Mitchell v. SHHS, 1st Cir. (1994)
Mitchell v. SHHS, 1st Cir. (1994)
Mitchell v. SHHS, 1st Cir. (1994)
No. 93-1612
TIMOTHY B. MITCHELL,
Plaintiff, Appellant,
v.
SECRETARY OF HEALTH AND HUMAN SERVICES,
Defendant, Appellee.
__________________
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MASSACHUSETTS
[Hon. Frank H. Freedman, Senior U.S. District Judge]
__________________________
___________________
Before
Breyer, Chief Judge,
___________
Selya and Cyr, Circuit Judges.
______________
___________________
Timothy B. Mitchell on brief pro se.
___________________
A. John Pappalardo, United States
____________________
Attorney,
Karen L.
_________
Goodwin, Assistant
United States Attorney, and
Robert M.
_______
__________
Peckrill, Assistant Regional Counsel, Department of Health &
________
Human Service, on brief for appellee.
__________________
__________________
Per Curiam.
___________
Pro se
___ __
claimant Timothy
Mitchell
bicyclist, claimant
wrists
and
hands.
alleged
in
that he was
from musculoskeletal
for SSI
He claimed
inflammation affecting
applied
particularly his
that his
pain
In
was
1987,
anthropology
from
time
jobs during
and after
college, including
dishwasher,
psychiatric
aide, stock
position
was
as
counsellor, prep
telephone
those of
cook, psychiatric
and salesperson.
fundraiser,
which
His last
required
application
was denied
upon
initial
(ALJ).
The
ALJ
disorder."1
The ALJ
____________________
1. Somatoform disorders are characterized by,"[p]hysical
symptoms for which there are no demonstrable organic findings
or known physiological mechanisms." See 20 C.F.R. Part 404,
___
Subpart P, App. I, 12.07. This listing may be satisfied if,
inter alia, the medical evidence documents either: (1) "[a]
_____ ____
______
-2-
ability
past work as
a telephone fundraiser,
it did
not prevent the claimant from performing his other past jobs.
Thus, the ALJ
the
sequential
evaluation
process.
See
___
step four of
Goodermote
__________
v.
has
taken
timely appeal.
Having
thoroughly
to
allegations.
complete
The record
16,000 kilometers
had
discloses that
understanding
of
is
claimant's
claimant bicycled
Dr. Robert
left knee.
surgery
on
Leach, an orthopedic
Claimant reported
his left
thigh
for
surgeon, for
that he
had
compartment
____________________
history of multiple physical symptoms of several years
duration, beginning before age 30, that have caused the
individual to take medicine frequently, see a physician often
and alter life patterns significantly; or" (2) [p]ersistent
nonorganic disturbance of ... [s]ensation (e.g., diminished
or
heightened)" or (3) [u]nrealistic interpretation of
physical
signs
or
sensations
associated
with
the
preoccupation or belief that one has a serious disease or
injury;...." Id., 12.07(A).
___
-3-
syndrome
and
that
he
had
previously
consulted
numerous
He had
undergone
from an
a myelogram.
around claimant's
tenderness
tendon, physical
recommendations.
area of
Apart
had also
He stated
Dr.
any ideas
are no
was apparently
times
counsellor.
Kurtis,
medical records
as a
prep
from 1985,
enrolled in
cook
college and
and adolescent
worked at
psychiatric
for bilateral
during which
his evaluation
was negative
that he had an
arm pain
for a severe
problem and
occupational tendonitis
of his
wrist."3
Claimant
graduated
from college
in
May
____________________
2. Compartment syndrome is "a condition caused by inward
pressure of an artery reducing blood supply. It can result
in a permanent contraction of the hand or foot." See Mosby
___ _____
Medical Encyclopedia, p. 182 (1985).
____________________
3. Claimant returned to Dr. Kurtis in January 1987 for left
heel pain cause by his cross-country ski boots. In reporting
these findings to the Social Security Administration (SSA),
Dr. Kurtis emphasized that he had not seen claimant since
-4-
1987.
it,
his graduation
claimant either
volunteered or worked
in an
administrative
September
1987
claimant
Schiffman, a rheumatologist,
pain
He reported
and elbows
pain and
consulted
Dr.
Lawrence
complaining of bilateral
as a dishwasher
wrist
and a carpenter.
lower
back
pain,
although
complaining of
the
latter
was
groin
not
chronic.
Claimant
problems.
denied
morning
stiffness
and
sleep
Dr.
arthritis medication.
arthritis were
Follow-up lab
negative.4
Claimant
tests for
apparently
and groin.
He
again denied
morning stiffness;
no
____________________
1987 and had no diagnosis consistent with chronic disability.
4. In January 1988, Dr. Schiffman advised claimant that he
had been unable to make a diagnosis of systemic tissue
connective disease (arthritis) based on his laboratory tests
and physical examination.
-5-
Apart
from the
areas of
an impression of tendonitis
tenderness
Dr. Schiffman's
and continued to
prescribe
medications.
for rheumatoid
some point
Denmark.
There he
Claimant returned
of
during 1988
bilateral
claimant also
travelled to
of his pain.
to Dr. Schiffman in
wrist, groin,
and thigh
that this
disclosed
no
resulted in
increased
swelling nor
Schiffman advised
other
claimant to
He
pain.
positive
stop swimming
was then
Physical exam
findings.
Dr.
and prescribed
Easthampton
Therapy
Physical
experiencing some
Services.
improvement from
He
the pain in
to
Dr.
reported
his wrists,
the
At
the
Allison
Ryan,
specialist
in
neurology
and
____________________
5. Claimant also consulted an occupational therapist at the
Communication Enhancement Clinic of the Children's Hospital
in Boston, although he was not referred there by any health
care providers identified in the record.
Claimant sought
computer components to eliminate the need for repetitive
wrist motions.
-6-
diagnosis" although he
likely
due
to
felt claimant's
an
overuse
symptoms were
syndrome,
"most
worsened
by
deconditioning."6
In November
Massachusetts
thereafter
Rehabilitation
he
began
fundraiser for
1989,
1988 claimant
Commission
working
claimant
returned
to
(MRC).
part-time
the Progressive
complain of "tendonitis" in
exam
as
at the
Shortly
telephone
Group, Inc.
On January
4,
Dr. Schiffman,
continuing
to
Physical
Claimant
regularly (10-20
was examined
evaluated
minutes).
On the following
claimant
for
claimant's extensive
the
MRC.
day, claimant
Dr.
history of complaints
Brummer
recounted
and unsuccessful
treatment
reported that
concluded
full range of
heat, or
complained of
multiple
he experienced no
normal, with a
swelling,
with
relief.
redness, although
claimant
Physical
claimant
exam was
that
medications,
claimant subjectively
and palpation.
suffers
no
from
Dr. Brummer
soft
tissue
____________________
6. We note that following his hearing before the ALJ,
claimant submitted a letter to the Appeals Council wherein he
alleged that Dr. Ryan concluded that claimant has chronic
pain syndrome and fibromyalgia, a condition discussed infra.
_____
However, Dr. Ryan's records are not before us.
-7-
inflammatory
probably
often
disease
fibromyositis
respond poorly
Dr.
Brummer's
determined
that
chronic tendonitis
or
to
fibromyalgia
medications.7
capable of
significant lifting,
on
such as
He suggested
that
him to
avoid
Based
evaluation,
claimant
in
was
January
eligible
services
as
individual.8
Claimant
also
began
with
syndrome" which
rehabilitation
treatments
or, "more
Jonathan
acupuncturist.
Dr.
throughout the
time his
Klate
for
weekly
to
MRC
handicapped
Ph.D.,
continued
the
vocational
severely
Klate,
claim was
1989
acupuncture
a
licensed
treat
pending and
claimant
submitted a
____________________
7. Fibromyalgia is pain
tendons, ligaments, and
muscles,
tissues,
report
to
the
SSA
which
opined
that
claimant
was
significantly disabled.
Claimant
fundraiser
resigned
around
June
from
29,
his
1989,
position
claiming
as
a telephone
that
he
was
benefits on
by warmer weather.
the same
day.
physical
exam
tendons
and
concluded
elbows,
but
that
unremarkable.
that
bilaterally.
exhibited 20
was subsequently
Dr. Petrillo
He did
not
applied for
musculoskeletal symptoms
and
Claimant
He
he
claimant
had
in the muscles
assess
claimant's
contractures of
joint
In particular
reported a
degree flexion
claimant's
Dr. Enrico
exam
noted that
was
otherwise
there
was no
muscle atrophy.
although he
claimant
to
did not
pursue
Robinson
clearly limited by
assess
gradual
Dr.
both
claimant's RFC.
muscle
his
He
strengthening
____________________
9. Dr. Robinson also noted that claimant might have an early
form of scleroderma, a disease that would not account for
claimant's symptoms.
-9-
Based on the
secured an
aforementioned medical
evidence, the
SSA
consultant.
Consequently, the
rheumatologist,
Dr.
Robert
Claimant
Gray,
on
consulted another
December
7,
1989.
no
synovial
swelling,
no
There
fibrositic trigger
Dr.
13,
Siegel,
another
disclosed
1989,
claimant
was examined
consulting
that claimant
internist.
appeared
syndrome.
by
Dr.
Jerome
Physical
well, had
On
no history
exam
of
no synovial
areas
normal.
thickening.
were palpated.
Dr. Siegel
No trigger
Shoulder
made a
x-rays
point tenderness
and lab
tests were
differential diagnosis
of pain
pain disorder.
Neither
-10-
reported
that he
affected
essentially all
complaints were
suffered from
a "painful
of his
condition" that
major joints
"completely subjective."
Claimant
although his
Although claimant
graduate school at
the University of
Massachusetts.
He
and
participate in
Despite being
the aforementioned
activities, claimant
professed
that he was in
sleeping.
would
make would
be
constant pain.
a somatoform
made
for
document
him,
pain
disorder, with
no
the diagnosis
fibrocytis
He denied trouble
or
that some
physicians
fibromyalgia."
Dr.
Bloomberg noted
that
where
one
local
expert
referring to Dr.
have fibrositis,
in
excess
of
pathology.10
what
one
would
expect
(presumably
if
not
were grossly
he
had
any
____________________
10. Dr. Bloomberg also observed that claimant's alleged
incapacity was not objectively observable and that claimant
presented as "vigorous, full of energy, walking and sitting
down and rising ... with no difficulty apparent."
-11-
RFC,
Lichtman,
psychologist.
claimant suffered
often result in
Dr.
Lichtman
from a somatization
concluded
disorder which
deficiencies of persistence,
that
would
concentration,
However,
he
found that
claimant's activities
of
like settings.
The ALJ credited
concluding that
found that
physical
result
claimant does
not have a
impairment that
in
claimant
the
degree
has alleged.
subjective
pain
could
of
The ALJ
complaints
in
and
He specifically
medically determinable
reasonably
pain
findings in
be expected
functional loss
then evaluated
accordance
1986),
allegations
and
were
concluded
not
that
credible
with
claimant's
in
view
that
claimant's
to
Avery
_____
v.
19, (1st
subjective
of
claimant's
that there was no physical basis for claimant's pain, and the
fact that claimant
took no
medications at the
time of
the
-12-
hearing.11
The
ALJ
found
that
claimant's
residual
functional
capacity
was
not
significantly
restricted
After the
the
hearing claimant
used
of treatment
to
a telephone fundraiser.
course
prevented
recounted that he
with amitriptyline,
treat fibromyalgia.
The
to
had begun a
an anti-depressant
Appeals
Council declined
supported by substantial
See,
___
e.g.,
____
Services,
________
seeking
Rodriguez
_________
disability
Cir. 1985).
part
Any claimant
the initial
type of
____
as a whole.
benefits
even
v.
proving that
former
burden
of
that he cannot
return to a
372 (1st
work
may
constitute
substantial
gainful
See
___
915 F.2d
____________________
11.
Claimant
had
been
accepted
to
graduate
school
and
1990); 20 C.F.R.
416.972(a)(work
may be
he
because
meets
he
the
has
Somatoform
repeatedly
Disorder
suffered
deterioration or decompensation at
Listing
from
( 12.07)
episodes
wrist tendonitis.
should
Claimant also
care providers
particularly
the
residual
functional
Claimant
emphasizes that
to the reports
doctors
capacity
contends that
he
did
is
of
not
unable
assessed
even
the ALJ
of his health
Brummer, and
who
due
Klate),
claimant's
examine
to use
his
him.
upper
gainful activity.
our limited
in the record.
fail given
First,
while
it
is
true
that the
ALJ
found
that
the
from the
degree of
paragraph B
functional loss
criteria of
12.07.
required to
Thus,
even if
-14-
to
increased
pain, this
experienced the
repeated
and
conclusion
functioning
resides with
were
seven
with
the
people,
supports
daily living
is able
the
Moreover, claimant's
SSA
significantly
that he
deterioration in
12.07.
activities of
not
not establish
episodes of
satisfy
contact
that his
alone does
impaired.
to
do
some
the
ALJ's
and social
Claimant
cooking,
addition to participating
SSI
has
impairment consistent
did
do not suggest
a level of
respect
to claimant's
second
be
rejected by
greater weight to
his own
contention,
treating physician's
the Secretary,
experts.
See,
___
who may
Cir.
1988)(per
curiam); Barrientos
__________
from a
F.2d
F.2d 271,
v.
1,
somatoform
v.
272
Secretary of
_____________
2-3
820
accord
e.g., Keating
____ _______
it is
(1st
Cir.
19, 21 (1st
not
from a
physical
-15-
of
Drs.
Siegel and
Bloomberg, both
of whom
suggested the
diagnosis
of
somatoform
disorder,
claimant's
own rheumatologist,
claimant's
symptoms
were
and
Dr.
the
opinion
Gray, who
inconsistent
stated
with
of trigger point
and complaints of
There
ALJ's
was no
more weight on
accorded a
entitled to the
416.972(a)(acceptable
physicians,
record
medical
osteopaths,
custodians).
The ALJ
by claimant's
sources.
sure,
be
do not recognize
sources
be
correctly
psychologists,
To
the
the opinions of
tenderness
error in
that
fibrositis,
of
See 20 C.F.R.
___
include
licensed
optometrists,
the
record
and
arguably
fibromyalgia
that
does
limit
exertionally.
in the evidence
the
to
e.g.,
____
Secretary
resolve,
see,
___
him
are for
Burgos Lopez
_____________
v.
1984), we
cannot second
guess the
ALJ's decision
to
ALJ
rejected
from
extremities,
claimant's
working
finding that
because
contention
he cannot
his complaints of
that
use
his
he
is
upper
disabling pain
-16-
An ALJ's credibility
Cir. 1989).
conclusion
Nevertheless,
that
limitations.
claimant
In
the
869 F.2d
we question
suffers
first
Dupuis v.
______
from
place,
622, 623
the
no
__
ALJ's
exertional
this
finding
is
significant
number
of
physicians
who
And
given
reported
that
to his
qualified
to
conclude
limitations
claimant's
condition
to
somatoform
disorder)
as opposed
Walston
_______
1967)(pain may
v.
even
that
exertional
See
___
light work.
Gardner,
_______
be
be
if
claimant
he
a mental
381
disabling even
to a
F.2d
if
found
suffered
the
no
cause
impairment
of
(i.e,
physical impairment.
580,
585
(6th
partly caused
Cir.
by
an
emotional
problem).
As a
general
rule,
an
ALJ is
not
bare
medical findings.
See,
___
e.g.,
____
Berrios Lopez
_____________
v.
1991).
However,
the record
work.
In
particular, we
supports the
ALJ's
that the
duties
of
this exertional
-17-
category,
and that
"the type
of work
involved in
a sales
and hands
for
long periods
job
substantial
as
...."
Gray
____
v.
psychiatric
evidence
of time
supports
aide.
the
Accordingly,
ALJ's
conclusion
where
that
judgment
-18-