Moret Rivera v. SHHS ( 1994 )


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  • USCA1 Opinion








    March 23, 1994
    [NOT FOR PUBLICATION]

    UNITED STATES COURT OF APPEALS
    FOR THE FIRST CIRCUIT
    ____________________


    No. 93-1700

    SONIA M. MORET RIVERA,

    Plaintiff, Appellant,

    v.

    SECRETARY OF HEALTH AND HUMAN SERVICES,

    Defendant, Appellee.


    ____________________

    APPEAL FROM THE UNITED STATES DISTRICT COURT

    FOR THE DISTRICT OF PUERTO RICO


    [Hon. Carmen Consuelo Cerezo, U.S. District Judge] ___________________

    ____________________

    Before

    Breyer, Chief Judge, ___________
    Torruella and Selya, Circuit Judges. ______________

    ____________________

    Juan A. Hernandez Rivera and Raymond Rivera Esteves on brief for ________________________ _______________________
    appellant.
    Cuillermo Gil, United States Attorney, Maria Hortensia Rios, ______________ ______________________
    Assistant United States Attorney, and Robert M. Peckrill, Assistant ___________________
    Regional Counsel, Department of Health and Human Services, on brief
    for appellee.


    ____________________


    ____________________
















    Per Curiam. Claimant Sonia Moret Rivera appeals a __________

    district court judgment that affirmed the decision of the

    Secretary of Health and Human Services denying claimant's

    application for Social Security disability benefits. The

    discrete question before us is whether substantial evidence

    supports the Secretary's conclusion that claimant retained

    the residual functional capacity (RFC) to perform her past

    work as a secretary before her insured status expired.

    Finding substantial evidence to support this conclusion, we

    affirm.

    I.

    On October 18, 1990, at age 49, claimant filed an

    initial application for disability benefits with a Florida

    district office of the Social Security Administration (SSA).

    Claimant alleged that she had been disabled from work since

    December 15, 1985 due to the surgical removal of two left

    ribs, left arm numbness and pain and back pains. (Tr. 61).

    Claimant's insured status expired on December 31, 1989.

    Claimant graduated from high school and received additional

    training as a secretary around 1961. (Tr.65) Between 1963

    and 1985, she worked as a secretary, receptionist, and office

    clerk at various companies in her native Puerto Rico. (Tr.

    66). Her responsibilities included typing letters, filing,

    answering the telephone, using calculators, taking orders



















    from customers, and other office procedures. (Tr. 33, 66).1



    The medical evidence discloses that claimant began

    experiencing left wrist pain with paresthesias of the left

    upper extremity in December, 1983. (Tr. 86). In early 1984,

    claimant was evaluated by Dr. Jose Lozada-Roman for recurrent

    anterior chest pain and numbness of the left arm. (Tr. 136).

    X-rays of claimant's cervical spine taken on February 6, 1984

    disclosed the presence of a left cervical rib and

    osteophytosis (bony growths) of the mid-dorsal vertebrae.

    (Tr. 85). Vascular studies from that period further revealed

    that claimant experienced severe compression of the sub-

    clavian artery with her arms overhead and mild vasospastic

    flow with the arms at rest. (Tr. 83-84). Dr. Lozada-Roman

    opined that claimant's evaluation, which included a positive

    Adson's test, "was strongly suggestive of thoracic outlet












    ____________________

    1. Claimant's disability report indicated that her past work
    required her to perform the light exertional tasks of lifting
    weights of up to 10 pounds frequently and 20 pounds
    occasionally, sitting for four hours and walking and
    standing, respectively, for two hours each. (Tr. 66). See ___
    20 C.F.R. 404.1567(b).

    -3-













    syndrome." (Tr. 136).2 He referred claimant to a vascular

    surgeon, Dr. Raul Garcia-Rinaldi.

    On March 25, 1984, claimant was admitted to the Houston,

    Texas Memorial Hospital under the care of Dr. Garcia-Rinaldi.

    She again reported that in December 1983 she experienced the

    onset of left wrist pain that radiated to her elbow and

    associated numbness of the left hand. Her condition was

    aggravated by physical activity. (Tr. 106). She also

    complained of left-sided neck and shoulder pain with

    paresthesias of the left upper extremity, tachycardia, light

    headedness, palpitations, diaphoresis, neck, facial, and

    anterior chest flushing, diarrhea, a sensation that there was

    a lump in her throat, and generalized anxiety. Dr. Garcia-

    Rinaldi found no increase of left wrist pain upon sustained

    hyperextension of the wrist and that the distal pulses were

    symmetrical at rest. (Tr. 107). His initial impression was

    that claimant suffered from a left cervical rib, rule out





    ____________________

    2. Thoracic outlet syndrome is "compression of the brachial
    plexus nerve trunks, characterized by pain in arms,
    paresthesia of fingers, vasomotor symptoms ... and weakness
    and wasting of small muscles of the hand; it may be caused by
    drooping shoulder girdle, a cervical rib or fibrous band, an
    abnormal first rib, continual hyperabduction of the arm, or
    (rarely) compression of the edge of the scalenus anterior
    muscle." R. Sloane, The Sloane-Dorland Annotated Medical- ______________________________________
    Legal Dictionary (1987), p. 697. Adson's test is one method _________________
    of diagnosing thoracic outlet syndrome. Dorland's _________
    Illustrated Medical Dictionary, (27th ed. 1988), p. 1674. ______________________________

    -4-













    thoracic outlet syndrome, and generalized anxiety with a

    history of acute anxiety attacks. (Tr. 107.)3

    On March 26, 1984, Dr. William Fleming evaluated

    claimant as a consultant to Dr. Garcia-Rinaldi. Dr. Fleming

    found that claimant exhibited a full range of motion of the

    cervical spine, although she complained of a popping

    sensation when she turned her neck. Tinel's sign was

    positive at both wrists, the left greater than the right.4

    There was moderate weakness of the left abductor pollicis

    brevis muscle (i.e., the muscle between the wrist and the ____

    first joint of the thumb) and decreased sensation in the

    first three fingers of the left arm. Dr. Fleming's

    impression was that claimant had left median neuropathy of

    the wrist (carpal tunnel syndrome).5 Other possible

    ____________________

    3. Claimant does not argue that she is disabled as a result
    of anxiety or any other mental impairment.

    4. Tinel's sign is "a tingling sensation in the distal end
    of a limb when percussion is made over the site of a divided
    nerve. It indicates a partial lesion or the beginning
    regeneration of the nerve." Dorland's Illustrated Medical ______________________________
    Dictionary, at 1526. "The sign is often present in the __________
    abnormal tingling sensation in the fingers and the hand
    (carpal tunnel syndrome)." The Mosby Medical Encyclopedia, _______________________________
    (1985), p. 730.

    5. Carpal tunnel syndrome is "a complex of symptoms
    resulting from compression of the median nerve in the carpal
    tunnel, with pain and burning or tingling paresthesias in the
    fingers and hand, sometimes extending to the elbow."
    Dorland's Illustrated Medical Dictionary, at 1632. "This __________________________________________
    compression produces paresthesias in the radial-palmar aspect
    of the hand plus pain in the wrist, in the palm, or sometimes
    proximal to the compression site in the forearm and shoulder.
    Sensory deficit in the first 3 digits and/or weakness and

    -5-













    conditions to be ruled out were thoracic outlet syndrome,

    left brachial plexopathy, and cervical radiculopathy. (Tr.

    103). Dr. Fleming recommended an electromyogram, nerve

    conduction studies, and x-rays of both wrists and the

    cervical spine.

    A March 27, 1984 electromyogram was normal. (Tr. 86).

    In addition, cervical spine films and x-rays of both wrists

    were within normal limits except for the presence of the left

    cervical rib that had been previously found. (Tr. 86). The

    record suggests that no nerve conduction studies were done in

    1984. On March 29, 1984, Dr. Garcia-Rinaldi diagnosed

    claimant to be suffering from thoracic outlet syndrome due to

    compression of the subclavian arteries caused by the left

    cervical and first ribs. (Tr. 93). He performed a

    transaxillary resection of these ribs. His operative report

    indicates that when the rib sections were removed, "the

    subclavian artery and its veins were released" and

    "[e]xcellent distal pulsations were obtained in all

    positions." (Tr. 93).6

    ____________________

    atrophy in the muscles controlling thumb abduction and
    apposition may follow." The Merck Manual, (Robert Berkow, ________________
    M.D., et al., eds., 16th ed. 1992), p. 1519.

    6. Dr. Garcia-Rinaldi later submitted a letter to the
    Florida disability evaluation service in connection with
    claimant's initial application. There he stated that the
    diagnosis of thoracic outlet syndrome resulting from a left
    cervical rib "was quite clear" and that, to the best of his
    knowledge, claimant had satisfactory results following the
    March 1984 surgery. (Tr. 132). During the course of

    -6-













    Claimant was discharged from the hospital on April 3,

    1984. She returned to work after the surgery and continued

    to work until December 1985. Claimant alleges that while she

    experienced some improvement following the surgery, she

    continued to experience arm pain and numbness that eventually

    adversely affected her work performance and caused her to be

    fired.7 Claimant has not worked since the alleged onset of

    her disability on December 15, 1985.

    There are no medical records from 1985, 1986, or 1987.

    Between August 12, 1988 and April 1991, Dr. Tomas Jordan saw

    claimant five times per year for various conditions. While

    Dr. Jordan's office records are largely illegible, they

    indicate that claimant had a history of thoracic outlet

    syndrome that was treated with the surgical removal of a

    cervical rib. (Tr. 108). Dr. Jordan treated claimant for

    numbness of the left arm, cervical spasm and hematuria during

    August and September 1988. He prescribed Decadron, an anti-

    inflammatory drug, and other medications. (Tr. 124-27). X-

    rays from that time disclosed mild straightening of the


    ____________________

    claimant's 1984 hospitalization claimant also underwent
    testing for chest pain and other problems. She was found to
    have chronic esophagitis and bladder polyps, which were
    removed. (Tr. 86, 89).

    7. Claimant's disability report states that the operation,
    which was performed under her left arm, caused "slow
    movement" of her arm. Claimant reported that as a result,
    she kept getting slower at work and that she did not perform
    her work with accuracy. (Tr. 61).

    -7-













    cervical spine and mild osteophytes of the thoracic spine.

    (Tr. 131). Dr. Jordan indicated that claimant's impairments

    included carpal tunnel syndrome, cervical myositis, hiatal

    hernia, microhematuria, gastritis, and irritable colon

    syndrome. (Tr. 112). However, he did not specify when she

    suffered from symptoms associated with these conditions, nor

    did he state that any of these conditions were disabling

    either during or after the insured period. Dr. Jordan

    referred claimant to a physiatrist for her thoracic outlet

    syndrome and prescribed medications, physical therapy, and

    diet for her other symptoms. (Tr. 108, 112).

    On December 17, 1990, claimant was examined by Dr.

    Percival Tamayo, a Florida internist and SSA consultant. At

    that time claimant reported that she could still do some

    housework and lift weights less than ten pounds. Physical

    examination disclosed that claimant's neck was supple and

    that claimant exhibited no pain on hyperextension or

    rotation. The back showed no significant paravertebral

    muscle spasm and no spine deformity. Her lower extremities

    were normal. There was no significant reduction in the range

    of motion in claimant's cervical or lumbar spine, and no pain

    was produced during the range of motion testing.

    Neurological examination was grossly unremarkable. Palpation

    of the chest wall elicited tenderness over the costochondral

    junction at the second and third rib levels, especially on



    -8-













    the left side. Dr. Tamayo concluded that claimant suffered

    from non-cardiac chest pain consistent with costochondritis

    (an inflammation of the cartilage connecting the ribs to the

    sternum) and that her residual left arm discomfort may be

    secondary to her previous thoracic outlet syndrome. No other

    significant abnormalities were noted. (Tr. 133-34).

    Dr. Lozada-Roman also submitted a report dated 12/20/90.

    In addition to the aforementioned history, he stated that

    claimant was then experiencing "some discomfort" in the left

    arm and difficulty writing and lifting objects. He

    recommended that she again see a vascular surgeon and have a

    neurological evaluation. (Tr. 136).

    On January 2, 1991, claimant's initial application was

    denied. She immediately filed a request for reconsideration

    which was also denied. Claimant filed a request for a

    hearing before an administrative law judge (ALJ) and

    submitted additional medical evidence. On April 9, 1991,

    claimant saw Dr. Victor Gonzalez, a specialist in physical

    medicine and rehabilitation. (Tr. 137-38). His records are

    also largely illegible. Nevertheless, Dr. Gonzalez reported

    that claimant was experiencing pain in her chest and elbows

    in 1991, as well as numbness of both arms, more so on the

    left. Claimant also alleged that she had pain in her left

    hip. Physical examination disclosed tenderness on palpation

    of the cervical resection area. A 4/10/91 note suggests that



    -9-













    claimant's symptoms were consistent with carpal tunnel

    syndrome and thoracic outlet syndrome. (Tr. 138).

    An April 17, 1991 electromyogram of claimant's upper

    limbs was normal. (Tr. 113). However, nerve conduction

    studies from that date showed early signs of carpal tunnel

    syndrome and entrapment neuropathy of the ulnar nerve at

    Guyon's canal. April 1991 x-rays of claimant's lumbar spine

    were normal. (Tr. 151-53). On May 24, 1991, claimant had

    another vascular study. This disclosed mild compression of

    the right subclavian artery with the arm to side and arm to

    back maneuvers and severe compression with the arms overhead.

    The left subclavian artery also exhibited mild compression

    with the arms overhead. Claimant's circulation was normal

    with her arms at rest, although she experienced mild

    vasospastic flow in both hands. Dr. Ivette Matos Serrano,

    a neurologist, began treating claimant around 1991. (Tr.

    28). On June 20, 1991, one and one-half years after

    claimant's insured status expired, Dr. Matos reported that

    claimant was experiencing numbness in the posterior part of

    the head, frequent headaches, paresthesias, cramps of both

    upper extremities, and "an electric-like sensation along the

    posterior aspect of the left upper extremity down to the

    fingers[.]" The remainder of her report suggests that

    claimant's condition was considerably more dire than that

    described by Dr. Tamayo, the SSA's consultant. For example,



    -10-













    Dr. Matos indicated that claimant had muscle spasms in her

    cervical, paravertebral, and trapezius muscles, that her

    range of motion testing revealed significant limitations and

    pain, and that claimant exhibited diminished sensation in her

    left arm and leg and "slight weakness" of both handgrips.

    Based on her examination and the 1991 vascular and nerve

    conduction studies, Dr. Matos diagnosed claimant to be

    suffering from severe bilateral thoracic outlet syndrome,

    chronic cervical syndrome, bilateral carpal tunnel syndrome,

    bilateral entrapment neuropathy of the ulnar nerves, and

    chronic lumbar syndrome with clinical signs and symptoms

    suggesting radicular involvement. She concluded that

    claimant had suffered from bilateral thoracic outlet syndrome

    since 1983, and that while she experienced some improvement

    on her left side following surgery in 1984, her condition

    became progressively aggravated. Dr. Matos opined that it

    was understandable for claimant's symptoms to remain

    following surgery as in many patients symptoms do recur. She

    advised that claimant would continue to need treatment for an

    indefinite time and that her labor prognosis was extremely

    poor. However, Dr. Matos did not express an opinion on

    whether claimant was disabled during the insured period.

    (Tr. 142-47).

    Claimant and her attorney appeared for a hearing before

    an ALJ on August 1, 1991. Claimant testified that she could



    -11-













    no longer work as a result of her 1984 operation and

    continuing pain and numbness. She explained that after her

    operation, her "ability to work decreased" and she was fired

    as a result. (Tr. 25).8 Claimant asserted that she did not

    go back to work because she felt "ill" and "demoralized",

    noting that she experienced "lots of pains in the neck,

    muscular spasms which continued after the operation[, and

    her] arms got numb." (Tr. 26). While claimant acknowledged

    that she experienced some improvement after the operation,

    pains and numbness of both arms continued. Claimant

    testified that she is incapacitated because of the pain she

    constantly feels. (Tr. 26, 32.)9

    On August 27, 1991, the ALJ issued a decision denying

    claimant's application for benefits. The ALJ specifically

    found that during the relevant insured period, claimant

    suffered from severe cervical myositis and status post trans-

    axillary resection of her left cervical and first ribs.

    Although these conditions did not meet or equal the SSA's


    ____________________

    8. We note that claimant indicated that her employer did not
    admit that her health problems cause her to be fired. (Tr.
    61). Moreover, Dr. Matos reported that claimant was
    dismissed from her job because of a nervous condition, not
    because of her physical complaints. (Tr. 143).

    9. Claimant also stated that she had problems swallowing
    related to her esophagus and hiatal hernia, and cramps in her
    arms and legs. (Tr. 26). She testified that she experienced
    strong neck and back pain which is only temporarily relieved
    with medication and that she can only sit and stand for 10
    minutes at a time. (Tr. 34-37).

    -12-













    listings of impairments, the ALJ found that they imposed

    significant limitations on claimant's ability to lift and

    carry. With respect to claimant's complaints of pain and

    numbness, the ALJ found:

    ... the claimant's neck pain is sustained
    as being secondary to her cervical
    myositis evidenced by mild straightening
    of the cervical spine. However,
    subsequent to the claimant's surgery on
    March 29, 1984, she did not present
    objective clinical findings in which to
    sustain her allegations of chest pain or
    left arm numbness until subsequent to the
    critical period in issue. Through
    December 31, 1989, the claimant was not
    prescribed strong analgesics and there is
    no evidence of significant restrictions
    in her daily activities and social
    functioning suggestive of her inability
    to perform within all exertional levels.

    Based on these findings, the ALJ concluded that claimant

    retained the residual functional capacity to perform

    sedentary work through December 31, 1989. (Tr. 15, 16). He

    then went on to conclude that claimant's impairments did not

    disable her from performing her past light work as a _____

    secretary. (Tr. 15, 16).10 Consequently, the ALJ denied

    ____________________

    10. The ALJ specifically found that claimant's past work
    "involved sitting four hours, standing and walking two hours,
    respectively, frequent bending and reaching and lifting and
    carrying 10 pounds frequently and 20 pounds occasionally.
    (Tr. 14). As noted above at n. 1, these exertional
    requirements are consistent with light work. Moreover, the
    ALJ also found that claimant has the RFC "to perform work
    related activities except for work involving lifting and
    carrying over 10 pounds frequently and 20 pounds ____
    occasionally." (Tr. 16). Implicit in this statement is the
    assertion that claimant can lift up to 10 pounds frequently
    and 20 pounds occasionally.

    -13-













    benefits at step four of the sequential evaluation process.

    See Goodermote v. Secretary of Health and Human Services, 690 ___ __________ ______________________________________

    F. 2d 5, 6-7 (1st Cir. 1982). The Appeals Council denied

    review, thus rendering the ALJ's decision final. Claimant

    sought judicial review pursuant to 42 U.S.C. 405(g). The

    district court summarily affirmed the Secretary. This appeal

    followed.

    II.

    On appeal, claimant argues that the ALJ's decision is

    not supported by substantial evidence on the record as a

    whole because the ALJ ignored the uncontroverted evidence of

    disability provided by Drs. Jordan, Tamayo, and Matos and

    substituted his own, unqualified medical opinion in place of

    the evidence provided by these physicians. Claimant says

    that the medical evidence provided by these physicians

    established that she is at least disabled from performing her

    past secretarial work due to thoracic outlet syndrome, carpal

    tunnel syndrome, left arm numbness, and pain. Claimant

    further argues that the ALJ erred in concluding that she has

    the residual functional capacity (RFC) to perform her past

    relevant work absent an RFC assessment by a physician.

    Finally, claimant contends that the ALJ failed to give

    appropriate consideration to her complaints of disabling

    pain.





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    We must affirm the Secretary's decision if it is

    supported by substantial evidence on the record as a whole.

    Rodriguez v. Secretary of Health and Human Services, 647 F.2d _________ ______________________________________

    218, 222 (1st Cir. 1981). "Claimant is not entitled to

    disability benefits unless [s]he can demonstrate that h[er]

    disability existed prior to the expiration of h[er] insured

    status." Cruz Rivera v. Secretary of Health and Human ____________ _________________________________

    Services, 818 F.2d 96, 97 (1st Cir.), cert. denied, 497 U.S. ________ _____ ______

    1042 (1987). It is not sufficient for a claimant to

    establish that her impairment had its roots before the date

    that her insured status expired. Rather, the claimant must

    show that her impairment(s) reached a disabling level of

    severity by that date. See, e.g., Deblois v. Secretary of ___ ____ _______ ____________

    Health and Human Services, 686 F.2d 76, 79 (1st Cir. 1982); _________________________

    Tremblay v. Secretary of Health and Human Services, 676 F.2d ________ ______________________________________

    11, 13 (1st Cir. 1982). This does not mean, however, that

    medical evidence from the post-insured period is always

    wholly irrelevant. Medical evidence generated after a

    claimant's insured status expires may be considered for what

    light (if any) it sheds on the question whether claimant's

    impairment(s) reached disabling severity before claimant's ______

    insured status expired. See, e.g., Smith v. Bowen, 849 F.2d ___ ____ _____ _____

    1222, 1225 (9th Cir. 1988); Basinger v. Heckler, 725 F.2d ________ _______

    1166, 1169 (8th Cir. 1984)(collecting cases); Gonzalez v. ________

    Secretary of Health and Human Services, 757 F. Supp. 130, 134 ______________________________________



    -15-













    (D.P.R. 1991); Alcaide v. Secretary of Health and Human _______ ________________________________

    Services, 601 F. Supp. 669, 672-73 (D.P.R. 1985). ________

    While we think claimant overstates the strength of the

    evidence from Drs. Jordan, Tamayo, and Matos, we are troubled

    by the ALJ's finding that claimant did not present objective

    clinical findings to sustain her allegations of left arm

    numbness until after her insured status expired in 1989. Dr.

    Jordan recorded that claimant was experiencing left arm

    numbness in connection with cervical spasm in August 1988.

    (Tr. 127). And while claimant was not prescribed strong

    analgesics through December 31 1989, Dr. Jordan did prescribe

    Decadron, an anti-inflammatory medication, in August 1988.

    (Tr. 126). The record as a whole suggests that claimant

    suffered from symptoms associated with thoracic outlet

    syndrome both before and after her insured status expired.

    Arguably, the ALJ should have considered this condition in

    evaluating claimant's RFC.

    Nevertheless, we cannot say that the ALJ erred in

    discounting the evidence from the post-insured period. The

    record discloses that for at least three of the five years

    after the alleged date of onset (i.e., 1985, 1986, and 1987),

    claimant sought no medical treatment. A gap in the medical

    evidence may itself be evidence that claimant's condition was

    not as dire as alleged. See Irlanda Ortiz v. Secretary of ___ _____________ ____________

    Health and Human Services, 955 F.2d 765, 769 (1st Cir. ___________________________



    -16-













    1991)(gaps in record supported conclusion that claimant's

    pain was not as intense as alleged). Apart from one 1988

    complaint of numbness and cervical spasm, which was treated

    with Decadron, there is no evidence that claimant's condition

    was particularly troubling during the insured period that

    remained after her surgery, much less disabling. We think

    that a single complaint of numbness and spasm does not

    undermine the ALJ's conclusion that claimant retained the RFC

    to perform sedentary work during the insured period. See ___

    Gordils v. Secretary of Health and Human Services, 921 F.2d _______ _______________________________________

    327, 329 (1st Cir. 1990)("if the only medical findings in the

    record suggest that a claimant exhibited little in the way of

    physical impairments, but nowhere in the record did any

    physician state in functional terms that the claimant had the

    exertional capacity to meet the requirements of sedentary

    work, the ALJ would be permitted to reach that functional

    conclusion himself"). This conclusion is further supported

    by the ALJ's finding that there is no evidence of significant

    restrictions in claimant's daily activities and social

    functioning during the insured period.11 We recognize that

    ____________________

    11. To be sure, claimant testified that she had not driven
    in 3 or 4 years, that her daughter did most of the housework,
    and that while she goes to church, she spends most of her
    time lying down due to her various ailments. (Tr. 24, 33,
    39). But it is clear that claimant was speaking of her
    condition at the present, and did not focus on her condition
    between 1985 and 1989. As it was claimant's burden to prove
    that she was disabled before her insured status expired,
    claimant was required to adduce evidence on her condition

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    the ALJ did not stop there, however, and went on to conclude

    that claimant retained the RFC to perform her past light work _____

    as a secretary. We expressly limited our holding in Gordils _______

    to sedentary work, noting that the evidence that the claimant

    had a "weaker back" was not sufficient to support the

    conclusion that the claimant could do the more physically

    demanding light work. See 921 F.2d at 329.12 Claimant ___

    argues that the ALJ erred by concluding that claimant could

    perform light work without an RFC from a physician. We have

    repeatedly admonished that ALJs generally are not qualified

    to assess RFC based on a bare medical record. See, e.g., ___ ____

    Gordils, 921 F.2d at 329; Rivera-Torres v. Secretary of _______ _____________ _____________

    Health and Human Services, 837 F.2d 4, 6-7 (1st Cir. 1988). _________________________

    And while this principle does not preclude ALJs from

    rendering "common sense judgments about functional capacity"

    that do not overstep the bounds of a lay person's competence,

    Gordils, 921 F.2d at 329, where significant exertional _______


    ____________________

    during that period. And, in contrast to claimant's
    testimony, the evidence in her 1990 disability report, which
    was prepared only ten months after claimant's insured status
    expired, indicated that claimant could drive, cook, do "some"
    cleaning and shopping, and take care of flowers. (Tr. 64).
    Given the gap in the medical evidence from the insured
    period, this supports the ALJ's conclusion that the sedentary
    base was intact during that time.

    12. We note that in Gordils, a nonexamining physician had _______
    indicated that claimant could do light work. We affirmed the
    denial of benefits only on the ground that the record
    supported the implicit conclusion that claimant also could
    perform sedentary work. See 921 F.2d at 329. ___

    -18-













    limitations are present, an exertional RFC is required. See ___

    Perez v. Secretary of Health and Human Services, 958 F.2d _____ ________________________________________

    445, 446-47 (1st Cir. 1991). However, in order to trigger

    this requirement, the claimant must first put her RFC in

    issue. Thus, in Santiago v. Secretary of Health and Human ________ ______________________________

    Services, 944 F.2d 1, 4 (1st Cir. 1992), we upheld an ALJ's ________

    determination that a claimant retained the RFC to perform her

    past, light work as a sewing machine operator absent an

    expert's RFC because the record demonstrated that claimant

    had "only relatively mild mental and physical impairments"

    and claimant never clarified the particular respects in which

    her impairments prevented her from performing her past work.

    We emphasized that to meet the burden of proof at step 4, a

    claimant must produce evidence of the physical and mental

    demands of her prior work and describe how her impairment(s)

    precluded the performance of that work "in the relevant ________________

    period." Id. at 5. ______ ___

    Here, while the claimant described both her duties and

    her present impairments, neither her testimony nor the _______

    medical evidence explained how her impairments precluded the

    performance of work-related tasks during the insured period.

    Rather, the record as a whole suggests that claimant

    recovered from her surgery and did not seek treatment for the

    three years that ensued (1985, 1986, and 1987). And while

    claimant sought treatment again in 1988, there was no



    -19-













    evidence as to the frequency or duration of her symptoms

    during the relevant period, nor did claimant explain how her

    symptoms precluded the performance of the various tasks

    associated with her past work during that time. Thus, where

    claimant failed to focus her proof on the relevant insured

    period, and the medical evidence from that time does not

    suggest that claimant continuously suffered from disabling

    symptoms, we think the ALJ supportably concluded that

    claimant retained the RFC to perform her past work as a

    secretary notwithstanding the absence of a physician's RFC.

    Finally, claimant argues that the ALJ did not give

    sufficient weight to her complaints of disabling pain. Once

    again, this argument fails because the claimant did not

    specify how her pain limited her functions during the insured

    period. The ALJ supportably found that claimant was not

    prescribed strong analgesics during the insured period

    (indeed, we cannot discern that claimant was prescribed any ___

    analgesics during this time). Claimant initially reported

    that she could drive, shop, cook, tend flowers, and maintain

    social contacts. Thus, the record does not suggest that

    claimant's pain was disabling during the relevant period.

    Judgment affirmed. _________________









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