Monthly Archives

February 2016

Lupus

By Legal issues

Lupus and Social Security Disability

Disseminated (systemic) lupus erythematosus can be a debilitating medical condition deserving of Social Security disability benefits. This material surveys the more significant cases discussing the medical condition in a Social Security disability context. Please note that discoid lupus should be distinguished from systemic lupus erythematosus in terms of medical significance.

Tip

Develop the record regarding all symptoms including arthritis, joint pain, kidney or blood disorders, skin eruptions, and/or fever. Be sure your subjective complaints are corroborated with medical evidence from the treating medical providers.

Regulations

20 C.F.R. Pt. 404, Subpt. P, App. 1, Listing of Impairments

Disseminated (systemic) lupus erythematosus (“SLE”) usually involves more than one body system and should be evaluated under Listings 14.02 and 14.04. Listing 14.02 provides that SLE is characterized clinically by constitutional symptoms and signs (e.g., fever, fatigability, malaise, weight loss), multisystem involvement, and, frequently, anemia, leukopenia, or thrombocytopenia. Immunologically, an array of circulating serum auto-antibodies can occur, but are highly variable in pattern. Generally, the medical evidence will show that patients with this disease will fulfill the 1982 Revised Criteria for the Classification of Systemic Lupus Erythematosus of the American College of Rheumatology. (Tan, E.M., et al., Arthritis Rheum. 25: 1271-1277, 1982).

Listing 14.06 governs “undifferentiated connective tissue disorders” and includes syndromes with clinical and immunologic features of several connective tissue disorders that do not satisfy the criteria for any of the disorders described. For instance, the individual may have clinical features of systemic lupus erythematosus and systemic vasculitis and the serologic findings of rheumatoid arthritis. It also includes overlap syndromes with clinical features of more than one established connective tissue disorder.

The specific requirements of Listing 14.02 for systemic lupus erythematosus include documentation of:

A. One of the following:

  1. Joint involvement, as described under the criteria in 1.00; or
  2. Muscle involvement, as described under the criteria in 14.05; or
  3. Ocular involvement, as described under the criteria in 2.00ff; or
  4. Respiratory involvement, as described under the criteria in 3.00ff; or
  5. Cardiovascular involvement, as described under the criteria in 4.00ff or 14.04D; or
  6. Digestive involvement, as described under the criteria in 5.00ff; or
  7. Renal involvement, as described under the criteria in 6.00ff; or
  8. Skin involvement, as described under the criteria in 8.00ff; or
  9. Neurological involvement, as described under the criteria in 11.00ff; or
  10. Mental involvement, as described under the criteria in 12.00ff.

or

B. Lesser involvement of two or more organs/body systems listed in paragraph A, with significant, documented, constitutional symptoms and signs of severe fatigue, fever, malaise, and weight loss. At least one of the organs/body systems must be involved to at least a moderate level of severity.

Applicable Case Law

Second Circuit

The ALJ’s refusal to permit the claimant to subpoena a treating and reporting physician as to whether the claimant actually suffered from lupus was proper. Yancey v. Apfel, 145 F.3d 106, 116 (2d Cir. 1998).

Fifth Circuit

In Newton, the Fifth Circuit noted that the ALJ improperly ignored the claimant’s “claims of severe fatigue, weakness, and swelling, all of which are completely consistent with a diagnosis of SLE.” Newton v. Apfel, 209 F.3d 448, 459 (5th Cir. 2000).

In Dowles v. Barnhart, 258 F. Supp.2d 478 (W.D. La. 2003), the court held that the ALJ erred in failing to consider whether the claimant’s systemic lupus erythematosus (SLE) met the requirements of Listing 14.02. Id. at 486. Instead, the ALJ gave “a bare and summary conclusion that a plaintiff does not meet the criteria of any listing,” a finding which is “beyond meaningful judicial review.” Id. The ALJ also erred in relying on the Medical-Vocational Guidelines to find that the claimant was not disabled given the fact that SLE is a nonexertional impairment and given the ALJ’s failure to consider the side effects of the claimant’s medication and the impact of periodic SLE flare-ups on her ability to keep a job. Id. at 486 n. 7. The court then evaluated this case in accordance with Listing 14.02 and found that the claimant met at least six of the 11 listed criteria (with only four being necessary to support a finding of SLE), thereby meeting the threshold requirement for Listing 14.02.Id.at 487. The court further held that the claimant’s lupus met Listing 14.02(A)(8), for severe involvement of her skin from SLE since at least the time she filed her claim for benefits on June 3, 1997 (protective filing date), as well as Listing 14.02(B), by meeting the criteria for “lesser involvement” of two or more organs/body systems as well as its requirement of “severe fatigue, fever, malaise, and weight loss.” Id. at 488-49.

Sixth Circuit

In Crouch v. Secretary of Health and Human Servs., 909 F.2d 852 (6th Cir. 1990), there was not substantial evidence of at least four out of eleven possible criteria required for a positive diagnosis of lupus. Id.at 856. The court also found that there was no objective medical evidence to confirm the severity of the alleged pain and that the objectively determined medical condition could reasonably be expected to give rise to the alleged disabling pain. Id. Specifically, the medical record showed that although there was diffused tenderness in multiple joints and along the paraspinal musculature, there were no definite ongoing inflammatory signs of swelling, redness or heat in the major joints of any of the extremities. Based on these findings, the court found that there was not substantial evidence of severe disabling pain due to lupus. Id.

Where the only evidence that the claimant’s SLE was of disabling severity during the period in question consisted solely of her testimony and affidavits by her husband, her daughter, and a boarder, the Commissioner’s findings were supported by substantial evidence. Gayton v. Secretary of Health & Human Servs., 691 F. Supp. 22, 24 (N.D. Ohio 1988).

Where the signs and symptoms of the claimant’s condition were so equivocal that her doctors could not even render a definite diagnosis of SLE, the claimant’s SLE or lupus-type impairment was not severe. Buettner v. Secretary of Health and Human Servs., 686 F. Supp. 616, 618 (W.D. Mich. 1988).

Seventh Circuit

Although the ALJ concluded that the claimant did have lupus, his decision that she was not disabled was not based on substantial evidence. Micus v. Bowen, 979 F.2d 602, 609 (7th Cir. 1992). As noted by the Micus court, lupus is a chronic, relapsing inflammatory disease that attacks connective tissues and is characterized by a wide range of symptoms, including arthritis, pain in the joints, kidney and blood disorders, skin eruptions, and fever. Id.,citing Dorland’s Illustrated Medical Dictionary 958 (27th ed. 1988). Although lupus is incurable and its cause unknown, medications (such as corticosteroids) can, at least temporarily, moderate its effects on many sufferers. Lupus may lie dormant or quiescent, exhibiting no or slight manifestations, only to flare suddenly and become debilitating. Id.at 603.

A district court held that there was objective evidence supporting the claimant’s subjective complaints where the ALJ’s own medical advisor stated that “[l]upus patients may develop joint pains . . . that are not accompanied by inflammatory changes.” Martin v. Sullivan, 750 F. Supp. 964, 970 (S.D. Ind. 1990).

Where the claimant suffered from drug induced lupus, even though she had a positive ANA reading, her condition did not meet the requirements of the listing for disseminated lupus erythmatosus, contained in Section 10.04 of the Listing of Impairments. Predki v. Heckler, 622 F. Supp. 495, 501 (N.D. Ill. 1985).

Eighth Circuit

Where the claimant suffered from lupus and fibromyalgia, the Eighth Circuit held that the ALJ improperly evaluated her subjective complaints of pain and failed to give proper weight to the opinions of her treating physicians. Kelley v. Callahan, 133 F.3d 583, 590 (8th Cir. 1998).

The fact that a treating physician noted that the claimant’s lupus was “in remission” and “ha[d] stabilized” did not mean that the claimant’s symptoms had gone away or that they did not exist. Gude v. Sullivan, 956 F.2d 791, 793 (8th Cir. 1992). The Eighth Circuit concluded that substantial evidence failed to support the ALJ’s conclusions that the claimant’s claims of pain and discomfort were not credible and that the claimant could do sedentary work. Id.

Because the ALJ failed to consider the progressive nature of the claimant’s spinal impairments and the relapsing, remitting nature of her systemic lupus, and failed to consider the combined effect of her impairments, both mental and physical, the medical evidence did not show, as the ALJ found, that the claimant’s condition had not significantly deteriorated since her onset date. Bowman v. Barnhart, 310 F.3d 1080, 1084 (8th Cir. 2002).

The court held in Gillette v. Barnhart, 291 F. Supp.2d 1071 (D.N.D. 2003) that the opinions of two treating physicians, that as a result of the claimant’s lupus, she lacked the endurance for full-time employment, were improperly disregarded by the ALJ and should have been accorded controlling weight. Id.at 1076. In so holding, the court noted that both physicians agreed in their assessments, the opinions were based upon having treated the claimant for several years (in contrast to the conclusions of the agency physicians who never examined her), and the medical record revealed a patient with the chronic and progressive disorder of lupus whose symptoms have followed a declining pattern of peaks and valleys. Id. The court also noted that the claimant’s reported activities were consistent with the nature of her lupus, stating:

[I]t tends to flare up and then subside only to flare-up again. The pain and fatigue come and go. It is clear that a person with lupus has good days on which she can be fairly active and bad days when little, if anything, can be accomplished.

Id. at 1078. The court concluded that, considering the totality of the record, the claimant’s limitations and disabilities presented a clear picture of a person who could not hold down a full-time position and reversed and remanded for an award of benefits. Id.

Where the medical evidence did not support that the claimant was suffering from ongoing severe symptoms of lupus, and the claimant had not been restricted by her physician from working more than part-time except in the letter generated at the request of her attorney just prior to her social security hearing, the ALJ properly determined that she did not suffer from a severe impairment. Meyer v. Callahan, 980 F. Supp. 1069, 1078 (W.D. Mo. 1997).

Because the record did not provide sufficient insight into the effects of SLE or what functional limitations were caused by this condition, and due to the illegibility of statements by the claimant’s treating physician who was then deceased, remand was required for further development. Bell v. Heckler, 609 F. Supp. 213, 216 (W.D. Mo. 1985).

Ninth Circuit

In Reed v. Massanari, 270 F.3d 838 (9th Cir. 2001), the Ninth Circuit held that the ALJ rejected, for an improper reason, the claimant’s request for a consultative examination by a rheumatologist for a claimant who suffered from lupus. Id. at 839. Specifically, the ALJ’s decision not to order the consultative examination was not based on a determination that the evidence already in the record was sufficient, but on the ALJ’s perception that both rheumatologists recruited by the state agency were unable or unwilling to provide reliable opinions on matters of rheumatology. Id. at 843. As there was no material in the record which supported this conclusion, the refusal to order the examination amounted to an “ad hoc, across-the-board disqualification of State-recruited consultative medical examiners” which exceeded the ALJ’s authority. Id. at 844. Thus, the court reversed and remanded and directed that, on remand, the matter be assigned to a different ALJ. Id. at 845.

Eleventh Circuit

A full range of motion, lack of synovitis, and intact motor function did not provide evidence that a claimant’s systemic lupus could not give rise to pain in her lower extremities and dizziness. Swindle v. Sullivan, 914 F.2d 222, 226 (11th Cir. 1990). On this basis, the Eleventh Circuit found that the ALJ’s determination that her testimony regarding pain and dizziness was only partially credible was not supported by substantial evidence. Id.

The district court found that because it was clear that the claimant’s impairments fell within the listings for rheumatoid arthritis or systemic lupus erythmatosis, the ALJ’s finding of no disability was not supported by substantial evidence in the record. Heidig v. Heckler, 608 F. Supp. 135, 142 (S.D. Fla.1985).

Manipulative limitations

By Legal issues

Manipulative Limitations and Social Security Disability

Social Security Ruling 96-9p examines the effect of various functional limitations on a Social Security disability claimant’s ability to perform the full range of sedentary work. Although SSR 85-15 generally discusses the effect of manipulative limitations on a claimant’s ability to work, SSR 96-9p is the first ruling to provide that any significant manipulative limitation necessarily results in the “significant erosion of the unskilled sedentary occupational base.” Based on this ruling, the ALJ has the authority to find a claimant disabled under such circumstances. Additionally, the ALJ arguably must obtain vocational expert testimony to establish that a claimant (who is otherwise limited to sedentary work and suffers from significant manipulative limitations) can perform other work.

Tip

If you suffer from medically documented manipulative limitations and are limited to unskilled sedentary work, your attorney should argue that the unskilled sedentary work base has been significantly eroded and that a finding of disabled is required. Alternatively, your attorney should argue that in light of your manipulative limitations, vocational expert testimony is needed to establish the existence of other work that you can perform.

Regulations

20 C.F.R. §§ 404.1545, 416.945

The regulations provide that a limited ability to perform certain physical demands of work activity, including manipulative functions such as reaching and handling, may reduce a claimant’s ability to do past work and other work.

20 C.F.R. §§ 404.1569a, 416.969a

Some examples of nonexertional limitations or restrictions include difficulty performing the manipulative or postural functions of some work such as reaching, handling, stooping, climbing, crawling, or crouching.

Rulings

Social Security Ruling 96-9p

SSR 96-9p provides that most unskilled sedentary jobs require good use of both hands and the fingers; i.e., bilateral manual dexterity. Fine movements of small objects require use of the fingers, e.g., to pick or pinch. Id. “Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions.” Id.

SSR 96-9p further provides that:

Any significant manipulative limitation of an individual’s ability to handle and work with small objects with both hands will result in a significant erosion of the unskilled sedentary occupational base.

Social Security Ruling 85-15

SSR 85-15 provides that reaching, handling, fingering, and feeling require progressively finer usage of the upper extremities to perform work-related activities. Reaching (extending the hands and arms in any direction) and handling (seizing, holding, grasping, turning or otherwise working primarily with the whole hand or hands) are activities required in almost all jobs. Significant limitations of reaching or handling may eliminate a large number of occupations a person could otherwise do. Varying degrees of limitations would have different effects, and a VE’s assistance might be needed to determine the effects of the limitations.

Fingering involves picking, pinching, or otherwise working primarily with the fingers. It is needed to perform most unskilled sedentary jobs and to perform certain skilled and semiskilled jobs at all levels of exertion. As a general rule, limitations of fine manual dexterity have greater adjudicative significance — in terms of relative numbers of jobs in which the function is required — as the person’s exertional RFC decreases. Thus, the loss of fine manual dexterity narrows the sedentary and light ranges of work much more than it does the medium, heavy, and very heavy ranges of work. The varying degrees of loss which can occur may require the adjudicator to have a VE’s assistance. However, a VE would not ordinarily be required where a person has lost the ability to feel the size, shape, temperature, or texture of an object by the fingertips, since this is a function required in very few jobs.

Social Security Ruling 83-14

SSR 83-14 describes Example 1 of § 201.00(h) of the Grids as illustrating that a limitation to unskilled sedentary work, with an additional loss of bilateral manual dexterity that is significant, warrants a conclusion of “disabled.” SSR 83-14 further notes that the bulk of unskilled sedentary jobs requires bilateral manual dexterity.

Case Law

First Circuit

In Heggarty v. Sullivan, 947 F.2d 990 (1st Cir. 1991), the court found that where uncontradicted medical evidence indicated that the claimant’s manual dexterity was limited, the ALJ’s conclusion that the claimant retained the capacity to perform the full range of sedentary work was not supported by substantial evidence and a remand for vocational evidence was required. Id. at 996-97.

In Prentice, the Commissioner moved for a remand pursuant to sentence four of 42 U.S.C. § 405(g), conceding that the claimant suffered from a nonexertional impairment (a manual-dexterity problem) which was significant enough to have undermined the administrative law judge’s sole reliance on the Medical-Vocational Guidelines, and contending that the appropriate remedy was remand for rehearing to obtain vocational expert testimony. Prentice v. Barnhart, 256 F. Supp.2d 4, 5-6 (D. Me. 2003). The claimant opposed the remand, and instead argued that his entitlement to benefits was clear enough to warrant remand with instructions to pay benefits. Id. at 6. In support, the claimant cited Social Security Ruling 96-9p for the proposition that a person “who is limited to unskilled sedentary work and lacks any manual dexterity of his non-dominant hand is ipso facto disabled.” Id.The court disagreed, citing three reasons: (1) nowhere in SSR 96-9p does it clearly direct that a claimant be found “disabled”; (2) circuit courts have rejected arguments similar to that made by the claimant’s and (3) the Commissioner clarified, in deleting example 1 of section 201.00(h) from the Grids effective September 27, 2001, that the agency has always intended that the example not be construed to direct a finding of disability. Id. at 7. As SSR 96-9p does not clearly direct a finding of disabled, remand with instructions for rehearing as requested by the Commissioner, rather than remand with instructions to pay benefits, was the appropriate remedy. Id. at 8.

Fifth Circuit

The Fifth Circuit rejected the claimant’s argument that the ALJ failed to obtain vocational expert testimony despite his limitation to sedentary work and his manipulative limitations. Hernandez v. Heckler, 704 F.2d 857, 861 (5th Cir. 1983).

Sixth Circuit

“As a general rule, limitations of fine manual dexterity have more significance regarding sedentary ranges of work than in medium ranges of work, because sedentary jobs commonly require such function.” Henderson v. Apfel, 142 F. Supp.2d 943, 946-47 (W.D. Tenn. 2001), citing SSR 85-15 and SSR 96-9p.

Noting that § 201.00 of the Grids did not mandate a finding of disability, the court stated that although the claimant was limited in his ability to engage in fine manipulation, he did not lack bilateral manual dexterity, both gross and fine, as did the claimant in § 201.00. Therefore, the Grids did not direct a finding of disability under the circumstances presented. Preston v. Sullivan, 785 F. Supp. 1267, 1272 (S.D. Ohio 1992).

Seventh Circuit

While most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions, there was sufficient evidence to support a finding that the claimant could perform sedentary jobs. Diaz v. Chater, 55 F.3d 300, 309 (7th Cir. 1995).

Although the claimant could not perform such manipulations as changing a spark plug, but admitted that he had the ability to perform fine manipulations such as picking up a rubber band, the ALJ properly concluded that the claimant’s capability to perform the full range of sedentary work was not significantly impacted by his hand restrictions. Luna v. Shalala, 22 F.3d 687, 692 (7th Cir. 1994).

In evaluating a claimant’s right to seek Equal Access to Justice Act attorneys’ fees, the court held that the Commissioner’s position was substantially justified when it exclusively relied on the Grids even though the claimant was precluded from using her nondominant hand for repetitive motions.Cummings v. Sullivan, 950 F.2d 492, 498 (7th Cir. 1991).

Limitations in the claimant’s hands and feet prevented his operating foot controls, typing, and writing for a substantial period, and impeded both bilateral and fine-hand manipulations, thereby precluding his performance of many unskilled sedentary occupations. Smith v. Schweiker, 735 F.2d 267, 272 (7th Cir. 1984).

Eighth Circuit

Substantial evidence supported the ALJ’s findings that the claimant could do the full range of sedentary work where the medical records contained no evidence that the claimant sought or received medical treatment for numbness in his hands. Ownbey v. Shalala, 5 F.3d 342, 344 (8th Cir. 1993).

Since a physician stated that the claimant would be limited in his ability to handle objects and that his slight hearing loss would affect his ability to hear low voices, and both of these conditions could limit the unskilled, sedentary jobs which the claimant could perform, VE testimony would be required upon remand. Sanders v. Sullivan, 983 F.2d 822, 824 (8th Cir. 1992).

Ninth Circuit

Where the ALJ specifically found that the claimant could not perform the full range of sedentary and light work because of significant mental and manipulative nonexertional limitations, the ALJ was required to obtain VE testimony. Burkhart v. Bowen, 856 F.2d 1335, 1341 (9th Cir. 1988).

Where the claimant had a permanent injury to one hand which precluded jobs requiring bilateral manual dexterity and thus significantly compromised the only range of work for which he was otherwise qualified, the ALJ erred in failing to obtain testimony from a VE as to other jobs the claimant could perform. Fife v. Heckler, 767 F.2d 1427, 1430 (9th Cir. 1985).

Tenth Circuit

The ALJ erred in finding that the claimant was not disabled under the Grids where the ALJ admitted that the claimant had reaching limitations and was limited to sedentary work. Saiz v. Barnhart, 392 F.3d 397, 399 (10th Cir. 2004).

Where the record did not support a finding that the claimant’s hands were fully functional, the ALJ’s failure to include any hand limitations in his hypothetical to the VE violated the established rule that such inquiries must include all impairments borne out by the evidentiary record. Evans v. Chater, 55 F.3d 530, 532 (10th Cir. 1995).

The Tenth Circuit noted that a claimant may possess nonexertional limitations in his manual dexterity which limit his ability to perform tasks with his fingers and fingertips, thereby reducing the claimant’s potential occupational base as set forth in the Grids. Trimiar v. Sullivan, 966 F.2d 1326, 1333 (10th Cir. 1992).

In Piatt v. Barnhart, 225 F. Supp.2d 1278 (D. Kan. 2002), the court held that the record did not contain substantial evidence to support the ALJ’s finding that there were no manipulative limitations. Id. at 1285.

Eleventh Circuit

The Eleventh Circuit reaffirmed its holding that limitations in manual dexterity and grip strength in one hand would significantly limit a person’s ability to adapt to other work, and should therefore preclude exclusive reliance on the Grids. Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995).

The Eleventh Circuit found that the claimant, who required an assistive device to ambulate, suffered from a manipulative limitation. Walker v. Bowen, 826 F.2d 996, 1003 (11th Cir. 1987). The ALJ erred in failing to make a specific finding as to whether the nonexertional impairment was severe enough to preclude the claimant from performing a wide range of sedentary work. Id.

Severe impairment definition

By Legal issues

The Definition of “Severe Impairment” in Social Security Disability

This is an overview of the applicable Social Security disability laws, regulations, rulings, and primary circuit court case law governing the definition of “severity,” as used in step two of the sequential analysis used by the Social Security Administration to determine eligibility for disability benefits.

Many circuits that have issued published decisions on this topic have held that an impairment can be considered as not severe only if it is a slight abnormality that has such minimal effect on the individual that it would not be expected to interfere with the individual’s ability to work. Other courts have held that the inquiry at step two is a “de minimus screening device to dispose of groundless claims.”

Tip

Each impairment and its resulting limitations must be documented with medical evidence. Simply alleging existence of the impairment is insufficient to establish “severity” as set forth in step two of the sequential evaluation process.

Statutes

42 U.S.C. § 423(d)

In determining whether an individual’s physical or mental impairment or impairments are of a sufficient medical severity that such impairment or impairments could be the basis of eligibility under this section, the Commissioner is required to consider the combined effect of all of the individual’s impairments without regard to whether any such impairment, if considered separately, would be of such severity. If the Commissioner does find a medically severe combination of impairments, the combined impact of the impairments shall be considered throughout the disability determination process.

Regulations

20 C.F.R. §§ 404.1520, 416.920

The regulations provide that a claimant must have a severe impairment. If the claimant does not have any impairment or combination of impairments that significantly limit his or her physical or mental ability to do basic work activities, the SSA will find that the claimant does not have a severe impairment and is, therefore, not disabled.

20 C.F.R. §§ 404.1521, 416.921

In §§ 404.1521 and 416.921, a non-severe impairment is defined as an impairment or combination of impairments that does not significantly limit a claimant’s physical or mental ability to do basic work activities. “Basic work activities” are defined as the abilities and aptitudes necessary to do most jobs. Examples of these include:

  1. Physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling;
  2. Capacities for seeing, hearing, and speaking;
  3. Understanding, carrying out, and remembering simple instructions;
  4. Use of judgment;
  5. Responding appropriately to supervision, co-workers and usual work situations; and
  6. Dealing with changes in a routine work setting.

Rulings

Social Security Ruling 96-3p

To be found disabled, an individual must have a medically determinable “severe” physical or mental impairment or combination of impairments that meets the duration requirement. At step two of the sequential evaluation process, an impairment or combination of impairments is considered “severe” if it significantly limits an individual’s physical or mental abilities to do basic work activities. An impairment that is “not severe” must be a slight abnormality (or a combination of slight abnormalities) that has no more than a minimal effect on the ability to do basic work activities.

Social Security Ruling 96-8p

When an individual is not engaging in substantial gainful activity and a determination or decision cannot be made on the basis of medical factors alone (i.e., when the impairment is severe because it has more than a minimal effect on the ability to do basic work activities, yet does not meet or equal in severity the requirements of any impairment in the Listing of Impairments), the sequential evaluation process generally must continue with an identification of the individual’s functional limitations and restrictions and an assessment of his or her remaining capacities for work-related activities.

Social Security Ruling 85-28

An impairment or combination of impairments is found “not severe” and a finding of “not disabled” is made at step two when medical evidence establishes only a slight abnormality or a combination of slight abnormalities that would have no more than a minimal effect on an individual’s ability to work even if the individual’s age, education, or work experience were specifically considered. The severity requirement cannot be satisfied when medical evidence shows that the person has the ability to perform basic work activities, as required in most jobs. Examples of these are walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling; seeing, hearing, and speaking; understanding, carrying out, and remembering simple instructions; use of judgment and responding appropriately to supervision, coworkers, and usual work situations; and dealing with changes in a routine work setting. Thus, these basic work factors are inherent in making a determination that an individual does not have a severe medical impairment.

Although an impairment is not severe if it has no more than a minimal effect on an individual’s physical or mental ability to do basic work activities, the possibility of several such impairments combining to produce a severe impairment must be considered. A claim may be denied at step two only if the evidence shows that the individual’s impairments, when considered in combination, are not medically severe (i.e., do not have more than a minimal effect on the person’s physical or mental ability to perform basic work activities). If such a finding is not clearly established by medical evidence, adjudication must continue through the sequential evaluation process.

If the medical evidence establishes only a slight abnormality that has no more than a minimal effect on a claimant’s ability to do basic work activities, but evidence shows that the person cannot perform his or her past relevant work because of the unique features of that work, a denial at the “not severe” step of the sequential evaluation process is inappropriate. The inability to perform past relevant work in such instances warrants further evaluation of the individual’s ability to do other work considering age, education and work experience.

Resources

POMS DI 24505.005 Evaluation of Medical Impairments that Are Not Severe

POMS DI 24505.005 sets forth the various considerations in evaluating severity issues. It confirms that although an impairment is not severe if it has no more than a minimal effect on an individual’s physical or mental ability(ies) to do basic work activities, the possibility of several such impairments combining to produce a severe impairment must be considered. When assessing the severity of whatever impairments an individual may have, the adjudicative team must assess the impact of the combination of those impairments on the person’s ability to function, rather than assess separately the contribution of each impairment to the restriction of his or her activity as if each impairment existed alone. A claim may be denied at step two only if the evidence shows that the individual’s impairments, when considered in combination, are not medically severe (i.e., do not have more than a minimal effect on the person’s physical or mental ability to perform basic work activities). If such a finding is not clearly established by medical evidence, however, adjudication must continue through the sequential evaluation process.

At the second step of sequential evaluation, evidence is evaluated to assess the effects of the impairment on the ability to do basic work activities. If the assessment shows the individual to have the physical and mental ability necessary to perform such activities, no evaluation of past work (or of age, education, and work experience) is needed. Rather, it is reasonable to conclude, based on the minimal impact of the impairment(s), that the individual is capable of engaging in SGA. The rationale of denial in the formal determination as to disability must also include a statement regarding the individual’s present functional abilities which supports the finding of a not severe impairment(s).

If the medical evidence establishes only a slight abnormality(ies) which has no more than a minimal effect on a claimant’s ability to do basic work activities, but evidence shows that the person cannot perform his or her past relevant work because of the unique features of that work, a denial at the “not severe” step of the sequential evaluation process is inappropriate. The inability to perform past relevant work in such instances warrants further evaluation of the individual’s ability to do other work considering age, education, and work experience.

Case Law

United States Supreme Court

The severity regulation increases the efficiency and reliability of the sequential evaluation process by identifying at an early stage those claimants whose medical impairments are so slight that it is unlikely they would be found to be disabled even if their age, education, and experience were taken into account. Bowen v. Yuckert, 482 U.S.137, 153, 107 S.Ct. 2287, 2297, 96 L.Ed.2d 119 (1987).

First Circuit

Under Social Security Ruling 85-28, a claim may be denied at step two for lack of a severe impairment only where the medical evidence establishes only a slight abnormality or combination of slight abnormalities that would have no more than a minimal effect on an individual’s ability to work even if the individual’s age, education, or work experience were specifically considered. Barrientos v. Secretary of Health and Human Servs., 820 F.2d 1, 2 (1st Cir. 1987). Social Security Ruling 85-28 clarifies that the step two severity requirement is intended “to do no more than screen out groundless claims.” McDonald v. Secretary of Health and Human Servs., 795 F.2d 1118, 1124 (1st Cir. 1986).

Second Circuit

A step two analysis can do no more than “screen out de minimus claims.” Pickering v. Chater, 951 F. Supp. 418, 424 (S.D.N.Y. 1996), citing Dixon v. Shalala, 54 F.3d 1019, 1030 (2d Cir. 1995) (finding that the Commissioner misapplied the severity step between 1976 and 1983 and ordering the readjudication of class member claims).

A severe impairment is one that imposes “more than a minimal restriction on a person’s ability to engage in basic work activities.” Torres v. Shalala, 938 F.Supp. 211, 215 n. 8 (S.D.N.Y. 1996).

Third Circuit

The step two severity standard is not intended to screen out significant disabilities. Bailey v. Sullivan, 885 F.2d 52, 56-57 (3d Cir. 1989).

Fourth Circuit

The establishment of “severity” is ordinarily not a difficult hurdle for the claimant to clear: “[A]n impairment can be considered as ‘not severe’ only if it is a slight abnormality which has such a minimal effect on the individual that it would not be expected to interfere with the individual’s ability to work, irrespective of age, education, or work experience.” Albright v. Commissioner of Social Sec. Admin., 174 F.3d 473, 478 n. 1 (4th Cir. 1999), citing Evans v. Heckler, 734 F.2d 1012, 1014 (4th Cir. 1984).

The Fourth Circuit law provides that “an impairment can be considered as ‘not severe’ only if it is a slight abnormality which has such a minimal effect on the individual that it would not be expected to interfere with the individual’s ability to work, irrespective of age, education, or work experience.” Evans v. Heckler, 734 F.2d 1012, 1014 (4th Cir. 1984).

Fifth Circuit

The Fifth Circuit assumed that the ALJ applied an improper standard for determining severity where the ALJ adverted only to the literal terms of 20 C.F.R. § 404.1520(c). Loza v. Apfel, 219 F.3d 378, 392-93 (5th Cir. 2000). The court further held that the ALJ should have either set forth the standard as it was construed in Stone v. Heckler, 752 F.2d 1099 (5th Cir. 1985) or another Fifth Circuit decision, or expressly stated that an impairment could be considered as not severe only if it was a slight abnormality having such minimal effect on an individual that it would not be expected to interfere with the individual’s ability to work, irrespective of age, education or work experience. Id.

An impairment can be considered as not severe only if it is a slight abnormality that has such minimal effect on the individual that it would not be expected to interfere with the individual’s ability to work, irrespective of age, education or work experience.Spellman v. Shalala, 1 F.3d 357 (5th Cir. 1993), citing Estran v. Heckler, 745 F.2d 340, 341 (5th Cir. 1984). As stated by the Spellman Court, in Stone v. Heckler, 752 F.2d 1099 (5th Cir. 1985), the Fifth Circuit stated that unless the correct standard was used in determining the severity of an impairment, the claim must be remanded to the Commissioner for reconsideration.Id. The court concluded that the Commissioner must indicate in his opinion that it evaluated severity in accordance with Estran and Stone. The court further noted that it would assume that the ALJ and Appeals Council applied an incorrect standard to the severity requirement unless the correct standard was set forth by reference to the Stone opinion or another of the same effect, or by an express statement that the proper construction was used. Id.

Sixth Circuit

An impairment can be considered non-severe only if it could constitute a “slight abnormality which has such a minimal effect on the individual that it would not be expected to interfere with an individual’s ability to work, irrespective of age, education and past work experience.” Farris v. Secretary of Health and Human Servs., 773 F.2d 85, 89-90 (6th Cir. 1985).

Seventh Circuit

The Seventh Circuit rejected a claimant’s argument that an ALJ was required to find that the claimant suffered from a severe mental impairment simply because one medical source opined that she often suffered from deficiencies of concentration. Nelson v. Apfel, 210 F.3d 799, 802-03 (7th Cir. 2000). The court reasoned that applicable regulations or SSR 96-3p did not equate the rating of “often” with a severe impairment as defined by a “significant limit” in a person’s ability to do basic work activities. The court added that because “we do not know what [the medical source] meant by ‘often’ . . . we conclude that the district court did not abuse its discretion when it remanded this case to the ALJ for further proceedings to resolve factual conflicts in the record.” Id.

Eighth Circuit

The Eighth Circuit held that the ALJ erred in not acknowledging the correct severity standard. Caviness v. Massanari, 250 F.3d 603 (8th Cir. 2001). The court further found that this error was not “harmless” and declined to make a finding of severity in “the first instance.” Id. at 605.

In Simmons v. Massanari, 264 F.3d 751 (8th Cir. 2001), the Eighth Circuit held that substantial evidence supported the determination that the claimant did not suffer from a severe impairment or combination of impairments prior to the expiration of his insured status. Id. at 755.

The Eighth Circuit rejected a claimant’s argument that reversal was necessary because the ALJ applied the wrong standard for determining severity. Johnston v. Apfel, 210 F.3d 870, 873 (8th Cir. 2000). The court reasoned that “[a]lthough the ALJ’s decision referred to the ‘no significant limitation’ standard instead of the ‘no more than a minimal effect’ standard, any error was harmless because it was undisputed that the district court used the correct ‘more than a minimal effect’ standard.” Id.

The Eighth Circuit held that the lack of any medically necessary restrictions in the record supported the ALJ’s finding that the claimant’s impairments were not severe. Mittlestedt v. Apfel, 204 F.3d 847, 852 (8th Cir. 2000).

In Gilbert v. Apfel, 175 F.3d 602 (8th Cir. 1999), the Eighth Circuit held that the ALJ’s conclusory finding that the claimant’s arthritis and carpal tunnel were non-severe impairments was not supported by the VE’s testimony that a manipulative limitation produced by these conditions would render the claimant unemployable. Id. at 604.

The regulations define a severe impairment as one that significantly limits the claimant’s physical or mental abilities to do basic work activities that are defined as the “abilities and aptitudes necessary to do most jobs.” Gwalthney v. Chater, 104 F.3d 1043, 1045 (8th Cir. 1997).

An impairment is non-severe when it has no more than a minimal effect on the claimant’s ability to work. Nguyen v. Chater, 75 F.3d 429, 431 (8th Cir. 1996). Denial of benefits at step two of the sequential evaluation process is justified only in cases where the claimant’s medical impairments are so slight that it is not likely that the claimant would be found disabled even if his or her vocational factors of age, education, and work experience were taken into consideration. Id.

The sequential analysis may be terminated at step two only when an impairment or combination of impairments would have “no more than a minimal effect on the claimant’s ability to work.” Henderson v. Sullivan, 930 F.2d 19, 21 (8th Cir. 1991), citingHudson v. Bowen, 870 F.2d 1392, 1396 (8th Cir. 1989).

Ninth Circuit

In Edlund v. Massanari, the Ninth Circuit held that the ALJ erred in finding that the claimant failed to demonstrate a severe mental impairment under step two of the five-step sequential evaluation process.Edlund v. Massanari, 253 F.3d 1152, 1159 (9th Cir. 2001). In finding that the claimant’s mental impairment was not severe, the ALJ “appears to have applied a more stringent legal standard than is mandated by law.” Id.at 1158. The step two inquiry is intended to be “‘a de minimis screening device to dispose of groundless claims.’” Id., quoting Smolen v. Chater, 80 F.3d 1273, 1290 (9th Cir. 1996).

The Ninth Circuit held in Bustamante v. Massanari, 262 F.3d 949 (9th Cir. 2001) that to the extent the ALJ determined that the claimant’s mental impairments were not severe regardless of the impact of alcoholism, the conclusion was not supported by substantial evidence. Id. at 955. The court noted that every psychiatrist or psychologist who examined the claimant found significant mental problems and that the evidence as a whole “overwhelmingly” supported his claim that he suffered from a severe mental impairment. Id. at 956.

The inquiry at step two is a “de minimus screening device to dispose of groundless claims.” Smolen v. Chater, 80 F.3d 1273, 1290 (9th Cir. 1996).

Tenth Circuit

The Tenth Circuit recently reiterated that “although a severe impairment must ‘significantly limit an individual’s physical or mental ability to do basic work activities,’ 20 C.F.R. § 404.1521, we have held that this is a ‘de minimus’ showing at step two of the five-step process.” Grogan v. Barnhart, 399 F.3d 1257, 1263 (10th Cir. 2005), citing Hawkins v. Chater, 113 F.3d 1162, 1169 (10th Cir. 1997) (citing Williams v. Bowen, 844 F.2d 748, 751 (10th Cir. 1988)).

Step two requires a “de minimis” showing of impairment. Hinkle v. Apfel, 132 F.3d 1349, 1352 (10th Cir. 1997). However, the claimant must show more than the mere presence of a condition or ailment. Id., citingBowen v. Yuckert, 482 U.S. 137, 153, 107 S.Ct. 2287, 2297, 96 L.Ed.2d 119 (1987) (holding step two was designed to identify “at an early stage” claimants with such slight impairments they would be unlikely to be found disabled even if age, education, and experience were considered).

At step two, a claimant is required only to make a “de minimus showing” that his or her medically determinable impairments, in combination, are severe enough to significantly limit his or her ability to perform work-related activity. Williams v. Bowen, 844 F.2d 748, 750-51 (10th Cir. 1988).

Where the record showed that the claimant suffered from joint disease or fibromyalgia, as well as chronic fatigue, migraines or chronic headaches, depression, and reflux disorder, the Tenth Circuit held that the ALJ’s determination that the claimant’s impairments were not severe was not based on substantial evidence. Langley v. Barnhart, 373 F.3d 1116, 1123-24 (10th Cir. 2004).

Eleventh Circuit

Where substantial medical evidence supported a conclusion that the claimant manifested few symptoms of sickle cell anemia and that her cognitive, social, and motor development were normal or close to normal during the relevant time period, the ALJ properly found that sickle cell anemia was not a severe impairment. Wilson v. Apfel, 179 F.3d 1276, 1278 (11th Cir. 1999). The court defined a severe impairment as an impairment “that is more than ‘a slight abnormality or a combination of slight abnormalities that causes no more than minimal functional limitations.’” Id.

An impairment is not severe if the abnormality is so slight and its effect so minimal that it would clearly not be expected to interfere with the individual’s ability to work, irrespective of age, education, or work experience. Brady v. Heckler, 724 F.2d 914, 920 (11th Cir. 1984).

The severity step is a threshold inquiry that allows only “claims based on the most trivial impairments to be rejected.” McDaniel v. Bowen, 800 F.2d 1026, 1031 (11th Cir. 1986). The claimant’s burden of showing severity is mild. A claimant “need show only that [his or] her impairment is not so slight and its effect is not so minimal.” Id.

A claimant who establishes the inability to perform past work activities has a severe impairment. Flynn v. Heckler, 768 F.2d 1273, 1275 (11th Cir. 1985).

Inability to speak English

By Legal issues

Inability to Speak English and Social Security Disability

The Social Security Administration’s (SSA) Medical-Vocational Guidelines (Grids) provide that in some instances where a claimant is limited to sedentary or light work and is unable to communicate in English, the claimant is deemed disabled. The Grids also provide, however, that in some cases, the claimant’s ability or inability to communicate in English is either not relevant or results in a finding that the claimant is not disabled.

One of the foremost issues in the Social Security disability case law has been whether Grid Rules 201.23 and 202.16 (governing individuals between the ages of 18 and 44) should be applied to direct a finding of nondisability where the claimant is both illiterate and unable to communicate in English. Both Grid Rules are phrased in the disjunctive (“or”) sense, as opposed to the conjunctive (“and”) sense.

In Martinez v. Heckler, 735 F.2d 795, 796 (5th Cir. 1984) (discussed below), the Fifth Circuit held that Grid Rule 201.23 does not apply where the claimant is both illiterate and unable to communicate in English. The SSA issued Acquiescence Ruling 86-3 (5) adopting the Martinez decision in the Fifth Circuit. However, other circuits considering the same issues have determined that the above-cited Grid Rules should be interpreted to direct a finding of “not disabled” regardless of whether the claimant is either illiterate or unable to communicate in English, or both illiterate and unable to communicate in English.

Regulations

20 C.F.R. §§ 404.1564, 416.964

These regulations provide that the ability to speak, read and understand English is considered to be an educational factor. Because English is the dominant language of the country, it may be difficult for someone who does not speak and understand English to do a job, regardless of the amount of education the person may have in another language. Therefore, the SSA considers a person’s ability to communicate in English when evaluating what work, if any, he or she can do.

20 C.F.R. Part 404, Subpt. P, App. 2 § 201.00 (h)

A finding of disabled is warranted for claimants (1) who are at least 45 years of age; (2) who are restricted to sedentary work; (3) who are unskilled or have no transferable skills; (4) who have no relevant past work or who can no longer perform vocationally relevant past work; and (5) who are either illiterate or unable to communicate in the English language. On the other hand, if the claimant is under age 45, age is usually not a significant factor in limiting such an individual’s ability to make a vocational adjustment, even an adjustment to unskilled sedentary work, and even where the individual is illiterate or unable to communicate in English.

20 C.F.R. Part 404, Subpt. P, App. 2 § 201.00 (i)

While the inability to communicate in English may significantly limit an individual’s vocational scope, the primary work functions in the bulk of unskilled work relate to working with things (rather than with data or people), and in these work functions at the unskilled level, the ability to communicate in English has the least significance. The functional capability for a full range of sedentary work represents sufficient numbers of jobs to indicate substantial vocational scope for those individuals ages 18-44, even if they are unable to communicate in English.

20 C.F.R. Part 404, Subpt. P, App. 2 §§ 202.00 (c) and (d)

A finding of disabled is warranted for individuals (1) who are at least closely approaching advanced age (ages 50 to 54); (2) who can no longer perform their past work; (3) who have a history of unskilled work experience, or who have only skills that are not readily transferable to a significant range of semi-skilled or skilled work that is within the individual’s functional capacity, or who have no work experience; and (4) who are unable to communicate in English.

Rulings

Acquiescence Ruling 86-3(5) (“AR 86-3(5)”)

AR 86-3(5) provides that when illiteracy and the inability to communicate in English are both alleged or appear to be in question, the ALJ must make findings with respect to both issues. Where individuals ages 18 to 44 are limited to sedentary work, are unskilled or have no work history, and are found to be both illiterate and unable to communicate in English, Grid Rule 201.23 cannot be mechanically applied.

In addition, Grid Rule 202.16 cannot be mechanically applied to individuals who are both illiterate and unable to communicate in English. Grid Rule 202.16 only applies to younger individuals limited to light work, who are unskilled or have no work history, and are illiterate or unable to communicate in English.

AR 86-3(5) applies only to cases in which the individual resides in Texas, Mississippi or Louisiana at the time of the determination or decision at any level of administrative review, i.e., initial, reconsideration, administrative law judge hearing or Appeals Council review.

Case Law

First Circuit

A Puerto Rico district court noted that for an individual limited to sedentary work, English is a relevant factor and the availability of jobs might be significantly reduced for persons unable to understand English. Vega v. Secretary of Health and Human Servs., 582 F. Supp. 1579, 1581 (D.P.R. 1984).

Second Circuit

The Second Circuit found that the absence of findings by the ALJ on the questions of literacy and the ability to communicate in English was crucial in light of the ALJ’s determination that the claimant was only capable of sedentary work, that her work experience was unskilled in nature, and that she was 45 years old at the time of the hearing. Vega v. Harris, 636 F.2d 900, 904 (2d Cir. 1981). If the claimant was also illiterate or “unable to communicate in English,” then the Grids mandated a determination of disability. Id.

Where the record contained strong evidence of the claimant’s inability to communicate in English, the ALJ erred in determining that the claimant was able to communicate in English based on a “brief exchange” with the claimant during the hearing. Lugo v. Chater, 932 F. Supp. 497, 502 (S.D.N.Y. 1996).

Assuming that a claimant retains an RFC to perform light work, the Grids direct a finding of “disabled” for individuals who are of advanced age, have unskilled work experience, and have limited knowledge of the English language.Hierrmann v. Bowen, 669 F. Supp. 595, 598 (S.D.N.Y. 1987).

The ALJ’s mechanical application of Grid Rules 201.18 and 201.24 was inappropriate in light of the uncertainty surrounding the claimant’s English language abilities. Rodriguez v. Heckler, 621 F. Supp. 194, 198 (S.D.N.Y. 1985).

Third Circuit

In Torres, the court rejected the claimant’s argument that she was disabled under § 200.00(h) of the Grids which requires a finding of disability for individuals aged 45-49 who: (1) are restricted to sedentary work; (2) are unskilled or have no transferrable skills; (3) have no past relevant work or can no longer perform past relevant work; and (4) are unable to communicate in English, or are able to speak and understand English but are unable to read or write English. Torres v. Thompson, 274 F. Supp.2d 678 (E.D. Pa. 2003).

The district court held that Acquiescence Ruling 86-3(5) necessitated the finding that Grid Rule 201.23 applied regardless of whether the claimant was both illiterate and unable to communicate in English (i.e., just unable to communicate in English), or merely illiterate. Flecha v. Shalala, 872 F. Supp. 1312, 1316-17 (D.N.J. 1994).

Fifth Circuit

Because the claimant was both illiterate and unable to communicate in English, Grid Rule 201.23 did not apply and the Commissioner’s decision denying continuing benefits was not supported by substantial evidence.Martinez v. Heckler, 735 F.2d 795, 796 (5th Cir. 1984).

The ALJ’s cumulative failures to make and/or document the relevant inquiries regarding Plaintiff’s language abilities required remand due to the lack of substantial supporting evidence. Delgado v. Barnhart, 305 F. Supp.2d 704, 716 (S.D. Tex.2004).

Seventh Circuit

The court held that considering the testimony of the claimant and the reports of witnesses, the ALJ’s direction to the VE to assume that the claimant spoke and understood some functional English, but was not fluent, was supported by the record. Ortiz v. Chater, 986 F. Supp. 479, 488 (N.D. Ill. 1997).

Ninth Circuit

The Ninth Circuit held that the word “or” in Grid Rule 201.23 should be interpreted as conjunctive and applies to claimants who are unable to communicate in English and/or are illiterate. In such a case, a claimant who was both illiterate and unable to communicate in English would be subject to Grid Rule 201.23, providing that the claimant is not disabled if the claimant is illiterate or unable to communicate in English, but still retains residual functional capacity for sedentary work. Chavez v. Department of Health and Human Servs., 103 F.3d 849, 852 (9th Cir. 1996).

Tenth Circuit

Grid Rule 202.16 applies to individuals who are both illiterate and unable to communicate in English, as well as to claimants who are either illiterate or unable to communicate in English. Cazares v. Chater, No. Civ 6:94-CV-401MV/LCS, 1995 WL 845646, at *2 (D.N.M. Dec. 8, 1995).

Eleventh Circuit

The Commissioner erred in finding that the claimant was English literate, where the claimant testified that he was educated through the fourth grade in Cuba, and that he neither read, wrote, nor spoke English (except for being able to speak in short phrases). Reyes v. Heckler, 601 F. Supp. 34, 36-37 (S.D. Fla. 1984).