Bakalarski v. Chater ( 1997 )

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
DEC 3 1997
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
WIESLAW BAKALARSKI,
Plaintiff-Appellant,
v. No. 97-1107
(D.C. No. 96-B-1749)
KENNETH S. APFEL, Commissioner, (D. Colo.)
Social Security Administration, *
Defendant-Appellee.
ORDER AND JUDGMENT **
Before BRORBY, LOGAN, and HENRY, Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
*
Pursuant to Fed. R. App. P. 43(c), Kenneth S. Apfel is substituted for
John J. Callahan, former Acting Commissioner of Social Security, as the
defendant in this action.
**
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
this appeal. See Fed. R. App. P. 34(a); 10th Cir. R. 34.1.9. The case is therefore
ordered submitted without oral argument.
Plaintiff-appellant Wieslaw Bakalarski appeals the district court’s judgment
affirming the decision by the Commissioner of Social Security denying his
applications for disability benefits and supplemental security income. Because
certain portions of the Commissioner’s decision are not supported by the
evidence, we reverse and remand for further proceedings.
Plaintiff has suffered from abdominal pain since at least 1988, when he had
his gallbladder removed. In 1990, he was diagnosed with chronic pancreatitis,
resulting in the removal of his spleen and part of his pancreas. Since that time,
plaintiff has continued to experience abdominal pain, vomiting and diarrhea.
The record shows numerous diagnoses of chronic pancreatitis and chronic pain
syndrome. An upper GI series also revealed duodenitis. Several chemistry tests
have shown abnormal liver function, and a liver biopsy showed mild acute
triaditis. In addition, plaintiff developed diabetes mellitus as a result of the
partial pancreatectomy, with mild peripheral neuropathy.
Plaintiff worked full-time as an electronics assembler until February 1994,
when he reduced his hours to part-time, ceasing work altogether in July 1994.
On February 11, 1994, plaintiff applied for benefits, alleging an inability to work
due to abdominal and leg pain, vomiting, and diarrhea. After a hearing, an
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administrative law judge (ALJ) found that plaintiff could return to his former
work, and thus was not disabled. The Appeals Council denied review, making the
ALJ’s determination the final decision of the Commissioner. The district court
affirmed, and this appeal followed.
We review the Commissioner’s decision to determine whether his factual
findings are supported by substantial evidence and whether correct legal standards
were applied. See Hawkins v. Chater, 113 F.3d 1162, 1164 (10th Cir. 1997).
Substantial evidence is “such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401
(1971) (quotations omitted). We may “neither reweigh the evidence nor substitute
our judgment for that of the agency.” Casias v. Secretary of Health & Human
Servs., 933 F.2d 799, 800 (10th Cir. 1991).
On appeal, plaintiff argues that the Commissioner’s decision is unsupported
by substantial evidence because the ALJ improperly assessed plaintiff’s
credibility regarding his allegations of chronic disabling pain, diarrhea, and
vomiting. In evaluating the credibility of a claimant, an ALJ must consider and
weigh a number of factors in combination. See Huston v. Bowen, 838 F.2d 1125,
1132 & n.7 (10th Cir. 1988). We recognize that the ALJ is “‘optimally positioned
to observe and assess witness credibility.’” Adams v. Chater, 93 F.3d 712, 715
(10th Cir. 1996) (quoting Casias, 933 F.2d at 801). Therefore, we may overturn
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such a credibility determination only when there is a conspicuous absence of
credible evidence to support it. See Trimiar v. Sullivan, 966 F.2d 1326, 1329
(10th Cir. 1992).
Here, the ALJ found plaintiff’s complaints incredible because (1) there was
no documented pathology for the abdominal pain, based on the repeated negative
results of imaging and laboratory studies; (2) several physicians had been unable
to find a cause for plaintiff’s abdominal and leg pain; (3) no treatment was
recommended other than prescriptions for sedatives and painkillers; (4) plaintiff
had a history of drug seeking behavior requiring restriction of his access to
narcotics; (5) plaintiff’s activities of helping with housework and shopping,
ability to drive, and a trip to Poland, were inconsistent with the pain and
limitations alleged; (6) plaintiff’s condition had not changed for four years during
which time he was able to work; (7) plaintiff’s claim that he stopped work
because of his physical condition was contradicted by the record which showed he
stopped work to travel to Poland; and (8) plaintiff’s claim of diarrhea up to
twenty times per day was contradicted by medical evidence that he only had
bowel movements three times per day. We conclude that several of these reasons
are not supported by the evidence.
First, the ALJ incorrectly determined that there was no documented
pathology to support plaintiff’s complaints of disabling pain. Although there was
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a lack of pathology to explain plaintiff’s complaints of severe leg pain, the record
contains a medical basis for his complaints of chronic abdominal pain. Plaintiff
has consistently been diagnosed with chronic pancreatitis and with a chronic pain
syndrome, both of which are capable of producing disabling pain. The fact that
plaintiff’s laboratory and gastrointestinal workups were negative does not negate
these diagnoses or render plaintiff’s pain complaints incredible, as both
conditions can exist without producing positive test results. See, e.g., The Merck
Manual of Diagnosis and Therapy 799 (Robert Berkow, M.D., 16th ed. 1992)
(describing chronic pancreatitis as producing “severe epigastric pain, whose
etiology is not always clear, [that] may last for many hours or several days,” and
noting that a possible cause is “acute inflammation that cannot be recognized by
conventional tests”); see also American Psychiatric Assoc., Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV), (4th ed. 1994), p. 461 (setting
out diagnostic criteria for pain disorder). When there is no “dipstick” test for a
particular condition, a physician’s unchallenged diagnosis may not be rejected
simply because it has not been proven conclusively by a laboratory test or other
technique. See Sisco v. United States Dep’t of Health & Human Servs., 10 F.3d
739, 743-44 (10th Cir. 1993) (holding ALJ erred in rejecting diagnosis of chronic
fatigue syndrome when there was no “dipstick” laboratory test). Further, although
plaintiff’s gastroenterologist questioned whether plaintiff’s pain was caused by
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his pancreatitis, he did not question the existence of plaintiff’s pain, theorizing
instead that the pain resulted from a chronic pain syndrome.
The ALJ also was not entirely correct in finding that no treatment other
than prescriptions for pain medication and tranquilizers had been recommended.
Over the years plaintiff’s physicians have prescribed a variety of medications to
treat his pancreatitis, diarrhea, vomiting, diabetes, and chronic abdominal pain.
In December 1993, plaintiff underwent a celiac plexus block, and in August 1994,
an intrathecal catheter was surgically implanted, on a trial basis, to deliver
continuous narcotic medication. Even if plaintiff’s treatment had been restricted
to prescriptions of pain medication, however, we do not see how this provides a
basis for rejecting his complaints of disabling pain.
Similarly, plaintiff’s history of drug seeking behavior does not render his
pain complaints incredible. Although several physicians noted plaintiff’s
tendency to abuse narcotics and the need to restrict his access to such drugs, they
continued to prescribe large doses of narcotics to treat his pain. Moreover, such
drug-seeking behavior is equally consistent with chronic pain. See The Merck
Manual at 799 (noting threat of narcotics addiction in patients with chronic
pancreatitis); DSM-IV at 459 (noting risk of opioid dependence or abuse
associated with chronic pain disorder).
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The discrepancies noted by the ALJ between plaintiff’s testimony and the
record also are not supported by the evidence. Although the record shows that
plaintiff visited his family in Poland after he ceased working, there is no evidence
that he stopped working because of the trip, and thus no contradiction with his
testimony that he stopped working because of his pain and other symptoms.
Further, notation in a single medical record that plaintiff had three bowel
movements on a particular day did not contradict plaintiff’s testimony that he had
diarrhea ten to fifteen days a month, and that sometimes it was so intense that he
had to use the restroom twenty times a day.
Although the ALJ’s remaining reasons find support in the record, this case
must be reversed for a reevaluation of plaintiff’s subjective complaints. Because
a credibility assessment requires consideration of all the factors “in combination,”
Huston, 838 F.2d at 1132 n.7, when several of the factors relied upon by the ALJ
are found to be unsupported or contradicted by the record, we are precluded from
weighing the remaining factors to determine whether they, in themselves, are
sufficient to support the credibility determination. On remand, the opinion by
plaintiff’s treating physician that plaintiff suffers from debilitating pain, which
the ALJ rejected because it rested on plaintiff’s subjective complaints, also must
be reconsidered. See Goatcher v. United States Dep’t of Health & Human Servs.,
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52 F.3d 288, 289-90 (10th Cir. 1995) (“A treating physician’s opinion must be
given substantial weight unless good cause is shown to disregard it.”).
The ALJ’s conclusion that plaintiff could return to his former work also
must be reconsidered in light of plaintiff’s testimony about numbness in his
hands. The medical evidence revealed “mild peripheral neuropathy” in both
plaintiff’s hands and feet. Appellant’s App. at 237-38. The ALJ did not consider
this impairment, however, finding instead that plaintiff’s diabetes did not place
significant limitations on his functional capacity. Because uncontradicted
medical evidence supported plaintiff’s complaints of numbness, it was error to
decide that he could return to his former electronics assembly work, which
required very precise hand skills, without considering the effect of his peripheral
neuropathy on his ability to do the job. See generally Henrie v. United States
Dep’t of Health & Human Servs., 13 F.3d 359, 361 (10th Cir. 1993). Plaintiff’s
argument regarding his ability to lift twenty to thirty pounds is without merit, as it
was his burden to show he lacked such a capacity.
We do not address plaintiff’s argument regarding the ALJ’s hypotheticals
to the vocational expert because it is unnecessary in light of our reversal on the
credibility issue. In any event, because this case was decided at step four,
improper questions to the vocational expert would not have provided a basis for
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reversal. See Glenn v. Shalala, 21 F.3d 983, 988 (10th Cir. 1994) (holding ALJ is
not required to obtain testimony of vocational expert in a step-four proceeding).
The judgment of the United States District Court for the District of
Colorado is REVERSED, and the case is REMANDED for further proceedings.
Entered for the Court
Robert H. Henry
Circuit Judge
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