Parker v. Bowen

• Decision Date: 09 July 1986
• Docket Number: No. 84-7678,84-7678
• Citation: 793 F.2d 1177
• Parties: , Unempl.Ins.Rep. CCH 16,878 Nelda A. PARKER, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee.
• Court: U.S. Court of Appeals — Eleventh Circuit

Page 1177

793 F.2d 1177

14 Soc.Sec.Rep.Ser. 106, Unempl.Ins.Rep. CCH 16,878

Nelda A. PARKER, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services Defendant-Appellee.

No. 84-7678.

United States Court of Appeals Eleventh Circuit.

July 9, 1986.

James A. Turner, Turner, Turner & Turner, Tuscaloosa, Ala., for plaintiff-appellant.

Frank W. Donaldson, U.S. Atty., Birmingham, Ala., Jenny L. Smith, Asst. U.S. Atty. William Kanter, Howard S. Scher, Appellant Staff, Civ. Div., Dept. of Justice, Washington, D.C. for defendant-appellee.

Appeal from the United States District Court for the Northern District of Alabama.

Before FAY and ANDERSON, Circuit Judges, and GIBSON ^*, Senior Circuit Judge.

PER CURIAM:

In Parker v. Bowen, 788 F.2d 1512 (11th Cir.1986), the en banc court vacated the panel opinion in Parker v. Heckler, 763 F.2d 1363 (11th Cir.1985), and remanded the case to the panel for further proceedings. The en banc court held that the proper scope of judicial review in Social Security cases focuses on the substantiality of the evidence supporting the Appeals Council's decision, even when the Appeals Council has rejected the decision of the Administrative Law Judge ("ALJ"). 788 F.2d at 1516-20. The court also held that if the Appeals Council rejects the ALJ's credibility findings, the substantiality of the evidence may be affected, and therefore the Appeals Council should ordinarily provide reasons for its rejection of the ALJ's credibility findings; such rejection in light of the stated reasons must be supported by substantial evidence on the record as a whole. Id. at 1520-22. We now reconsider this case in light of the foregoing standards.

Parker was born in 1932 and was trained as a licensed practical nurse. Her past relevant work experience was as a nurse, bookkeeper, and general office worker in Dr. Wheeler's office. During the last three years of her employment, her declining health forced her to work on a part-time basis, and in March 1983 she finally retired. She has not worked since that time.

In March 1983, Parker applied for disability benefits, alleging that she was unable to work due to renal artery dysplasia, diabetes, hypertension, and neuritis of the hands and feet. The ALJ found that she suffered from hypertensive cardiovascular disease, fibromuscular dysplasia, and exogeneous obesity, and concluded that these impairments in combination rendered her disabled. In reaching this conclusion, the ALJ determined that the testimony of Parker and her employer, Dr. Wheeler, was credible. ¹

The Appeals Council, however, reviewed the ALJ's decision on its own motion, and found that Parker was not disabled. In reaching this conclusion, the Appeals Council found that Parker's allegations of disabling subjective symptoms were not credible, ² both because the evidence did not establish the existence of a medical condition that could reasonably be expected to produce symptoms of the severity alleged, and because her daily activities and her ability to care for her personal needs have not been significantly restricted. ³ The Appeals Council, however, neither discussed Dr. Wheeler's testimony nor explained why his testimony was not credible. The Appeals Council also considered Dr. Todd's opinion that Parker was disabled, ⁴ but rejected his opinion apparently because the absence of end organ complications established that her hypertension was not severe. ⁵

We conclude that the Appeals Council's explanations for its rejection of the ALJ's credibility findings do not satisfy the Parker v. Bowen requirements. Turning to the Appeals Council's primary justification (the absence of a medically determinable basis for Parker's subjective complaints), we find that the record does contain evidence of a medical condition that could reasonably be expected to produce the symptoms complained of by Parker. The medical evidence establishes that she has had a history of high blood pressure, which has not been adequately controlled by medication. See, e.g., Record on Appeal, vol. 2 at 34-36, 146-48, 179-84, 197. The record also indicates that high blood pressure and the side effects of her medications could cause the symptoms of which she complains. See id. at 48-50, 197. The Appeals Council's failure to even mention Dr. Wheeler's testimony, which the ALJ found to be credible, is especially troubling. Dr. Wheeler, who had employed Parker for approximately 20 years, corroborated her claim that at work, she had experienced weakness, visual problems and difficulty in standing, and indicated that when her blood pressure was taken at work, her systolic pressure was over 200, and her diastolic pressure was over 150. Id. at 48-50. He also confirmed that the side effects of her medications and her high blood pressure could cause drowsiness, weakness and blurred vision--the symptoms of which she complained. Id. at 49-50. Since the Appeals Council has not explained why the medical evidence and Dr. Wheeler's testimony would not establish a medical basis for her symptoms, we conclude that the first explanation does not comply with the Parker v. Bowen requirements. ⁶ The Appeals Council's second justification--that her daily activities and her ability to care for her personal needs have not been significantly affected--is not supported by substantial evidence on the record as a whole. This explanation is apparently based on Parker's testimony that she could do simple household chores. Record on Appeal, vol. 2 at 39. The Appeals Council, however, ignored other evidence that her daily activities have been significantly affected. For example, she testified that she had to lie down every two hours, id. at 42-43, and Dr. Wheeler discussed the problems she had experienced at work (difficulty in standing, fatigue and blurred vision), id. at 48-50. ⁷ We have consistently held that in ascertaining whether the Secretary's findings are supported by substantial evidence, we do not consider only those parts of the record that support those findings, but rather must "view the entire record and take account of evidence in the record which detracts from the evidence relied on by the [Secretary]." Tieniber, 720 F.2d at 1253; see also Owens v. Heckler, 748 F.2d 1511, 1514 (11th Cir.1984). After considering all of the evidence in the record, we conclude that there is not substantial evidence to support the Appeals Council's finding that Parker's daily activities have not been significantly restricted.

We also hold that the Appeals Council improperly disregarded the findings of Parker's treating physician. We have repeatedly held that the Secretary must accord "substantial" or "considerable" weight to the opinion of a claimant's treating physician unless "good cause" is shown to the contrary. See, e.g., Broughton v. Heckler, 776 F.2d 960, 961 (11th Cir.1985); Spencer ex rel. Spencer v. Heckler, 765 F.2d 1090, 1093-94 (11th Cir.1985). As we explained in Broughton, " '[i]t is not only legally relevant but unquestionably logical that the opinions, diagnosis and medical evidence of a treating physician whose familiarity with the patient's injuries, course of treatment, and responses over considerable length of time, should be given considerable weight.' " 776 F.2d at 962 (quoting Smith v. Schweiker, 646 F.2d 1075, 1081 (5th Cir.1981)).

In the instant case, the Appeals Council stated that it had considered the opinion of Parker's treating physician, Dr. Todd, but found that there were no clinical findings to support his conclusion that she was medically unable to work. This conclusion was apparently based on Social Security Ruling 82-55, which provided that hypertension without significant end organ damage was not a severe impairment. This explanation, however, does not constitute "good cause" to disregard Dr. Todd's report. Courts have recognized that hypertension without significant end organ damage may be a severe impairment, see, e.g., Flynn v. Heckler, 768 F.2d 1273, 1274-75 (11th Cir.1985) (hypertension may be severe with only minimal end organ damage, i.e., in absence of significant end organ damage); Martin v. Secretary of Department of Health, Education & Welfare, 492 F.2d 905, 909-10 (4th Cir.1974) (same), and SSR 82-55 has been rescinded, SSR 85-III-II (April 1985). ⁸ Since hypertension without significant end organ damage may constitute a severe impairment, and since the record contains medical evidence establishing that Parker suffers from hypertension which has not been adequately controlled by medication, we hold that the Appeals Council applied an erroneous legal standard with respect to the findings of the treating physician.

Finally, the Appeals Council's finding of non-severe hypertension was apparently based on its conclusion that hypertension without significant organ damage could not be a severe impairment. To the extent that the finding of non-severe hypertension rested on the absence of end organ damage, we conclude that the Appeals Council applied an incorrect legal standard. We have held that in order for an impairment to be non-severe, "it [must be] a slight abnormality which has such a minimal effect on the individual that it would not be expected to interfere with the individual's ability to work, irrespective of age, education, or work experience." Brady v. Heckler, 724 F.2d 914, 920 (11th Cir.1984); see also Flynn, 768 F.2d at 1274; Edwards v. Heckler, 736 F.2d 625, 630 (11th Cir.1984). In Flynn, we specifically held that hypertension with only minimal end organ damage may qualify as a severe impairment under this test. 768 F.2d at 1275. Since the Appeals Council did not consider whether her hypertension had only a "minimal effect" on her ability to do basic work activities, we remand for the Secretary to apply the correct legal standard. ⁹

For the foregoing reasons, we reverse the district court's order affirming the Secretary's denial of disability benefits, and remand for the Appeals...