence of pain in her right hip. Review of X-rays showed loosening of the acetabular component of the hip prosthesis with no actual migration and relative good preservation of the joint space. Dr. Clark noted that the hip did not appear to be particularly symptomatic (indicative of a disease) and recommended a one-year follow-up visit.

Dr. Naides reported to the State of Iowa Department of Human Services in June of 1987 the results of appellant's examinations at the University of Iowa. Dr. Naides stated that nerve conduction studies, electromyograms, and X-rays of appellant's chest, left elbow, left shoulder, hands, left hip, and pelvis were all normal, thus ruling out a diagnosis of carpal tunnel syndrome, and that appellant's most likely diagnosis is fibromyalgia--pain in the fibrous connective tissue components of muscles, tendons, ligaments, and other white connective tissues. Fibromyalgia often leads to a distinct sleep derangement which contributes to a general cycle of daytime fatigue and pain. Dr. Naides indicated that appellant was under supervision and that it would be difficult to predict the expected duration of her condition. Dr. Naides also stated that while a diagnosis of fibromyalgia does not usually result in total incapacitation, the patient's subjective perceptions of her pain and discomfort could limit her work capacity.


Appellant was the only witness to testify at the administrative hearing. According to her testimony, appellant had been employed in a restaurant part-time as a waitress/hostess showing guests to tables and acting as a cashier. This employment earned appellant $450-$500 per month. On the job, appellant sometimes carried two to three dishes at a time and poured coffee, but she used a steel wrist support to balance the items so that her wrist would not give out. She also testified that many times she fell while working and that her supervisor did not require her to do hard physical work. Appellant further testified that she could stand without moving for up to a half-hour, could sit comfortably for a long period only if she could put up her feet, and could drag, but not lift, a gallon container.

When not at work, appellant and her husband, who is totally disabled and unable to work, spend their days at home talking, taking short walks, watching television, and reading. They do not socialize, or attend movies or church. Appellant drives a car daily or every other day to the grocery store, located eight blocks from her home, but must use both feet to apply the brakes. She can carry a sack of groceries if they are not too heavy, and she must pull, rather than push, her grocery cart. Appellant can cook one light meal a day, but uses small kitchen appliances with pain. Her husband washes her hair because appellant can not raise her arms to apply pressure. Appellant testified that her joints swell if she stands too long, and that she tries to relieve pain by alternately moving and sitting.

In her testimony, appellant stated that her whole body hurt, particularly the joints in her hands and feet, that the bones are constantly aching, and that she felt numbness in the last two fingers on both hands. She also testified that her pain had increased in the previous two years, that she could not remember a moment free of pain, and that doctors had told her that the pain would get worse in the future. Appellant testified that her feet hurt very much after sitting for 50 minutes at the administrative hearing.

Finally, appellant testified that she took daily doses of numerous prescription medications for relief from headaches, hypertension, and muscle inflammation. Appellant also testified that she did not take prescribed pain medication or Tylenol and that she is allergic to aspirin. Appellant testified that she is pain-free only in deep sleep because she is heavily medicated by the time she goes to bed.

The ALJ found that appellant suffered from possible fibromyalgia manifested by pain involving multiple joints and some instability in her right leg as a result of the loosening...

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