Aragon v. Apfel

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
DEC 22 1998
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
NICHOLAS T. ARAGON, JR.,
Plaintiff-Appellant,
v. No. 98-2097
(D.C. No. CIV-97-605-BB/LCS)
KENNETH S. APFEL, Commissioner, (D. N.M.)
Social Security Administration,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before PORFILIO, BARRETT, and KELLY , Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1.9. The case is therefore
ordered submitted without oral argument.
*
This order and judgment is not binding precedent, except under the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.
Plaintiff appeals from a district court order affirming the Commissioner’s
finding of nondisability and consequent denial of social security benefits. The
Administrative Law Judge (ALJ) determined that exertional impairments limited
plaintiff to a “light” residual functional capacity (RFC); that plaintiff therefore
could not return to his past relevant work; that, given the absence of significant
nonexertional impairments, plaintiff could perform a full range of light work; and
that, therefore, the pertinent medical-vocational guideline, or grid, dictated a
finding of nondisability. Plaintiff submitted additional evidence of disability to
the Appeals Council, which summarily rejected the new evidence and denied
review, leaving the ALJ’s decision as the final disposition in the case. We review
the decision to determine whether it is legally correct and supported by substantial
evidence. See Winfrey v. Chater , 92 F.3d 1017, 1019 (10th Cir. 1996). As
explained below, we reverse and remand for further proceedings.
Plaintiff filed for Supplemental Security Income benefits in August 1994,
alleging disability based on (1) partially controlled but worsening paroxysmal
atrial tachycardia (PAT), (2) residual complications from a back injury suffered in
1980, and (3) hearing loss and fluid drainage caused by a gunshot to the right side
of his head in 1971. The ALJ held the first two conditions limited plaintiff to a
light RFC, which was not further restricted by significant nonexertional
limitations associated with any of these conditions (though the ALJ also noted,
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without explanation, that plaintiff could not work around excessive noise,
unprotected heights, or moving machinery, see App. II at 17). We have nothing
of substance to add with respect to the assessment of plaintiff’s back and head
injuries, which is consistent with the relevant evidence and controlling law.
Rather, our objection to the Commissioner’s decision relates to the analysis of the
PAT condition, particularly in light of the new evidence submitted to the Appeals
Council.
It is clear from the ALJ’s decision and the record that plaintiff’s primary
impairment is the PAT, which has both exertional and nonexertional dimensions.
See id. at 13 (ALJ’s decision noting plaintiff “attributes his inability to work
mostly to frequent episodes of heart palpitations (occurring allegedly up to four
days a week and lasting as long as 10 hours at a time) and also dizziness and
nausea”); see also, e.g. , id. at 222 (physician’s opinion of disability “due to
recurrent rapid palpitations, that are associated with nausea and dizziness, with
fatigue lasting for hours afterward”). For the reasons that follow, we hold that
(1) the ALJ’s limited acknowledgment of the exertional dimension of the PAT
(reflected in the RFC for light work), while possibly justifiable on the initial
hearing record, was undercut by evidence submitted on administrative appeal, and
(2) the ALJ’s disregard of the nonexertional dimension of the condition was error
from the outset, compounded by the Appeals Council’s decision.
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Exertional Limitation
Discussing plaintiff’s PAT, the ALJ concluded that “[e]xtensive treatment
notes provided by Kenneth Yamamoto, M.D., [plaintiff’s] treating physician . . .
do not reveal any significant cardiac findings that support the degree of symptoms
and functional limitations alleged by [plaintiff].” Id. at 13-14. This conclusion
was based on three observations, none of which support it.
The ALJ noted that “cardiac examinations have indicated a normal heart
rate and heart sounds.” Id. at 14. However, plaintiff’s symptoms would not be
seen on cardiac examination unless, instead of seeking therapeutic rest, he
actually came in for an examination during an episode. In fact, he did that on at
least one occasion, when an EKG confirmed his complaint. See id. at 118.
The ALJ also stated that “objective testing, such as electrocardiograms,
echocardiograms, and chest x-rays, has been essentially unremarkable, except for
atrial tachycardia [i.e., PAT] .” Id. at 14 (emphasis added). This comment is
clearly not adverse to plaintiff, as the consistently diagnosed and rigorously
treated PAT is precisely what his physicians identify as the underlying, operative
condition.
Finally, the ALJ indicated that “[s]uch findings [i.e., the objective testing
noted above] led Dr. Yamamoto to conclude that [plaintiff] should avoid ‘heavy
lifting’ but could return to ‘light’ work.” Id. at 14. We have searched the record
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and have not located the statement about returning to light work (the ALJ
indiscriminately and unhelpfully references three entire exhibits here, including
long compilations of treatment notes). There is a statement that plaintiff “is
unemployable in his usual line of work as a laborer,” id. at 124, from which the
ALJ might have inferred the unstated suggestion that perhaps plaintiff could
handle another, less rigorous (equals “light”?) line of work. But that inference,
and the speculative equation to light work it requires, is clearly too slender a
thread on which to base any definitive conclusions about RFC.
Notwithstanding the above objections to the ALJ’s stated rationale, we do
not think the medical record available to the ALJ would necessarily have ruled
out an RFC for light work. The notes and reports submitted prior to the ALJ’s
decision generally do not touch on the relationship between physical exertion and
plaintiff’s palpitation episodes. Thus, it is not clear whether light--or any other
level of--work would increase their frequency or intensity. Once an episode is
triggered, however, the resultant fatigue and consequent need for rest would
presumably impact any exertional activity.
In any event, just days after the ALJ issued his decision, plaintiff’s treating
physician added the following unqualified statement of disability to the medical
record: “[The plaintiff] is unable to work in any capacity at this time due to
recurrent rapid palpitations, that are associated with nausea and dizziness, with
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fatigue lasting for hours afterward; these have been occurring daily.” Id. at 222
(June 3, 1996 letter); see also id. at 232 (November 18, 1996 note reiterating same
conclusion). Because this evidence was provided to the Appeals Council, it is
part of the administrative record for the decision under review and may warrant
reversal or remand if it is (1) new, (2) material, and (3) related to the period on or
before the ALJ’s decision. See O’Dell v. Shalala , 44 F.3d 855, 858 (10th Cir.
1994). The evidence qualifies as new and temporally relevant, so the only
question is its materiality.
Given that it comes from the same (and only) physician previously relied on
by the ALJ for his RFC assessment of plaintiff’s PAT condition, this new
evidence would appear quite material. While these more recent opinions from Dr.
Yamamoto are somewhat conclusory, just like the earlier less definitive reports
the ALJ deemed sufficient to rely on, they are based on many previous months’
treatment notes. See generally App. II at 205, 223-26 (notes provided
post-hearing, dated October 1995 through November 1996, reflecting increased
frequency and severity of palpitation episodes and various medicinal measures
taken, with uneven success, in response thereto). And, the Appeals Council,
which simply “concluded [without explanation] that . . . the additional evidence
provides [no] basis for changing the [ALJ’s] decision,” id. at 4, clearly did not
give the “specific, legitimate reasons” necessary to justify rejection of a treating
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physician’s opinion, Miller v. Chater , 99 F.3d 972, 976 (10th Cir. 1996) (further
quotation omitted).
Thus, we therefore cannot affirm the Appeals Council’s reflexive
confirmation of the ALJ’s determination--in the face of contrary new evidence
from the same medical authority the ALJ relied on--that the plaintiff had the
exertional capacity to do light work. Further, there is a related but even more
serious problem here concerning the nonexertional dimension of plaintiff’s PAT
condition.
Nonexertional Limitation (Grid Use)
As previously noted, plaintiff’s palpitation episodes involve symptoms such
as dizziness, nausea, and generalized fatigue, requiring responsive therapeutic
rest, all of which could interfere with work at any exertional level. But, by
focusing solely on the RFC question, the ALJ’s analysis effectively ignored the
nonexertional limitations associated with the plaintiff’s condition. Cf. Evans v.
Chater , 55 F.3d 530, 532 n.2 (10th Cir. 1995) (reversing denial of benefits where
impairment had both exertional and nonexertional consequences and ALJ focused
on only one). All we have to review in this regard is the ALJ’s unexplained and
unsubstantiated conclusion, stated apropos of nothing in particular prior to his
invocation of the grids, that plaintiff “has no non-exertional limitations that
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significantly compromise the range of work he is capable of performing.” 1
App.
II at 16. Even assuming the ALJ had the PAT in mind when making this
statement (which is not evident from the context), there simply is no basis in the
present record for the conclusion that plaintiff’s consistently reported and
rigorously treated palpitation episodes, striking (with variability) as often as
several times a week and for as long as several hours, would not significantly
affect his ability to work.
Thus, even on the initial hearing record, the ALJ’s indirect rejection of the
nonexertional effects of plaintiff’s PAT condition, and hence his reliance on the
grid for light work, is problematic. See generally Thompson v. Sullivan , 987 F.2d
1482, 1488 (10th Cir. 1993) (stating familiar rule that resort to grids is
inappropriate when nonexertional impairments limit claimant’s ability to work at
given RFC level). Considering the post-hearing notes indicating a deterioration
of plaintiff’s PAT condition, and the treating physician’s unequivocal opinion
about its disabling effect, the Appeals Council’s summary approval of the ALJ’s
decision is plainly insupportable.
1
In his concluding summary of findings, the ALJ did recognize--contrary to
the above quote and again without explanation--some unspecified nonexertional
impairment precluding work “at unprotected heights, or around moving
machinery,” App. II at 17, for which dizziness caused by PAT seems the only
possible source.
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In sum, while the extant record does not necessarily settle the ultimate
question of disability, it does fatally undermine the existing denial of benefits
based on the grids. We therefore reverse and remand the case for further
proceedings. In particular, the Commissioner should give explicit, responsive
consideration to the post-hearing evidence relating to PAT and, if necessary,
obtain testimony from a vocational expert about the occupational consequences of
plaintiff’s palpitation episodes, addressing both their exertional and nonexertional
impact.
The judgment of the United States District Court for the District of New
Mexico is REVERSED, and the cause is REMANDED to the district court with
directions to remand, in turn, to the Commissioner for further proceedings
consistent with this order and judgment.
Entered for the Court
James E. Barrett
Senior Circuit Judge
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