Gatson v. Bowen

• Decision Date: 02 February 1988
• Docket Number: No. 86-1078,86-1078
• Citation: 838 F.2d 442
• Parties: Helen GATSON, Plaintiff-Appellant, v. Otis R. BOWEN, M.D., Secretary of the Department of Health and Human Services, Defendant-Appellee.
• Court: U.S. Court of Appeals — Tenth Circuit

Page 442

838 F.2d 442

20 Soc.Sec.Rep.Ser. 474

Helen GATSON, Plaintiff-Appellant, v. Otis R. BOWEN, M.D., Secretary of the Department of Health and Human Services, Defendant-Appellee.

No. 86-1078.

United States Court of Appeals Tenth Circuit.

Feb. 2, 1988.

Martha Ridgway Schmid (Luis Mata with her on the brief), Wyandotte-Leavenworth Legal Services, Kansas City, Kan., for plaintiff-appellant.

Robert A. Olsen, Asst. U.S. Atty. (Benjamin L. Burgess, Jr., U.S. Atty., with him on the brief), Kansas City, Kan., for defendant-appellee.

Before McKAY, ANDERSON and BALDOCK, Circuit Judges.

STEPHEN H. ANDERSON, Circuit Judge.

Helen Gatson applied for social security disability insurance benefits in June 1983, having met the earnings requirements through December 31, 1982. Her application was denied at all stages of the Social Security Administration's review process. The denial was upheld by the district court. We reverse for failure to apply the correct standards to the evaluation of subjective pain.

BACKGROUND

The claimant alleges that she became disabled perhaps as early as September 1978 but in no event later than December 31, 1982 due to a heart condition, arthritis, right-hand impairment, hiatal hernia, and kidney problems, all accompanied by severe pain in her left leg and hip, right hand, chest, shoulders, and neck. During the five years prior to September 1978 she performed medium-heavy work in a chair factory, preceded by ten years as a sewing machine operator in a garment factory. In 1978, because of an injury to the nerves in her right hand, she left her job in the chair factory. She received worker's compensation benefits for a brief period and has not worked for pay since the injury.

In July 1982, the claimant was hospitalized for severe bronchitis and hemoptysis (expectoration of blood from the respiratory tract). At the time of her hospitalization, x-rays were taken, indicating marked cardiomegaly (enlarged heart). Other diagnostic findings indicated some congestive heart failure, atherosclerotic heart disease, and angina pectoris (chest pain). R. Vol. I at 128. At the time of her hospital admission, her treating physician, Dr. Reginald W. Hall, noted the claimant's previous medical history of both "carpal tunnel release" (referring to the prior surgery on the nerves of her right hand) and "some rheumatoid arthritis." Id. at 129. There are medical findings in the record supporting the claimant's right hand impairment but no such evidence as to the rheumatoid arthritis. In the same hospital report, Dr. Hall stated that the claimant "complains of chronic arthralgias and weakness of the arms and legs and [has been] unable to work as a result...." Id. at 129. She was released early from the hospital "because of some financial matters" after marked improvement in her bronchitis. Id. at 128.

On June 30, 1983, Dr. Hall, who had treated the claimant since 1980, wrote a letter to the Social Security Administration describing the claimant's medical condition over the past several years. He noted 1980 objective test results substantiating the claimant's right hand impairment, and reported stiffness, weakness, inflammation, and muscular atrophy in the hand subsequent "somewhat compromised by the fact that [the claimant] has been taking lanoxin for the control of congestive heart failure which she has developed in the past two years. Her official report therefore only reveals a boarderline [sic] abnormal tracing with S-T segment changes which possibly where [sic] releated [sic] to the digoxin but which in fact are true abnormal findings. Mrs. Gatson, dispite [sic] her determination has very little exercise tolerance and has had marked orthopnea which is now improving somewhat although her angina is still very active. This lady also needs further care toward her cardiovascular system in terms of evaluation but is also unable to afford this because of the situation which has resulted from the disability of her hand."

to her carpal release surgeries. Id. at 150. Dr. Hall observed that financial constraints prevented "definitive therapy" on her wrist. The letter also reported the claimant's recurring angina and the results of a treadmill electrocardiogram (ECG). Dr. Hall stated that the treadmill results were

The treadmill results are in the record and were available for review by the Social Security Administration's consulting physicians.

According to the record, the claimant began taking Nitrostat for her enlarged heart in 1980, Bufferin # 3 in 1982 for arthritis and body pain, potassium in 1982 for energy, and LaSix in 1982 to drain fluid from her heart. In 1983 she began using nitroglycerin ointment and Lanoxin for her heart, and Motrin for her arthritis. In 1984 valium was prescribed. R. Vol. I at 170.

The claimant testified that the pain in her side and right hand became bad in 1977, shortness of breath developed in 1980, pain in her left leg and hip became pronounced in 1981 and in her shoulders and neck in 1982. Id. at 40-41. The testimony of the claimant and two other witnesses then focused on the nature of her pain and her limited daily activity. Neither the claimant's attorney nor the ALJ made an effort to clarify the extent of the claimant's pain and limitations prior to December 31, 1982, the date by which her disability had to be established in order to receive disability benefits. The claimant indicated that, in general, the pain had intensified since 1977 and that her chest pain had been getting worse since 1980. Although this would suggest that her overall pain in 1982 was greater than in 1977, it is not clear whether the pain levels in late 1982 and at the time of the 1984 hearing were different in any significant degree. Certainly, the basic complaints had not changed from the initial claim for disability in June 1983, and except for a few statements referring to a current time frame, the testimony seemed to refer to the claimant's condition both before and after December 31, 1982. Furthermore, there is no indication that the testimony was not accepted by the ALJ as referring to the pre-1983 period.

The claimant and her friends described her continuing inability to reach, lift, bend, carry groceries, hold her coffee cup, garden, reel in her fish when she went fishing with her husband, curl her hair, sing, or even sit through church because of the pain and discomfort. The testimony also revealed the adaptations made by the claimant in order to dress, wash dishes, cook, and do the laundry. The claimant testified that she could not sit or stand for any length of time, nor walk around the block, without exhaustion and pain. She described severe pain even upon resting and sleeping. She also testified that currently she could not lift a ten pound bag of potatoes but could lift five pounds of sugar if she used both hands, although not without chest pain. The claimant also described kidney problems and a hiatal hernia that accentuated her distress, neither of which is addressed by the medical evidence, although the claimant referred to interaction with physicians with respect to those conditions. In the case of the hernia, it appears that the pain testimony described current pain and did not address the level of pre-1983 pain. According to her, "[e]verything that I lift, sometime I bend over, it just seem like everything in my chest is going to come out through my mouth. And everything I pick up now, it just seem like it go right straight to my The ALJ also considered medical evidence from a consulting physician and an occupational therapist, both of whom examined the claimant for the Social Security Administration in August 1983. The consulting physician, Dr. George Varghese, reported the claimant's multiple pain symptoms, found them "rather vague," and noted that the claimant appeared "emotionally very upset." Id. at 153. He noted some limitation in the joints of the claimant's right hand, along with decreased grip strength, although he did not detect continuing inflammation and muscle atrophy. He also acknowledged a pre-existing report of "ischemic heart disease" and opined that "her major disability should be on the basis of cardiovascular system than [sic] musculoskeletal involvement." Id. at 153. The occupational therapist, Janice Vollmer, evaluated the strength, range of motion, coordination, and sensation in the claimant's two upper extremities. She found restricted range of motion and strength in the right upper extremity, along with minor sensory loss and impaired coordination in the right hand. She reported that the left upper extremity was within grossly normal limits on the four measures. Id. at 153-54.

                chest.  It just hurt and make a pain in my chest."    Id. at 47 (emphasis added)
                

In addition to these examinations, the ALJ considered the residual functional capacity (RFC) assessments of two consulting physicians who filled out RFC forms based on their evaluation of the records but without examination of the claimant. Without explanation, they both opined that the claimant had the RFC for light work, with limitations as to fine work with the right hand.

Based on the medical evidence of record the ALJ found that the claimant had an impairment that precluded her return to past relevant work. He nonetheless found that she retained the RFC to engage in light work that did not require fine motor skills with the right hand. He determined that her capacity for light work "was not significantly compromised by her exertional limitations," which he equated with her allegations of pain, shortness of breath, and right hand limitations. Id. at 12. Elaborating, he stated that "[t]he claimant's subjective complaints of pain in her left leg and hip, right hand pain, chronic shortness of breath, hiatal hernia, coughing, and pain in her neck and shoulders are not as credible or limiting as alleged prior to December 31, 1982, based on the medical evidence of record." Id. at 12 (emphasis...