January 8, 1993
Plaintiff Nga X. Mac brought this action pursuant to 42 U.S.C. §§ 1383(c)(3) & 405(g) for review of the final decision of the Secretary of Health and Human Services ("the Secretary") denying her claim for Supplemental Security Income ("SSI") under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq.
I. PROCEDURAL BACKGROUND
Mac first applied for SSI benefits in July, 1990. Record ("R.") at 53-56 . Her application was denied. R. 57-59. She filed a request for reconsideration in September 1990, which was also denied. R. 60-64. Mac then filed a request for a de novo hearing before an Administrative Law Judge ("ALJ"). R. 65. The hearing was held on February 22, 1991. Mac attended the hearing, where she testified with the assistance of an interpreter and was represented by counsel. R. 23-49.
In a written decision ("Decision") the ALJ found that Mac suffers from severe degenerative joint disease of the left knee, mild hypertension, the residuals of gynecological surgery, and a hearing loss in the left ear. R. 14, Decision at 4, Finding 2. However, the ALJ found that these impairments are not of sufficient severity to meet or equal the severities of any relevant impairments described in Appendix 1 to Subpart P of Regulations No. 4 of the Social Security Administration. R.14, Decision at 4, Finding 3. He concluded that Mac retains the residual functional capacity for sedentary work. R. 14, Decision at 4, Finding 5. The ALJ further found that Mac is a younger individual, that she is unable to communicate in English, and that she has no past relevant work experience. R. 14-15, Decision at 4-5, Findings 6-8. Based upon these findings of age, education, past relevant work experience, and residual functional capacity, the ALJ applied Rule 201.23 of Table No. 1 of Appendix 2 to Subpart P of regulations No. 4 of the Social Security Administration, which required a finding that Mac is not disabled. R. 15, Decision at 5, Finding 9.
Mac's request for review of the ALJ's decision was denied by the Social Security Administration Appeals Council on March 23, 1992, R. 3-4, making the denial of benefits a final decision of the Secretary. Plaintiff now appeals that decision pursuant to 42 U.S.C. §§ 1383(c)(3) & 405(g).
Hearings before an ALJ to decide SSI disability claims involve shifting burdens of proof.
A claimant satisfies her initial burden of proof by showing that she is unable to return to her customary occupation. . . . Once she has made such a demonstration, the burden of proof shifts to the Secretary to show that the claimant, given her age, education and work experience, has the capacity to perform specific jobs in the national economy.
Kent v. Schweiker, 710 F.2d 110, 114 (3d Cir. 1983) (citations omitted). The ALJ found that plaintiff had no past relevant work experience, R. 15, Decision at 15, Finding 8. Plaintiff thus satisfied her burden. The burden then shifted to the Secretary to show that plaintiff can perform jobs which exist in substantial numbers in the national economy. The Secretary's burden is to be strictly construed. Dobrowolsky v. Califano, 606 F.2d 403, 407 (3d Cir. 1979).
Certain impairments have been determined by the Secretary to be so severe that anyone suffering from them is disabled, irrespective of any other vocational factors such as her age, education, and previous work experience. These impairments are listed in the Secretary's regulations at 20 C.F.R. Pt. 404, Subpt. P, Appendix 1 (the "Medical Listings"). The ALJ found that Mac suffers from severe degenerative joint disease of the left knee, mild hypertension, the residuals of gynecological surgery, and a hearing loss in the left ear. R. 14, Decision at 4, Finding 2. However, the ALJ found that these impairments are not of sufficient severity to meet or equal the severities of any relevant impairments described in the Medical Listings. R.14, Decision at 4, Finding 3. Therefore, the ALJ concluded that medical evidence alone did not compel a finding of disabled.
When a claimant's medical condition alone does not compel a finding that she is disabled, the Secretary must consider whether the claimant is disabled by her medical condition in conjunction with other vocational factors. In some circumstances the Secretary's burden to show that plaintiff can perform specific jobs in the national economy may be met through reliance on the Medical-Vocational guidelines, 20 C.F.R. Pt. 404, Subpt. P, App. 2, (the "grids"). The Medical-Vocational grids "contain all possible combinations of the four relevant vocational factors -- age, education, work experience, and residual functional capacity. With respect to each combination, the guidelines reveal whether an individual described by those particular characteristics is 'disabled' or 'not disabled' -- that is, able or not able to engage in any other significant, gainful employment that exists in the national economy." Santise v. Schweiker, 676 F.2d 925, 927-28 (3d Cir. 1982).
The ALJ found that plaintiff retains the residual functional capacity for sedentary work. R. 14, Decision at 4, Finding 5. In other words, she is capable of meeting the strength demands of jobs which the Department of Labor has classified as sedentary.
Because plaintiff is limited to sedentary work, the ALJ applied the "grid" regulations of 20 C.F.R. Pt. 404, Subpt. P, App. 2, Table 1, which are predicated upon a residual functional capacity to perform sedentary work. Rule 201.23 of this Table commands that a person of claimant's age,
and previous work experience
who is limited to sedentary work is not disabled.
The gravamen of plaintiff's appeal is that it was improper for the ALJ to apply the Medical-Vocational grids to find her not disabled. She argues that she suffers from urinary incontinence, and that incontinence is an impairment which is not taken into account by the grids. As a result, she argues, the Secretary's reliance on the grids for a determination that she is not disabled was error.
For the reasons stated below, we agree with plaintiff that it is error to rely upon the grids to determine that a claimant who suffers from incontinence is not disabled. The grids are predicated upon the assumption that the claimant suffers only "exertional" impairments. When a claimant suffers from urinary incontinence, a "nonexertional impairment," evidence in addition to the grids must be used to determine if she is disabled. We also find that the only conclusion supported by substantial evidence is that plaintiff suffers from incontinence. Therefore, it was error for the ALJ to use the grids to determine that she is not disabled.
A. Exertional and Nonexertional Impairments
The Secretary's regulations recognize two different types of impairments which may establish disability, either alone or in combination. Exertional limitations or impairments are those that affect a claimant's ability to meet the strength demands of jobs. The classification of a limitation as exertional is related to the United States Department of Labor's classification of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of the strength demands for sitting, standing, walking, lifting, carrying, pushing, and pulling. Limitations or restrictions which affect a claimant's ability to meet the demands of jobs other than the strength demands, that is, demands other than sitting, standing, walking, lifting, carrying, pushing or pulling, are classified as nonexertional. 20 C.F.R. § 404.1569a.
The ALJ arrived at the conclusion that plaintiff is not disabled by applying the Medical-Vocational grids. However, the grid rules "are predicated on an individual's having an impairment which manifests itself by limitations in meeting the strength requirements of jobs," i.e. an exertional impairment. 20 C.F.R. Pt. 404, Subpt. P, App. 2, § 200.00(e)(2). Therefore, the rules "may not be fully applicable" when a claimant has nonexertional impairments. Id.; Green v. Schweiker, 749 F.2d 1066, 1072 (3d Cir. 1984); Wallace v. Secretary of HHS, 722 F.2d 1150, 1155 (3d Cir. 1983); Burnam v. Schweiker, 682 F.2d 456, 457-58 (3d Cir. 1982); Santise, 676 F.2d at 934-35.
If a claimant has nonexertional as well as exertional impairments, the grids are not to be applied unless they direct a conclusion that the claimant is disabled. If the grids do not direct a finding of disabled, "full consideration must be given to all of the relevant factors in the case." 20 C.F.R. pt. 404, subpt. P, app. 2, § 200.00e(2); Burnam, 682 F.2d at 458. In such a situation, the grids are to serve only as a "framework" to guide the Secretary's decision. 20 C.F.R. § 404.1569a(d); 20 C.F.R. Pt. 404, Subpt. P, App. 2, § 200.00(e)(2). The Secretary may not rely solely on the grids, but must call a vocational expert to show that the claimant can perform substantial gainful activity even though she suffers from the nonexertional impairment. Gilliland v. Heckler, 786 F.2d 178, 183-84 (3d Cir. 1986); Santise, 676 F.2d at 934-35; Burton v. Bowen, 704 F. Supp. 599, 604-05 (E.D. Pa. 1989); Johnson v. Bowen, 699 F. Supp. 475, 482 (E.D. Pa. 1988); Atkins v. Bowen, 690 F. Supp. 383, 389-90 (E.D. Pa. 1988); Singleton v. Schweiker, 551 F. Supp. 715, 723-24 (E.D. Pa. 1982). Therefore, if plaintiff suffers from a nonexertional impairment, the ALJ's reliance on the grids was improper.
Urinary Incontinence Is A Nonexertional Impairment
Plaintiff claims, and defendant does not dispute, that urinary incontinence is a nonexertional impairment for the purposes of SSI benefits determinations. Although there appears to be no dispositive case law in this circuit, courts in other jurisdictions have uniformly held that urinary incontinence is a nonexertional impairment. See, e.g., Gibson v. Heckler, 779 F.2d 619, 623 (11th Cir. 1986); Nichols v. Califano, 556 F.2d 931 (9th Cir. 1977); Torres v. Secretary of HHS, 791 F. Supp. 342, 344 (D.P.R. 1992); Pascariello v. Heckler, 621 F. Supp. 1032 (S.D.N.Y. 1985); Castellanos v. Bowen, 1986 WL 12007 at *14 (N.D. Ill. 1986).