Patterson v. Bowen

Decision Date22 September 1986
Docket NumberNo. 85-3750,85-3750
Parties, Unempl.Ins.Rep. CCH 16,975 Annie B. PATTERSON, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee.
CourtU.S. Court of Appeals — Eleventh Circuit

Alice K. Nelson, Tampa, Fla., for plaintiff-appellant.

Peter B. Loewenberg, Asst. U.S. Atty., Tampa, Fla., for defendant-appellee.

Appeal from the United States District Court for the Middle District of Florida.

Before VANCE and ANDERSON, Circuit Judges, and PITTMAN *, Senior District Judge.

ANDERSON, Circuit Judge:

Annie Patterson appeals from a district court order affirming the final decision of the Secretary of Health and Human Services denying her application for supplemental security income and disability insurance benefits. 1 Because the ALJ's finding that prior to January 1981, Patterson could perform her past work as a janitor is supported by substantial evidence, we affirm the Secretary's denial of disability benefits for the period from September 1980 to January 1981. However, because the ALJ mechanically applied the age grids with respect to the period from January 1981 to May 1983, 2 we reverse the district court's order and remand to the district court with instructions to remand the case to the Secretary for further proceedings consistent with this opinion. We also conclude that Patterson is not precluded from receiving disability benefits by 20 C.F.R. Sec. 404.1530 (1986).

I. BACKGROUND

In October 1981, Patterson applied for supplemental security income and disability insurance benefits, alleging onset of disability in September 1980 because of diabetes mellitus, left carpal tunnel syndrome, an umbilical hernia, chronic bladder infections, a partially amputated right index finger, and possible cataracts. She was born on May 14, 1933, and was forty-nine years old at the time of the hearing. She has a tenth grade education and past relevant work experience as a janitor.

In February 1978, Patterson was first diagnosed as having an umbilical hernia. In April 1978, Dr. A. Mouradian treated her for headaches, shortness of breath, and urinary frequency, nocturia, and urgency. He noted that she had been hypertensive in the past, and diagnosed probable hypertensive cardiovascular disease. He also indicated that her diabetes, which she had had for seven years, was not under control, and that she had peptic ulcer syndrome. Finally, he observed that she had exogenous obesity and that there were cardiac irregularities on the electrocardiogram ("EKG"), including sinus tachycardia, non-specific ST-T wave changes, and low voltage.

In November 1978, Patterson was hospitalized after she developed gangrene of the distal portion of her right index finger. The right index finger was partially amputated. An EKG indicated that there were minor non-specific ST-T wave changes, but Dr. R.T. Bramson diagnosed no active cardiopulmonary disease.

In September 1979, she was hospitalized with complaints of urinary problems and an abnormal episode of menstrual bleeding. She was diagnosed as having leiomyomata of the uterus with pelvic inflammatory disease, and a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed.

In January 1981, Patterson complained of some discomfort in her left hand, and by late February 1981, she was diagnosed as having probable carpal tunnel syndrome in her left hand. In April 1981, she was scheduled for surgery to release her left carpal tunnel syndrome, but the surgery was cancelled because her diabetes was not under control.

In July 1981, she was hospitalized for a biopsy of her bladder. The examination revealed that she had some chronic pyelonephritis, but the biopsy did not reveal any malignancies.

In November 1981, Patterson was examined by Dr. George Adams, a consulting physician. His examination revealed that her left carpal tunnel syndrome was accompanied by marked atrophy of the thenar eminence and a "marked decreased grip and decreased dexterity of the fingers and an inability to grasp well or to oppose the thumb against the tips of the digits." Record on Appeal, vol. 2 at 128. He also noted that while her diabetes had produced neovascularity in her eyes, there was no retinopathy to any advanced degree. He also indicated that there was a decreased sensation to pinprick on the soles of both feet, but there were no superficial variocosities or marked evidence of any chronic venous insufficiency. Finally, he noted that although she has an umbilical hernia, there are normal bowel sounds and there is neither any rebound tenderness nor any evidence of strangulation.

In October and December 1981, Patterson was scheduled for surgery to relieve her left carpal syndrome. However, the October surgery was cancelled due to the failure of the anesthesia to work, and the December surgery was cancelled because of her diabetic condition.

In January 1982, Patterson complained of constant pain in her left hand, and a volar splint and wrist corset were prescribed. In May 1982, she was once again hospitalized because she had been suffering a headache and chest pain for three weeks. The EKG revealed sinus tachycardia and minor T wave changes, but she was not diagnosed as suffering from any "acute" cardiovascular disease. Record on Appeal, vol. 2 at 427.

At the hearing, Patterson testified that she works as a babysitter for her three year-old grand-niece on a daily basis for approximately eight hours per day. She also indicated that she does her own housework, shops for groceries with her niece, and drives her car when necessary.

The ALJ found that Patterson was not disabled within the meaning of the Social Security Act. The ALJ first found that she suffered from the following impairments: poorly controlled diabetes mellitus; chronic urinary tract infections and pyelonephritis; an umbilical hernia without complications; left carpal tunnel syndrome; partial amputation of the distal right index finger; mild hypertension; and marked exogenous obesity. The ALJ, however, determined that her impairments, whether considered individually or in combination, did not meet or equal any impairment listed in 20 C.F.R. pt. 404, subpt. P, app. 1 (1986). The ALJ then found that prior to January 1981, Patterson's impairments either in combination or individually did not preclude her from performing her past relevant work as an industrial maid. With respect to the period after January 1981, the ALJ concluded that her left carpal tunnel syndrome precluded her from performing her past work, but found that she retained the residual functional capacity to perform light and sedentary work and was therefore not disabled. The ALJ noted that while the left carpal tunnel syndrome limited grip strength and dexterity in her left hand, it did not prevent her from performing a wide range of jobs at the light and sedentary exertional levels.

The ALJ also suggested that even if he found that Patterson were disabled, she would still not be entitled to benefits "because of her disregard for prescribed medical treatment expected to improve her functional capacity." Record on Appeal, vol. 2 at 21. The ALJ, however, did not make an express finding that she should be denied benefits because of her noncompliance with prescribed medical treatment.

The Appeals Council denied Patterson's request for review, and she filed suit in the United States District Court for the Middle District of Florida. Relying on Reeves v. Heckler, 734 F.2d 519 (11th Cir.1984), the magistrate concluded that the ALJ had applied the age grids in a mechanical fashion, and therefore gave Patterson an opportunity to make a proffer of evidence on her ability to adapt. In her proffer, Patterson stated that her ability to adapt to a new work environment is less than the level established under the grids for persons her age because of her limited education and work experience, her inability to lift or carry any weight with her left hand, and her physical condition. After considering this proffer and the record, the magistrate recommended that the Secretary's finding of no disability be affirmed since the Secretary's decision was supported by substantial evidence and since Patterson's proffer did not show that her "ability to adapt to a new work environment is less than the level established under the grids for persons who are [her] age." Record on Appeal, vol. 1, doc. 32 at 10. The magistrate also concluded that even if she were disabled, she would not be entitled to disability benefits because she had failed, without good cause, to follow the diet prescribed as part of her medical treatment. After reviewing the record, the district court adopted the magistrate's recommendation and affirmed the Secretary's denial of benefits. This appeal ensued.

II. DISCUSSION

Patterson raises two principal contentions on appeal. 3 First, she argues that the proffer of evidence on the question of whether her ability to adapt to a new work environment was less than that presumed under the grids for a person her age was sufficient to require a remand to the Secretary on this question. Second, she contends that since she did not refuse to follow prescribed medical treatment, 20 C.F.R. Sec. 404.1530 (1986) does not preclude her from receiving disability benefits.

Before turning to Patterson's first contention, we note that she is not entitled to disability benefits for the period from September 1980 to January 1981. The ALJ found that prior to January 1981, Patterson had not met her burden of showing that she could not perform her past relevant work as a janitor, and this finding is amply supported by the record. For example, Patterson's hypertension was mild, and her diabetes, though poorly controlled, had not resulted in any significant complications. In addition, her umbilical hernia was easily reducible, and there was no evidence of any strangulation or rebound tenderness. The...

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