Heckler, Secretary of Health and Human Services ("Secretary"),
denying the plaintiff's application for disability and
disability insurance benefits pursuant to Title II, sections
216(i) and 223 of the Social Security Act, 42 U.S.C. § 416(i),
423 (1982). The parties have filed cross motions for summary
For the reasons set forth below, this Court reverses the
decision of the Secretary and remands the case for further fact
I. History of Proceedings
On November 3, 1981, the plaintiff applied to the Social
Security Administration ("SSA") for a period of disability and
for disability insurance benefits. Plaintiff claims that she
suffers from lupus syndrome, ventricular tachycardia, and
Barlow's Syndrome, and that she lives under the threat of
severe ventricular arhythmias and the possibility of sudden
death. The plaintiff's application was denied initially on
March 9, 1982 (R. 65), and again on reconsideration on April
28, 1982. A hearing was conducted on January 10, 1983 before an
administrative law judge ("ALJ"). The ALJ denied plaintiff's
claim on February 22, 1983.
In his decision denying disability benefits, the ALJ determined
initially that the claimant is unable to perform her past
relevant work. The ALJ also found, however, that the plaintiff
was not under a disability and that she maintains the capacity
to perform a full range of light work. The plaintiff sought
review of the ALJ's decision by the Social Security
Administration Appeals Council. The Appeals Council denied
review, which renders the ALJ's opinion the final decision of
the Secretary. The plaintiff then filed a timely request for
federal judicial review pursuant to 42 U.S.C. § 405(g) (1982).
II. Review of the Evidence
The plaintiff, Emilia Predki, was fifty years old at the time
of the hearing. She was born in Poland and received a high
school education in Africa. The plaintiff came to the United
States in 1952 and thereafter learned English by listening.
Although she can read and write, the plaintiff testified that
she misses a few words and that she has trouble spelling. The
plaintiff was employed first in quality control at a television
factory and later she worked as a bindery worker. The
defendant's vocational expert characterized these jobs as
semi-skilled (R. 9).
Plaintiff claims that she has been disabled since April of 1981
because she suffers from several serious diseases. First,
plaintiff claims that she has lupus syndrome, because she
suffers pain and swelling in her arms and hands. Systemic lupus
erythematosus is an inflammatory connective tissue disorder.
The Merck Manual at 1207 (14th ed. 1982). As the medical
evidence shows, however, plaintiff does not suffer from
systemic lupus erythematosus but rather she suffers only from
drug-induced lupus syndrome (R. 104, 112, 133, 134, 137). Next,
plaintiff complains that she suffers from Barlow's syndrome, or
mitral prolapse syndrome. Prolapse of the mitral valve is a
chronic heart valve disease "now recognized as a common and
sometimes serious and progressive lesion." The Merck Manual
at 526 (14th ed. 1982). Plaintiff also suffers from ventricular
tachycardia. This disease is defined as "an abnormal rapid beat
of the heart, from 150 to 200 beats per minute, associated with
minor irregularities of the rhythm." 3 Schmidt's Attorney's
Dictionary of Medicine at V-50 (1979). Finally, plaintiff
claims that she lives "under the threat of severe ventricular
arhythmias and the incidence of sudden death." Arhythmia is the
loss of or variation in the normal rhythm of the heart beat,
resulting in, inter alia, fast beats. 3 Schmidt's Attorney's
Dictionary of Medicine at A-274 (1979).
The medical evidence begins with the records of Memorial
Hospital of Elmhurst. The plaintiff was hospitalized on January
16, 1979. She complained of syncope (fainting) preceded by
moments of dizziness. An electrocardiogram given to the
plaintiff confirmed the presence of ventricular
tachycardia. The plaintiff was released on January 23, 1979,
put on medication, and advised to avoid excessive activity (R.
The plaintiff was again hospitalized at Memorial Hospital in
July of 1979 due to complaints of syncope (R. 126). The
treating physician at Memorial Hospital, Dr. J.M. Stoker, M.D.,
diagnosed the plaintiff as having ventricular tachycardia,
documented at a rate of 210, and possibly having Barlow's
Syndrome. Dr. Stoker then advised that the plaintiff be
transferred to the Arhythmia Unit of Northwestern University
Medical Center for evaluation and therapy by Dr. Martin Grais,
M.D., a cardiologist (R. 126-127, 129).
The records at Northwestern Hospital noted that the plaintiff
continued to have persistent syncopal episodes while on
antiarhythmic therapy. She was suffering from paroxysmal
ventricular tachycardia (R. 98). While at Northwestern
Hospital, the plaintiff underwent an echocardiographic test
which showed that plaintiff also suffered from Barlow's
syndrome (R. 101). In a letter to Dr. Stoker, dated August 9,
1979, Dr. Grais reported that the plaintiff remains
asymptomatic and has no augmentation of arhythmia (R. 101). Dr.
Grais also noted the possibility of lupus in view of the
plaintiff's intake of Pronestyl. Dr. Grais determined that the
plaintiff could be discharged for outpatient follow up. The
plaintiff subsequently was discharged but remained on
medication, including Pronestyl and Inderal, in order to
control her tachycardia (R. 99).
The plaintiff was hospitalized again at Northwestern Hospital
on April 5, 1981, complaining of transient joint symptoms in
the knees, wrists, and shoulders (R. 103, 112). Dr. Grais
determined that the plaintiff had a reaction to the drug
Pronestyl, which caused the plaintiff to develop a lupus-like
syndrome (R. 104). This lupus-like syndrome was documented by a
positive ANA test. Consequently, she was taken off Pronestyl in
April of 1981 (R. 103).
In November of 1981, Dr. Stoker reported that the plaintiff had
been free of significant syncope episodes (R. 104).
Furthermore, Dr. Stoker noted that the plaintiff had tolerated
the omission of the drug Pronestyl but "subsequently has had a
general fatigue feeling and has some residual arthritic
symptoms although the Lupus status is gradually clearing". He
also noted, however, that plaintiff carries a continual
long-term risk of syncope or serious cardiac arhythmia. She is
on high doses of Inderal which has a sedative and depressing
effect, but the use of adequate medication is extremely
important. Dr. Stoker also noted that there is a potential risk
that heavy physical or stressful situations would subject
plaintiff to serious arhythmias. In his November, 1981 letter,
Dr. Stoker concluded that "the only practical employment
situation for her would be near her home . . . in situations of
strictly office or clerical and minimum stress activity" (R.
In December of 1981, the Illinois Bureau of Disability
Adjudication Services referred plaintiff to a Dr. Bacalla, M.D.
(R. 105). After examining plaintiff, Dr. Bacalla reported that
the heart rate was normal and that there were no gross
cardiomegaly or murmurs (R. 107). Dr. Bacalla did find sinus
bradycardia, which is a slowness of the heart beat due to a
disturbance in the right atrium of the heart; 3 Schmidt's
Attorney's Dictionary of Medicine at B-76 (1979). While he
observed some soft tissue swelling and tenderness of the hands,
there were no joint deformities noted. Dr. Bacalla did not
diagnose arhythmia. Moreover, Dr. Bacalla did not offer any
evidence or make any statements regarding the plaintiff's
functional capacity to work.
The administrative record also includes a letter written by Dr.
Stoker on January 18, 1983, which the ALJ did consider in
making his determination (R. 135-136). For four years, Dr.
Stoker was plaintiff's treating physician. Dr. Stoker reported
that the plaintiff is subject to increasing or changing
susceptibility to ventricular irritability even though at times
in the past her condition
has been under control. Dr. Stoker further reported:
At this time, she is manifesting increased ventricular
extrasystoles and the history strongly supports an episode of
fainting with symptoms compatible with a return of at least
short bouts of tachycardia. Mrs. Predki continues on extremely
high doses of the beta-blocker medication called . . . Inderal,
and this continues to have a sedative effect and has a slowing
effect on her basic heart rate and a tendency to drop her blood
pressure. All of the above side effects must be accepted in the
treatment program and contribute to her reduced functional
status (R. 135).
Dr. Stoker further advised that the only kind of work situation
of which plaintiff is capable would be clerical-type work in
her home. The basis of this evaluation is that the plaintiff
lives under the threat of severe ventricular arhythmias and the
incidence of sudden death (R. 135). The risk of sudden death is
enhanced by increased heart irritability "which could be a
result of unusual physical activity, increased metabolic
changes such as high fever or even the stress of mental
aggravation or strain" (R. 135). In other words, in order to
prevent and control the risk of these serious illnesses, not
only does the plaintiff have to be on high dosages of
medication, but her physical environment must be strictly
controlled. Finally, Dr. Stoker also stated that the
plaintiff's condition "has to do with a possible gradual
degeneration of the collagen disease in the heart muscle and
valves," and that with the passage of time, the plaintiff will
need regular follow-up examinations and "possibly the use of
more and newer suppressive medication" (R. 135).
In addition, the plaintiff testified regarding her symptoms and
diseases at the administrative hearing. The plaintiff stated
that she was unable to work after April of 1981 (R. 38). She
testified that she had pain in her chest and that her arm was
swollen. She was unable to walk because her entire body was in
pain. She stated that although she could move her arm, if she
reached for too long a period of time, she would get dizzy (R.
39). Plaintiff also testified that she suffered fatigue because
of her chest pains. In a period of six months, the plaintiff
stated that she had fainted twenty times.
With regard to her residual functional capacity, the plaintiff
testified that she was told by her doctor not to lift heavy
articles or shovel snow and that she was to rest (R. 45).
Plaintiff also stated that she can do only some housework for
ten to fifteen minutes before she becomes fatigued and must sit
or lie down. Furthermore, during the summertime, she can do
housework for only five minutes at a time (R. 46). Plaintiff
testified that she cannot work at all because she gets tired
very fast and gets dizzy soon afterwards (R. 47). Finally, the
plaintiff stated that the medication she takes makes her drowsy
III. Establishment of Disability
In order to qualify for a period of disability and for
disability insurance benefits, an applicant must:
a. be insured for disability insurance benefits;
b. not have attained the age of 65;
c. have filed an application for disability insurance
d. must be under a disability as defined in the Act.
42 U.S.C. § 416(i), 42 U.S.C. § 423 (1982). Plaintiff met the
necessary earnings requirements for disability insurance at the
time of her application in April of 1981 and continued to meet
them at least through December, 1984 (R. 8). Since the
plaintiff has fulfilled the requirements listed under a, b, and
c, the only issue is whether the plaintiff is disabled.
To be found disabled under the Social Security Act, a claimant
must prove the existence of a medically determinable physical
or mental impairment which has lasted or can be expected to
last for a continuous twelve month period.
42 U.S.C. § 423(d)(1)(A) (1982). Furthermore, the claimant must prove that
because of the
impairment, she is unable to engage in any substantial gainful
activity. 42 U.S.C. § 423(d)(2)(A); Lovejoy v. Schweiker, No.
80 C 5295, Mem. Op. at 7 (N.D.Ill. June 9, 1983).
The Secretary has issued regulations which provide a five-step
sequential evaluation procedure to determine whether a claimant
is eligible for disability benefits. 20 C.F.R. § 404.1520
(1985); Krapfl v. Heckler, No. 83 C 7188, slip op. at 3
(N.D.Ill. May 9, 1985), appeal filed, No. 85-1968 (7th Cir.
June 21, 1985). The five inquiries of this evaluation are:
1. whether the claimant is currently engaged in substantial
gainful employment. If it is found that the claimant is
currently working, then he will not be found disabled. If
the claimant is not currently working, then the second
inquiry is considered.
2. whether the claimant does not suffer from such an
impairment. If the claimant does not suffer from such an
impairment, the claim is denied. If a severe impairment is
present, then the third part is,
3. whether the impairment meets or equals one of the
impairments listed in Appendix 1, 20 C.F.R. part 404,
subpart P, Appendix 1 (1985). If it does meet or equal one
of the impairments, then the claimant will be considered
disabled. If it does not, then the fourth inquiry is,
4. whether the claimant's impairment prevents him from
performing his past work. If the claimant is capable of
returning to his past relevant work, then the claim is
denied. If the claimant is not capable of returning to his
past work, then the fifth and final inquiry must be
5. whether the claimant is capable of performing some other
type of substantial gainful activity considering his age,
education, and prior work experience. If he is not, then the
claim is approved.
Krapfl v. Heckler, No. 83 C 7188, slip op. at 3.
In his sequential evaluation of the plaintiff's claim, the ALJ
found that 1) the plaintiff suffered from ventricular
tachycardia with Barlow's Syndrome; 2) the plaintiff's
testimony and medical records indicate that the plaintiff's
arthritic problems are not serious and that the plaintiff's
complaints of weakness, chest pain, tiredness and nervousness
are not credible and are not borne out by the necessary medical
documentation; 3) the plaintiff is unable to return to her past
relevant work; 4) the plaintiff, however, has the residual
functional capacity to perform a full range of light work; and
5) considering her residual capacity, age, education, and work
experience, the plaintiff is not disabled (R. 12). Therefore,
the ALJ found that the plaintiff was not under a disability as
defined in the Social Security Act (R. 12).
The final decision of the Secretary is reviewable under
42 U.S.C. § 450(g) (1982). The reviewing court, however, does not
decide the case de novo. Krapfl v. Heckler, No. 83 C 7188
slip op. at 2. Rather, the issue before the court is whether
the Secretary's findings of fact are supported by substantial
evidence. Whitney v. Schweiker, 695 F.2d 784, 796 (7th Cir.
1982); Krapfl v. Heckler, No. 83 C 7188, slip op. at 2. In
order to determine if substantial evidence exists to support
the ALJ's conclusions, the court must examine the record as a
whole. Zblewski v. Schweiker, 732 F.2d 75, 78 (7th Cir.
1984); Jackson v. Heckler, 592 F. Supp. 1124, 1127 (N.D.Ill.
1984), quoting Strunk v. Heckler, 732 F.2d 1357, 1369 (7th
Cir. 1984). Substantial evidence is "such relevant evidence as
a reasonable mind might accept as adequate to support a
conclusion." Garfield v. Schweiker, 732 F.2d 605, 607 (7th
Cir. 1984). If the court finds an error of law or that the
record lacks substantial evidence to support the factual
findings, then the court need not uphold the Secretary's
decision. Taylor v. Schweiker, 739 F.2d 1240, 1241 (7th Cir.
Having reviewed the decision of the ALJ and the record as a
whole, this Court finds that the ALJ's decision is not
supported by substantial evidence.
A. Appendix 1 Listings
Since the plaintiff is not currently working and the ALJ found
that she does suffer from a severe physical impairment, the
Court's initial inquiry is whether the impairment meets or
equals one of the impairments listed in Appendix 1. Appendix 1
of the Secretary's Regulations provides a Listing of
Impairments which are considered severe enough to automatically
qualify a person as disabled. 20 C.F.R. part 404, subpart P,
app. 1 (1985). The required level of severity for each
impairment is also shown. 20 C.F.R. § 404.1525(c) (1985).
Furthermore, in each section of the Listing of Impairments,
certain specific medical findings are required to establish the
existence of each impairment. 20 C.F.R. § 404.1525(c) (1985).
Section 404.1520(d) of the Regulations provides that claimants
may be found disabled if their impairments are either listed in
Appendix 1, or are determined to be medically equivalent to a
listed impairment. 20 C.F.R. § 404.1520(d) (1985).
Plaintiff argues that several of her impairments meet or equal
impairments listed in Appendix 1. First, plaintiff claims that
she suffers from mitral prolapse or Barlow's syndrome, which is
listed at section 4.02(C) of Appendix 1. To satisfy section
4.02(C) of the Listing of Impairments, a claimant must have
both congestive heart failure and "persistent mitral type heart
involvement." Plaintiff, however, has denied having congestive
heart failure (R. 105), and no medical findings were submitted
to support a diagnosis of congestive heart failure. Thus,
plaintiff is not disabled under section 4.02(C) because of her
Second, plaintiff complains that she suffers from lupus
syndrome and therefore is disabled under section 10.04 of the
Listing of Impairments, 20 C.F.R. part 404, subpart P. Appendix
1, Part A (1985). Section 10.04 lists the impairment
"disseminated lupus erythematosus," which is a connective
tissue disorder. As the Secretary appropriately noted, however,
plaintiff's physician has described her condition as a
"Pronestyl (drug) induced lupus syndrome" or a "Pronestyl
lupus-like reaction." (R. 104, 112, 133, 134, 137). Medical
sources distinguish drug-induced lupus from the inflammatory
connective tissue disorder systemic (disseminated) lupus
erythematosus, which is listed in Appendix 1. The Merck
Manual at 1207 (14th ed. 1982). Therefore, although plaintiff
had a positive ANA reading in 1980 which establishes a
diagnosis of lupus (R. 120), her condition does not meet the
Listing of Impairments under Appendix 1 because she has not
been diagnosed as having disseminated lupus erythmatosus.
Section 4.05 of Appendix 1 addresses another of plaintiff's
impairments: arhythmias. Section 4.05 requires recurrent
arhythmias resulting in uncontrolled episodes of cardiac
syncope and documented by resting or ambulatory (Holter)
electrocardiogram. 20 C.F.R. part 404, subpart P, Appendix 1, §
4.05 (1985). The evidence contains a great deal of medical
opinion that the plaintiff lives under the severe threat of
arhythmias (R. 104, 135). But although Dr. Grais notes that
plaintiff takes medication to control her arhythmatic condition
(R. 103), no formal diagnosis of this disease has been made.
Furthermore, no arhythmias were noted on an electrocardiogram
conducted by Dr. Bacalla (R. 107). Therefore, plaintiff cannot
be disabled pursuant to section 4.05 of the Listing of
In sum, none of plaintiff's physical impairments meets or
equals one of the impairments listed in Appendix 1. Thus, she
is not automatically disabled under the Regulations and this
Court must review the ALJ's findings in the next steps of the
B. Residual Functional Capacity to do Light Work
Since the plaintiff's impairments do not meet or equal the
impairments listed in
Appendix 1, according to the fourth step of the sequential
evaluation, the next inquiry is whether the claimant's
impairment prevents her from performing her past work. Krapfl
v. Heckler, No. 83 C 7188 Mem. Op. at 3. Although he gave no
rationale, the ALJ did find that "the claimant is unable to
perform her past relevant work as a bindery worker or in
quality control" (R. 12). "Once such a determination is made,
the burden shifts to the Secretary to prove that there is some
other kind of substantial gainful employment available which
the claimant would be able to perform," considering the
claimant's age, education, and prior work experience. Smith v.
Heckler, 582 F. Supp. 1529, 1530 (N.D.Ill. 1984). The fifth and
final inquiry of the sequential evaluation mandates approval of
a disability claim if the claimant cannot otherwise be
gainfully employed. 20 C.F.R. § 404.1520 (1985).
The ALJ held that while the plaintiff could no longer perform
her past relevant work, she could perform a full range of light
work (R. 12). The light work definition in the regulations
Light work involves lifting no more than 20 pounds at a time
with frequent lifting or carrying of objects weighing up to 10
pounds. Even 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. To be
considered capable of performing a full or wide range of light
work, you must have the ability to do substantially all of
20 C.F.R. § 404.1567(b) (1985).
After finding the plaintiff capable of performing a full range
of light work, the ALJ applied the Appendix 2 grids to this
case and held that Rule 202.11 dictates a finding that the
claimant is not disabled (R. 12); see 20 C.F.R. part 404,
subpart P, Appendix 2 (1985). "The Appendix 2 Guidelines
indicate in grid form whether a significant number of jobs
exist in the national economy for individuals with various
impairments of physical capacity, ages, education, and work
experience." Smith v. Schweiker, 735 F.2d 267, 270 (7th Cir.
1984). An individual's characteristics correspond to the
factors listed on the grids or charts, and by reading the grid
under the appropriate work limitation, the guidelines will
direct a finding of disabled or not disabled. Id. at 270.
Thus, the reasonableness of a determination of disability based
on the grids is only as correct as the accuracy of the
underlying criteria, including work capacity.
Based, upon the record, however, this Court is compelled to
hold that the ALJ's finding that the plaintiff has the residual
functional capacity to perform light work is not supported by
Courts have held that where the treating physician states that
the plaintiff is disabled as a result of his or her
impairments, and no other physician makes any assessment of the
plaintiff's residual functional capacity, then an ALJ's
determination that plaintiff is capable of light or sedentary
work is not supported by substantial evidence and must be
reversed. E.g., Kail v. Heckler, 722 F.2d 1496 (9th Cir.
1984); Carroll v. Secretary, 705 F.2d 638 (2d Cir. 1983);
Perez v. Schweiker, 653 F.2d 997 (5th Cir. 1981). See also
Spencer v. Schweiker, 678 F.2d 42 (5th Cir. 1982) (medical
opinion on which ALJ relied was ambiguous regarding the
plaintiff's residual functional capacity). In Kail, for
example, it appeared that the ALJ had relied primarily on a
report by a Dr. Weese, who made a thorough diagnosis of the
claimant's condition but expressed no opinion regarding the
claimant's residual functional capacity. One of the claimant's
treating physicians had rendered an opinion that the claimant
was permanently disabled due to his lung condition. Kail, 722
F.2d at 1497. The court held that the ALJ's finding that the
claimant was capable of sedentary work was not supported by
In the instant case, Dr. Stoker, Mrs. Predki's treating
physician for four years,
has stated his opinion that, given her medical condition, the
plaintiff is permanently disabled for any work situation except
perhaps clerical work in her home. Neither Dr. Grais, her
treating cardiologist, not Dr. Bacalla, the consulting
physician, gave any opinion at all regarding plaintiff's
residual functional capacity or whether she is disabled by her
impairments. The ALJ, apparently relying on the diagnoses of
Dr. Grais and Dr. Bacalla, found that the plaintiff's arthritic
symptoms are not a serious impairment and that her heart
condition is well controlled by medication. The ALJ further
found, based solely on his own interpretation of the
plaintiff's medical history, that she retains the capacity for
a full range of light work.
Because the only medical evidence in the record regarding
plaintiff's residual functional capacity is found in Dr.
Stoker's letters, this Court holds that the ALJ's decision is
not supported by substantial evidence. As described above, the
ALJ proceeded to the fifth and final step of the sequential
evaluation, and found Mrs. Predki disabled by applying the
light work grid to her age, education and past employment.
Application of the grids is useful only where each of the
underlying criteria listed in the grid used match up to the
plaintiff's characteristics and capacity. Perez, 653 F.2d at
1001. Because the ALJ's decision that plaintiff is capable of
performing the full range of light work is not supported by
substantial evidence, the Secretary's determination that
plaintiff is not disabled must be reversed.
Remand for Introduction of New Evidence
The final question for this Court is whether to remand this
case to the Secretary for further development of the medical
evidence. Under 42 U.S.C. § 405(g),
The court may, on motion of the Secretary made for good cause
shown before he files his answer, remand the case to the
Secretary for further action by the Secretary, and it may at
any time order additional evidence to be taken before the
Secretary, but only upon a showing that there is new evidence
which is material and there is good cause for failure to
incorporate such evidence into the record in a prior proceeding
Despite these apparent limitations on the court's remand power,
courts frequently remand social security disability cases for
additional evidence. See, e.g., Strittmatter v. Schweiker,
729 F.2d 507 (7th Cir. 1984); Perez, 653 F.2d at 1002.
In Strittmatter, the ALJ had ended his inquiry at the third
stage; relying solely on one doctor's statement that the
patient could work while sitting down, he found that the
claimant was able to perform her past relevant work. The
Seventh Circuit held that the ALJ was required to determine the
physical demands of the particular type of sedentary work that
the claimant had done and then compare those demands to her
present capabilities. Therefore, the court directed the
district court to remand the case to the Secretary for
additional findings on Mrs. Strittmatter's capability to do her
former work. Id. at 509.
While there are cases which hold that 42 U.S.C. § 405(g)
precludes a remand for additional evidence unless there is a
showing of new material evidence and a good reason for its
earlier omission, Carroll v. Secretary, 705 F.2d 638 (2d Cir.
1983); Czubala v. Heckler, 574 F. Supp. 890 (N.D.Ind. 1983),
the Seventh Circuit recently explained its more liberal
interpretation of the statutory remand provision. In Garfield
v. Schweiker, 732 F.2d 605 (7th Cir. 1984), the Seventh
The Social Security Act, as amended in 1980, provides for
remand of cases in several situations, none of which clearly
apply in this case. . . . However, other courts have held and
the legislative history indicates that remand is also proper
when the findings of the Secretary are not supported by
substantial evidence but do not provide sufficient evidence to
support a reversal and a finding that the claimant is disabled.
See Abeuf v. Schweiker, 649 F.2d 107,115-116 (2d Cir. 1981);
H.R.Rep. No. 96-100, 96th Cong., 1st Sess. 13 (1979).
Id. at 610 n. 8.