The opinion of the court was delivered by: WEINFELD
Plaintiff Carol McGuire ("McGuire") brought this action pursuant to 42 U.S.C. § 405(g) (1982) to review the final determination of the Secretary of Health and Human Services ("Secretary") denying her Social Security disability benefits. The Secretary moves, and McGuire cross-moves, for judgment on the pleadings in accordance with Rule 12(c), Fed. R. Civ. P. There is no dispute that plaintiff was insured during the relevant period for provision of disability benefits.
The sole question on this appeal is whether the Secretary's determination that McGuire was not disabled within the meaning of 42 U.S.C. § 423(d) (1982) is supported by "substantial evidence."
Plaintiff, who for seven years worked as a legal secretary, claims that since 1979 she has been afflicted with arthritis and lupus erythematorsus ("L.E."). This latter, she claims, affects her skin and joints, and causes fatigue and chronic, at times severe, pain, precluding her return to work as a legal secretary, which entailed typing, filing papers, answering the telephone, and other duties. She has been treated for L.E. by two physicians, Dr. Chandra Menon, from 1979 through February 1980, and, from February 1980 through the present, by Dr. Richard Benda. In 1982 she also was treated by Dr. Thomas A. Cerillo, a podiatrist, for cysts in her feet, which he diagnosed as associated with L.E. McGuire has also been examined by two consultative physicians designated by the Social Security Administration, Drs. Murray Sherwin and Harry Jackson.
Following a hearing, McGuire's claim was rejected by the Administrative Law Judge ("ALJ") on the ground that she failed to meet the requirement under the Secretary's regulations that she have a "severe impairment," that is, "any impairment which significantly limits [claimant's] physical or mental ability to do basic work activities. . . ."
The ALJ noted that plaintiff's condition was "under control" and that her prescription for Aristocort cortisone compound had been reduced from 48 milligrams to alternating doses of 16 and 32 milligrams "with improvement."
He also relied upon McGuire's testimony purportedly to the effect that "she can do a full range of activities, including housework, taking care of her child, playing ball games, driving (or taking public transportaiton) -- activities which involve sitting, standing, grasping[,] and manipulation of the hands."
In deciding McGuire was thus not disabled, the ALJ rejected not only the findings of McGuire's treating physician, Dr. Benda but also those of the Social Security Administration's consultative physician, Dr. Sherwin, who examined McGuire in June 1981. Dr. Benda had concluded in his most recent report, dated March 4, 1982, that McGuire "is unable to hold a steady job as she is unable to do anything with her hands and her stamina is very poor."
Dr. Sherwin found that in an eight-hour work day claimant could not walk for even two hours and could not repetitively use her hands for "grasping, pushing/pulling, or fine manipulation."
The ALJ rejected these findings on the ground that Dr. Benda's conclusion was not backed by "supporting objective clinical findings"
and that Dr. Sherwin's evaluation was "inconsistent with the medical findings" and not substantiated by an "objective medical report."
The ALJ, relying on his assessment of McGuire's demeanor and the consistency of her testimony, also rejected what he characterized as McGuire's claim of "constant, severe[,] and debilitating pain." In this regard, the ALJ relied on Dr. Jackson's finding that when McGuire was examined on October 15, 1981, she appeared to be in only "mild distress."
The ALJ also relied on statements by plaintiff's podiatrist, Dr. Cerillo, which he construed as indicating that the pain associated with the cysts on McGuire's right foot could be "corrected by surgery."
Finally, the ALJ reiterated McGuire's testimony concerning her activities, noted above, as a basis for rejecting plaintiff's claim of disabling pain.
On February 16, 1983, the Social Security Administration's Office of Hearings and Appeals denied McGuire's request that the decision of the ALJ be reversed. The ALJ's decision thus became the Secretary's final decision,
leading to the instant action.
The Court's task on this motion is limited to reviewing the record to determine whether the Secretary's factual determination that McGuire did not suffer any "severe impairment"
is supported by substantial evidence.
"Substantial evidence is defined as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.""
Before concluding that McGuire is not entitled to benefits, the Secretary is obligated to consider the record evidence of (1) objective medical facts; (2) diagnoses or medical opinions based on these facts; (3) subjective evidence of pain and based on these facts; (3) subjective evidence of pain and disability testified to by the claimants; and (4) the claimant's educational background, age, and work experience.
It is the Court's duty not only to determine whether this consideration has been made, but more particularly, to review the Secretary's compliance with "well established"
principles governing the evaluation of the record evidence, especially that of expert medical opinions by treating physicians. As our Court of Appeals has recently noted:
The . . . cases [in this Circuit] establish a sequence, and in effect posit an analytical framework, which the ALJ should follow. Initially, the ALJ should see whether the treating physician has determined that the claimant is disabled. He should then examine the record for conflicting evidence. Upon finding conflicting evidence, he should compare the probative value of the treating physician's opinion with the probative value of the conflicting evidence. . . . It [i]s improper for the ALJ to . . . requir[e] from the start that [claimant's treating physician's] expert opinion be accompanied by concrete and detailed clinical support.
Recognizing that the scope of review of the Secretary's decision is narrow and limited, the Court is nevertheless persuaded by its own word-by-word reading of the administrative record that the decision of the ALJ, which stands as the Secretary's final decision in this case, was not rendered with due regard for the rules governing the consideration of expert medical opinions and the plaintiff's subjective evidence of pain and disability, and is not otherwise supported by substantial evidence.
The record evidence that McGuire's treating physician, Dr. Benda, had concluded McGuire was disabled is clear and unequivocal. In his March 4, 1982, report, Dr. Benda noted that McGuire suffered form "severe tiredness and lethargy" as well as "swelling and redness of the fingers and both hands with marked limitation of motion," and that, notwithstanding doses of 48 milligrams of Aristocort, four days per week, "her joint and skin manifestations [of systemic lupus erythematosus] are unchanged."
His conclusion, quoted in part above, reads as follows:
the prognosis for recovery is guarded and this tends to be a chronic condition and requires constant monitoring of her physical status and blood chemistries. At this point in time [McGuire] is unable to hold a steady job as she is unable to do anything with her hands and her stamina is very poor. In addition she also has complaints of pains in her feet which she has seen a [p]odiatrist for in the past, and she is unable to stand for any prolonged lengths of time.
I believe on the basis of the preceding that this patient is disabled and is unable to work at this time.