Fischer v. Colvin
831 F.3d 31
| 1st Cir. | 2016Background
- Gloria Gean Fischer applied for DIB alleging onset from an October 31, 1995 fall; her date last insured (DLI) was March 31, 1998.
- Contemporaneous records (1996–1998) include clinic exams, an October 1996 MRI showing a bulging lumbar disc and treatment for sciatica, and a normal January 1998 cervical MRI; later (post-DLI) imaging and treatment continued, including a 2006 spinal cord stimulator.
- A state reviewer (2012) and the ALJ (2013 hearing) concluded the record did not establish disability prior to the DLI; the ALJ denied benefits.
- The district court vacated and remanded, holding the ALJ erred by not calling a medical advisor under SSR 83-20 when onset had to be inferred from ambiguous evidence.
- The Commissioner appealed; the First Circuit assumed arguendo SSR 83-20 applied but held the contemporaneous medical evidence was not ambiguous, so no medical advisor was required; the district court’s judgment was vacated and the case remanded for further issues.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether SSR 83-20 required the ALJ to obtain a medical advisor before deciding onset | SSR 83-20 applies when onset must be inferred from ambiguous records; ALJ should have called an expert | SSR 83-20 applies only to onset after a finding of present disability or is non-mandatory; not triggered here | Assuming SSR 83-20 applies, it was not triggered because the medical evidence was not ambiguous; no medical advisor required |
| Whether the ALJ’s conclusion that Fischer was not disabled prior to DLI was based on a gap requiring inference | The record contained ambiguity about when disabling severity began, requiring expert inference | ALJ relied on precise contemporaneous imaging and exam findings showing non-disabling results around DLI | Court: contemporaneous normal imaging/exam were precise evidence eliminating need for inference |
| Whether SSR 83-20’s "should" is mandatory | SSR 83-20’s medical-advisor directive must be followed where onset must be inferred | Commissioner argued "should" is permissive (though conceded otherwise at oral argument) | Court did not resolve mandatory-versus-permissive broadly but noted agency inconsistency and problems arising from it |
| Whether the district court erred in remanding for SSR 83-20 noncompliance | Fischer: remand required because ALJ failed to consult a medical advisor | Commissioner: remand unnecessary because no ambiguity and SSR 83-20 inapplicable | Court vacated district court judgment and remanded for remaining claims because SSR 83-20 did not require an advisor here |
Key Cases Cited
- Seavey v. Barnhart, 276 F.3d 1 (1st Cir. 2001) (standard of review in Social Security cases)
- Manso-Pizarro v. Sec'y of Health & Human Servs., 76 F.3d 15 (1st Cir. 1996) (on inference in onset determinations)
- Grebenick v. Chater, 121 F.3d 1193 (8th Cir. 1997) (no ambiguity where post-DLI records show symptoms had not yet become disabling)
- Karlix v. Barnhart, 457 F.3d 742 (8th Cir. 2006) (discussion of onset inference and medical evidence)
- Blea v. Barnhart, 466 F.3d 903 (10th Cir. 2006) (ALJ erred making inferences from a gap in medical record)
- Flaten v. Sec'y of Health & Human Servs., 44 F.3d 1453 (9th Cir. 1995) (discussion of relationship between present disability and prior-onset determinations)