with external controls, imparts electrical impulses to the spinal cord to block the pain impulses generated by the compressed nerve roots. This device has brought significant relief to plaintiff, but has not relieved all of his pain and discomfort.
The critical issue on this appeal is the extent of that residual pain and its impact on plaintiff's functional capacities. Not coincidentally, this is where the ALJ and the doctors part company in their assessments of plaintiff.
The ALJ concluded that plaintiff's complaints of disabling pain were not credible because they were inconsistent with: (1) clinical evidence and physicians' assessments; (2) appearance and demeanor at hearing; (3) range of daily activities; (4) effect of stimulator; and (5) lack of pain medication. If the ALJ's conclusion is based on substantial evidence, affirmance is required.
The ALJ's reliance on clinical findings is misplaced. The record is replete with objective findings indicating significant dysfunction and pain in the low back and leg. Tenderness and spasm in the low back, positive Fabere and Lasegue's tests, positive straight leg raising tests, decreased pinprick sensation, narrowed L4-5 disc space, positive electromyography, lumbar spurs and the visual confirmance of scar tissue involvement in the nerve roots constitute a litany of misfortune and pain. The most striking aspect of these findings is their remarkable consistency over time and different examining physicians. In the face of such clinical evidence the ALJ's selective reliance on reports of strong reflexes is indefensible, and does not constitute substantial evidence.
The physicians' reports are likewise striking in their consistency. Plaintiffs' treating physician of 14 years, Adib Barsoum, M.D. indicated that the nerve root damage was permanent and irreversible, that plaintiff's pain persisted despite constant use of the dural stimulator, that the pain was aggravated by any sitting, standing or walking in excess of very short periods. (Trans. at 183, 184, 317-336). Most importantly, Dr. Barsoum explains that any period of sitting or standing in one position exacerbates the nerve root irritation and it is therefore necessary for plaintiff to frequently change positions and to lie down on his back with his knees raised to relieve the pain and spasm.
The other two physicians examined plaintiff and prepared reports at the request of the ALJ. Both physicians indicate multiple objective findings consistent with past findings and with plaintiff's complaints. After reviewing their independent findings in comprehensive examinations, both physicians concluded that plaintiff's pain persisted despite his use of the dural stimulator and that plaintiff was totally disabled for all substantial gainful activity (Trans. at 277-281, 289-290, 307-308).
The Secretary relies heavily on the functional capacity forms completed by these physicians to reject their findings and opinions. (Trans. at 291-292, 309-310). However, both physicians note significant impairment in the ability to sit, stand, and walk, and both indicate that plaintiff cannot engage in those activities for periods without interruption, findings consistent with Dr. Barsoum's description of plaintiff's difficulties in functioning.
The remaining grounds for the ALJ's conclusion require little discussion. The "sit and squirm test" is of little or no value. The fact that a claimant can sit quietly through a brief hearing is no basis for a decision on disability. Plaintiff's daily activities are severely limited, consisting of watching TV, very short walks, an occasional short drive in the car, all punctuated by the need to lie down to relieve the pain. Finally, plaintiff's limited use of medication is to be attributed not to the absence of pain, but to past allergic reactions and his treating physician's good sense reluctance to prescribe potentially addictive narcotics to a young patient with a permanent condition. (Trans. at 317-336).
We conclude therefore that the ALJ's decision is not only unsupported by substantial evidence but is contrary to the overwhelming weight of medical evidence, both in objective findings and in the unanimous opinion of three physicians. The Secretary's decision will be reversed and benefits awarded to plaintiff.
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