Houston v. Secretary of Health and Human Services, 83-5325

• Decision Date: 14 June 1984
• Docket Number: No. 83-5325,83-5325
• Citation: 736 F.2d 365
• Parties: , Unempl.Ins.Rep. CCH 15,422 Christine HOUSTON, Plaintiff-Appellant, v. SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant-Appellee.
• Court: U.S. Court of Appeals — Sixth Circuit

Page 365

736 F.2d 365

5 Soc.Sec.Rep.Ser. 344, Unempl.Ins.Rep. CCH 15,422

Christine HOUSTON, Plaintiff-Appellant, v. SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant-Appellee.

No. 83-5325.

United States Court of Appeals, Sixth Circuit.

Argued March 16, 1984.

Decided June 14, 1984.

James A. Anderson III (argued), Benton, Ky., for plaintiff-appellant.

Ronald E. Meredith, U.S. Atty., David T. Gray (argued), Louisville, Ky., for defendant-appellee.

Before ENGEL and KRUPANSKY, Circuit Judges, and WEICK, Senior Circuit Judge.

KRUPANSKY, Circuit Judge.

Appellant Christine Houston appealed from an order of the United States District Court for the Western District of Kentucky affirming the Secretary's decision that appellant was not entitled to disability benefits or supplemental security income under the Social Security Act as amended.

When she applied for benefits appellant was fifty-three years old and had worked from 1962 to 1979 as a hotel maid for the Commonwealth of Kentucky, Department of Parks. In her application dated March 25, 1980 appellant claimed that she was totally disabled because of muscle spasms. She was denied benefits initially by both the examiner and the reviewer. A hearing was subsequently held, and on January 16, 1981, the Administrative Law Judge (A.L.J.) found appellant to be ineligible for benefits. The Appeals Council upheld this decision initially and on remand from the district court, after the submission of additional evidence.

When supported by substantial evidence, the findings of fact of the Secretary are conclusive, and a decision denying benefits cannot be overturned. 42 U.S.C. Sec. 405(g). Substantial evidence means more than a mere scintilla of evidence. There must be "such relevant evidence as a reasonable person might accept as adequate to support a conclusion". Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 1427, 28 L.Ed.2d 842 (1971) (citing Consolidated Edison v. N.L.R.B., 305 U.S. 197, 229, 59 S.Ct. 206, 216, 83 L.Ed. 126 (1938)); Kirk v. Secretary of Health and Human Services, 667 F.2d 524 (6th Cir.1981). Substantiality must also be based on the record "as a whole". Allen v. Califano, 613 F.2d 139 (6th Cir.1980). This court is, therefore, charged to review the record in its entirety to determine if the finding of ineligibility was supported by substantial evidence.

To qualify for disability benefits the appellant must provide evidence of a medically determinable disability of a continuous twelve months duration which precluded her from engaging in substantial gainful activity. 42 U.S.C. Sec. 423(d)(1)(A). Appellant was required to prove that the impairment was severe and that it significantly limited her ability to perform basic work-related tasks such as walking, standing, sitting, seeing, speaking, following directions, getting along with co-workers, etc. 20 C.F.R. Secs. 404.1520, 404.1521. 20 C.F.R. Sec. 404.1522 proscribes combining unrelated physical impairments to satisfy the twelve-month durational mandate.

Appellant's medical records disclosed that she had several unrelated chronic physical ailments. She had abdominal muscle spasms resulting in urinary difficulties which occasionally required catheterization and the use of muscle relaxants. She had hypertension, cardio-vascular disease, osteoarthritis, decreased visual acuity, chronic cystitis, and adjustment disorder with atypical features. She was hospitalized nine times from August 1979 through February 1982 for treatment related to these problems and for other ailments including pneumonia, peptic ulcer and hiatal hernia, from which she recovered. Her treating physician, in a brief conclusory letter, stated that she was permanently and totally disabled. Appellant argued that the diagnosis of these various conditions, her nine hospitalizations, and her doctor's brief statement constituted sufficient proof of disability.

The diagnosis of multiple impairments in appellant's hospital records, however, did not automatically entitle appellant to benefits, absent proof of sufficient duration and disabling effect. The medical evidence reflected that appellant's impairments were controlled with medication and were not seriously disabling. Her physician described the hypertension as "mild". It did not result in a severe impairment of her cardiac reserve or in any retinal, renal, cerebral, or cardiac involvement, or in any end organ damage. The osteoarthritis caused no real loss of movement. The visual decrease was not significant in acuity or field. The urinary tract infection, although recurrent was treatable, as were the muscle spasms. Moreover, a review of the final diagnoses from the various hospitalizations did not show that any of appellant's impairments lasted for a continuous twelve months. Appellant recovered totally from several of her maladies. Hence there was no clear support for a finding of disability. See Henry v. Gardner, 381 F.2d 191, 195 (6th Cir.1967).

Appellant correctly asserted that the opinion of the treating physician should be given greater weight than that of the government's physician. See Allen v. Califano, supra at 145. This is true, however, only if the treating physician's opinion is based on sufficient medical data. 20 C.F.R. Sec. 404.1529. Ultimately, the determination of disability is the prerogative of the Secretary, not the treating physician, and the brief conclusory letter from appellant's treating physician, was not dispositive of the issue. Kirk v. Secretary of Health and Human Services, supra at 538; 20 CFR Sec. 404.1527 (1981).

Appellant claimed that her muscle spasms alone caused disabling pain. Although pain caused by clinically proven multiple impairments can be the disabling illness, Allen v. Califano, supra at 145, (citing Beavers v. Secretary of Health, Education and Welfare, 577 F.2d 383 (6th Cir.1978) and Noe v. Weinberger, 512 F.2d 588 (6th Cir.1975)), tolerance of pain is a highly individual matter and a determination of disability based on pain by necessity depends largely on the credibility of the claimant. Since the A.L.J. had the opportunity to observe the demeanor of the appellant, his conclusions with respect to credibility "should not be discarded lightly". Beavers v. Secretary of Health, Education and Welfare, supra at 387.

The A.L.J. noted that plaintiff did not appear preoccupied with personal discomfort and was able to get about without difficulty. The medical evidence contained no proof that appellant's spasms were frequent or of disabling severity, and appellant took muscle relaxants to control the spasms. Based on the evidence of record, on appellant's personal appearance and demeanor, he concluded that appellant's muscle spasms were not of such severity, duration, or frequency as to be disabling for a continuous period of twelve months, appellant's testimony notwithstanding.

In conclusion, the record included substantial evidence in support of the finding that appellant was not disabled under the provisions of the Social Security Act. Since the findings of the Secretary were supported by substantial evidence, deference to his decision is statutorily mandated. The decision of the district court is, therefore, affirmed.

WEICK, Senior Circuit Judge, dissenting:

I respectfully dissent.

42 U.S.C. Sec. 423(d)(1)(A) defines "disability" as the

inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

The Secretary has prescribed a five step sequential review for processing applications for benefits. See 20 C.F.R. Sec. 404.1520 (1983). As this Court noted in Kirk v. Secretary of Health and Human Services, 667 F.2d 524, 528 (6th Cir.1981), the regulations require that an initial determination be made as to whether the claimant is currently engaged in substantial gainful activity; if so, the claimant is found "not disabled." Second, the Secretary must determine if the claimant has a severe impairment--one that significantly limits the ability to perform work-related functions; if not, then on the medical evidence alone the claimant is determined to be not disabled. Third, if a severe impairment is found, the impairment is compared against those listed in Appendix 1, 20 C.F.R. Subpart P, Sec. 404 (1983), to see if, on the medical evidence alone, the claimant can be found to be disabled. Assuming the claimant is not found disabled by reference to Appendix 1, the fourth step requires inquiry into whether the claimant can perform past relevant work; if so, then the claimant is not disabled. Finally, the Secretary will apply the medical vocational tables, Appendix 2, 20 C.F.R. Subpart P, Sec. 404 (1983), to determine whether the claimant can perform any substantial gainful activity in the national economy; if not, then the claimant can be found to be disabled.

Two different methods are prescribed by the regulations to accomplish the second step of the decisional sequence. Under Sec. 404.1521, an impairment is not severe if it does not significantly limit the claimant's physical and mental abilities to do basic work activities including walking, standing, lifting, carrying out instructions, using judgment and others. Under 20 C.F.R. Sec. 404.1522, as the majority correctly notes, two or more unrelated severe impairments cannot be combined to meet the 12 month duration test of 42 U.S.C. Sec. 423(d)(1)(A), supra, even though, for example, two severe impairments six months each in duration in reality may last for a total of twelve months. 20 C.F.R. Sec. 404.1522 continues:

However, we can combine unrelated impairments to see if together they are severe enough to keep you from doing substantial gainful activity. We will consider the combined effects of unrelated impairments only if all are severe and expected to last 12 months. (...