[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FILED
FOR TH E ELEV ENTH C IRCUIT
U.S. COURT OF APPEALS
________________________ ELEVENTH CIRCUIT
January 23, 2004
No. 03-13705 THOMAS K. KAHN
Non-Argument Calendar CLERK
________________________
D. C. Docket No. 02-00407-CV -TWT-1
REN EE S . PHIL LIPS ,
Plaintiff- Appe llant,
versus
JO A NNE B. BA RNH ART ,
Comm issioner, S ocial Sec urity Ad ministratio n,
Defen dant-A ppellee.
________________________
Appeal from the United States District Court
for the N orthern District o f Geor gia
_________________________
(January 23, 2004)
Before AN DERS ON, HU LL and W ILSON , Circuit Judges.
HULL, Circuit Judge:
Renee S. Phillips, through counsel, appeals the district court’s order
affirmin g the Co mmissio ner’s den ial of her a pplication for socia l security
disability insurance benefits under 42 U.S.C. § 405(g). After review, we vacate the
district court’s order and remand this case to the Commissioner for further
consideration of Phillips’s application for social security disability insurance
benefits.
I. BACKGROUND
The main issue on appeal is under what circumstances may an
Administrative Law Judge (“ALJ”) rely on the Medical Vocational Guidelines
instead of a vocational expert. Because the ALJ’s authority to rely on the Medical
Vocational Guidelines instead of a vocational expert depends in part on the
severity of Phillips’s limitations, we first review Phillips’s medical history.
A. Phillips’s Application
On October 2 7, 1998, Phillips applied for disability insurance benefits,
alleging th at she had been dis abled an d unab le to wo rk since J uly 31, 1 997.
Phillips claimed to be disabled due to fibromyalgia, chronic fatigue, cervical facet
syndro me, irritab le bow el syndro me, Sjö gren’s sy ndrom e, bilateral sa croiliitis, a
herniated disk, depression, mitral valve prolapse, and urinary tract infections.
On A pril 26, 2000 , the ALJ co nducted a h earing to determ ine Phillips’s
eligibility for disability insurance benefits. At the hearing, the ALJ heard
2
testimony from Phillips and reviewed extensive medical records covering
Phillips’s medical history from 1993 - 2000. We outline that evidence.
B. Phillips’s Testimony
At her h earing, P hillips testifie d that she was an unemp loyed, 45 -year-old
high school graduate, with one year of vocational training in secretarial science and
business. Phillips further testified that she previously had worked for the State of
Georgia for 18 years as a clerk, administrative assistant, administrator of the food
and farm progra m, quality improv ement co ordinato r, and dir ector of c ommu nity
service programs.
According to Phillips, she left her position as director of community service
programs in 1993 or 1994 due to exh austion, headaches, muscle and bod y aches,
and fatigue. Thereafter, she transferred to the office of quality control, where she
worked until she retired due to her alleged disability in July 1997. Phillips stated
that she did not consider taking another position that was less demanding with a
state agen cy becau se she “did n’t feel fina ncially that th ere was any reaso n for tha t,
to go backwards in [her] career.” Phillips also surmised that taking a job with a
reduced salary would affect her retiremen t benefits.
Phillips testified that her daily routine consisted of reading the paper,
drinking coffee, watching the news, and doing things around the house such as
3
laundry and starting dinner. Additionally, she stated that she talked on the phone,
shopped for groceries, went to the mall, painted sometimes, and had taken painting
lessons. P hillips also stated that s ince she q uit wor king, sh e had trav eled by ca r to
several destinations for leisure purposes in the southeastern United States. Phillips
also flew to Mexico to attend her daughter’s wedding. Finally, Phillips told the
ALJ that she drove to the drug and grocery stores two to three times per week.
In addition to her other conditions, Phillips testified that she didn’t manage
anxiety very well and that she was “probably all the time moderately depressed.”
However, Phillips stated that her emotional condition was not disabling in and of
itself, and that she co uld probab ly do a “very less, less stre ssful job that w asn’t
very physically demanding for a short period of time but probably not every day
and certainly not all day every day.” Phillips explained that stressful psychological
or emotional situations caused her physical condition to worsen.
C. Medical History From Treating Physicians
In 199 3, Phillip s began treatmen t with D r. Sam S chatten, a r heuma tologist.
Phillips c omplain ed of: eye , mouth , and nail d ryness; m emory lo ss; itching ; muscle
pain; low energy; fatigue; trouble sleeping; easy bruising; and mitral valve
prolapse. Dr. Schatten remained Phillips’s primary treating physician through the
time of her administrative hearing in this case.
4
Dr. William Whaley, a specialist in oncology and hematology, examined
Phillips on Ju ly 13, 1995 , and indicated th at he though t Phillips had S jögren’s
syndrome, mitral valve prolapse syndro me, multiple urinary tract infections,
fibrocystic disease of the breast, and allergies. Dr. Whaley reported that “[t]he
problem list looks a little long, b ut [Phillip s] is basically a 40 year old com pletely
and fun damen tally healthy state emp loyee.”
On F ebruary 26, 199 6, Phillip s saw D r. Olivia M ulligan, an endocr inologis t,
compla ining of night sw eats, mus cle pain, irr itability, and brief dep ression.
How ever, all test r esults w ere norm al.
On October 14, 1996, Phillips saw Dr. Amy Lang, a specialist in physical
medicine and rehabilitation, complaining of constant neck and back pain that
averaged 5 on a scale of 1 to10 in intensity. Dr. Lang reported that the pain was
beginning to interfere with Phillips’s participation in social and recreational
activities and completion of household chores and projects. Dr. Lang noted that
Phillips demonstrated “multiple symmetric tender points above and below the
diaphragm meeting the criteria for fibromyalgia syndrome.” An October 26, 1996
radiology report indicated small to moderately sized disc herniation in two places
on Ph illips’s cerv ical spine. T he rema inder of Phillips’s spine ap peared n ormal.
On D ecembe r 30, 19 96, Ph illips’s psyc hologis t, Mary M elton, Ph .D.,
5
terminated treatment after six months, noting “major depression resolved.” On an
employer’s form for disability retirement verification, Dr. Melton noted that
Phillips’s depress ion wa s not disa bling, an d that Ph illips had b een “succ essful in
treatment for depression and in altering lifestyle to adjust for her chronic illness.”
On D ecembe r 31, 19 96, Dr . Lang n oted that P hillips’s “left- sided ne ck pain
is ‘almost well.’” Dr. Lang’s examination notes indicated that Phillips’s cervical
active range of motion was within normal limits with no pain reported. Dr. Lang
diagno sed cerv ical facet syn drome (characte rized by n eck pain and a de crease in
range of motion of the neck); regional myofascial pain syndrome of the neck and
upper back; bilateral sacroiliitis (inflammation of the sacroiliac joint (located
betwee n the lum bar spin e and the pelvis)); o ne centim eter right le g length
discrepancy; d epression, w ith noted intoleran ce of Paxil side effects; and Sjö gren’s
syndrome, noted as stable. Dr. Lang provided Phillips with heel inserts to correct
the leg discrepancy and to help Phillips’s sacroiliitis. That same day, Dr. Lang
wrote a separate report to an insurance provider, diagnosing fibromyalgia and
cervical degenerative disease.1
On February 26, 1997, Dr. Lang noted that Phillips’s stabilization exercises
and stretching program had helped to decrease fibromyalgia symptoms and that her
1
Dr. Alfonso Dampog, an anesthesiologist, treated Phillips with epidural steroid
injections for her cervical facet syndrome on November 5 and 27, 1996, and January 14, 1997.
6
pain had been reduced to soreness. On May 28, 1997, Dr. Lang documented
Phillips’s problem s as Sjög ren’s syn drome ; fibrom yalgia; cerv ical spon dylosis
(lesion of the spine of a degenerative nature); cervical facet syndrome; bilateral
sacroiliitis; pes planus (flatfoot); one centimeter leg length discrepancy; and
depression, noted as treated.
Dr. Lang noted that Phillips did not pursue cervical facet rhizotomy (surgical
severance of spinal nerve roots to relieve pain), nor did Phillips fill the prescription
for orthotics to correct the leg length discrepancy. Dr. Lang indicated that Phillips
was planning to file for long-term disability due to inability to keep up with the
pace at work. Dr. Lang wrote that virtually all activities of daily living aggravated
Phillips’s pain problems, and that she felt “overwhelmed by chronic pain and
depress ion.”
On June 25, 1997, Dr. Whaley evaluated Phillips and performed
comprehensive laboratory an d physical testing. Dr. Whaley described the issue as:
“is she disabled by virtue of a medical condition such as hyp othyroidism, lupus,
collagen vascular disease, or is the disability psychiatric?” On July 16, 1997, Dr.
Whale y docum ented no rmal test re sults and reported that “[w]e still don’t k now if
she really is disabled or not but if she is disabled, it is certainly not from anemia,
hypothyroidism, biochemical abnormality or lupus.” Dr. Whaley noted that
7
Phillips was to be seen by Dr. Gene Abel, a psychiatrist, for evaluation and
consultation.2 Dr. Whaley also noted that Phillips had discontinued using
Plaquenil, a drug used to manage the symptoms of Sjögren’s syndrome.
On July 22, 1997, Dr. Susan Dreyer, a specialist in physical medicine,
diagnosed chronic back and neck pain, secondary to fibromyalgia; remote history
of disk herniation (stable); and history of depression. Dr. Dreyer emphasized the
importance of aerobic exercise and stretching in treating fibromyalgia. Radiology
reports from that day revealed that Phillips’s lumbar spine was normally aligned
and the interspaces were well maintained, with mild degenerative disc disease at
one of Phillips’s vertebrae.
On Nov ember 5, 1998, D r. Schatten indicated that Phillips’s exercise
routine c onsisted of wate r aerobic s 2-3 tim es week ly and w alking o ne and a half
miles four to five times per week. On December 21, 1998, D r. Whaley wrote,
Phillips is “much better now in exercise than she has been in prior years going 5
days a week, 2 sessions of water aerobics, 3 on a stationary bike, and some light
weigh ts for oste oporo sis preve ntion.”
A February 24, 1999, assessment of Phillips’s psychological condition by
Gary Bible, Ph.D., indicated that typical activities for Phillips included reading,
2
There is nothing in the record to indicate Phillips ever saw Dr. Abel.
8
stretching and bending exercises, watching television, doing a small amount of
chores, preparing dinner without difficulty, preparing sandwiches for lunch, eating
out two or three times per week, visiting with a friend twice per week, talking on
the phone, shopping for groceries twice a week, trips outside the home to do
errands or visit friends two to three times per week, and occasional movies or trips
to Florida. Dr. Bible’s impression was that Phillips was “capable of functioning
within a ny num ber of sim ple and m inimally d emand ing wo rk setting s that wo uld
make allo wance s for her medical p roblem s.” He n oted that P hillips app eared qu ite
capable of understanding and carrying out simple instructions and handling social
interactions, but that Phillips had mild impairments with regard to sustaining
focused attention and task persistence.
On M arch 9, 1 999, P hillips saw Dr. Joh n Hor ney, a spe cialist in
gastroenterology, for an assessment of he r bowel condition that she indicated w as a
problem for approximately five years. Phillips described her symptoms as
constipation alternating with diarrhea with some associated left lower quadrant
pain. D r. Horn ey diagn osed “[c]h ange in b owel h abits con sistent w ith irritable
bowel syndrome.” A flexible sigmoidoscopy (a procedure in which a scope is used
to view the colon ) was n ormal.
Phillips saw Dr. Robert Cowles III in January of 1999 for recurrent urinary
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tract infections. On April 19, 1999, Dr. Cowles reported that Phillips’s “symptoms
have co mpletely r esolved on the M acrobid suppre ssion an d she is n ot only
asympto matic bu t says she h as not felt th is well in m any years .”
On May 3, 1999, Dr. Schatten noted that Phillips had a runny nose and
runny e yes, but th at prior to the date o f the exam , she “ove rall felt goo d” with
“intermittent fatigue, depression, LBP [lower back pain], pain in hips, thighs, and
knees.” He noted further that Phillips had neck and trapezii pain with activity, but
that the pain was less severe overall than before. Dr. Schatten assessed Phillips as
having primary Sjögren’s syndrome, stable; cervical myofascial pain syndrome,
stable; urinary tract symptoms, treated well with drugs; osteoporosis; intermittent
myalgias (pain in the muscles) of the lower back and lower extremities, exact
etiology unclear; and allergic sinusitis.
In a functional capacities evaluation completed on January 24, 2000, Dr.
Schatten reported that Phillips: (1) could work three hours in an eight-hour day; (2)
could sit intermittently for up to 30 minutes; (3) could stand and walk up to 30
minutes; (4) had to lie down three to four times per day for 30 minutes to an hour
at a time; (5 ) could n ever lift or carry mo re than ten pound s, and oc casionally could
lift or carry up to 10 pounds; (6) cou ld use her hands and feet for rep etitive actions;
(7) could never crawl or climb; (8) could occasionally bend, squat, or reach; and
10
(9) had mild restrictions for activities involving unprotected heights and exposure
to chang es in clima te, mode rate restrictio ns for activities invo lving ex posure to
dust, fumes and gases, and no restrictions for activities involving moving
machinery or driving automotive equipment. Dr. Schatten’s medical rationale for
the assessment was listed as: Sjögren’s syndrome; fibromyalgia; myofascial pain;
sleep disorder; cervical facet syndrome, including several surgeries; and frequent
urinary tract infections.
D. The Five-Step P rocess
Before we discuss the ALJ’s decision in this case, we outline generally the
five-step process the ALJ must follow in a social security disability case. In
evaluating a claim for disability benefits, an ALJ must evaluate the claimant’s case
with respect to the following five criteria, as set forth in 20 C.F.R. § 404.1520:
1. Is the individual performing substantial gainful activity;
2. Does s he have a severe im pairmen t;
3. Does she have a severe impairment that meets or equals an impairment
specifically listed in 20 C.F.R. Part 404, Subpart P, Appendix 1;
4. Can she perform her past relevant work; and
5. Based on her age, education, and work experience, can she perform other
work of the sort foun d in the national economy.
We discuss each step in greater detail below.
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E. Step One
At the first step, the ALJ must consider the claimant’s current working
situation. If the claimant is “doing substantial gainful activity, [the ALJ] will find
that [the claimant is] not disabled.” 20 C.F.R. § 404.1520(a)(4)(i) & (b). If,
however, the claimant is not currently “doing gainful activity” then the ALJ moves
on to the second step.
In this case, the ALJ determined that Phillips “has not engaged in substantial
gainful activity since July 31, 1997.” Therefore, the ALJ concluded that Phillips
satisfied the first step in the analysis described above. Accordingly, the ALJ
moved on to the second step.
F. Step Two
At the second step, the ALJ is to “consider the medical severity of [the
claimant’s] impairment(s).” 20 C.F.R. § 404.1520(a)(4)(ii). When considering the
severity of the claimant’s medical impairments, the ALJ must determine whether
the impairme nts, alone or in co mbination, “sign ificantly limit” the claiman t’s
“physical or mental ability to do basic work skills.” 20 C.F.R. § 404.1520(c). If
the ALJ concludes that none of the claimant’s impairments are medically severe,
the AL J is to con clude tha t the claima nt is not d isabled. 20 C.F .R. §
404.152 0(a)(4)(ii) & (c). If, howe ver, the AL J concludes th at the claimant’s
12
impairments are medically severe, then the ALJ moves on to the third step.
As for the second step, the ALJ stated that Phillips “has Sjögren’s syndrome
and fibr omyalg ia, which I find to b e ‘severe’ im pairmen ts.” 3 Because Phillips had
“severe” impairments, the ALJ went on to step three.
G. Step Three
At the third step, the ALJ again considers the “medical severity of [the
claimant’s] impairm ent(s)” in orde r to determine w hether the claima nt’s
impairm ent(s) “m eets or eq uals” on e of the liste d disabilitie s. 20 C.F .R. §
404.15 20(a)(4 )(iii). Alth ough th e list is too v olumin ous to re cite here, th e idea is
that the listin gs “stream line[] the d ecision p rocess b y identifyin g those c laimants
whose medical impairments are so severe that it is likely they would be found
disabled regardless of their vocational background.” Bowen v. Yuckert, 482 U.S.
137, 153 , 107 S. C t. 2287, 229 7 (1987) . If the ALJ concludes th at the claimant’s
impairments meet or equal one of the listed disabilities and meet the duration
requirem ent, the A LJ will c onclud e that the cla imant is d isabled. 2 0 C.F.R . §
404.152 0(a)(4)(iii) & (d). If, how ever, the AL J concludes th at the claimant’s
impairments do not meet or equal the listed impairments, then the ALJ will move
on to step four.
3
The ALJ, however, specifically concluded that Phillips’s depression was not severe.
13
As for step three, the ALJ concluded that Phillips did “not have an
impairment or combination of impairments listed in, or medically equal to one
listed” in the regulations. Therefore, the ALJ moved on to step four.
H. Step Four
At the fourth step, the ALJ must assess: (1) the claimant’s residual
functional capacity (“RFC”); and (2) the claiman t’s ability to return to her past
relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). As for the claimant’s RFC, the
regulations define RFC as that which an individual is still able to do despite the
limitations caused by his or her impairments. 20 C.F.R. § 404.1545(a). Moreover,
the ALJ will “assess and make a finding about [the claimant’s] residual functional
capacity based on all the relevant medical and other evidence” in the case. 20
C.F.R . § 404.1 520(e) . Furthe rmore, th e RFC determin ation is us ed both to
determine whether the claimant: (1) can return to her past relevant work under the
fourth step; and (2) can adjust to other work under the fifth step, discussed below.
20 C.F.R. § 404.1520(e).
If the claimant can return to her past relevant work, the ALJ will conclude
that the claimant is not disabled. 20 C.F.R. § 404.1520(a)(4)(iv) & (f). If the
claimant c annot re turn to h er past rele vant w ork, the A LJ mo ves on to step five.
14
In determining whether Phillips can return to her past relevant work, the ALJ
must determine the claimant’s RFC using all relevant medical and other evidence
in the case. 20 C.F.R. § 404.1520(e). That is, the ALJ must determine if the
claimant is limited to a particular work level. See 20 C.F.R. § 404.1567.4 Once the
ALJ a ssesses th e claiman t’s RFC and dete rmines th at the claim ant cann ot return to
her prior relevant work, the ALJ moves on to the fifth, and final, step.
As for step fou r, the AL J assessed Phillips’s RFC and con cluded in this case:
“I find that [Phillips] has the residual functional capacity (RFC) to perform the
very limited demands of entry level work at the sedentary exertional level.” The
ALJ further stated: “I have limited [Phillips] to sedentary work based on her
allegations of pain and fatigue and I have limited her to entry level work in light of
her asser tion that sh e can on ly handle one thin g at a time to avoid str ess.”
In reaching her conclusion, the ALJ gave Dr. Schatten’s “assessment [of
Phillips] little evidentiary weight” because “his rather dire assessment [of Phillips]
is in conf lict with h is [other] tr eatment n otes, and [Phillips ’s] own testimon y as to
4
To determine the physical exertion requirements of different types of employment in the
national economy, the Commissioner classifies jobs as sedentary, light, medium, heavy, and very
heavy. These terms are all defined in the regulations. For example, sedentary work is defined
by the federal regulations as work that “involves lifting no more than 10 pounds at a time and
occasionally lifting or carrying articles like docket files, ledgers, and small tools.” 20 C.F.R. §
404.1567. The regulations also recognize that “[a]lthough a sedentary job is defined as one
which involves sitting, a certain amount of walking and standing is often necessary in carrying
out job duties. Jobs are sedentary if walking and standing are required occasionally and other
sedentary criteria are met.” Id. Each classification outlined above has its own set of criteria.
15
her daily activities.” However, the ALJ also rejected “the findings of the DDS
consulta tive phys icians for light wo rk.” 5
In this cas e, the AL J specifica lly determ ined that P hillips cou ld not retu rn to
“her past relevant work.” However, the ALJ believed Phillips was “capable of
much more than she suggests.” The ALJ further stated that “while I realize that
performing work (i.e. simple work) which is well below the level of her past work
may be undesirable, both from a financial and job satisfaction perspective, she can
nonetheless perform such work, and should have few difficulties doing so, given
her wid e range o f daily activ ities.” Afte r conclu ding tha t Phillips h ad an R FC to
perform sedentary work and that she could not return to her past relevant work, the
ALJ moved on to step five.
I. Step Five
At the fifth step, the ALJ considers the claimant’s RFC, age, education, and
work experien ce to deter mine w hether th e claiman t “can mak e an adju stment to
other work.” 20 C.F.R. § 404.1520(a)(4)(v).6 Essentially, the ALJ must determine
5
Light work is define as work that “involves lifting no more than 20 pounds at a time
with frequent lifting or carrying of objects weighing up to 10 pounds.” 20 C.F.R. § 404.1567.
The regulations further state that “[e]ven though the weight lifted may be very little, a job is in
this category when it requires a good deal of walking or standing, or when it involves sitting
most of the time with some pushing and pulling of arm or leg controls.” Id.
6
According to the regulations:
If [the ALJ] find[s] that you cannot do your past relevant work because you have a
severe impairment(s) (or you do not have any past relevant work), [the ALJ] will
16
if there is other work available in significant numbers in the national economy that
the claima nt has the ability to pe rform. I f the claim ant can m ake the ad justmen t to
other work, the ALJ will determine that the claimant is not disabled. If the
claimant cannot make the adjustment to other work, the ALJ will determine that
the claima nt is disab led.
There are two avenues by which the ALJ may determine whether the
claimant has the ability to adjust to other work in the national econom y. The first
is by applying the Medical Vo cational Guidelines.
Social Security regulations currently contain a special section called the
Medical Vocational Guidelines. 20 C.F.R. pt. 404 subpt. P, app. 2. The Medical
Vocational Guidelines (“grids”) provide applicants with an alternate path to qualify
for disability benefits when their impairments do not meet the requirements of the
listed qualifying impairments. The grids provide for adjudicators to consider
factors such as age, confinement to sedentary or light work, inability to speak
English, educational deficiencies, and lack of job experience. Each of these factors
can inde penden tly limit the n umber of jobs r ealistically av ailable to an individu al.
consider the same residual functional capacity assessment [it] made under paragraph
(e) of this section, together with your vocational factors (your age, education, and
work experience) to determine if you can make an adjustment to other work. If you
can make an adjustment to other work, [the ALJ] will find you not disabled. If you
cannot, [the ALJ] will find you disabled.
20 C.F.R. § 404.1520(g)(1) (internal citation omitted).
17
Combinations of these factors yield a statutorily-required finding of “Disabled” or
“Not D isabled.”
The other means by which the ALJ may determine whether the claimant has
the ability to adjust to other work in the national economy is by the use of a
vocational expert. A vocational expert is an expert on the kinds of jobs an
individual can perform based on his or her capacity and impairments. When the
ALJ uses a vocational expert, the ALJ will pose hypothetical question(s) to the
vocational expert to establish whether someone with the limitations that the ALJ
has previously determined that the claimant has will be able to secure employment
in the national economy. 7
Under step five, the ALJ used only the grids in Phillips’s case and did not
rely on a v ocationa l expert. In so doin g, the A LJ con sidered: ( 1) Phillip s’s RFC to
perform entry-level sedentary work; (2) that Phillips was 45-years-old; (3) that
Phillips had a high school application and one year of secretarial school; and (4)
Phillips’s prior work experience. The combination of these factors under the grids
lead to the conclusion that Phillips was not disabled.
II. DISCUSSION
7
Should the ALJ find it necessary to consult a vocational expert, we note that “[i]n order
for a VE’s testimony to constitute substantial evidence, the ALJ must pose a hypothetical
question which comprises all of the claimant’s impairments.” Jones v. Apfel, 190 F.3d 1224,
1229 (11th Cir. 1999) (citing McSwain v. Bowen, 814 F.2d 617, 619-20 (11th Cir. 1987)).
18
Phillips appeals, arguing that the ALJ improperly rejected the medical
conclusions of Dr. Schatten when determining Phillips’s RFC. Phillips also argues
that the ALJ was required to consult a vocational expert in this case.
A. Treating Physician’s Opinion
We first consider Phillips’s argument that the ALJ erred when rejecting Dr.
Schatten’s opinion concerning Phillips’s medical condition.8 Because the ALJ
articulated several leg itimate reasons fo r giving less w eight to Dr. S chatten’s
opinion, w e readily conclud e that the AL J’s determination that Dr. Sch atten’s
opinion should be given little weight is supported by substantial evidence.
The opinion of a treating physician, such as Dr. Schatten, “must be given
substantial or considerable weight unless ‘good cause’ is shown to the contrary.”
Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997). This Court has
concluded “good cause” exists when the: (1) treating physician’s opinion was not
bolstered by the evidence; (2) evidence supported a contrary finding; or (3) treating
8
Our review in a Social Security case is the same as that of the district court. Martin v.
Sullivan, 894 F.2d 1520, 1529 (11th Cir.1990). “We may not decide the facts anew, reweigh the
evidence, or substitute our judgment for that of the [Commissioner].” Bloodsworth v. Heckler,
703 F.2d 1233, 1239 (11th Cir. 1983). Rather, we must defer to the Commissioner’s decision if
it is supported by substantial evidence. Id. “Substantial evidence is more than a scintilla, but
less than a preponderance. It is such relevant evidence as a reasonable person would accept as
adequate to support a conclusion.” Id. (citing Richardson v. Perales, 402 U.S. 389, 401, 91 S.
Ct. 1420, 1427 (1971)). “If the Commissioner’s decision is supported by substantial evidence
we must affirm, even if the proof preponderates against it.” Miles v. Chater, 84 F.3d 1397, 1400
(11th Cir. 1996) (citing Martin, 894 F.2d at 1529).
19
physician’s opinion was conclusory or inconsistent with the doctor’s own medical
records . Id. When electing to disregard the opinion of a treating physician, the
ALJ m ust clearly a rticulate its re asons. Id.
In support of her decision to reject Dr. Schatten’s opinion, the ALJ found
that Dr. Schatten’s assessment conflicted with his May 3, 1999 treatment notes and
Phillips’s own testimony regarding her daily activities. On May 3, 1999, Dr.
Schatten documented that Phillips had a runny nose and runny eyes, but that prior
to the date of the exam, she “overall felt good” with “intermittent fatigue,
depression, LBP [lower back pain], [and] pain in hips, thighs, and knees.” Dr.
Schatten also noted that Phillips had neck and trapezii pain with activity, but that
the pain was less severe overall than before.
Dr. Schatten’s January 24, 2000 assessment, however, was very restrictive,
indicating that Phillip s could w ork thre e hours in an eigh t hour d ay, that she could
sit intermittently for up to 30 minutes, that she could stand and walk up to 30
minutes, that she had to lie down three to four times per day for 30 minutes to an
hour at a time, and that she had significant weight lifting and carrying restrictions,
as well as restrictions on her movements. The ALJ concluded that this assessment
was at odd s with Dr . Schatten’s prio r observation s and contrar y to Phillips’s
20
admissions concerning her activities. 9
Dr. Scha tten also indicated th at a sleep disorde r was a reaso n for Phillips’s
disability. However, Phillips reported that she slept a full night most of the time.
Furthe rmore, P hillips testifie d that urin ary tract pr oblems were sy mptom atic
of her Sjögren’s syndrome, and that she experienced such problems, and other
related sym ptoms o n “a daily b asis every day.” Bu t, as of Jan uary 14 , 1999, a
consulting physician reported that Phillips’s urinary tract symptoms had been
“comple tely resolv ed.”
In sum, the ALJ articulated several reasons for giving less weight to the
treating physician ’s opinion. T hus, this Cou rt readily conclud es that the AL J’s
determination that Dr. Schatten’s opinion should be given little weight is supported
by subs tantial evid ence. Th erefore, th e ALJ ’s decision to limit Ph illips to
sedentary work is supported by substantial evidence.
B. Grids Versus Vocational Expert
As ou tlined abo ve, the A LJ used the five-s tep proc ess and d etermine d that:
(1) Phillips was not performing substantial, gainful activity; (2) Phillips had severe
9
Phillips’s reported activities included household chores, dining out, visiting with friends,
shopping, trips away from home that involved significant time in the car or airplane, walking,
lifting weights, and doing water aerobics. There was also evidence that on one occasion, Phillips
did yard work, despite her testimony that she “was not a gardener,” and despite Dr. Schatten’s
assessment that she could never crawl or climb, and that she could only occasionally bend, squat,
or reach.
21
impairments; (3) Phillips’s severe impairments did not meet or equal any
impairment listed in the regulations; and (4) Phillips could not return to h er past
relevant work. The issue in this case is how the ALJ applied step five.10 That is,
we mu st determ ine wh en an A LJ may rely on th e grids an d whe n an A LJ is
required to consult a vocational expert under step five.
The general rule is that after determining the claimant’s RFC and ability or
inability to return to past relevant work, the ALJ may use the grids to determine
wheth er other jo bs exist in the nation al econo my that a c laimant is a ble to per form.
However, “[e]xclusive reliance on the grids is not appropriate either when [the]
claimant is unable to perform a full range of work at a given residual functional
level or when a claiman t has non -exertion al impairm ents that sig nificantly lim it
basic work skills.” Francis v. Heckler, 749 F.2d 1562, 1566 (11th Cir. 1985)
(emphasis added) (citing Broz v. Schweiker, 677 F.2d 1351, 1361 (11th Cir. 1982),
adhered to sub nom. Broz v. Heckler, 711 F .2d 957 (11th C ir. 1983 )); see also
Jones v. Apfel, 190 F .3d 122 4, 1229 (11th C ir. 1999 ); Wolfe v. Charter, 86 F.3d
1072, 1 077 (1 1th Cir. 1 996); Martin v. R.R. Ret. Bd., 935 F.2d 230, 234 (11th Cir.
1991) ; Walker v. Bowen, 826 F.2d 996, 1002-03 (11th Cir. 1987); Sryock v.
10
At step five, the burden shifted to the Commissioner to prove that other jobs exist in the
national economy that Phillips is able to perform. Wolfe v. Chater, 86 F.3d 1072, 1077 (11th
Cir. 1996).
22
Heckler, 764 F.2d 834, 836 (11th Cir. 1985).
Therefore, we must determine whether either of these tw o cond itions exis t in
this case. If either condition exists, the ALJ was required to consult a vocational
expert.
C. Exertional Limitations
The firs t conditio n that req uires the A LJ to co nsult a vo cational ex pert is
when the claimant’s exertional limitations prevent the claimant from performing a
full rang e of emp loymen t.11 This Court has interpreted a “full range of
employment” as being able to do “unlimited” types of work at the given exertional
level. Ferguson v. Schweiker, 641 F.2d 243, 248 (5th Cir. Unit A Mar. 30, 1981), 12
overruled on other grounds, Johnson v. Heckler, 767 F .2d 180 , 183 & n.13 (5 th
Cir. 198 5); see also Marbury v. Sullivan, 957 F.2d 837, 839 (11th Cir. 1992). In
this case, the ALJ must determine whether Phillips can perform a full range or
11
There are two types of impairments at issue in Phillips’s case: exertional limitations and
nonexertional limitations. The terms exertional and nonexertional describe types of functional
limitations or restrictions resulting from a medically determinable physical or mental
impairment. See Social Security Ruling 96-4, 61 Fed. Reg. 34488 (July 2, 1996). Exertional
limitations affect an individual’s ability to meet the seven strength demands of the job: sitting,
standing, walking, lifting, carrying, pushing, and pulling. Id. Nonexertional limitations or
restrictions affect an individual’s ability to meet the other demands of jobs and include mental
limitations, pain limitations, and all physical limitations that are not included in the seven
strength demands. Id.
12
The Eleventh Circuit is bound by Fifth Circuit precedent decided before October 1,
1981. Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc).
23
unlimited types of work at the sedentary level given h er exertional limitations.13
If the ALJ concludes that Phillips cannot perform a full range or unlimited
types of work at the sedentary level given her exertional limitations, then the ALJ
must consult a vocational expert to determine whether there are sufficient jobs at
the sedentary work level within the national economy that Phillips can perform. If,
however, the ALJ concludes that Phillips can perform a full range or unlimited
types of work at the sedentary level despite any exertional limitations, the ALJ next
must de termine to what ex tent Phillip s’s none xertiona l limitations affect her ability
to secure employment at the sedentary w ork level in the national economy.
D. Nonexertional Limitations
When determining to what extent Phillips’s nonexertional limitations affect
her ability to secure em ployme nt in the n ational eco nomy, th e test is sligh tly
different. When considering Phillips’s nonexertional limitations, the ALJ need
only dete rmine w hether P hillips’s no nexertio nal impa irments s ignifican tly limit
her basic work skills. Jones, 190 F .3d at 12 29; Wolfe, 86 F.3 d at 107 7; Walker,
826 F .2d at 10 02-03 ; Francis , 749 F.2d at 1566. This Court has interpreted
13
As this Court stated in Sryock:
The grid regulations are not applicable in all situations. At a given residual
functional capacity, if a claimant is capable of some work at that level but not a
full range of work, then that level of the grids is not applicable. . . . Second, in
determining residual functional capacity only exertional limitations are
considered, i.e., ability to lift, stand, push, pull, handle, etc.
Sryock, 764 F.2d at 836 (citations and internal indentation omitted).
24
“significantly limit basic work skills” as limitations that prohibit a claimant from
performing “a wide range” o f work at a given work level. See Foote v. Chater, 67
F.3d 1553, 1559 (11th Cir. 1995) (The ALJ must determine “whether the
nonexertional limitations are severe enough to preclude a wide range of
employment at the given work capacity level.” (emphasis added) (internal
quotation marks and citations omitted)).
If the ALJ determines that Phillips’s nonexertional limitations do not
significantly limit her basic work skills at the sedentary work level, then the ALJ
may rely on the grids to determine if Phillips is disabled. If, however, the ALJ
determines that Phillips nonexertional limitations significantly limit her basic work
skills at the s edentary work level, then the AL J must co nsult a vo cational ex pert. 14
E. Phillips’s Limitations
In this case, the A LJ did no t specifically determin e whether P hillips’s
exertional limitations prohibited her from a full range or unlimited types of work at
the sedentary w ork level. Alth ough the A LJ discredited much of P hillips’s
14
A few isolated cases contain language that might be interpreted as, at the very least,
blurring the line between exertional limitations and nonexertional limitations, on the one hand,
and a full range or unlimited types of work and wide range or significantly limiting basic work
skills on the other. See, e.g., Passopulos v. Sullivan, 976 F.2d 642, 648 (11th Cir. 1992); Allen
v. Sullivan, 880 F.2d 1200, 1202 (11th Cir. 1989). However, we do not read these decisions as
creating any intra-circuit conflict. In any event, the prior precedent rule requires this Court to
follow the decision issued first in time that established the appropriate test. Morrison v. Amway
Corp., 323 F.3d 920, 929 (11th Cir. 2003).
25
testimony concerning her limitations, the ALJ nonetheless concluded that Phillips
suffered from Sjögren’s syndrome and fibromyalgia, and that these were “‘severe’
impairments.” It is possible that Phillips suffered exertional limitations that
rendered her unable to perform unlimited types of work at the sedentary level. On
the other hand, it is also possible that, while severe, Phillips’s Sjögren’s syndrome
and fibromyalgia did not affect her exertional capabilities at the sedentary work
level -- after all, the ALJ specifically considered Phillips’s Sjögren’s syndrome and
fibromyalgia when limiting Ph illips to sedentary work. How ever, the ALJ must
address and reso lve this issu e in the firs t instance b efore rely ing on th e grids.
Because the ALJ did not address this issue, we remand this case to the
Commissioner so that the ALJ may consider whether Phillips’s exertional
limitations affect her ability to perform a full range or unlimited types of sedentary
work.
The ALJ also identified one specific nonexertional limitation – that Phillips
was lim ited to “entr y level w ork in lig ht of her assertion that she ca n only h andle
one thing at a tim e to avoid stress.” G iven that the A LJ limited Ph illips’s
employment at the sedentary level to jobs that do not involve multi-tasking, the
ALJ must specifically determine in the first instance whether such a restriction
significantly limits Phillips’s basic work skills; that is, whether there are a wide
26
range o f sedenta ry jobs th at do no t require m ulti-taskin g. Foote, 67 F.3d at 1559
(“The ALJ must make a specific finding as to whether the nonexertional limitations
are severe enough to preclude a wide range of employment at the given work
capacity level indicated by the exertional limitations.” (internal quotation marks
and citations omitted)). The ALJ must address and resolve this issue before relying
on the g rids. Bec ause the A LJ did n ot addre ss this issu e, we rem and this c ase to
the Commissioner so that the ALJ may consider whether Phillips’s nonexertional
limitations significan tly limit her b asic wo rk skills at th e sedenta ry wor k level.
III. CONCLUSION
For all the above reasons, we vacate the district court’s order affirming the
denial of disability insurance benefits to Phillips and remand this case to the
Comm issioner to reconsid er Phillip s’s applica tion for d isability insu rance be nefits
under the standards outlined above. By this opinion, we do not suggest that
Phillips is entitled to d isability insu rance be nefits. Ra ther, this o pinion s peaks o nly
to the process the ALJ m ust engage in and the findings and analysis the ALJ must
make b efore elec ting to us e the grid s or con sult a voc ational ex pert.
VACATED and REMANDED.
27