Felisky v. Bowen
| Decision Date | 07 July 1994 |
| Docket Number | No. 93-1529,93-1529 |
| Citation | 35 F.3d 1027 |
| Parties | , Unempl.Ins.Rep. (CCH) P 14132B Margaret FELISKY, Plaintiff-Appellant, v. Otis R. BOWEN, M.D., Secretary of Health and Human Services, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Sixth Circuit |
Gerald Benjamin, Levine, Benjamin, Tushman, Bratt, Jerris & Stein, Southfield, MI (briefed), for plaintiff-appellant.
Edward J. Kristof, Michael R. Mendola (briefed), Dept. of Health and Human Services, Office of Gen. Counsel, Region V, Chicago, IL, for defendant-appellee.
Before: MARTIN, RYAN, and SUHRHEINRICH, Circuit Judges.
Plaintiff, Margaret Felisky, applied for Social Security Disability Benefits on February 2, 1990, claiming disability as of July 18, 1988, due to pelvic and low back pain. Her application was denied initially and on reconsideration. Following an administrative hearing, the ALJ issued his decision finding Felisky not disabled. The Appeals Council denied review.
Felisky filed suit in federal district court challenging the Secretary's denial of her application for benefits. The parties filed cross-motions for summary judgment, and the district court found in favor of the Secretary and against Felisky. Felisky now appeals, raising the general issue of whether the Secretary's denial of her application is supported by substantial evidence. Specifically, Felisky raises, inter alia, the issues of whether the ALJ improperly rejected Felisky's testimony as not credible and whether the ALJ erred in finding that Felisky did not satisfy the standard for proving disabling pain. We find that the record does not contain substantial evidence to support the denial of Felisky's claim and reverse.
We know of no way to adequately explain the reason for our decision except to review the extensive evidence produced at the administrative hearing.
Felisky was born June 22, 1937. She has a high school education and completed a college nursing program in 1972. After obtaining her R.N., she worked at the Hurley Medical Center for seventeen years. In 1978, she was promoted to head nurse for both the intensive care unit and the "step down" unit. Felisky stopped work about July 18, 1988, to undergo a urinary bladder suspension operation. On the second day after surgery, she developed severe anterior pubic pain and was diagnosed as suffering from osteitis pubis, an inflammation of the pelvic bones. She also developed lateral pelvic pain on both her left and right sides. Low back pain soon followed. Felisky attempted to return to work on January 17, 1989. She was assigned limited duties, but had to stop working on April 4, 1989, after she injured her back moving a patient. The ALJ would later deem this to be a failed work attempt, a finding not disputed before this court.
Felisky's primary care physician appears to be Dr. Allen Stawis. Dr. Stawis has, however, referred Felisky to several other physicians in an attempt to determine the exact nature of her problem. One of these referrals was to Dr. Howard Duncan, who is the head of Henry Ford Hospital's Division of Rheumatology. On February 6, 1989, Dr. Duncan wrote a letter to Dr. Stawis detailing the results of his examination. Dr. Duncan's letter is not very helpful in determining the exact nature of Felisky's problem. He does, however, suggest various possible alternatives which could be explored to help pin down the problem. He concludes his letter by stating, "I wish we could be a little more positive in helping eradicate the problems in this patient, but at the present time I think the best we can hope for is gradual, spontaneous improvement with little help with analgesia."
Dr. Duncan's negative opinion was also shared by Dr. S. Martin, an orthopedist at the Hurley Medical Center. Dr. Martin examined Felisky several times after she sustained the back injury which forced her to stop working again on April 4, 1989. Dr. Martin opined:
I have a very bad feeling about this lady's ability to continue to work. I wonder if due to the nature of this workman's compensation I will ever be able to get her back to work in as much as she has already been sent to see a rheumatologist in July and because she is on Coumadin. We cannot give her nonsteroidals. She already has lumbosacral corset and she states that physical therapy makes her worse and not better. I feel that I can do nothing at this time to help her.
Dr. Stawis also referred Felisky to Dr. C. William Castor, Jr. at the University of Michigan Medical Center. Dr. Castor specializes in rheumatology. On July 14, 1989, Dr. Castor wrote a letter to Dr. Stawis in which he commented on the "astounding collection of x-rays, MRIs, bone scans, etc., as well as ample laboratory studies" which Felisky brought to the examination. Dr. Castor's initial impression is that Felisky was suffering from a form of reactive arthritis resembling Reiter's. 1 Dr. Castor, however, had ordered a number of studies, which he wanted to review before reaching a definite diagnosis.
These studies apparently were not determinative because, on November 17, 1989, Dr. Castor wrote to Dr. Stawis suggesting that "we take a fresh look at [Felisky's] problem, and to that end, I have repeated some of the imaging studies done earlier for evidence of either progression or hopefully for evidence of regression or alteration of the previous findings." In that same letter, Dr. Castor noted that Felisky continued to have severe pain in her spine, in the very low sacral area, as well as the pelvis in general. Dr. Castor also noted that Felisky had indicated she was uncomfortable lying, sitting, standing, and walking.
Similar conclusions were also expressed in a letter that Dr. Stawis wrote to the employee health services at Hurley Medical Center. This letter is dated October 18, 1989, and stated that Felisky had suffered almost continuous pain in her pelvic area and lower back. Dr. Stawis noted that Felisky continued to complain of a significant amount of pain even while sitting, and that this pain had caused Felisky to become inactive. He opined,
On January 5, 1990, Dr. Castor again examined Felisky. Dr. Castor's notes from the examination make it clear that he still had no definite diagnosis for her problems. The medical record indicates that by this point in time, Dr. Castor had become Felisky's primary care physician with respect to her low back and pelvic pain problems. Dr. Castor, however, only ordered studies and recommended treatments. Dr. Stawis implemented those recommendations, and he was the one who actually prescribed the medications. In addition, Dr. Stawis continued to treat Felisky for her other problems, including obesity, essential hypertension, hyperlipidemia, hypothyroidism, and chronic venous insufficiency of her lower extremities. In a letter dated March 20, 1990, Dr. Stawis indicated:
It is my feeling that Mrs. Felisky continues to be unable to perform any type of working duty because of her above mentioned problems. As I previously mentioned, she is unable to even perform normal household activities such as cooking and house cleaning and consequently is totally unable to be employed in any gainful occupation at this time.
The medical record also contains a March 23, 1990, letter from Dr. Neil A. Friedman, to the disability examiner of the Michigan Disability Determination Service. In reviewing Felisky's medical history, Dr. Friedman stated:
Ms. Felisky has had extensive diagnostic testing performed. She has been seen in the Rheumatology Clinic at the University of Michigan. Apparently, no specific diagnosis has been established; however, she does have radiographic and bone scan evidence for degenerative joint disease of the lumbosacral spine. There is also radiographic evidence for osteitis pubis; and, on at least one of the three bone scans she has had, the sacro-iliac joints demonstrated increased uptake of the radioactive material. Apparently, no specific diagnosis has been firmly established. The patient states that her low back and pelvic pain is increased with any form of activity. Specifically, she stated that following trips to the Rheumatology Clinic in Ann Arbor she has increased back and pelvic pain for six to eight weeks. Her pain is also apparently aggravated by undergoing physical examinations. She is able to achieve some symptom relief with the use of narcotic analgesics or by laying supine and motionless on a firm mattress.
Dr. Friedman next details his examination of Felisky, but does not draw any conclusion from this examination about Felisky's functional capabilities.
On April 13, 1990, Dr. Stawis wrote a "To Whom It May Concern" letter, again detailing a brief history of Felisky's medical problems. In that letter, as in the March 20, 1990 letter, he states that Felisky's progress has been followed by Dr. Castor at the University of Michigan Medical Center. Dr. Stawis noted that Dr. Castor has dictated the therapy for Felisky's problems. An April 27, 1990, letter from Dr. Castor to Dr. Stawis, however, shows that Dr. Castor had still not determined the exact source of Felisky's problems:
I had the pleasure of seeing your patient, Margaret Felisky, today, 4-27-90 in the University of Michigan Arthritis Outpatient Clinic. As you know, I have seen Mrs. Felisky a number of times since the fall of 1989 with reference to her unusual musculoskeletal complaints. These complaints of pain over the lower back, the iliac crest, the groin and the os pubis arose rather precipitously shortly after pelvic surgery related to a bladder suspension in mid 1989. The positive findings have been the finding of osteitis pubis by x-ray last summer as...
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