Gude v. Sullivan

• Decision Date: 07 February 1992
• Docket Number: No. 91-1464,91-1464
• Citation: 956 F.2d 791
• Parties: , Unempl.Ins.Rep. (CCH) P 16445A, 2 NDLR P 234 La Vern GUDE, Appellant, v. Louis W. SULLIVAN, Secretary of Health and Human Services, Appellee.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 791

956 F.2d 791

36 Soc.Sec.Rep.Ser. 360, Unempl.Ins.Rep. (CCH) P 16445A,

2 NDLR P 234

La Vern GUDE, Appellant, v. Louis W. SULLIVAN, Secretary of Health and Human Services, Appellee.

No. 91-1464.

United States Court of Appeals Eighth Circuit.

Submitted Sept. 13, 1991.

Decided Feb. 7, 1992.

Thomas E. Kalmbach, Clayton, Mo., argued, for appellant.

Therese A. Yost, Kansas City, Mo., argued (Stephen B. Higgins, U.S. Atty., and Wesley D. Wedemeyer, Asst. U.S. Atty., St. Louis, Mo., and Frank V. Smith, III and Mary Dey Purcell, Kansas City, Mo., on brief), for appellee.

Before ARNOLD, ^* Circuit Judge, HEANEY, Senior Circuit Judge, and JOHN R. GIBSON, Circuit Judge.

HEANEY, Senior Circuit Judge.

La Vern Gude appeals from the order of the district court affirming the Secretary of Health and Human Services' (Secretary) denial of her application for social security disability and Supplemental Security Income (SSI) benefits. We reverse and remand with instructions to the Secretary to grant benefits.

Background

Gude is a twenty-eight year old woman with a high school education. She has an IQ of 75, which puts her in the borderline range of intelligence. Gude claims to have been disabled since July 5, 1986 due to systemic lupus erythematosus (SLE) and seizures. SLE is a chronic, relapsing inflammatory disease that attacks connective tissues and is characterized by a wide range of symptoms, including arthritis, pain in the joints, kidney and blood disorders, skin eruptions, and fever. Dorland's Illustrated Medical Dictionary 958 (27th ed. 1988).

Gude filed her claim for benefits on December 16, 1987. Her claim was denied initially and on reconsideration. Gude then requested and received a hearing before an administrative law judge (ALJ). At the hearing, Gude testified that she has suffered from pain and swelling in her knees and hands since she got SLE in 1986. Gude stated that she takes prednisone to control her SLE, but that the drug makes her dizzy and causes swelling. Gude said that she also has bad headaches about once a week for which she takes Dolobid, ¹ although the drug has little effect; that she is often fatigued; that bright sunlight gives her skin rashes and hurts her eyes; that her doctor told her not to go outside in temperatures above eighty degrees or below thirty degrees; and that she has four "bad" days each week. Gude stated she did not drive or go grocery shopping and did little housework because of fatigue. Her activities consist of going to church once a week, taking short walks, reading, and watching TV until her eyes give her trouble.

Gude's last job was as a pre-school babysitter in 1986; she left that job because parents complained that the swelling of her hands interfered with her work. Before that, Gude put tags on clothes at Goodwill Industries, was a cashier and cook at two fast food restaurants, and was a file clerk.

The medical evidence in the record indicates that Gude was hospitalized on July 13, 1986 complaining of chest and rib pain. She was diagnosed as having pneumonia and SLE. The next month Gude was hospitalized for renal failure; manifestations of her SLE during that hospitalization included grand mal seizures associated with lupus cerebritis, joint pains, and hematological abnormalities. Since then, Gude has seen her treating physician, Eric Jacobson, M.D., approximately every three months, but sometimes more frequently. In a September 7, 1988 letter, Dr. Jacobson reviewed Gude's past manifestations of SLE, including arthritis, joint pain, hair loss, kidney disease, and seizures. After noting that Gude's condition had "stabilized over the past year," Dr. Jacobson stated that Gude's present symptoms include migratory arthritis, severe headaches, fatigue, persistent hair loss, and mild photosensitive skin rash. Although Dr. Jacobson noted that the medication he prescribed "seems to control her symptoms rather well," he concluded that Gude's prognosis was unclear and that her "symptoms are significant and would interfere with permanent employment."

Following the hearing, the ALJ found Gude not disabled. The ALJ did not believe Gude's allegations concerning her severe chronic headaches, discomfort, and severely restricted activities. Although he acknowledged that Gude had SLE in remission, fatigue, joint stiffness, a borderline intellectual function, and a history of one seizure, he found that she did not have an impairment or combination of impairments listed in Appendix 1, Subpart P of the social security regulations. The ALJ then found that Gude could not perform her past relevant work as a fast food restaurant worker, babysitter, Goodwill employee, or file clerk, and that Gude could not work in bright sunlight, lift more than ten pounds, or walk or stand for prolonged periods. Nonetheless, the ALJ concluded that Gude had the residual functional capacity to perform the full range of sedentary work, applied the Medical-Vocational Guidelines, and found Gude not disabled. The Appeals Council denied Gude's request for review, making the ALJ's decision the final decision of the Secretary.

Gude sought review in the United States District Court for the Eastern District of Missouri. Magistrate Judge Robert Kingsland recommended that Gude's case be remanded because the ALJ failed to call a vocational expert to testify regarding Gude's ability to perform other jobs in the economy. The district court declined to adopt the magistrate's recommendation and granted summary judgment for the Secretary. In the district court's view, the ALJ did not need to call a vocational expert because the ALJ's decision to discredit Gude's claim of pain was supported by the record. This appeal followed.

Discussion

The ALJ concluded that Gude's claims of pain and discomfort were not credible and that Gude could do sedentary work. Gude claims that substantial evidence in the record as a whole fails to supports these conclusions. We agree.

1. Treating physician's opinion

The ALJ did not give due deference to the opinion of Dr. Jacobson, Gude's treating physician. The opinion of a treating physician is entitled to great weight unless it is unsupported by medically acceptable clinical or diagnostic data. Kirby v. Sullivan, 923 F.2d 1323, 1328 (8th Cir.1991). Here, Dr. Jacobson's letter set forth Gude's present symptoms, characterized them as significant, and concluded that they would interfere with permanent employment. Although Dr. Jacobson's conclusions are well supported by the medical evidence in the record, and there is no contrary medical evidence, the ALJ chose to disregard Dr. Jacobson's findings.

The ALJ did so by relying on statements in Dr. Jacobson's letter which, in the ALJ's view, minimized the significance of Gude's symptoms. As the ALJ noted, Dr. Jacobson's letter stated that Gude's SLE had been in remission, that her condition had stabilized, that her symptoms were controlled by prednisone, and that she had not experienced any seizures since August 1986. While these statements by Dr. Jacobson are well supported by the record, we believe the ALJ took these statements out of context and ignored the thrust of Dr. Jacobson's report. The fact that Gude's SLE is "in remission" and "has stabilized" does not mean that Gude's symptoms have gone away or that they do not exist. Indeed, Dr. Jacobson's letter stated that Gude has continued to experience precisely the symptoms she related during her hearing testimony, and it characterized Gude's present symptoms as significant.

Significantly, Dr. Jacobson's medical notes indicate that Gude has had symptoms associated with her SLE even while she has been in "remission." For example, on November 25, 1987, Dr. Jacobson noted that Gude "[c]ontinues to do well," even though Gude complained of chronic fatigue, hair loss, and persistent joint pains and stiffness in her hands and knees. It may well be that Gude was "doing well" during 1987--for someone who suffers from SLE--but the record shows that she still experienced symptoms during that time. Moreover, less than three months later Gude had a "flare" and what Dr. Jacobson described as "worrisome" SLE symptoms: new joint pains in Gude's neck, feet, knees, and hands, as well as general fatigue, facial swelling, and "red" eyes with photophobia and pain. By March 9, 1988 Gude's eyes were better, but her pain remained. In sum, nothing in the record suggests that the symptoms described by Jacobson during his treatment of Gude are fabricated or inconsistent with the diagnosis of SLE.

This case is thus similar to Fleshman v. Sullivan, 933 F.2d 674 (8th Cir.1991), where the applicant had undergone a kidney transplant and claimed disabling pain. The ALJ discounted the applicant's allegations of pain because physician's notes stated that the claimant was "doing well." We held this to be improper, noting that although the claimant in Fleshman may have been doing well for someone with a kidney transplant, that fact neither compelled nor supported a finding that the applicant was not disabled where the uncontradicted medical evidence supported the applicant's claims of pain and confusion. Id. at 676. Likewise, Gude may be doing as well as can be expected given her case of SLE, but we find nothing in this record to contradict Dr. Jacobson's conclusion that Gude's symptoms exist and will impede her from performing full-time employment.

2. Subjective complaints of pain

Although the ALJ agreed that Gude's SLE involved some fatigue and joint stiffness, he disbelieved Gude's subjective claims of pain and discomfort because he found them inconsistent with the record as a whole. After examining the record, we conclude that the ALJ's decision on this point was not supported by substantial evidence.

At the outset, we note that Gude's complaints of pain and fatigue are entirely consistent with the general course of SLE. "Mild" SLE includes fever, arthritis, pleurisy, pericarditis, headaches, and rash, while "...