Manso-Pizarro v. SHHS ( 1996 )

UNITED STATES COURT OF APPEALS
FOR THE FIRST CIRCUIT
No. 95-1241
VICTORIA MANSO-PIZARRO,
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. Salvador E. Casellas, U.S. District Judge]
Before
Torruella, Chief Judge,
Selya and Lynch, Circuit Judges.
Raymond Rivera Esteves and Juan A. Hernandez Rivera on brief for
appellant.
Guillermo Gil, United States Attorney, Maria Hortensia Rios-
Gandara, Assistant United States Attorney, and Donna C. McCarthy,
Assistant Regional Counsel, Department of Health and Human Services,
on brief for appellee.
February 8, 1996
Per Curiam. Claimant Victoria Manso-Pizarro was
fifty-eight years old when she applied for social security
insurance benefits on September 5, 1991. She alleged that a
heart condition, high blood pressure and bad circulation had
disabled her from working since June 24, 1991. After a
hearing, an Administrative Law Judge (ALJ) concluded that
claimant suffered from hypertension, obesity, and mild
anxiety, but that she could still perform her last previous
job. Upon judicial review, a magistrate judge recommended
affirming the ALJ's decision. The district court agreed.
The claimant appeals. We vacate and remand for further
proceedings.
I.
We must uphold a denial of social security
disability benefits unless "the Secretary has committed a
legal or factual error in evaluating a particular claim."
Sullivan v. Hudson, 490 U.S. 877, 885 (1989). The
Secretary's findings of fact are conclusive if supported by
substantial evidence. See 42 U.S.C. 405(g); see also
Richardson v. Perales, 402 U.S. 389, 401 (1971).
There is substantial record evidence that claimant
met her initial burden to provide enough information about
the activities her usual work required and how those
activities were compromised by her functional inability to
perform that work. Claimant has a twelfth-grade education
and worked for twenty-two years as a kitchen helper in a
public school cafeteria. Her duties included serving
children, preparing milk, washing dishes and trays, helping
the cook, and cleaning the floor. The job required her to
stand or walk for six hours a day, to sit for one-half hour,
and to lift and carry up to thirty pounds (including, on
occasion, lifting and carrying large, hot cooking pots). She
described her work as fairly heavy and stated that she could
no longer perform it because: she lacked the strength to
lift anything heavy; she had limited ability to lift and
carry because her hands cramped due to bad circulation; she
had blurry vision and became dizzy when bending; and she
could not stand for very long due to pain on her left side
and in her feet. Upon this foundation, the ALJ supportably
concluded that claimant's past relevant work involved medium
physical exertion, and required her alternately to walk or
stand for six hours, to lift or carry up to thirty pounds.
This finding implicated step four of the
Secretary's sequential evaluation process. See 20 C.F.R.
404.1520(e). At step four the initial burden is on the
claimant to show that she can no longer perform her former
work because of her impairments. See Santiago v. Secretary
of HHS, 944 F.2d 1, 5 (1st Cir. 1991). At that point, the
ALJ must compare the physical and mental demands of that past
work with current functional capability. See id.; see also
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20 C.F.R. 404.1560(b). In making a step four appraisal,
the ALJ is entitled to credit a claimant's own description of
her former job duties and functional limitations, see id.,but has some burden independently to develop the record. See
id. at 5-6.
In this instance, the ALJ decided that claimant
retained the residual functional capacity (RFC) to perform
her past relevant work as a cook's helper. In comparing
claimant's retained capacities with the mental and physical
demands of her prior work, the ALJ concluded that because the
record indicated no physical restrictions limiting her
ability to alternately walk or stand for six hours, or to
lift up to thirty pounds, claimant's RFC coincided with her
past relevant work activities.1 The claimant argues that in
1
making this RFC assessment, the ALJ impermissibly interpreted
raw medical evidence, and instead should have obtained an RFC
assessment by a physician. The Secretary disagrees. She
contends that the non-severity of claimant's impairments
entitled the ALJ to make a commonsense RFC assessment and
that the ALJ, in finding that claimant retained the RFC to
perform medium-level exertion, did not overstep the bounds of
lay competence.
1The ALJ deemed it "advisable" to limit the claimant to a
1
medium work level of exertion. See generally 20 C.F.R.
404.1567(c) (medium work involves lifting no more than 50
pounds at a time with frequent carrying or lifting of objects
weighing up to 25 pounds).
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II.
With a few exceptions (not relevant here), an ALJ,
as a lay person, is not qualified to interpret raw data in a
medical record. See Perez v. Secretary of HHS, 958 F.2d 445,
446 (1st Cir. 1991); Gordils v. Secretary of HHS, 921 F.2d
327, 329 (1st Cir. 1990). Of course, where the medical
evidence shows relatively little physical impairment, an ALJ
permissibly can render a commonsense judgment about
functional capacity even without a physician's assessment.
See, e.g., id. But when, as now, a claimant has sufficiently
put her functional inability to perform her prior work in
issue, the ALJ must measure the claimant's capabilities, and
to make that measurement, an expert's RFC
evaluation is ordinarily essential unless
the extent of functional loss, and its
effect on job performance, would be
apparent even to a lay person.
Santiago, 944 F.2d at 7.
Here, the record contains no analysis of functional
capacity by a physician or other expert. Thus, the question
whether substantial evidence supports the ALJ's finding that
claimant retains the functional capacity to do medium-level
work and otherwise perform her prior vocational activities
depends on a qualitative assessment of the medical evidence
that was before the ALJ. If that evidence suggests a
relatively mild physical impairment posing, to the
layperson's eye, no significant exertional restrictions, then
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we must uphold the ALJ's finding; elsewise, we cannot (in the
absence of an expert's opinion). See Perez, 958 F.2d at 446-
47; Gordils, 921 F.2d at 329. It is to that perscrutation
that we now turn.
III.
On June 27, 1991, three days after she stopped
working, claimant saw Dr. Ruiz for chest pain, dizziness and
palpitations. Dr. Ruiz diagnosed her as having high blood
pressure and premature ventricular contractions.2 Although
2
he prescribed medication, the claimant's condition worsened
and he hospitalized her on July 6. She was placed in the
intensive care unit. Tests showed ventricular tachycardia
(an abnormally rapid ventricular rhythm, most commonly
associated with atrioventricular dissociation, see Dorland's,
supra, at 1655), frequent PVCs, premature arterial
contractions, and some evidence of paroxysmal atrial
tachycardia (a condition marked by sudden onset and cessation
of rapid cardiac rate in the atrial locus, Dorland's, supra,
at 655).3 The principal diagnosis was ventricular
3
tachycardia. Coexisting admission diagnoses included
premature ventricular beats, hyperthyroidism, excess calcium
2Premature ventricular contractions (PVCs) are "often
2
indicative of organic heart disease." Dorland's Illustrated
Medical Dictionary 363 (28th ed. 1994).
3Several other entries in the record are illegible.
3
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and uric acid in the blood, moderate dehydration, and two
other illegible conditions.
During the claimant's twelve-day hospital stay,
seven electrocardiograms combined conclusively to show sinus
tachycardia. Two chest x-rays revealed an enlarged heart.
No fewer than five physicians were asked to consult.4 A
4
July 8 consultation report related a diagnostic impression of
sinusal tachycardia and a history of arterial hypertension.
The discharge summary is mostly unreadable. It
indicates, however, that the claimant's laboratory, chemical
profile, and radiology tests were not within normal limits.
The prognosis was described as "fair." Claimant was released
on a regime of medication and extremely limited physical
activity.
Dr. Ruiz saw the claimant as an out-patient in July
and August, and again in January of 1992. At the August
visit, he found her chest pain to be precipitated by
hyperthyroidism with supraventricular tachycardia and
occasional episodes of ventricular tachycardia. He diagnosed
her as suffering from hyperthyroidism with associated
hypertensive cardiovascular disease, ventricular and atrial
tachycardia, and PVCs. He noted other adverse conditions,
4Four of the consulting physicians' reports (Dr. Gonzalez
4
-July 7; Dr. Guerra - July 8; Dr. Rodriguez - July 10; and
Dr. [illegible] - July 11) are, like many other record
entries, inscrutable not because of copy quality but because
the handwriting is not intelligible.
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but they are unreadable. During that same month, the
claimant was also evaluated at the State Insurance Fund.
Tests showed cardiomegaly, an elongated aorta with a
calcified knob, and multifocal PVCs.
On November 26, 1991, the claimant was seen by Dr.
Medina-Ruiz, the Secretary's consulting cardiologist. At
that point, the claimant's chief complaints were fatigue,
lack of energy, cramping of the legs, palpitations and
numbness. The physical examination and associated tests
revealed many of the same heart-related problems. Dr.
Medina-Ruiz's diagnostic impression included a finding of
hypertensive cardiovascular disease.
On June 13, 1992, the claimant was hospitalized for
three days due to high blood pressure, headaches and blurred
vision. The diagnosis was hypertensive crisis and renal
insufficiency. She improved with medication and was
discharged with a one-week restriction of activities.
IV.
Putting aside the many unreadable entries in the
medical evidence,5 those reports otherwise unambiguously
5
indicate the existence of medical conditions and
symptomatology that do not appear, at least without further
5In this case, the unreadable entries may have some
5
import. We think that it is the duty of the ALJ, on remand,
to make some effort to decipher them.
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evaluation by an expert, to be so mild as to make it obvious
to a layperson that the claimant's ability to perform her
particular past work as a cook's helper was unaffected. The
Secretary acknowledges that the record shows cardiac
abnormalities and other serious conditions. Even if we were
to conclude that substantial evidence documented no more than
mild physical impairments with relatively insignificant
exertional loss, the record here is sufficiently ramified
that understanding it requires more than a layperson's effort
at a commonsense functional capacity assessment. See
Gordils, 921 F.2d at 329 (limiting ALJ's assessment of
claimant's functional capacity to sedentary work activities
only). To sum up, given the illegibility of non-trivial
parts of the medical reports, coupled with identifiable
diagnoses and symptoms that seem to indicate more than mild
impairment, we believe that the record alerted the ALJ to the
need for expert guidance regarding the extent of the
claimant's residual functional capacity to perform her
particular past employment. See Perez, 958 F.2d at 447;
Santiago, 944 F.2d at 4; Gordils, 921 F.2d at 329.
We need go no further. Since the ALJ's conclusion
that the claimant can continue to do her prior medium-level
work is not readily verifiable on the record as it stands, we
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think that the case must be remanded to the Secretary for
additional evidence of functional ability.6
6
The judgment of the district court is vacated and
the case is remanded with directions to remand to the
Secretary for further proceedings consistent with this
opinion.
6Because we remand for further development of the record,
6
we do not reach the other arguments advanced by the claimant
on appeal.
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