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SNEE v. SECRETARY OF HHS

May 8, 1987

Joseph Snee, Plaintiff,
v.
Secretary Of Health And Human Services, Defendant



The opinion of the court was delivered by: FISHER

 This action is brought under Section 205(g) of the Social Security Act (the Act), as amended, 42 U.S.C. § 405(g), to review a final determination of the Secretary of Health and Human Services which denied plaintiff's application for a period of disability and disability insurance benefits. For the following reasons, the decision of the Secretary is reversed.

 An administrative decision to deny benefits will be upheld if supported by "substantial evidence." Dobrowolsky v. Califano, 606 F.2d 403, 406 (3d Cir. 1979). Substantial evidence means "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401, 28 L. Ed. 2d 842, 91 S. Ct. 1420 (1971) (quoting Consolidated Edison Co. v. National Labor Relations Bd., 305 U.S. 197, 229, 83 L. Ed. 126, 59 S. Ct. 206 (1938)).

 The term disability has essentially the same definition under both Title II and Title XVI of the Act, "an inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. §§ 423(d)(1)(A) and 1382c(a)(1)(3)(A). The Act defines impairment as the result of an anatomical, physiological or psychological abnormality which can be demonstrated by medically acceptable clinical and laboratory diagnostic techniques. 42 U.S.C. §§ 423(d)(3) and 1382c(a)(3)(C). An individual shall be determined to be under a disability only if his physical or mental impairments are of such severity that he is not only unable to do his previous work but cannot engage in any other kind of substantial gainful work which exists in the national economy. 42 U.S.C. §§ 423(d)(2)(A) and 1382c(a)(3)(B). While this section casts upon the claimant the initial burden of persuasion that he is unable to continue with his previous employment, it is the Secretary's burden to show that there exists work which this particular claimant can realistically be expected to do. Livingston v. Califano, 614 F.2d 342, 345 (3d Cir. 1980).

 Despite the deference to be granted the decision of the administrative law judge (ALJ), it is the responsibility of the reviewing court to scrutinize the entire record and reverse or remand if the decision is not supported by substantial evidence nor based on current legal standards. Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981); Livingston, 614 F.2d at 345. There are four elements to be weighed in determining whether there is substantial evidence to support the Secretary's decision: (1) objective medical facts; (2) diagnoses and expert opinions of examining physicians; (3) subjective evidence of pain; and (4) the claimant's educational background, work history and age. Blalock v. Richardson, 483 F.2d 773, 778 (4th Cir. 1972).

 Plaintiff filed an application for a period of disability and disability insurance benefits on April 11, 1984. The application was denied initially [Tr. 68-72] and on reconsideration [Tr. 73-82]. Plaintiff appealed to an ALJ, and the case was considered de novo on December 7, 1984 [Tr. 22-63]. The ALJ found that plaintiff was not under a disability [Tr. 9-16], and this decision became final when it was approved by the Appeals Council on July 19, 1985 [Tr. 20-8].

 Plaintiff's claims for disability benefits are based upon the following severe medical impairments: lumbrosacral herniation disc syndrome, cervical sprain and carpal tunnel syndrome. Complaint at 1, Para. 5.

 Pursuant to Section 205 of the Act, 42 U.S.C. § 405(a), and as incorporated by reference in 42 U.S.C. § 1383(d)(1), the Secretary has promulgated regulations to effectuate the provisions of the Act. See 20 C.F.R. § 404.1520. These regulations establish a sequential process to be applied when evaluating an individual's claim for disability benefits. If the Secretary finds that an individual is or is not disabled at any point in the review, the evaluation process will cease. 20 C.F.R. § 404.1520(a).

 First, the Secretary must determine whether the claimant is working, and whether that work constitutes substantial gainful activity. If the claimant is engaging in substantial gainful activity, then a determination will be made that the individual is not disabled, notwithstanding medical condition, age, education and work experience. In the present case the ALJ found that plaintiff met the disability insured status requirements of the Act on September 30, 1982 (the date the claimant stated he became unable to work), and he continued to qualify for this status as of the date of the ALJ's decision. Further, the claimant has not engaged in substantial gainful activity since September 30, 1982.

 Upon a finding that a claimant is not engaged in a substantial gainful activity, the ALJ then determines, solely on the basis of medical evidence, whether the impairment(s) meets or equals a listed impairment in Appendix 1 of the Regulations. If the impairment is listed in Appendix 1 or is the equivalent of a listed impairment, the claimant is found disabled without considering age, education and work experience. 20 C.F.R. § 404.1520(d).

 If, however, a determination cannot be made on the basis of medical facts alone, then the ALJ assesses claimant's residual functional capacity and reviews the physical and mental demands of the individual's past work. If the ALJ determines that the claimant possesses the residual functional capacity to perform his or her past work, then no disability is found. 20 C.F.R. § 404.1520(e). According to the ALJ, plaintiff has the residual functional capacity to perform work-related activities except for work involving heavy lifting and carrying, frequent bending, crawling or climbing; constant uninterrupted walking or standing; repetitive pushing or pulling; or performing fine manipulations. Rule 48 Document - Stipulation of Facts at 2, Para. 5; see 20 C.F.R. § 404.1545. Further, the ALJ found that plaintiff's past relevant work as a sales representative did not require the performance of work-related activities precluded by the limitations mentioned above. Rule 48 Document - Stipulation of Facts at 3, Para. 6; see 20 C.F.R. § 404.1565.

 First, plaintiff contends that the ALJ substituted his own medical judgment for that of the physicians who examined plaintiff. The ALJ's responsibility is to analyze all the evidence and to provide adequate explanations when disregarding portions of it. Cotter v. Harris, 642 F.2d 700 (3d Cir. 1981); Dobrowolsky, 606 F.2d at 409; Gober v. Matthews, 574 F.2d 772 (3d Cir. 1978). Further, a clear and satisfactory explanation of the evidence upon which the decision is based should accompany the decision. Cotter v. Harris, 642 F.2d at 704-05. The ALJ should also indicate any "significant probative" evidence that was rejected, along with the reasons for the rejection. Id. at 705.

 Most important, the ALJ may not substitute his own conclusion, opinion or judgment for that of the physicians who present competent medical evidence of disability. Van Horn v. Schweiker, 717 F.2d 871 (3d Cir. 1983); Green v. Schweiker, 749 F.2d 1066 (3d Cir. 1984); Coria v. Heckler, 750 F.2d 245 (3d Cir. 1984). Here, the ALJ concluded that plaintiff retained the capacity to perform light work activity, excluding fine ...


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