Mulvenna has lost on the second issue as well as the first.
ALJ Lanter concluded his opinion by finding that Mulvenna could do sedentary work, rejecting his argument about the likely effects of work-related stress. It is worth observing at the outset that the combination of a weakened heart and high susceptibility to work-related stress may support a finding of disability ( Schmidt v. Sullivan, 914 F.2d 117, 119 (7th Cir. 1990), citing Stewart v. Heckler, 730 F.2d 1065 (6th Cir. 1984)).
It is not clear whether Mulvenna meant to waive the stress argument on appeal. Mulvenna Mem. 10 does not raise the argument, declaring instead that the "clear" evidence of angina makes the stress issue "fascinating yet unnecessary to the resolution of the . . . claim" (Mulvenna Mem. 10). But Mulvenna R. Mem. 4 essentially resuscitates the argument by suggesting that the stress-plus-weakened-heart combination represented the equivalent of a listed impairment. This opinion will assume that Mulvenna intended to argue the stress theory in the alternative, rather than abandoning it.
There is no dispute that Mulvenna is physically capable of sedentary work: Dr. Abramson thought he could lift up to ten pounds and Dr. Schreiber actually thought he could lift up to 30 (R. 17). What is in dispute is whether Mulvenna is too stressprone to handle even a sedentary job without the risk of renewal of his acute heart trouble. Dr. Schreiber, the only source of any medical evidence supporting Mulvenna's position, sent the ALJ several articles describing the relationship of stress to heart trouble, and he added in his cover letter (R. 269-70):
I feel that John may have the personality and the anxiety level of the individuals that are referred to in these articles. I feel it is possible if John is required to return to work that a bad medical outcome could result to him. . . . Since I know John quite well I feel that he is at an increased risk of suffering a cardiac event in the future if he is required to return to work. There is medical evidence to support the belief that some individuals may be at risk for subsequent cardiac events if they are placed in what they feel are stressful conditions.
Mulvenna also testified that he felt he could not handle the stress of even a sedentary job. Thus ALJ Lanter was obligated to articulate his reasons for rejecting both Dr. Schreiber's opinion and Mulvenna's testimony.
ALJ Lanter discussed Mulvenna's susceptibility to stress only after having stated (R. 17):
He does not have any impairments equalling the Listings since no other condition is present.
At that point he went on (id. (emphasis added)):
Since the claimant's status post myocardial infarction condition does not meet or equal any listing, an assessment of his residual functional capacity is necessary.
That appears to be a step 5 type of approach, rather than the appropriate one under which a claimant's RFC depends entirely on the severity of his or her impairments, which are earlier determined at step 3. Ability "to respond appropriately to . . . work pressures" (Reg. § 404.1545(c)) figures in the RFC analysis only when the claimant has a mental impairment. Mulvenna denied any such impairment, and ALJ Lanter agreed (R. 13).
ALJ Lanter should instead have made an explicit finding at step 3 as to whether the combination of Mulvenna's weakened heart with his susceptibility to stress formed the medical equivalent of a Listing under Reg. § 404.1526.
Then and only then would it have become proper to discuss the impact of Mulvenna's stress-related "impairment" on his RFC.
To determine whether ALJ Lanter's error in failing to deal with the subject at step 3 was harmless, this opinion must look at the substance of his discussion of the stress issue at step 5. If that analysis actually covered the bases that would have been required at step 3, there would be no point in remanding on this issue if the only result would be Secretary's reaching--albeit in a different format--the same preordained result.
ALJ Lanter did effectively reject the "medical equivalency" argument on the basis of medical evidence as required by Reg. § 404.1526(b): he relied on the opinion of medical consultant Dr. Abramson, something specifically authorized by that regulation. In that respect the ALJ credited Dr. Abramson's conclusion that Mulvenna could handle a low-stress job and rejected Dr. Schreiber's opinion that Mulvenna could not. ALJ Lanter considered the neutral doctor more reliable because he found that Dr. Schreiber's views were skewed by sympathy for the patient (R. 17 said "the treating doctor's physician/patient relationship has caused him to overstate the degree to which the claimant can tolerate stress").
Secretary offers Reynolds v. Bowen, 844 F.2d 451, 454-55 (7th Cir. 1988) for the proposition that the treating physician's views may be disregarded pretty much automatically on grounds of presumed bias. As this Court has said in earlier cases, the law is neither so simple nor so pro-Secretary. Both the case law and Secretary's own Social Security Ruling ("SSR") (incorporated in the Amendments to 20 C.F.R. Parts 404 and 416, 56 Fed.Reg. 36,932 (1991)) confirm the general rule that "the ALJ must normally give extra weight to a treating physician's evaluation" ( Grindle v. Sullivan, 774 F. Supp. 1501, 1509-10 (N.D. Ill. 1991)). It is improper for an ALJ to disregard that rule based only on an unsupported and conclusory declaration that the treating physician is biased--especially in this case, where the treating physician's statement reflected a professional and even-handed objectivity, including the explicit acknowledgement that to somebody not familiar with Mulvenna's case his daily activities might seem to belie a claim of disability (R. 270).
Instead an ALJ must reject the treating physician's views for reasons that comport with the case law and the SSR. ALJ Lanter did not do so, so that his decision to discredit Dr. Schreiber's views on the ipse dixit basis that the ALJ employed must be reversed.
Because the ALJ offered no other reason for discrediting Dr. Schreiber's opinion, the evidence poses a classic jump ball situation: One physician finds the stress factor disabling, the other does not, and neither bases his opinion on any well-documented clinical findings present in the record. It would be equally improper for this Court to resolve that standoff in the first instance--it must rather remand the case for proper consideration of the medical-equivalency issue at step 3.
One last issue requires consideration on remand. ALJ Lanter rejected Mulvenna's own testimony that he was too stress-prone to do sedentary work, crediting Dr. Abramson's objective opinion over the claimant's subjective allegations (R.17; in support of such a rationale, see, e.g., Veal v. Bowen, 833 F.2d 693, 698-99 (7th Cir. 1987)). But in the next paragraph of his opinion the ALJ also appeared to cite his own opinion of Mulvenna's likely reaction to stress on the job (R. 17).
Schmidt, 914 F.2d at 118 teaches that an ALJ must rely on medical evidence and not on the ALJ's layperson intuition when assessing how a claimant's daily activities reflect his or her susceptibility to work-related stress. On remand the ALJ must take care not to let his own amateur evaluation of the significance of Mulvenna's ability to handle exercise and chores ("the temptation to play doctor," as Schmidt, id. put it) influence the resolution of this issue.
Neither party has proved an entitlement to a judgment as a matter of law. This case is remanded to Secretary with instructions to give full consideration to the possibility that Mulvenna's susceptibility to stress, when combined with his weakened heart, forms the medical equivalent of a listed impairment.
Milton I. Shadur
United States District Judge
Date: June 2, 1992