Fischer v. Colvin , 831 F.3d 31 ( 2016 )


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  •           United States Court of Appeals
    For the First Circuit
    No. 15-1041
    GLORIA GEAN FISCHER,
    Plaintiff, Appellee,
    v.
    CAROLYN W. COLVIN,
    Acting Commissioner of Social Security,
    Defendant, Appellant.
    APPEAL FROM THE UNITED STATES DISTRICT COURT
    FOR THE DISTRICT OF NEW HAMPSHIRE
    [Hon. Paul J. Barbadoro, U.S. District Judge]
    Before
    Barron, Selya, and Lipez,
    Circuit Judges.
    Joshua M. Salzman, Attorney, Appellate Staff, Civil Division,
    United States Department of Justice, with whom Benjamin C. Mizer,
    Acting Assistant Attorney General, John P. Kacavas, United States
    Attorney, Beth S. Brinkmann, Deputy Assistant Attorney General,
    Alisa B. Klein, Attorney, Appellate Staff, Civil Division, U.S.
    Department of Justice, David F. Black, General Counsel, Social
    Security Administration, Christopher A. Michaels, Acting Regional
    Chief Counsel, Region 1, Social Security Administration, Matthew
    J. Del Mastro, Assistant Regional Counsel, Social Security
    Administration, and Sean D. Santen, Assistant Regional Counsel,
    Social Security Administration, were on brief, for appellant.
    Christine Woodman Casa, with whom Francis X. Quinn, Jr. and
    Boynton Waldron Doleac Woodman & Scott, PA were on brief, for
    appellee.
    July 29, 2016
    LIPEZ, Circuit Judge.   An administrative law judge (ALJ)
    denied   Gloria   Gean   Fischer's   claim   for    disability      insurance
    benefits (DIB) under the Social Security Act.            The ALJ concluded
    that Fischer was not disabled prior to the date on which her
    insured status expired and thus not eligible to receive benefits.
    On petition for judicial review, the district court found that the
    ALJ erred as a matter of law when he failed to consult a medical
    expert before reaching this conclusion.        The district court relied
    upon Social Security Ruling (SSR) 83-20, which instructs an ALJ to
    consult a medical expert when the ALJ must infer a claimant's date
    of disability onset on the basis of ambiguous medical evidence.
    See SSR 83-20, 
    1983 WL 31249
    , at *3 (Jan. 1, 1983); May v. Soc.
    Sec. Admin. Comm'r, 
    125 F.3d 841
     (1st Cir. 1997) (per curiam)
    (unpublished table decision), 
    1997 WL 616196
    , at *1.
    Defendant-appellant     Carolyn       W.     Colvin,      Acting
    Commissioner of Social Security, challenges the district court's
    interpretation of SSR 83-20 and its application to the facts of
    this case.    We find it unnecessary to resolve the parties' dispute
    concerning the general applicability of SSR 83-20 to the disability
    inquiry in this case.    Even assuming that the ruling applies here,
    the medical evidence was not ambiguous and thus the ALJ did not
    need to draw inferences as to whether Fischer's onset date preceded
    the expiration of her insured status.          Hence, SSR 83-20 did not
    require the ALJ to consult a medical expert.            We therefore vacate
    - 3 -
    the judgment of the district court and remand for consideration of
    Fischer's remaining claims.
    Although our conclusion does not require us to determine the
    scope of SSR 83-20, we take this opportunity to highlight the
    analytical disarray surrounding the rule. We identify our concerns
    below so that the Commissioner is aware of the need to clarify the
    ruling's purpose and resolve the inconsistencies in her approach
    to its applicability.
    I.
    A.   Background1
    On February 28, 2012, Gloria Gean Fischer applied for
    disability insurance benefits, alleging a disability stemming from
    a fall from a ladder in the late 1990s.     Fischer had previously
    worked as a hair stylist, a lingerie store owner, and operator of
    a gift basket company.     She alleges a disability onset date of
    October 31, 1995.   Fischer's date last insured (DLI) was March 31,
    1998.     For Fischer to be eligible for benefits, she had to
    demonstrate that her disability existed prior to her DLI.      See
    Cruz Rivera v. Sec. of Health & Human Servs., 
    818 F.2d 96
    , 97 (1st
    Cir. 1986) (per curiam).
    Fischer's first relevant medical records reflect that
    she visited the Exeter Hospital Pain Clinic in October 1996,
    1The facts recounted here are not in dispute and are taken
    from the decisions of the ALJ and the district court.
    - 4 -
    complaining of increasingly severe left buttock and leg pain,
    resulting from a June 1996 fall.2              Fischer reported that the pain
    worsened with standing and that it woke her up at night.                           An
    examination revealed that Fischer had a full range of motion of
    the   lumbar     spine,    good      flexion    and    extension    of     the   lower
    extremities, and that she was able to toe walk and heel walk.                      The
    examination also revealed that Fischer had tenderness between
    vertebrae in both the lumbar vertebrae and the thoracic vertebrae
    regions of her spine and "unusual paraspinal tenderness."                           A
    magnetic resonance imaging (MRI) indicated a bulging disc in the
    lumbar    vertebrae,      and   an    admitting       physician    administered    an
    epidural    steroid       injection,     diagnosed       Fischer    with    sciatica
    secondary to a lumbar strain, and prescribed Naproxen for six
    weeks.
    In    January       1998,   Fischer        underwent    an   MRI     after
    complaining of neck pain radiating to her left shoulder.                          The
    results of the MRI were normal.            Three months later, on March 31,
    1998, Fischer's insured status expired.                  In October 1998, x-rays
    were taken of Fischer's pelvis and left hip to rule out either a
    bone abnormality or inflammation; the imaging results were again
    normal.
    2The record is not clear as to whether the June 1996 fall is
    the ladder fall from which Fischer alleges her troubles began.
    - 5 -
    The record contains no relevant medical reports for the
    next five and a half years.    In March 2004, Fischer presented with
    sensitivity on her left side and hip joint pain.       Multiple x-rays
    and an MRI did not reveal any hip or sacroiliac joint problems,
    but an MRI of her lumbar spine suggested degenerative disc changes
    though no disc herniation.     In May 2004, Fischer was treated for
    constant pain in her left buttock and down into her leg, as well
    as numbness and tingling in her left arm.       After a series of MRIs
    in 2004 and 2005, Fischer underwent an operation in December 2006
    to implant a spinal cord stimulator.     As of 2009, Fischer reported
    to her treating primary care physician that she held two jobs and
    was happy and active.    However, in 2010 and 2011, Fischer again
    sought treatment for pain in her left buttock, leg, and foot, and
    for pain in her lower back, which was aggravated by sitting.           From
    2011 through 2013, Fischer reported improvements in her pain
    followed   by   recurrences,   which   ranged   from   dull   aching    to
    significant limitations on her ability to stand or walk for more
    than two hours.
    B.   Agency proceedings & determinations
    In September 2012, a state agency physician reviewed
    Fischer's application for benefits and determined that there was
    not enough evidence to support the conclusion that Fischer was
    disabled between her alleged onset date of October 31, 1995 and
    her DLI of March 31, 1998.     Fischer requested a hearing before an
    - 6 -
    ALJ, which took place on May 16, 2013.      At the hearing, Fischer
    testified that she was working at her retail shop when she fell
    from a ladder in the late 1990s and this fall exacerbated injuries
    from a car accident that took place in the 1980s.   She stated that
    after the fall, she had pain throughout her entire left side,
    including her back, arm, and leg, and she had to rely on her
    daughter and other employees to do most of the work at the shop.
    She testified that she then closed her shop in 2003 and later
    underwent the spinal cord stimulator implant procedure.     Fischer
    testified that after the implantation, she tried to return to work
    part-time as a hair stylist, but she could not sustain the work
    because of the required grasping, standing, and bending.   Her pain
    worsened, and she now spends the majority of her time lying down
    or in bed for relief.     She also testified that she developed
    depression during this time.
    Following the hearing, the ALJ issued an order denying
    Fischer's claim.   The ALJ found that, "although there is some
    evidence that corroborates the claimant's testimony of a fall in
    1996, the medical evidence of record is insufficient to support"
    Fischer's assertion that she had a severe impairment prior to her
    DLI.
    The Appeals Council denied Fischer's appeal, and she
    sought judicial review in district court.   See 
    42 U.S.C. § 405
    (g).
    - 7 -
    C.    District court decision
    The district court vacated the Commissioner's decision
    and   remanded    the    case    for    further   administrative      proceedings
    because the ALJ failed to comply with SSR 83-20 and consult a
    medical advisor before concluding that Fischer was not disabled as
    of her DLI. The court first concluded that SSR 83-20's application
    is not predicated on a finding of present disability.                         In so
    holding, the court relied almost entirely on its previous decision
    in Wilson v. Colvin, 
    17 F. Supp. 3d 128
     (D.N.H. 2014).
    In Wilson, the court refused to adopt the Commissioner's
    contention that an ALJ must first find a claimant presently
    disabled    in    order    for    SSR    83-20,    and     its    medical    expert
    requirement, to apply.          
    Id.
     at 141–42.     In the court's view, such
    a reading "would permit, and possibly encourage, an ALJ to avoid
    the inconvenience of either calling a medical advisor or making a
    finding regarding present disability in a case in which the
    evidence of a claimant's disability onset date is ambiguous."                     Id.
    at 142.    Hence, the court concluded that the Commissioner could
    not condition the application of SSR 83-20 on a finding of present
    disability.      Id.    In Fischer's case, the court then found that the
    record    did    not   unambiguously      establish      that    Fischer    was   not
    disabled as of her DLI, thus requiring the ALJ to consult a medical
    advisor under SSR 83-20.
    - 8 -
    II.
    In social security cases, we review the district court's
    decision   de    novo,    and   we   review   the    Commissioner's   ultimate
    determination for substantial evidence.              Seavey v. Barnhart, 
    276 F.3d 1
    , 9 (1st Cir. 2001).           We review questions of law presented
    by an ALJ's decision de novo.          See 
    id.
    The stated purpose of Social Security Ruling 83-20 is to
    "describe the relevant evidence to be considered when establishing
    the onset date of disability under the provisions of titles II and
    XVI   of   the   Social    Security    Act    (the   Act)   and   implementing
    regulations."3 SSR 83-20, 
    1983 WL 31249
    , at *1. The ruling states:
    In addition to determining that an individual
    is disabled, the decisionmaker must also
    establish the onset of disability.     In many
    claims, the onset date is critical; it may
    affect the period for which the individual can
    be paid and may even be determinative of
    whether the individual is entitled to or
    eligible for any benefits.
    
    Id.
    When determining the onset date of disability, an ALJ
    considers factors that include "the individual's allegation, the
    3Title XVI of the Social Security Act governs applications
    for Supplemental Security Income (SSI) and Title II governs
    applications for DIB, such as Fischer's. See SSR 83-20, 
    1983 WL 31249
    , at *1.    An award of SSI benefits requires a finding of
    present disability but, unlike an award of DIB, does not require
    the claimant to be insured at the time of onset. See 42 U.S.C.
    §§ 1381a, 423(a)(1)(A); Splude v. Apfel, 
    165 F.3d 85
    , 87 (1st Cir.
    1999).
    - 9 -
    work    history,      and   the    medical     evidence."      
    Id.
         The    ruling
    recognizes that this determination may be especially difficult
    when "the alleged onset and the date last worked are far in the
    past and adequate medical records are not available."                    Id. at *2.
    In    such   cases,    if    the    alleged    disability     involved    a   slowly
    progressing impairment, the ALJ may need "to infer the onset date"
    based on "medical and other evidence that describe the history and
    symptomatology of the disease process."                Id.    Where an inference
    must be made, it "must have a legitimate medical basis."                      Id. at
    *3.    To this end, SSR 83-20 requires that "[a]t the hearing, the
    [ALJ] should call on the services of a medical advisor when onset
    must be inferred."          Id.
    The   Commissioner         challenges     the     district       court's
    interpretation of SSR 83-20's general application to Fischer's
    case as well as the court's specific application here of SSR 83-
    20's    medical    advisor        directive.      As   a    general   matter,     the
    Commissioner asserts that "onset" is conceptually distinct from
    the disability determination, and "[t]he Ruling," as a whole, "is
    not concerned with the threshold question of whether a disability
    exists," which the ALJ was tasked with deciding in Fischer's case.
    The Commissioner also argues that SSR 83-20's medical advisor
    directive applies only if "an impairment of nontraumatic origin is
    [first] found to be presently disabling."                  However, even if that
    directive could apply here, the Commissioner argues that the
    - 10 -
    district court erred in concluding that Fischer's medical evidence
    was ambiguous, requiring the ALJ to infer Fischer's onset date and
    call a medical advisor.
    As    we   discuss    in   detail    below,   the    Commissioner's
    arguments as to SSR 83-20's general applicability are confusing
    and inconsistent.     However, we need not resolve this case on the
    basis of the ruling's general applicability, if, based on the facts
    before us, we conclude that Fischer's medical evidence is not
    ambiguous and therefore the ruling's medical advisor requirement
    would not apply here.
    Where "[p]recise [e]vidence [is] [n]ot [a]vailable" and
    thus there is a "[n]eed for [i]nferences," SSR 83-20 instructs the
    ALJ to call a medical advisor.          SSR 83-20, 
    1983 WL 31289
    , at *3.
    Therefore, the dispositive question before us is whether SSR 83-
    20's requirement to consult a medical advisor applies to the facts
    of this case.   That is, did the ALJ need to make an inference based
    on a lack of "precise evidence" as to disability onset prior to
    DLI?
    Arguably,     every    onset    determination       reached   by   an
    ALJ -- a lay individual with no required medical training -- will
    involve some degree of ambiguity and inference.           See Manso-Pizarro
    v. Sec'y of Health & Human Servs., 
    76 F.3d 15
    , 17 (1st Cir. 1996).
    However, there must be some line.             In Grebenick v. Chater, the
    Eighth Circuit concluded that no ambiguity existed where the
    - 11 -
    claimant's multiple records from the two years subsequent to her
    DLI indicated that her "symptoms had not yet reached the disabling
    level of severity" prior to her DLI.              
    121 F.3d 1193
    , 1201 (8th
    Cir. 1997); see also Karlix v. Barnhart, 
    457 F.3d 742
    , 747 (8th
    Cir. 2006).
    Similarly, Fischer's medical tests around the time of
    her   DLI   consist   of   an   MRI   and    x-rays   whose   results   were
    consistently normal.       A diagnostic report of Fischer's January
    1998 cervical spine MRI, taken two months prior to her DLI, found
    "the cord to be normal," and stated that the imaging revealed "no
    extra-dural defects," "no disc herniation or degeneration," "[n]o
    destructive    lesions     of   bone,"    "[n]o    anterior   or   posterior
    subluxation," and that "the nerve root sleeves [were] exiting in
    a normal fashion from C3 to C7."             These results led Dr. Eric
    Geslien, who reviewed the MRI, to conclude that the imaging was a
    "[n]ormal MRI of the cervical spine."         The diagnostic report of x-
    rays of Fischer's pelvis and left hip, taken about seven months
    after her DLI, also was normal.          With regard to Fischer's pelvis,
    Dr. Michael Marrero saw "no fracture or dislocation" and "a normal
    appearance to the . . . joints."         Dr. Marrero studied two views of
    Fischer's left hip and again found "[n]o evidence of a fracture,
    dislocation or other intrinsic bony pathology."
    The ALJ did not rely upon the absence of medical evidence
    but rather the existence of "precise" medical evidence -- the
    - 12 -
    normal results of the diagnostic imaging -- when concluding that
    Fischer's impairments had not reached disabling severity prior to
    her DLI.    Compare Grebenick, 121 F.3d at 1201 (discussed supra),
    with Blea v. Barnhart, 
    466 F.3d 903
    , 912–13 (10th Cir. 2006)
    (concluding that the ALJ improperly made inferences based on a
    "gap in the [claimant's] medical record").           This precise medical
    evidence eliminated the need for the ALJ to infer that Fischer's
    onset date preceded her DLI.
    We recognize that where contemporaneous medical evidence
    is lacking, post-DLI medical records may support a finding that
    the    claimant's   impairments   were     severe    prior     to    her   DLI,
    "[d]epending on the nature of the disability."           Arnone v. Bowen,
    
    882 F.2d 34
    , 39 (2d Cir. 1989). Here, however, the contemporaneous
    medical evidence was specific and unequivocal.          See Grebenick, 121
    F.3d at 1201; Jakubowski v. Comm'r of Soc. Sec., 
    215 F. App'x 104
    ,
    108 (3d Cir. 2007).       Hence, assuming arguendo that SSR 83-20
    applies to the disability inquiry in Fischer's case -- a matter on
    which we take no view -- the ruling would not require the ALJ to
    call upon the services of a medical advisor to determine date of
    onset, and the district court erred when it concluded that the ALJ
    had to infer onset on the basis of ambiguous medical evidence.
    III.
    As noted at the outset of this opinion, we see a need to
    call    attention    to   the     analytical        problems        confronting
    - 13 -
    decisionmakers who must interpret and apply SSR 83-20.                Although
    delineating    the   application    of   SSR    83-20    ultimately      proved
    unnecessary to resolve this case, our attempt to clarify the law
    was frustrated by the Commissioner's failure to provide a full
    explanation of the DIB eligibility process and the inconsistent
    positions she has taken both in this case and across cases.                  We
    describe   below     three   instances   in    which    the    Commissioner's
    approach has generated confusion.
    A. The shifting relevance of SSR 83-20
    The Commissioner argues that SSR 83-20 applies only to
    the question of "onset" -- the pinpoint inquiry into when a
    previously determined disability began -- and not to the threshold
    question of whether a claimant has a disability, either presently
    or prior to her DLI.         The Commissioner asserts that "onset" and
    "disability"   are    distinct   inquiries     even    when    the   disability
    question focuses on the claimant's condition on a particular date
    in the past -- i.e., whether the claimant was disabled prior to
    her DLI.
    Inconsistently, however, the Commissioner suggests that
    the ruling does apply to the disability-prior-to-DLI inquiry if
    the claimant is found to be presently disabled.4              The Commissioner
    4  The Commissioner has not always taken this position.
    Previously, the agency insisted that SSR 83-20 does not apply even
    where a present disability has been found. For example, in May,
    where the ALJ had found a present disability for SSI purposes, the
    - 14 -
    therefore argues that the onset determination and the disability-
    prior-to-DLI determination are distinct, except when they are not.
    Inexplicably, the Commissioner has not identified a
    rationale for applying SSR 83-20 to the disability-prior-to-DLI
    inquiry only when an ALJ makes a present disability finding.5
    Thus, oddly, when an ALJ considers disability prior to DLI where
    there is a finding of present disability, the claimant receives
    the protection of the ruling; when confronting the same question
    where there is no finding as to present disability, the claimant
    does not have that protection.      In sum, even though the DIB
    question is the same in both scenarios, the Commissioner does not
    explain why the ruling applies in one setting but not the other.
    agency nevertheless argued that SSR 83-20 did not apply because
    May had not been found disabled prior to his DLI. See Brief for
    Defendant-Appellee at 8 n.4, 12–13, May, 
    1997 WL 616196
    ; see also,
    e.g., Armstrong v. Comm'r of Soc. Sec. Admin., 
    160 F.3d 587
    , 590
    (9th Cir. 1998) (noting that, in a case where the ALJ had found a
    present disability, the Commissioner argued that "the ALJ did not
    err in refusing to call a medical expert because Armstrong did not
    fulfill his burden of proving that he was disabled prior to" his
    DLI).
    5 According to the Commissioner (in her brief to the district
    court), this scenario typically occurs in "a concurrent
    application case, where both SSI and DIB are sought." Def.'s Mem.
    in Supp. of Mot., at 12 & n.6. In such a case, "the ALJ has an
    obligation to make a finding of present disability" for SSI
    purposes and, if a present disability is found, the ALJ would apply
    SSR 83-20 in determining, for purposes of the DIB inquiry, whether
    the disability existed prior to the claimant's DLI. Def.'s Mem.
    in Supp. of Mot., at 12 & n.6.
    - 15 -
    B. The role of present disability
    We also struggle with the Commissioner's unsupported and
    undeveloped contention that a claimant's present disability status
    is irrelevant to a claimant's DIB application.      The Commissioner
    asserted below, and reiterates on appeal, that an ALJ considering
    a DIB-only claim needs solely to determine disability status prior
    to DLI.   See Def.'s Mem. in Supp. of Mot., at 11 n.4 (stating that
    the agency "has not adopted a rule requiring adjudicators to
    determine disability for the period after a claimant's date last
    insured where the claimant seeks DIB only"); see also Appellant's
    Br. at 17.    Thus, when a claimant in Fischer's circumstances seeks
    only DIB, the Commissioner maintains that the applicability of SSR
    83-20 to the question of disability prior to DLI depends on whether
    the ALJ chooses to perform a present disability inquiry that the
    Commissioner has told us is unnecessary.6
    Taking at face value the Commissioner's assertion that
    an award of DIB does not depend on disability status after DLI,
    she appears to contemplate benefit payments to an individual who,
    though not disabled in recent years, is found to have been disabled
    within the meaning of the Social Security Act before her insurance
    status expired decades ago.     This is the necessary implication of
    6 This choice appeared to concern the district court in Wilson
    because it left the ruling's application to the ALJ's whim. See
    17 F. Supp. 3d at 142.
    - 16 -
    her contention that the only required inquiry in a DIB case is
    whether the claimant was disabled prior to her DLI. This position,
    without elaboration, is perplexing and may well be antithetical to
    the spirit of the Social Security Act.     See Flaten v. Sec'y of
    Health & Human Servs., 
    44 F.3d 1453
    , 1458-59 (9th Cir. 1995) ("The
    Social Security Act . . . [was] designed both to provide protection
    for individuals who can no longer work because of disability and
    to encourage individuals who have previously suffered from a
    disability to return to substantial gainful employment when their
    medical condition improves sufficiently to allow them to do so.").7
    The Commissioner nowhere -- in her briefing to the
    district court or on appeal -- fully explains the analysis an ALJ
    must employ to determine whether a claimant may receive disability
    7 We note that a claimant may be entitled to insurance
    benefits, despite the termination of a disability, if the claimant
    applies for benefits within twelve months of the disability
    termination. See Soc. Sec. Admin., Program Operations Manual Sys.,
    DI 10105.015, Retroactivity of Disability Application (Feb. 12,
    2013); cf. Nguyen v. Chater, 
    172 F.3d 31
    , 35 n.2 (1st Cir. 1999)
    (per curiam) ("Irrespective of claimant's status on the hearing
    date, he qualified for benefits if he was disabled for any
    relevant, continuous twelve-month period."). The Commissioner did
    not raise or address this qualification and its effect on the ALJ's
    decisionmaking process in either her briefing or at argument.
    Moreover, the Commissioner's broad contention that present
    disability is irrelevant to a DIB-only claim appears at odds with
    the rule, embraced across many circuits, that "an individual cannot
    receive disability benefits . . . unless the individual can
    establish that the current period of disability began on or prior
    to the expiration of insured status." Flaten, 
    44 F.3d at 1458
    ,
    1460–62 (listing cases).
    - 17 -
    insurance benefits.   She cites no current statute, regulation, or
    policy directive explaining the relationship between a present
    disability and an application for disability benefits based on
    long-ago expired insurance coverage.8   Because we need not do so
    on the facts of this case, we decline to speculate about how (or
    whether) the Commissioner's positions can be reconciled with each
    other and with the logic of the disability benefits system.
    Unsurprisingly, there is no uniform approach in the courts on when
    to apply SSR 83-20.   Compare Eichstadt v. Astrue, 
    534 F.3d 663
    ,
    667 (7th Cir. 2008) ("The ALJ in this case found that Eichstadt
    was not disabled at any point before [her DLI].    With no finding
    of disability, there was no need to determine an onset date."),
    and Key v. Callahan, 
    109 F.3d 270
    , 274 (6th Cir. 1997) (similar),
    with Grebenick, 121 F.3d at 1200–01 (applying SSR 83-20 to the
    8 In her brief to the district court, the Commissioner did
    quote language from the agency's litigation manual, which at one
    time stated that "it serves 'no purpose to make findings regarding
    the claimant's impairments or ability to work after the date last
    insured.'" Def.'s Mem. in Supp. of Mot., at 11 n.4 (quoting Soc.
    Sec. Admin., Hearings, Appeals and Litig. Law Manual ("HALLEX")
    § I-5-4-40 (Implementation of the Difford Acquiescence Ruling)
    (Sept. 28, 2005)). However, the agency removed the cited section
    from the manual on October 31, 2013, months before the Commissioner
    filed her brief.    See HALLEX § I-5-440 (Implementation of the
    Difford Acquiescence Ruling) (Oct. 13, 2013) ("We removed the
    [temporary instructions] titled 'Implementation of the Difford
    Acquiescence Ruling.'").
    Moreover, the district court in Wilson rejected the reference
    to the manual section, finding that the quoted material was taken
    out of context. See 17 F. Supp. 3d at 143 n.30 (quoting HALLEX
    § I-5-4-40).
    - 18 -
    disability-prior-to-DLI determination where the ALJ made no prior
    finding    of   disability,   either   at   present   or   prior   to   DLI).
    Plainly, there is a need for clarification.
    C. The meaning of "should"
    To compound the confusion, the Commissioner has taken
    directly conflicting positions during this case on the meaning of
    a key provision within SSR 83-20.           The ruling states that "the
    [ALJ] should call on the services of a medical advisor when onset
    must be inferred."      SSR 83-20, 
    1983 WL 31249
    , at *3 (emphasis
    added).    Before the district court, the Commissioner argued that
    "SSR 83-20 . . . does not explicitly require an ALJ to call a
    medical advisor, but states that one should be called," thus
    appealing to the non-mandatory nature of the word "should." Def.'s
    Mem. in Supp. of Mot., at 13 n.8.       During oral argument on appeal,
    however, counsel for the Commissioner conceded that "should" is
    mandatory.9     This concession is especially puzzling given that
    other circuits have held to the contrary -- i.e., that SSR 83-20's
    directive is not mandatory because the ruling states that the ALJ
    "should" seek the aid of a medical advisor rather than "must" or
    "shall."    See, e.g., Eichstadt, 
    534 F.3d at 667
    .
    9  When asked if the Commissioner's position is that SSR 83-
    20's use of "should" should be read as "shall," counsel for the
    Commissioner replied in the affirmative, adding "we don't contest
    that."
    - 19 -
    In   sum,     the   gaps    and   inconsistencies   in   the
    Commissioner's arguments as to the general applicability of SSR
    83-20 pose a challenge to any decisionmaker attempting to determine
    when or how to apply the ruling.      We urge the Commissioner to act
    swiftly to revise SSR 83-20 and enunciate a coherent explanation
    of the ruling's purpose and application, thereby providing much-
    needed clarity for claimants, the agency's own adjudicators, and
    the courts.
    IV.
    As explained above, assuming the applicability of SSR
    83-20, we find error in the court's determination that Fischer's
    contemporaneous medical evidence was ambiguous and required the
    ALJ to call a medical advisor.       We therefore vacate the judgment
    of the district court and remand for consideration of Fischer's
    remaining claims.10
    So ordered.
    10In her brief to the district court, Fischer argued, among
    other things, that the ALJ violated SSR 03-02p when he did not
    properly evaluate her Chronic Pain Syndrome diagnosis.          The
    district court did not reach Fischer's asserted claims, and the
    parties have not argued them before us or asked us to resolve them.
    We therefore leave these matters to the district court to address
    in the first instance on remand.
    - 20 -