*2 unremarkable, and the doctor only noted III, Atty., Osborn Office of the U.S. J.S. tenderness the back range with reduced Lexington, Ky., defendant-appellee. Despite of motion. these limited clinical BOGGS, Before NELSON and Circuit findings, opined Dr. Shafter in a letter dat- ENSLEN, Judges; Judge.* and District 1, 1985, February ed appellant that and a possible ruptured lumbar disc with left arm PER CURIAM. (Tr. 118-121). contusion.1 pursuant This is an action to Section Dr. Guberman conducted a consultative Act, 205(g) of the Social 42 U.S.C. exam in September of 1985. He found 405(g), to review final decision appellant historian, poor to be a contra- Secretary of Health and Human Services dictory, Appellant and inexact. mentioned denying appellant’s claim for in- more injury than one at the mine in 30, 1985, July appel- surance benefits. On and hospitals talked of treatment at applications period filed lant for a of dis- examination, mentioned the record. On benefits, ability, disability insurance and appellant hostile, doctor found un- income, supplemental security alleging a friendly, sullen, withdrawn, and complain- February onset date of ing pain throughout body. his entire initially upon Benefits were denied and physical The exam revealed moderate Appellant requested consideration. tenderness in the cervical and lumbar granted hearing before Adminis- spine, range motion, limitation in (AU). AU, Judge noting trative Law muscle weakness and sensory diminished appellant last met the insured status capacity right the entire side. 30, 1985, requirements on June concluded normal, reflexes were there nowas muscle appellant entitled to an atrophy, and evidence of nerve root dam- supplemental security award of income age was absent. The doctor ap- (SSI). (Tr. 24-25, 50-67, 71). This decision pellant with acute and chronic lumbosacral became the final determination of the Sec- strain, spine post-traumatic. and cervical retary Appeals when the Council denied X-rays negative. 123-25, 131). were plaintiff’s request May for review Appellant appeals now the District Court’s Appellant was also seen that month 1987 affirmation of the Sec- orthopedic surgeon Rapier. Appellant com- retary’s decision. plained gotten that his condition had worse years. X-rays over the last two or three years day was 32 old on the slight narrowing revealed at the L5-S1 lev- hearing before the AU. testified Rapier appellant el. Dr. concluded that experience that he had relevant work as a degenerative could have mild disc disease. clerk, janitor, theater and a coal miner. (Tr. 136-37). A December 1985 CT scan injured lifting He claimed he was timber by Dr. was ordered Shafer and revealed Something snapped the coal mine. had posterior bulging, especially disc to the left back, and he fell and struck his neck side, deformity of the thecal sac. hospi- and head. He was examined in the Skull, spine, tal. cervical and lumbosacral spine x-rays negative. began were suf- records, Based on the medical the AU fering leg from back and constant concluded that suffered from a aches, eventually quit had to work. degree degenerative mild disc dis- (Tr. 53-57, 118). findings ease. Based on the of the CT scan,
Plaintiff did not seek the AU found that could further back treat- activities; perform heavy January Orthopedic ment until of 1985. work how- ever, surgeon diagnosed appellant orthopedic impairment was not Shafer * Enslen, AU, presented The Honorable Richard A. United States 1. This letter was not before Judge Appeals District for the District Michi- but was considered Council. Western (Tr. 8). gan, sitting by designation. spontaneity productivity verbal performance preclude enough to severe patient As for limits. below normal light activities. work the AU stat- pain,
subjective moderately anxious peared to be ed: or de- No bizarre clinical interview. significance of weighing the After He was lusional material noted. per- diagnostic tests numerous results of place, person and as to correctly oriented *3 Shafer, the various and by Dr. formed memory, concentra- patient’s The time. consulting by expressed opinions appear to defective tion and attention Law Administrative specialists, degree. to November Judge finds that 130). general- (Tr. He with was pain did symptoms claimant’s 1985 the neurosis,2 and chron- anxiety moderate ized light work preclude performance not difficulties. ic, physical associated activities. the doctor guarded was and prognosis His injury precipitated the 1979 believed a nonexertional claimed Appellant also par- Permanent psychiatric disorder. four di- Wayne conducted Dr. impairment. thirty per- estimated at tial was in October of agnostic tests cent. neatly groomed and Appellant was 1980. impairments were bodily year later Dr. friendly, Appellant no seen one and was reports: The doctor Feuss, analysis indicated. This psychiatrist. a constantly. handwriting samples that his back hurts and an through He stated done panics and and tired. weak feels handwriting was Appellant’s interview. happen to him. something will is afraid year with one appropriate for a man head- constantly from severe He suffers interview, appellant During the college. something is chok- He feels like aches. than feel- irritability rather emphasized his patient has in the throat. ing him speaking, when physical pain, and ings of doc- He has seen various pains. chest (inappropriate ex- Belle Indifference La any noise at all. tolerate cannot tors. He Although the doctor noted. pression) was in a crowd of finds himself Any time he claims of fully accept appellant's did upset. gets very people he hallucinations, concerned the doctor was testing low (Tr. 129). I.Q. revealed Ap- religiosity. appellant’s extreme about although he intelligence, and range of well-oriented, but pellant was considered instructions, he was slow could follow his fuzzy and memory was somewhat perform- and on verbal questions answer poor. Appel- insight judgment testing showed motor testing. Visual ance reac- diagnosed with conversion lant was damage, the visual but organic brain no indifferent demonstrated Appellant tion.3 developed mild indicated a test retention hallucinations, non-physi- affect, fuzzy tests indi- Ink-Blot memory impairment. Dr. also ological symptoms. Feuss developed psy- appellant had a cated that could type of condition marked fair Although he had disorder. choneurotic incident, but one traumatic start with relations, difficulty had interpersonal person- long-standing underlying is a cause status his mental impulses. On controlling Appellant developmental condition. ality the doctor stated: general, thirty percent disabled. considered him- difficulty expressing He had some 132-33). His describing symptoms. self and 101.44(2a) 101.44(2) 101.44(1), Paras. anxiety is characterized disorder 2. Generalized (1987). tension, apprehension dif- hyperactivity, symptoms are ficulty These in concentration. With type ways person of somatoform disorder. maladaptive which a This is a different disorders, anxiety "attempts to alleviate anxiety feelings that are these attempts alleviate physical suggestive of give symptoms normally be ex- rise than one would more extreme disorder, organic dis- no demonstrable but with given one’s life. periencing the conditions 101.44(2b). Medicine, Id. orders." Attorneys’ Gordy-Gray Textbook of
JU9
George, psychiatrist,
Dr.
examined
psychiatric
final
exam took Place
September of
1982. After
Dr. Lurie reviewed
previous
interview,
stated,
George
reports,
tests and
appellant.
interviewed
He also had
Examination shows
slightly
him
evidence of
physiological
condition, and
overweight 28-year
man
old
who is neat-
opinion
a 1983
from the Worker’s Compen-
ly
groomed.
dressed and
He walks rath-
sation
Board.5
incapable
er
flat,
and stiffly, has a rather
giving specific and detailed information and
staring expression
spontaneity.
and lacks
explain
unable to
his “all
pain.
over”
Frequently
says,
‘I don’t know’ or ‘I
On mental
examination,
status
Mr.
don’t remember’ and does seem to have
Blankenship was noted to
stiffly
walk
difficulty with recent events.
I didn’t
and slowly into the examining room and
see
evidence of
thinking
delusional
psychomotor
evidenced
retardation
today
hallucinations
but he claims to
*4
speech
both his
and behavior. He sat
have had the visual hallucinations of oth-
rigidly in his chair holding onto his cane
people being
er
in the room.
implies
which he used in walking.
expres-
An
people get
also that when
loud and bois-
sionless, mask-like facies was noted and
community
terous
it
is
threat-
he tended to stare
if preoccupied.
as
ening and he
explain
overreacts and can’t
appeared
uncertain,
bewildered and
really why.
appear
He does
to be a little
unsure of anything, having great diffi-
depressed
culty in making
and made
a
reference to the fact
definite statement. He
spoke in
general terms,
definite
thought
that he has
hurting himself,
making
it necessary to extract
tell,
information from
but as far as I can
has never done
speech
him. His
was slow and he related
anything.
knowledge
His fund of
seems
simple,
a
child-like manner. He had
rather low for a man of his education.
difficulty in comprehending anything but
Much of
may
be due to the fact that
simplest
words and
appeared
overall
try very
he doesn’t
hard and is more
quite
Clinically
obtunded.
appeared
preoccupied
present symptoms.
with his
to be of severely limited intellectual en-
(Tr. 135). Appellant
was
in sharp
dowment
reportedly
contrast to
personality.4
schizoid
The doctor did com-
having graduated
high
from
school at
ment on the difficulty
evaluating
he had
age 22
took some time off for ‘de-
[he
appellant
testing
without
and a more accu-
pression’],
college
followed
some
edu-
history. Appellant
rate
appeared a border-
cation. His memory
impaired
was
line
psychotic-like
individual with a
appear-
events of the
past
intermediate to remote
thinking
ance and
(although he could not
vague
past.
the recent
He was
say appellant was
clear-cut
schizo-
give
able to
correctly
the date
but had no
phrenic). Lacking any
relating
information
age
idea of his wife’s
or birthday. The
appellant’s personality prior
to the acci-
sensorium was clouded and he described
dent, the doctor would not make an assess-
vague
auditory hallucinations while
ment as to the
denying
relation between the 1975
visual hallucinations. His affect
and his
personality
apathy
accident
current
one
status.
and was decreased in
quantity
range
both
while the mood
appellant
doctor stated that
depressed.
significantly handicapped
by his emo-
problems
tional
and in need of psychiatric
(Tr. 139-40). Dr.
Lurie believed
(Tr. 134-35).
treatment.
mental
severely
status had
deteriorated
personality
Compensation
4. This is a
similar to
disorder
that of
5. Evidence of the Workers’
deci-
Schmidt,
report,
schizophrenia only
sion is
Attorneys’
found Dr.
which states:
milder.
Lurie’s
Compensation
(1988).
previ-
"The Workers’
ously recognized
Dictionary
Board has
Schizophrenia
Medicine
Opinion
Award
their
reality,
characterized
withdrawal from
un-
6/6/83,
psychiatric
repre-
condition
predictable
response,
emotional
introversion
dormant,
pre-existing,
non-disabling
sents a
regression,
response
inappropriate
and un-
triggered
emotional condition
ality by
into
re-
social behavior.
Id.
140).
injury
of 2/23/79.”
exams,
occupations
significant number of
involv-
but
previous
since his three
progres-
repetitive
in low-stress
ing simple,
was of a
tasks
deterioration
noted that
presently
It had
settings
then.
sive nature even
work
within
framework
schizophreniform disor-
into a
grid
deteriorated
rules
C.F.R. Part
the vocational
[20
der,
schizophrenic disorder.6
if not actual
P,
Subpart
Appendix 2].
Compensa-
repeating the Worker’s
After
appellant
It is this conclusion that
concluded,
findings, Dr. Lurie
tion Board
challenges.
now
has resulted
“the
disorder
court
that the Secre-
The district
believed
occupa-
(100%)disability from
total
both
restricting ap-
tary
charitable
had been
standpoint
body functional
tional and a
prior
low-stress work
orthopedic dis-
any physical
aside
was found
(Tr. 140).
ability
have.”
which
depressed”
opinion
and no
only “a little
Addressing these nonexertional
limita-
expressed
capacity
for work.
about
tions,
appellant pri-
concluded that
the AU
Physiologically, the court found
from a mental disorder that
marily suffers
wanting
laboratory
case
because all
exams
intensity
slowly progressed in
since
has
appel-
expiration
conducted
to the
He stated that
was not
negative
insured status returned
lant’s
disor-
schizophrenic, but had an affective
sults.
Although
had satisfied
der.
12.04(A)
disorder
criteria for affective
jurisdiction
“The
of this court is confined
*5
(20
Listing
Impairments
C.F.
under the
Secretary’s
a limited
of the
deci-
review
404,
P,
1)
Subpart
Appendix
even
R. Part
sion and of the record made
the adminis-
Wayne’s
the time of Dr.
1980 assess-
at
hearing process.”
v.
trative
Willbanks
ment,
meet the functional
appellant did not
Services,
Secretary Health and Human
12.04(B)
required by
until No-
limitations
301,
Cir.1988).
(6th
847 F.2d
As stated
13,
Only on that date did
vember
1985.
Bowen,
(6th
nificantly by reduced the combined 1147, (8th Cir.1984). To with- F.2d exertional affects of the claimant’s tional review, Secretary’s determination stand prior limitations to No- and nonexertional date, substantially supported by the fac- 13, the must be 1985. Prior to this vember upon legal proper based capable performing tual record claimant was capacities. Appellant gener- could still do Schizophreniform has the functional resembles or 6. schizophrenia. Id. This complex Feuss’ functional re- al characteristics tasks. And Dr. through type mental disorder manifests itself findings The AU dis- striction were similar. communication, disturbances of characteristic language, thought, George’s altogether be- counted Dr. conclusions mood, perception, and be- finding tendencies was cause the of schizoid Medicine, Attorneys’ Textbook havior. one examination and the doctor made after 104.44(8a). diagnostic picture. The less than clear noted a assessment as the AU considered Dr. Lurie’s conclusion, the AU determined To reach this disabling of a mental ill- first documentation finding average intelligence, Wayne's Dr. ness. loss, anxiety memory did and moderate mild any significant impact not have
H21
Gaffney
George's
Second,
(Tr. 135).
erroneously disregarded
ing.”
the
appellant
AU
He did not think
George’s findings.
findings
Dr.
schizophrenic
These
was a clear-cut
un-
was
George
willing
discounted because Dr.
exam-
to correlate the accident to his men-
appellant
ined
only
one occasion and
tal condition without more information.
remained, however,
present
diagnostic
capable
there was not
a clear
The doctor
picture.
presented psychotic
concluding
appellant
significantly
“The claimant
agree
problems.
is
handicapped by
that did not
with the doc-
his mental
It
(Tr. 22).
findings.”
umented clinical
to
How-
clear that when the doctor was unable
ever,
record,
upon
of the
the court
on the information
review
draw conclusion based
interview,
diagnosis
contradicting
finds no medical evidence
Dr.
obtained
the
unwilling-
His
the medical and other evidence that
not offered.
opinion
history
is not a
symptomology
those conclusions
describe the
ness to draw
discounting the assess-
justification
process.
of the disease
George
able to make.8
ments
Particularly
in the case of
impairments, it is
progressive
not nec-
Third,
ap-
Secretary’s conclusion that
essary
impairment
for an
to have
was not disabled until November
pellant
(i.e.,
Listing severity,
reached
be decid-
1985 runs counter to Social
alone)
grounds
on medical
(SSR)
ed
before
Rule
83-20.9 SSR 83-20 was estab-
policy
onset can
established.
lished to state
describe
be
considered when
relevant evidence
Dr. Lurie believed
condition
establishing
disability.
onset date of
It
was,
enough
severe
to render
provides
part:
percent
one hundred
disabled based
is the first
The onset date
psychological
on his
condition alone. That
as defined in
day an individual is disabled
why
chose his
date
is
the AU
examination
regulations.
and the
Factors
the Act
appellant’s disability. By
as the onset of
determination of
relevant to the
disabili-
date,
effect,
choosing
was,
the AU
allega-
ty onset include the individual’s
erroneously requiring
impairments
tions,
history, and the medical
the work
Listing severity
finding appel-
reach
before
evidence. These factors are often evalu-
disabled,
failing
erroneously
lant
together to
at the onset date.
ated
arrive
any inferences from the
draw
allegations or
the individual’s
other evidence as to whether
stoppage
significant
the date work
engage
gainful
activi-
able
substantial
determining
onset
if it is consist-
expiration
ty prior to the
of his insured
condition(s)
severity
ent with
status.
shown
the medical evidence.
addition,
acknowledged
and somewhat
found dis-
A Title II
cannot be
worker
83-20,
by SSR
there is the common sense
sta-
under the Act unless insured
abled
suddenly
notion that
did not
find
a time when the evi-
tus is also met at
himself,
expiration
five months after the
presence
of a dis-
dence establishes
coverage, completely incapacitated by
condition(s).
abling
Although important
schizophreniform
disorder. To con-
period
of a
of dis-
to the establishment
impairment
clude
benefits,
ability
payment
and to the
working
him
only prevented
with the
expiration
of insured status is
working in
public or from
normal stress
determining
itself a consideration
employment
beyond
until and
level
June
began....
first
when
*7
progressive
ignores
the
nature
impair-
slowly progressive
With
appellant’s
impairment, ignores
of
ments,
impossible
it
sometimes
to
is
severity
impairment,
of that
fails to
the
establishing
medical
obtain
evidence
as
account for Dr. Guberman’s statements
impairment
precise
the
date an
became
appellant’s
hostility,
sullenness and
and
to
disabling. Determining
proper on-
the
gives
appearance that the examination
the
difficult, when,
particularly
set date is
solely chosen
it fell out-
date was
because
alleged
example,
onset and the
period.
side the insured status time
past
in the
date last worked are far
Fourth,
difficulty
the court has
adequate medical records are not
and
appel-
of
cases,
Secretary’s
assessments
it
with
In such
will be
available.
During the
subjective statements.
necessary
infer the onset date from lant’s
to
422.408,
negatively
C.F.R.
social securi-
about the
9. Pursuant to 20
8. The AU also
commented
binding
ty rulings
Social
are
on all
nature of the
interviews.
referral
including
agen-
personnel,
nothing fundamentally wrong
state
with a
Administration
There is
doctor,
judges,
cy adjudicators,
law
and
lawyer sending
especially
administrative
a client to a
Secretary
Appeals
McDonald v.
capacity
Council.
when the
of that client to care
Services,
(1st
Bolling
H23
hearing, appellant claimed that
is
symptoms
he
unable
tive
is not required. Duncan,
block,
stand, sit,
to walk one-half
or
or lift
breath,
wearing
and
a back
keeps
brace
presented evidence of a mental disorder
him misery.
He states he is nervous all
that even as early as 1981 indicated the
of the time and this condition is not allevi- presence of conversion reaction. Whereas
mow,
ated by
shop,
medicine. He cannot
objective
evidence of the
degenera-
disc
socialize,
fish,
spends
or
and he
day
his
tion
support
only
finding
a
that appel-
watching
television. His
outside activ-
precluded
lant was
from medium heavy
or
(Tr.
ity
attending
is
57-64).
church.
He
work,
exertional level
there is also the add-
experiencing
pain
has been
his
since his
appellant’s
ed factor that
objectively deter-
and,
fact,
injury,
what
impairment
mined mental
likely
to ex-
did,
him quit
job.
caused
to
how-
feelings
acerbate
pain.
those
At the
ever, testify that his condition
continues
very least,
psychopathologist
a
noted his
(The
worsen.
AU observed appellant to
excessive
pain.
focus on that
walking
be
with a cane
displaying
and
a
But back pain was not the only subjec-
hearing.)
flat affect
symptom appellant
tive
expressed.
In 1980
19).
The AU stated that
sub-
reported
feeling panic, fear, severe and
jective complaints
pain
of severe
were not
headaches,
choking
constant
sensation,
diagnostic
substantiated
tests and
pains.
and chest
inability
also had an
consulting specialists’ opinions. This as-
to tolerate
Appetite
noise.
sleep
and
sessment fails because it does
take into
poor,
had no social life.
consideration the effect
nonex-
In
he noted nervousness in his
impairment
ertional
has on his capacity to
report
Feuss,
along
with hot-tem-
pain,
tolerate
and does not refer to the
pered tendencies,
proclivity
for stum-
subjective symptoms
panic, tension,
bling, and an intolerance for noise.
frustration.
1982, he repeats
feelings
of nervous
Subjective complaints
or oth
interfering
trouble
sleep,
with his
a smoth-
er symptoms may support a claim of dis
ering and choking feeling, and irritation
ability.
these
must
people.
depression
He notes his
and a
be
underlying
evidenced
an
medical con
overreact;
tendency
explained
dition,
there must
objective
be either
early attempt
an
to return to work resulted
confirming
evidence
the severity of
feelings
everything closing
in on him.
alleged pain,
objec
there must
be
year
This
psychiatrist
found
tively determined medical condition of a
significantly handicapped by
reasonably
which can
severity
expected
his emotional condition.
give
pain.
rise to that
McCormick
Secretary
Services,
Health and Human
Appellant’s allegations
pain, panic,
(6th Cir.1988);
Duncan
depression,
F.2d
supported by
are
evidence
v. Secretary
Health and Human Ser
of underlying musculoskeletal and emotion-
vices,
(6th Cir.1986).
sidered, reality, in no combined there AU further years after 1979.” The found symptom subjective in the AU’s treatment on Novem- the claimant was disabled that Title U.S.C. analysis or elsewhere. 13, 1985, psychiatric the of the ber date 423(d)(2)(C)requires Secretary the to con- Although I do by Dr. Lurie. examination impairments. effects sider the combined required to that the AU was not believe (6th F.2d Foster v. subjective complaints accept the claimant’s Cir.1988). value, accept the face or to at face value although credibility determi- finally, And George, in of Dr. who conclusions ALJ, province the of the are within nations diagnosis personality” made a of “schizoid any rea- appear valid there does interview, single without on the of a basis disbelieving appellant’s assertions. son having history the benefit of an accurate in his testi- no inconsistencies There were psychological testing, I and without regarding to doctors mony or statements evidentiary support no for the can find Secretary Health pain. Gooch dis- AU’s conclusion that the claimant’s Services, 833 F.2d Human very eve of ability did not arise until the Cir.1987). (6th subjective His statements Dr. Lurie’s November examination injury after the 1979 remained consistent have hospitalization.11 Security 83-20 declares it Social Rule treatment for his failed to seek disability the onset date of “essential” that condition, questionable it is a mental but supported by correctly “be established im- a mental practice chastise one Where, as seem the evidence....” would poor judgment pairment for the exercise here, possible it is to infer to be the case Secretary seeking rehabilitation. the onset of occurred at the less than cred- appellant’s complaints found prior to date of the point the first perceived paucity of medical given a ible establishing recorded medical examination not be a de- proof. this should disability, says that the onset SSR 83-20 credibility assess- factor terminative on the “must be fixed based date effect, It, the Dun- readdresses ment. ” finding A that the claimant’s facts.... of com- analysis, where reasonableness can became disabl- progressive disorder light evidence has plaints in of medical 13, 1985, ing on November cannot rational- already assayed. been Dr. Lurie ly fact that be based foregoing that the Secre- establishes his examination on happened to conduct tary’s appellant was determination that that date. meaning of the Social within the disabled it, 83-20, it clear as I makes SSR read 13,1985 is not until Act is not to that in a case such this the AU as The Secre- record. substantiated having date without determine the onset hereby tary’s decision is reversed medical advisor: called on the services of a evidence additional manded obtain such hearing, law administrative “At regarding progression on the services of judge ... should call and to call on the impairment as obtainable in- must be advisor when onset medical advisor determin- services of a here, and I not done ferred.” That was ing date. onset fully agree with conclusion in- so that must be sent back NELSON, Judge, case A. Circuit DAVID can of a medical advisor judgment formed concurring. be obtained. court erred agree I that the district what the way predicting no Secretary. I have affirming the decision say, and it remains advisor will primari- medical that “the claimant The AU found *9 George 1980, his back hurt whenev- 11. informed Dr. appellant complained back lifts; pain treatments and he back Wayne; about er started he told Dr. Feuss to Dr. lift; January of 1985. inability with Dr. Shafer his headaches and be determined whether the onset of disabil-
ity did or did not occur before June
1985, the date which the claimant last
met the insured requirements. status here,
Nothing it, said I should take intimating
taken as ques- how think the we ought
tion ultimately to be decided. JONES, Jr., Plaintiff-Appellant,
Robert LEWIS; Gary Ashby; Hig
James E. John
gins; Safety Louisville; Director Stansbury;
William B. James Thorn
bury; Frey; Richard Mitchell McCon
nell, Jr.; Greene, and Joe Defendants-
Appellees.
No. 86-5171.
United Appeals, States Court
Sixth Circuit.
Argued Nov. May
Decided
Rehearing 11, 1989. July Denied