Ramirez v. Barnhart, 01-2911.

• Decision Date: 05 June 2002
• Docket Number: No. 01-2911.,01-2911.
• Citation: 292 F.3d 576
• Parties: Theresa RAMIREZ, Appellant, v. Jo Anne B. BARNHART, Social Security Commissioner, Appellee.
• Court: U.S. Court of Appeals — Eighth Circuit

292 F.3d 576

Theresa RAMIREZ, Appellant, v. Jo Anne B. BARNHART, Social Security Commissioner, Appellee.

No. 01-2911.

United States Court of Appeals, Eighth Circuit.

Submitted: February 15, 2002.

Filed: June 5, 2002.

Danny C. Wilmoth, argued, Des Moines, IA, for appellant.

Inga Bumbary-Langston, United States Attorney, argued, Des Moines, IA (Frank V. Smith III, Chief Counsel, Region VII, Social Security Administration, and Susan Meehan, Asst. Regional Counsel, SSA, Kansas City, MO, on the brief), for appellee.

Before McMILLIAN and RILEY, Circuit Judges, and KORNMANN,¹ District Judge.

McMILLIAN, Circuit Judge.

Theresa Ramirez ("Claimant") appeals from a final judgment entered in the United States District Court² for the Southern District of Iowa affirming the decision of the Social Security Administration ("SSA") to deny her application for Supplemental Security Income ("SSI") benefits under Title XVI of the Social Security Act, 42 U.S.C. §§ 401 et seq. Ramirez v. Halter, No. 4-00-cv-10196 (S.D. Iowa June 4, 2001) (memorandum and order). For reversal, Claimant argues that the district court erred in evaluating her subjective complaints of pain and in finding substantial evidence in the record to support the decision of the administrative law judge ("ALJ") that Claimant was able to return to light work. For the reasons discussed below, we affirm the judgment of the district court.

Jurisdiction

Jurisdiction in the district court was proper based upon 42 U.S.C. §§ 405(g) and 1383(c)(3). Jurisdiction on appeal is proper based upon 28 U.S.C. § 1291. The notice of appeal was timely filed pursuant to Fed. R.App. P. 4(a).

Background

Prior to her application for benefits, Claimant's past work experience consisted entirely of: waitressing from July 1986 to October 1987, performing janitorial work from October 1987 until February 1988, clerking in a retail store from December 1994 until December 1995, and parking cars as a valet from August 1995 until December 1995. Claimant filed for SSI benefits in October 1996,³ alleging an inability to work since October 1993 as a result of chronic lower back problems. The SSA initially denied Claimant's application for benefits, and again denied benefits following a requested hearing before an ALJ. The SSA Appeals Council subsequently affirmed the denial of benefits, and pursuant to 42 U.S.C. § 405(g), Claimant appealed that decision in federal district court.

The SSA record documents Claimant's treatment for back pain from May 1993 until June 1998. Over that five-year period, Claimant received continuous treatment from her primary care physician as well as several specialists. Following injuries in October and December 1993, Claimant complained of back and leg pain. Claimant's complaints continued even after she had back surgery to repair a herniated disc in July 1994. In January 1996, Claimant became pregnant, which exacerbated her back pain and prompted difficulty sleeping. During her pregnancy, in August 1996, Claimant sought emergency room treatment for elevated back pain after doing strenuous lifting during a move. In September 1996, Claimant delivered her baby. At that time, an x-ray revealed a slight narrowing of disc space at three places in her spine compared to an x-ray taken a year earlier.

Throughout the course of Claimant's medical treatment, she repeatedly was prescribed painkillers as well as physical therapy exercises, which she admitted neglecting. Beginning in October 1996, Claimant began taking diet pills in an effort to lose weight to alleviate some of her back pain. In December 1996, Claimant's primary physician noted that Claimant was becoming depressed as a result of her inability to lose weight in addition to her chronic back pain, and he prescribed Prozac. Claimant discontinued the diet pills because they conflicted with the Prozac. Later, in April 1997, Claimant stopped taking the Prozac and resumed taking diet pills.

In January 1997, Claimant was examined by Dr. McGuire, an orthopaedic surgeon, who diagnosed her with mild sciatica. Dr. McGuire did not credit Claimant's pain complaints, believing instead that she inaccurately perceived her pain and magnified her symptoms. In addition, he refused to perform another surgery on the basis of her pain complaints and prescribed physical therapy instead.

In April 1997, Eva Christiansen, Ph.D., performed a psychological evaluation on Claimant at the request of the Disability Determination Service. During the two-hour session, she noted that Claimant complained of pain and alternated sitting and standing. The test results showed a verbal IQ of 73, a performance IQ of 79, and a full scale IQ of 75, which placed Claimant's overall level of functioning in the borderline range. Dr. Christiansen concluded that (1) Claimant would be able to adequately remember and understand instructions to perform basic tasks and some routine and modeled concrete tasks, (2) her judgment was adequate for basic tasks and pace was not a problem, (3) changes in the workplace might require additional adjustment time, and (4) Claimant's attention and concentration might vary depending upon her pain.

In July 1997, Claimant consulted Dr. Allaire, who performed a physical exam and found essentially normal results demonstrating Claimant's ability to walk on her heels and toes without pain, her ability to perform deep knee bends, full range of motion in her lumbar region, no gross sensory deficits, no muscle atrophy, and normal strength testing in the lower extremities. Dr. Allaire performed a lumbar caudal epidural steroid injection to reduce inflammation, after which Claimant felt significant relief. In September 1997, Claimant was examined by Dr. Hitchon, another back specialist. Again, her test results were essentially normal, except for slightly diminished sensory perception on her right side.

In October 1997, Claimant began a three-week treatment program at a pain clinic, where she received pain management lessons. In addition, she was injected with pain medication at multiple trigger points and her sleeping pill dosage was increased. Her doctor at the pain clinic, Dr. Blessman, believed that her pain was manageable through medication, although he questioned Claimant's emotional stability. In January 1998, Dr. David Boarini, who had treated Claimant for back problems since 1995, examined Claimant and found no objective medical evidence to account for her pain complaints, and suggested that she exercise and lose weight.

At Claimant's SSA disability hearing, held in February 1998, Claimant testified that she had experienced continuous pain since 1995 and that it had become so severe that she could no longer find relief or concentrate on anything. Claimant further testified that she was essentially unable to care for her four children — ranging in age from thirteen years old to seventeen months old — without the help of her husband and the children themselves. She explained that she does drive a car, but prefers not to because she does not like to sit down, and that shopping and house-cleaning frequently were done by others. The hearing record reflected that Claimant alternated sitting and standing at two to three minute intervals, which she indicated was customary. Claimant also testified that she had to lie down up to six hours during each day to relieve her pain. She estimated that she could stand for no more than ten minutes at a time, and asserted that she followed her prescribed physical therapy exercise program. She claimed that she could not lift more than a gallon of milk at a time, and that she could not perform the demands of any of her past work because she could not stand, lift or move about as required.

At the time of the hearing, Claimant was 29 years old. Claimant testified that she had taken special education classes at school, where she had problems with math. During the hearing she could not perform simple subtraction or division in her head. Lois Smidt, a family development specialist, testified that she had visited Claimant two or three times a month for two years and observed Claimant's difficulty reading as well as her manifestations of pain, including getting up and down, wincing, and lying down. In early July 1997, Smidt saw Claimant on the floor in pain and helped her get treatment.

After the hearing, Claimant submitted records of her continuing medical treatment, including reports of more trigger point injections in March and April 1998, and Dr. McGuire's decision to perform the back surgery he had previously refused. On June 25, 1998, the ALJ issued the decision to deny SSI benefits based upon the lack of credibility of Claimant's pain complaints coupled with the lack of objective medical evidence in the record to substantiate those pain complaints. On June 4, 2001, the district court affirmed the decision of the SSA, finding sufficient evidence in the record to support the ALJ's credibility determination. This appeal followed.

Discussion

I. Evaluation of Subjective Pain Complaints

Claimant contends that the ALJ improperly evaluated her subjective complaints of back pain by erroneously requiring objective medical evidence to substantiate the severity of her pain. Claimant argues that the ALJ's decision conflicts with this court's holding in Polaski v. Heckler, 739 F.2d 1320 (8th Cir.1984) (Polaski), which does not require direct medical evidence of the cause and effect relationship between the impairment and the pain.

Pursuant to the Social Security Act, the SSA follows a sequential evaluation process in determining disability. See 20 C.F.R. § 416.920. During the five-step process, the ALJ considers whether (1) the claimant is gainfully employed, (2) the claimant has a severe impairment, (3) the impairment meets the criteria of any SSI listings, (4) the impairment prevents the claimant from performing past relevant work, and (5) the impairment necessarily prevents the claimant from doing...