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HADDON v. SHALALA

March 19, 1993

ANTHONY HADDON, Plaintiff,
v.
DONNA SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant.



The opinion of the court was delivered by: MILTON I. SHADUR

 Anthony Haddon ("Haddon") appeals the final decision of Secretary of Health and Human Services Donna Shalala ("Secretary") *fn1" denying his claim for supplemental security income ("SSI") under the Social Security Act, 42 U.S.C. §§ 1382-1382(c). *fn2" As is usual in these cases, both Thomas and Secretary have filed motions for summary judgment under Rule 56. For the reasons stated in this memorandum opinion and order, this action is remanded to Secretary for the taking of additional evidence.

 Facts3

 Haddon was born November 25, 1949. He supplemented his 10 years of formal education by acquiring a G.E.D. (R. 18, 19, 41). It is not entirely clear from the record whether he is married. *fn4"

 In 1969 Haddon was honorably discharged for chronic motion sickness after two years' service in the Navy (R. 55-56). Between 1973 and 1975 Haddon worked full time as a security guard for a lounge, protecting patrons and patrolling the parking area (R. 20). That job ended when the lounge closed (R. 20). Haddon looked for work after that, but he testified that he gave up the search in 1979 (R. 21).

 Haddon testified that he has continual stomach pain from bleeding ulcers, for which he has taken Maalox, Mylanta and Tagamet for 14 years (R. 22, 23). *fn5" Haddon has declined surgery to treat his ulcer, and he has also avoided having x-rays (R. 35, 33). On several occasions he has visited emergency rooms to obtain blood transfusions due to loss of blood from vomiting and dehydration (R. 29, 30, 32-34). Often he has no appetite, and he has lost weight--at the time of the Hearing he was five feet eleven inches tall and weighed 135 pounds (R. 21, 24).

 Haddon also has back pain, which is sometimes linked to his stomach pain. That back pain causes him to have problems bending and lifting (R. 23, 29). Sometimes the pain in his stomach and back wakes him up (R. 37).

 Haddon gets dizzy if he stands for more than a few hours (R. 22). Essentially he spends his days drawing and reading (R. 26).

 Since 1968 Haddon had used illegal street drugs. For two years before the Hearing he had gone daily to a Veteran's Administration methadone treatment program (R. 25, 211), and at the time of the Hearing he had been off of heroin for a year (R. 22).

 Medical Evidence

 Since 1985 Haddon has been treated at several hospitals for stomach pains and vomiting blood. Haddon was hospitalized for four days beginning December 2, 1985 at Cook County Hospital, being diagnosed there with duodenitis (R. 229). On March 4, 1986 Haddon was transferred from St. Bernard's Hospital to the University of Illinois Hospital, showing symptoms of epigastric pain radiating to the back with nausea and vomiting of undigested food (R. 91, 153). There he was diagnosed with acute pancreatitis (R. 163). Rather than undergo an endoscopy and have a naso-gastrointestinal tube inserted, Haddon left the hospital on March 7 (R. 99, 149). On May 20, 1986 Haddon was admitted to Michael Reese Hospital with abdominal pain, vomiting and fever (R. 166). Physicians there were unsure of the etiology of his symptoms (R. 171). After again refusing a naso-gastrointestinal tube (R. 166, 177), Haddon was discharged on May 23 with a diagnosis of probable gastroenteritis, pancreatitis and opiate abuse (R. 166).

 On October 17, 1987 Haddon was admitted to the detox unit at the West Side VA Hospital (R. 249). He was diagnosed with heroin dependence and accepted into the substance abuse program (R. 249).

 After having treated Haddon in the emergency room at Englewood Hospital in April 1987, Dr. Brahm Gupta saw him on several occasions between April 7, 1987 and March 12, 1988 at Dr. Gupta's clinic (R. 29, 57-60, 75-79). Dr. Gupta reported *fn6" that Haddon had a duodenal ulcer and took his medicine only irregularly. However, Dr. Gupta opined that Haddon was fully capable of doing work, taking care of himself and his house, shopping, paying bills and other ordinary daily activities (R. 58). Dr. Gupta also judged Haddon capable of managing his own funds and of carrying out and understanding instructions (R. 60).

 Dr. Kuangjyh Chen, an internist, examined Haddon on a consultative basis on January 19, 1988 (R. 71-73). Dr. Chen reported no significant physical or mental abnormalities. Haddon told Dr. Chen that he did his own shopping and cooking, that he got along with others satisfactorily, and that he liked to play the saxophone and draw. He also told Dr. Chen that he was in school (R. 72-73).

 On August 29, 1988 Haddon went to the West side VA clinic, complaining of stomach pain and inability to keep down food (R. 243-44). He was diagnosed with viral gastroenteritis and was told to drink plenty of fluids and eat bland foods (R. 244).

 Statutory and Regulatory Framework

 Section 1382c defines an individual as "disabled":

 Young v. Secretary of HHS, 957 F.2d 386, 389 (7th Cir. 1992) (case citations omitted) explains the process that guides Secretary's evaluation of a disability claim:

 
When considering whether a claimant is eligible for benefits, the secretary uses a five-step inquiry: 1) is the claimant presently unemployed; 2) is the claimant's impairment or combination of impairments severe; 3) does the impairment meet or exceed any of the list of specific impairments (the grid) that the secretary acknowledges to be so severe as to preclude substantial gainful activity; 4) if the impairment has not been listed by the secretary as conclusively disabling, is the claimant unable to perform his or her former occupation; and 5) if the claimant cannot perform the past occupation, is the claimant unable to perform other work in the national economy in light of his or her age, education and work experience. A negative conclusion at any step (except for step three) precludes a finding of disability. An affirmative answer at steps one, two or four leads to the next step. An affirmative answer at steps three or five results in a finding of disability. 20 C.F.R. § 404.1520 (1991).

 If the assessment of an individual reaches step five, the rules in the Medical Vocational Guidelines of Reg. Part 404, Subpart P, App. 2 (the "Grid") come into play. Those Grid rules reflect an analysis of the vocational factors of age, education and work experience (Reg. §§ 404.1563-.1565) in combination with the claimant's residual functional capacity ("RFC"). RFC is defined by Secretary as a ( Marcus v. Sullivan, 926 F.2d 604, 608 (7th Cir. 1991), quoting SSR 83-10):

 
medical assessment of what an individual can do in a work setting in spite of the functional limitations and environmental restrictions imposed by all of his or her medically determinable impairments.

 RFC is expressed in terms of a claimant's maximum sustained work capability for either "sedentary," "light," "medium," "heavy" or "very heavy" work as those terms are defined in Reg. § 404.1567.

 Where an ALJ's findings of fact as to the vocational factors and RFC coincide with all the criteria of a particular Grid rule, the rule directs a conclusion of "disabled" or "not disabled." Because the Grid takes into account the number of unskilled jobs in the national economy at the various functional levels (Reg. § 404.1566), the existence of such jobs is established when the findings of fact coincide with the criteria of a rule (Reg. App. § 200.00(b)). However, nonexertional limitations (such as pain, inability to grasp objects or bimanual dexterity) are not reflected in Grid determinations. Hence Reg. App. § 200.00(e)(2) says:

 
However, where an individual has an impairment or combination of impairments resulting in both strength limitations and nonexertional limitations, the rules in this subpart are considered in determining first whether a finding of disabled may be possible based on the strength limitations alone and, if not, the rules reflecting the individual's maximum residual strength capabilities, age, education, and work experience provide a framework for consideration of how much the individual's work capability is further diminished in terms of any types of jobs that would be contraindicated by the nonexertional limitations. Also, in these combinations of nonexertional and exertional limitations which cannot be wholly determined under the rules in this appendix 2, full consideration must be given to all of the relevant facts in the case in accordance with the definitions and discussions of each factor in the appropriate sections of the regulations, which will provide insight into the adjudicative weight to be accorded each factor.

 Procedural History and Administrative Findings

 Haddon applied for SSI on December 3, 1987, alleging disability due to bleeding ulcer and drug abuse as of March 1987 (R. 41-50). Secretary denied his application both initially and upon reconsideration, after determining that Haddon's condition was not disabling (Supp. R. 1, 5).

 Haddon then requested a de novo Hearing held before ALJ John Mondi on May 24, 1989 (R. 14-39). On September 14, 1989 ALJ Mondi denied Haddon's application, finding (R. 183):

 
1. The claimant has not engaged in substantial gainful activity since December 3, 1987.
 
2. The medical evidence establishes that the claimant has a history of severe drug abuse, situational depression and anxiety, and peptic ulcer disease, but not an impairment or combination of impairments listed in, or medically equal ...

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