4 F.4th 656
8th Cir.2021Background
- Tammy Koch was found disabled from Feb 1, 2014, through Dec 12, 2016; the ALJ later concluded her disability ended on Dec 13, 2016. The Appeals Council denied review and the district court affirmed.
- Koch has chronic low back pain from a 2009 car accident; she underwent lumbar fusion on Oct 7, 2016 and reported pain 8/10 at a Dec 13, 2016 post-op visit in which her surgeon noted she was "very satisfied" and that symptoms "improved significantly."
- State consultative examiners (Dec 2016 and Apr 2017) and a nurse evaluator found severe range-of-motion restriction, ongoing pain, poor prognosis, and functional limitations; one examiner opined she could not return to work soon and another noted pain would slow task completion.
- The ALJ found medical improvement as of Dec 13, 2016, removed a prior RFC limitation that she would miss two or more workdays per month due to pain, credited the surgeon’s brief post-op note, and gave reduced weight to other examining providers.
- The Eighth Circuit held the ALJ’s determination was not supported by substantial evidence on the record as a whole and reversed and remanded for a new medical-improvement evaluation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the ALJ properly discounted Koch’s subjective pain complaints | Koch: ALJ wrongly discounted pain; record shows continued significant pain post-surgery | SSA: Patient satisfaction and post-op notes show significant improvement in pain | Court: ALJ erred — substantial evidence as a whole does not support discounting Koch’s pain complaints |
| Weight given to medical opinions (Drs. Honghiran, Hester; Nurse Branscum) | Koch: ALJ improperly discounted in-person examiners and relied on surgeon’s conclusory note | SSA: Surgeon’s post-op note justified discounting other opinions | Court: ALJ erred — gave insufficient weight to examining evaluators; surgeon’s brief note did not justify discounting them |
| Whether ALJ drew improper inferences to craft RFC (removal of absenteeism limitation) | Koch: RFC not supported by medical evidence; ALJ impermissibly inferred work capacity from surgeon’s note | SSA: RFC supported by medical record and vocational testimony | Court: ALJ impermissibly drew own inferences from a non-committal surgical note; RFC not supported by substantial evidence |
| Remedy on erroneous termination of benefits | Koch: Award benefits now | SSA: Remand for further administrative consideration | Court: Vacated judgment and remanded for a new medical-improvement evaluation (no immediate award of benefits) |
Key Cases Cited
- Delph v. Astrue, 538 F.3d 940 (8th Cir. 2008) (defines medical-improvement standard and requirement to compare current condition to condition at most recent favorable decision)
- Muncy v. Apfel, 247 F.3d 728 (8th Cir. 2001) (burden shifts to Commissioner to show improvement relates to ability to work)
- Combs v. Berryhill, 878 F.3d 642 (8th Cir. 2017) (standard of review and that RFC is a medical question requiring medical evidence)
- Moore v. Astrue, 572 F.3d 520 (8th Cir. 2009) (ALJ must assess RFC prior to step four)
- Kraus v. Saul, 988 F.3d 1019 (8th Cir. 2021) (treating physician opinions are generally entitled to greater weight but must be well-supported)
- Hutsell v. Massanari, 259 F.3d 707 (8th Cir. 2001) (a treating doctor’s silence on work capacity is not substantial evidence supporting an RFC determination)