CORRECTED OPINION
Mаry W. Hines appeals from the order of the district court denying her disability insurance benefits and supplemental security income under 42 U.S.C. § 401 et seq. and 42 U.S.C. § 1381. The district court found that there was substantial evidence to support the conclusion of an Administrative Law Judge (AU) that Hines does not have an impairment or combination of impairments listed in or medically equivalent to any of those listed at 20 C.F.R. Pt. 404, Subpart P, App. 1 (1988), and that Hines’ medical problems do not prevent her from continuing past relevant work as it is performed in the national economy. Because we believe the Secretary fаiled to consider and to explain the combined effect of Hines’ impairments on her ability to work, we vacate the decision of the district court and return it to the Secretary for further сonsideration.
I.
Mary Williams Hines is a 63 year old former nursing assistant. She has a ninth grade education. Before her 1984 retirement Hines was employed for thirty years at a hospital in her hometown of William-stоn, North Carolina. Hines claims that since August, 1984, a combination of ailments has prevented her from continuing this work.
Hines first filed for benefits in May, 1985. Although an AU denied her application in January, 1986, the Social Sеcurity Administration’s Appeals Council subsequently vacated the AU decision in March, 1986. The Appeals Council considered that
Hyatt v. Heckler,
The relеvant medical evidence consists of Hines’ personal testimony and the reports of examining and Social Security Administration physicians. In her written applications and in her appearance before the AU Hines stated that when she stopped working she suffered from pain in her arms, feet, and chest. She described debilitating
Hines’ problems have been further identified by physicians. Non-examining, Social Security Doctors Issac Wright and J.H. Dykes recognized that Hines has a history of hypertensive cardiovascular disease, os-teoarthritic cardiovascular disease with chest pain, exogenous obesity, diabetes, and gout. One of Hines’ personal physicians, Beverly Lewis, who treated Hines during the period of this disability application, reported that Hines had shortness of breath with minimal physical exertion, had intermittent burning pain in her feet, hypertension, peripheral vаscular disease, chest pain, hyperglycemia, diabetes, and with a weight of just over 226 pounds, exogenous obesity. Two other examining physicians, John Blount and Omatta Sirise-na, reached similar conclusions.
II.
The general procedure of a Social Security disability inquiry is well established. Five questions are to be asked sequentially during the course of a disability determination. 20 C.F.R. §§ 404.1520, 1520a (1988). An AU must consider (1) whether the claimant is engaged in substantial gainful activity, (2) whether the claimant has a severe impairment, (3) whether the claimant has an impairment which equals a condition contained within the Social Security Administration’s official listing of impairments (at 20 C.F.R. Pt. 404, Subpart P, App. 1), (4) whether the claimant has an impairment which prevents past relevant work, and (5) whether the claimant’s impairment prevents her from any substantial gainful employment. An affirmative answer to question 1 or negative answers to questions 2 or 4 result in a determination of no disability. Affirmative answers to questions 3 or 5 establish disability. 20 C.F.R. § 404.1520. An AU’s factual determinations must be upheld if supported by substantial evidence,
Smith v. Schweiker,
Hines’ appeal does not involve questions one or two of the sequential evaluation, as the AU conceded that Hines was not presently engaged in substantial gainful activity. He further admitted that she was “severely impaired.” Regarding question three, however, the AU determined that Hines’ condition did not meet or exceed the requirements of any impairment listed at 20 C.F.R. Pt. 404, Subpart P, App. 1. Proceeding to question four, the AU decided that Hines’ limited impairments did not prevent her from continuing her past relevant work as a nurse’s aid. Because the question of disability under the five-part scheme was resolved by a negative answer to question four, it was not necessary for the AU to continue to an examination of question five, involving whether Hines’ impairment prevented her from performing any other kind of work.
Despite the fact thаt the AU ostensibly denied benefits based on Hines’ purported ability to work as a nurse’s aid, his decision was ultimately dependent on an evaluation of Hines’ impairments. The best evidence of the AU’s rеasoning is his decision, which discusses various aspects of Hines’ medical condition. The AU mentioned Hines’ history of hypertension, diabetes, chest pain, obesity, joint pain and peripheral vascular disease. Yet the AU stressed that Hines’ worst problems were either controlled by medication, or were not adequately proven by objective evidence. He concluded thаt the impairments, alone or in combination, did not meet or equal any of the Subpart P listings.
Hines concedes that not one of her conditions by itself equals the requirements of a
A failure to establish disability under the listings by reference to a single, separate impairment, does not always prevent a disability award. Congress explicitly requires that “the combined effect of all the individual’s imрairments” be considered, “without regard to whether any such impairment if considered separately” would be sufficiently severe. 42 U.S.C.A. § 423(d)(2)(c) (1982 and Supp.1988). Further, this court has held that in determining whether an individual’s impаirments are of sufficient severity to prohibit basic work related activities, an AU must consider the combined effect of a claimant’s impairments.
Reichenbach v. Heckler,
A. History of pain and limitation of motion in any weight bearing joint or spine (on physical examination) associated with X-ray evidence of arthritis in a weight bearing joint or spinе; or
B. Hypertension with diastolic blood pressure persistently in excess of 100 mm. Hg measured with appropriate size cuff; or
C. History of congestive heart failure manifested by past evidencе of vascular congestion such as hepatomegaly, peripheral or pulmonary edema; or
The AU here has not satisfied any of these basic requirements. Despite the fact that Hines is only a few pounds below the threshold weight specified in listing 10.10, the AU failed to sufficiently explain why obesity could not be considered disabling. The AU also wrongly concluded that Hines’ angina was only “possible.” This condition was conclusively established by the record. Moreover, Hines’ high blood pressure, joint pain, and the negative impact of her medication were insufficiently addressed, for unеxplained reasons. As a result of these errors and omissions, the AU did not demonstrate that he adequately considered the combined effect of Hines’ impairments. It is necessary to the review process that this court be given a full explanation. The AU must make a particularized finding on the effect of the combination of impairments.
The judgment of the district court is reversed and the сase shall be remanded with instructions to return it to the Secretary for further proceedings in accordance with this opinion. We deny appellant’s motion to submit additional evidence on appeal, but this denial is without prejudice to apellant’s right to submit such evidence to the Secretary on remand.
D. Chronic venous insufficiency with superficial varicosities in a lower extrеmity with pain on weight bearing and persistent edema; or
E. Respiratory disease with total forced vital capacity equal to or less than 2.0L. or a level of hypoxemia at rest equal tо or less than the value specified in Table III-A or III-B or III-C.
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Notes
. 10.10 Obesity. Weight equal to or greater than the values specified in Table I for males. Table II for females (100 percent above desired level) and one of the following: