Remand Ordered for Back Injury Claim (SSDI)

byron david conway florenceRadford v. Colvin, Acting Comm’r of Social Security (Lawyers Weekly No. 001-216-13, 17 pp.) (Davis, J.) No. 13-1021, October 29, 2013; USDC at Raleigh, N.C. (Boyle, J.) 4th Cir.

Holding: A district court did not err in its application of the Social Security Administration’s Listing 1.04A to claimant’s back impairment, but it did abuse its discretion in directing the administrative law judge to award benefits, and the 4th Circuit orders a remand to the agency for further proceedings.

The SSA has promulgated regulations containing “listings of physical and mental impairments” which, if met, are conclusive on the issue of disability. A claimant is entitled to a conclusive presumption that he is impaired if he can show that his condition “meets or equals the listed impairments.

At issue in this case is the listing that covers disorders of the spine: A claimant is entitled to a conclusive presumption that he is disabled if he can show that his disorder results in compromise of a nerve root or the spinal cord. Listing 1.04A further describes the criteria a claimant must meet or equal to merit a conclusive presumption of disability arising out of compromise of a nerve root or the spinal cord.

Claimant worked as tree trimmer and in 2002, when he was 38, he was injured lifting part of a tree at work. Over the next five years, he consulted several doctors who collectively observed – at various points in time – different symptoms of nerve root compression in claimant. An ALJ denied claimant’s 2007 claim for social security benefits, finding that his two severe impairments of lumbar degenerative disc disease and chronic obstructive pulmonary disorder did not qualify as impairments under Listings 1.04A (spine disorders) or 3.02 (chronic pulmonary insufficiency). The ALJ found claimant could not work as a tree trimmer but found he could perform other kinds of work.

The district court concluded that ALJ’s opinion failed to apply the requirements of the listings to the medical record and that the extensive medical record showed that claimant fell within Listing 1.04A because all of the required medical findings were present. The district court reversed the ALJ decision and remanded with instructions to award benefits.

On appeal, the commissioner argues the listed signs and symptoms must be simultaneously present over a period of time sufficient to establish that the impairment has lasted or can be expected to last at listing-level severity for a continuous period of at least 12 months. The commissioner modified that position somewhat at oral argument. We reject the commissioner’s invitation to read an additional proximity-of-findings requirement into Listing 1.04A.

The regulation does not specify when the findings must be present because it does not need to: The regulation already imposes a duration requirement on the claimant.  The critical durational inquiry for purposes of awarding benefits is whether the impairment has lasted or is expected to last for continuous period of at least 12 months. This language mirrors that of the statute.

We hold that Listing 1.04A requires a claimant to show only what it requires him to show: that all of the symptoms are present, and that the claimant has suffered or can be expected to suffer from nerve root compression continuously for at least 12 months. A claimant need not show that each symptom was present at precisely the same time – i.e., simultaneously – in order to establish the chronic nature of his condition. Nor need a claimant show that the symptoms were present in the claimant in particularly close proximity. To require proximity of findings would read a new requirement into the listing that is unsupported by the text, structure, medical practice or common sense, and we decline to do so.

Although we hold the district court did not apply the wrong legal standard, we nonetheless vacate its judgment because it chose the wrong remedy: Rather than “reversing” the ALJ and remanding with instructions to award benefits to claimant, the district court should have vacated and remanded with instructions for the ALJ to clarify why claimant did not satisfy Listing 1.04A. the commissioner correctly notes that there is at least conflicting evidence in the record as to whether claimant satisfied the listing. It is not our province – nor the province of the district court – to engage in these exercises in the first instance.

Vacated and remanded.


Posted on November 15, 2013, in Uncategorized and tagged , , , , , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

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