Voigt v. Colvin, No. 14-2303 (7th Cir. 2015)
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The plaintiff, then age 40, applied to the Social Security Commission in 2009 for benefits, claiming to be disabled from gainful employment as a result of psychiatric disorders (depression and bipolar disorder), chronic back and hip pain, and an anal fissure. He had been trained as a machinist and, until 2002, had worked intermittently as a machinist and an assembly line worker. The administrative law judge denied his claim on the ground that he was capable of performing unskilled sedentary work. The district court upheld the denial of benefits. The Seventh Circuit reversed, noting contradictions and gaps in the ALJ’s reasoning. The court did “not say that Voigt is in fact totally disabled from gainful employment, however— only that he’s entitled to a more careful analysis of his claim by the Social Security Administration.”
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In the United States Court of Appeals For the Seventh Circuit ____________________ No. 14 2303 KEVIN VOIGT, Plaintiff Appellant, v. CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant Appellee. ____________________ Appeal from the United States District Court for the Western District of Wisconsin. No. 3:13 cv 00170 bbc — Barbara B. Crabb, Judge. ____________________ ARGUED MARCH 3, 2015 — DECIDED MARCH 26, 2015 ____________________ Before POSNER, KANNE, and TINDER, Circuit Judges. POSNER, Circuit Judge. The plaintiff had applied to the So cial Security Commission in 2009 (when he was 40 years old) for benefits to which he claimed to be entitled by reason of being disabled from gainful employment as a result of psy chiatric disorders (primarily depression and bipolar disor der), chronic back and hip pain, and an anal fissure (cut or tear). The administrative law judge to whom his application 2 No. 14 2303 was referred (John H. Pleuss) denied his claim on the ground that he’s capable of performing unskilled sedentary work and is therefore not totally disabled. The district court, to which the applicant turned, upheld the denial of benefits, precipitating this appeal. Voigt had been trained as a machinist, and until 2002 (the claimed onset date of his total disability) had worked inter mittently as a machinist and as an assembly line worker, jobs that the administrative law judge agreed he was no longer capable of doing, because of his physical and mental problems. Between 2001 (possibly earlier) and 2008, Voigt had taken prescription antidepressant medications such as Paxil, but he quit taking them because of their adverse side effects. In the fall of 2009, having abandoned the antidepressant medications, he sought the help of “crisis workers” at a men tal health clinic. The intake report of his visit to the clinic summarizes his confused and rather wild description of his mental state. In a subsequent visit to the clinic he told the crisis worker who interviewed him that he thought it might be good for him to be in prison, where he might (he thought—we know not on what basis) get some additional experience as a machinist and earn money that he could save. Yet he also told that same worker in a later interview that his goal was to own a restaurant, which was and is both unrealistic given his mental condition and irrelevant to im proving his skills as a machinist. He was examined at the clinic by “an advanced practice psychiatric nurse” (see APNA, “What Is an Advanced Prac tice Psychiatric Nurse?” www.apna.org/i4a/pages/index.cfm ?pageid=3866#1, visited March 15, 2015, as were the other No. 14 2303 3 websites cited in this opinion). The nurse, Debra Day, diag nosed him as suffering from depression (no surprise), but two years later (after his eighth examination by her), she submitted a report to the Social Security Administration in which she described Voigt as bipolar (oddly she did not mention depression, though of course depression is an as pect of bipolar disorder, which used to be called “manic de pression”) and opined that his mental illnesses would cause him to miss work more than four days each month—which the vocational experts on whom the administrative law judges rely testify disqualifies a person from gainful em ployment. Garcia v. Colvin, 741 F.3d 758, 760 (7th Cir. 2013); Pepper v. Colvin, 712 F.3d 351, 361 (7th Cir. 2013); Treichler v. Commissioner of Social Security Administration, 775 F.3d 1090, 1096 (9th Cir. 2014); Ghanim v. Colvin, 763 F.3d 1154, 1159 (9th Cir. 2014). To qualify for gainful employment one must be able to work on a “sustained basis,” defined as eight hours a day five days a week, see 20 C.F.R. §§ 404.1512(a), 416.912(a); Rollins v. Massanari, 261 F.3d 853, 859 (9th Cir. 2001); SSR 96 8p, “Purpose,” ¶ 1, and to be incapable of gain ful employment is to be totally disabled within the meaning of the Social Security Act. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). To miss four workdays a month would re duce one’s average workweek from five to four days, which would not constitute working on a sustained basis as de fined by the Commission. Day’s report listed a total of 13 symptoms exhibited by Voigt of poor psychological and social functioning, ranging from paranoia to “oddities of thought, perception, speech or behavior.” She deemed him “unable to meet competitive standards” (requirements for gainful employment) of punc tuality, of “sustain[ing] an ordinary routine without special 4 No. 14 2303 supervision,” of “work[ing] in coordination with or proximi ty to others without being unduly distracted,” and of being able to “complete a normal workday,” “accept instructions,” “get along with coworkers,” and “deal with normal work stress.” (We omit five other requirements of gainful em ployment that Nurse Day deemed Voigt unable to satisfy.) At her first examination of him, in October 2009, Day gave him a GAF score of 50. “GAF” stands for Global As sessment of Functioning, and a score of between 41 and 50 signifies serious psychiatric illness. The American Psychiat ric Association has since eliminated the GAF scale from its Diagnostic and Statistical Manual of Mental Disorders as being unreliable—but this occurred after the administrative law judge issued his decision, which was in January 2012. (The length of time it’s taken the case to get to us is lamentable.) Day prescribed an antidepressant medicine called Cym balta. Voigt reported improvement in his mental states and absence of the side effects that he’d experienced with the an tidepressant medications that he had been taking previously. On the basis of that report, Day raised Voigt’s GAF score to 55. That brought it into the range of “moderate symptoms” or “moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co workers).” He continued making progress, and after examin ing him again, Day raised his GAF score to 65, signifying “mild symptoms” and “generally functioning pretty well.” During two of their sessions she gave him a score of 70. GAF scores bounce around a great deal, however, because they depend on how the patient happens to feel the day he’s ex amined. See Punzio v. Astrue, 630 F.3d 704, 710 (7th Cir. 2011); I. H. Monrad Aas, “Guidelines for Rating Global As No. 14 2303 5 sessment of Functioning (GAF),” Annals of General Psychiatry 10:2, pp. 4–5 (2011). Overall Voigt’s GAF score rose from 50 at his first examination by her to 65 at the last one, consistent with her treatment notes, which state that Voigt reported that the medication was working, enabling him to control his irritation and other negative emotions better. It’s not surpris ing that his mood improved over the course of his visits, as he got to know her better and the therapy she prescribed took effect. His GAF scores were computed anew at each vis it; what they would have been had they been computed elsewhere by a practitioner whom he was being examined by for the first time is unknown. The critical question, how ever, was whether the medication that Day prescribed so improved his mental health as to enable him to qualify for a full time job. She thought not. Meanwhile he’d been visiting another clinic because of physical distress that included the anal fissure, the back and hip pain (he described the hip pain as “sharp” and “stab bing”), and hemorrhoids (possibly related to the fissure). An osteopath designated by the Social Security Commission to examine Voigt after he applied for disability benefits report ed that he suffers from lower back pain and trochanteric bursitis (an inflammation near the hip that causes pain in the hip, see Cleveland Clinic, “Trochanteric Bursitis,” http://my.clevelandclinic.org/health/diseases_conditions/hic _Bursitis/hic_Trochanteric_Bursitis). The osteopath also ob served that Voigt walked with a “slow and painful gait.” Another physician and a psychologist examined Voigt’s medical records and concluded that despite his physical and psychiatric problems he was capable of performing un skilled sedentary work. Neither examined him, however. 6 No. 14 2303 After many months of gradual improvement, Voigt com plained to Day, and to another licensed professional counse lor as well, of a deterioration in his mental condition. He re ported “raging in the parking lot” of the mental health clinic and becoming “very angry and upset” at a Super Bowl game. Day left Voigt’s GAF score at 65, but the other counse lor reduced it to 51 to 60. (The administrative law judge erred in stating that Voigt’s lowest GAF score was 55.) This discrepancy in their scores is consistent with the probability noted earlier in this opinion that one’s GAF score will rise as one builds up a relationship with the practitioner who is scoring him. Day believed that Voigt’s deterioration was attributable in part to his drinking, taking Vicodin (a pain relieving drug), and smoking marijuana, and that these behaviors were retarding his progress in therapy. But while they were a big concern, she didn’t think they played the primary role in his problems. (This is important, since if Voigt’s deteriora tion were attributable solely to drug and alcohol abuse he might well be barred from obtaining benefits no matter how serious his disability. See 42 U.S.C. § 423(d)(2)(C); Kangail v. Barnhart, 454 F.3d 627, 628 (7th Cir. 2006).) The administrative law judge went far outside the record when he said that if Voigt were as psychologically afflicted as Day thought, he “would need to be institutionalized and/or have frequent inpatient treatment”—a medical con jecture that the administrative law judge was not competent to make, see Browning v. Colvin, 766 F.3d 702, 705 (7th Cir. 2014); Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 2014); Pate Fires v. Astrue, 564 F.3d 935, 946–47 (8th Cir. 2009), and that was implausible to boot. The institutionalization of the men No. 14 2303 7 tally ill is generally reserved for persons who are suicidal, otherwise violent, demented, or (for whatever reason) inca pable of taking even elementary care of themselves. Voigt is none of these things, and so cannot be institutionalized against his will: “a State cannot constitutionally confine [against his will] without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.” O’Connor v. Donaldson, 422 U.S. 563, 576 (1975). But it doesn’t follow, as the administrative law judge may have thought, that Voigt is therefore capable of gainful employ ment. The judge remarked that because Voigt’s “parents appar ently pay his rent and expenses …, these facts raise a ques tion as to whether [his] continuing unemployment is actual ly due to medical impairments.” No, it doesn’t, because if he can’t work, he has to be supported by someone or by some agency. More to the point is the administrative law judge’s remark that Voigt had had only sporadic employment in the decade preceding the claimed onset of his disability in 2002. He may have been a malingerer, mooching off his parents, or he may have been more psychologically disturbed than anyone realized. In any event his parents may be continuing to support him because whatever his physical and mental state in the decade ending in 2002 he may now no longer be capable of working. The administrative law judge also contradicted himself about whether Voigt is currently a malingerer when later in his opinion he remarked that Voigt had “made statements during treatment suggesting he actually is eager to work, but is unable to find work, which suggests that the claimant 8 No. 14 2303 is not unemployed due to disability.” Actually those state ments were consistent with his wanting to lead a normal life yet being unable to land a job because he’s disabled from gainful employment by a combination of physical and men tal problems that a prospective employer would quickly no tice. Voigt acknowledged that having been unemployed for such a long time makes it harder for him to get a job, but that’s not inconsistent with his being disabled. A disabled person may want to work, may seek work, and in some cas es may land work. We’ve noted cases in which although the claimant is not only working but also “earning a decent wage, he really is permanently disabled from engaging in gainful activity. Maybe his boss feels desperately sorry for him and is retaining him on the payroll even though he is incapable of working. That act of charity ought not be pun ished by denying the employee benefits and thus placing pressure on the employer to retain an unproductive employ ee indefinitely. Maybe a seriously disabled worker is able to work only by dint of his extraordinary determination and the extraordinary assistance extended to him by kindly fel low workers.” Jones v. Shalala, 21 F.3d 191, 192 (7th Cir. 1994) (citations omitted). The only other witness at the hearing was a vocational expert, who testified on the basis of what the administrative law judge found that Voigt could and could not do that while he could no longer work as a machinist he could do simple sedentary work such as that of an office assistant (whatever that means), security guard (very doubtful—a se curity guard with significant mental health problems is like ly to be a danger to himself and others), an assembler, or a packager. The vocational expert said that there are 23,000 such jobs in Wisconsin (where Voigt lives), but did not ex No. 14 2303 9 plain where he’d gotten that figure. He added that anyone who would miss work two or more days per month (not just three or more) more than occasionally would not qualify for gainful employment. Although concluding that Voigt was not totally dis abled, the administrative law judge characterized Voigt’s trochanteric bursitis, fissure, depression, and bipolar disor der as severe, while discounting his back pain on two grounds. One was that “he ha[d] not taken any narcotic based pain relieving medications.” He had, however, taken Vicodin (albeit illegally), which though an opiate rather than a narcotic is a powerful pain reliever. The other ground was Voigt’s failure to undergo “intensive treatment[,] like injec tions, which would be expected [to be prescribed for] a per son experiencing disabling pain.” Injecting steroids or other drugs is sometimes suggested for treating back pain, see WebMD, Back Pain Health Center, “Injections for Back Pain Relief,” www.webmd.com/back pain/guide/back pain injec tion treatments, but the administrative law judge offered no reason for thinking that it would have been appropriate for Voigt. Nor did he note the natural reluctance of a person with psychiatric problems (perhaps of any person) to take powerful pain medications, as they can have serious side ef fects if not carefully used. A mentally ill person is more like ly to abuse opiates like Vicodin (see National Alliance on Mental Illness, “Opiates and Mental Illness,” www2.nami. org/Content/NavigationMenu/Hearts_and_Minds/Smoking_ Cessation/Opiate_Abuse_and_Mental_Illness.htm) than a healthy person. In addition, opiates can increase symptoms of bipolar disorder. See La Hacienda Treatment Center, “Opiates,” www.lahacienda.com/resources/articles/opiates/; cf. Beardsley v. Colvin, 758 F.3d 834, 840 (7th Cir. 2014); Myles 10 No. 14 2303 v. Astrue, 582 F.3d 672, 677–78 (7th Cir. 2009); Craft v. Astrue, 539 F.3d 668, 679 (7th Cir. 2008). At the hearing Voigt described some of his psychological symptoms but also emphasized health problems resulting from his anal fissure, including bleeding, and poor bowel control that requires him to spend 40 consecutive minutes on the toilet about four times every month. The administrative law judge discounted these problems by noting Voigt’s re fusal to undergo a colonoscopy between 2006 and 2008 and a rectal examination in 2010, but failed to note that Voigt testi fied that he’d been told that he would have to have surgery to repair the fissure and that he was fearful of having a co lonoscopy—a common fear, known as “colonoscopy jitters.” See, e.g., Riverside, “Got the Colonoscopy Jitters?” www.riversideonline.com/services/cancer/colon/colonoscop y jitters.cfm; cf. Beardsley v. Colvin, supra, 758 F.3d at 840; Craft v. Astrue, supra, 539 F.3d at 679; Orn v. Astrue, 495 F.3d 625, 638 (9th Cir. 2007). The administrative law judge discounted Voigt’s mental problems on the ground that they had been solved by his taking Cymbalta. That was contrary to Day’s report, howev er, which said that his mental state continued to be dis turbed, and though it was exacerbated by his substance abuse she did not consider that the primary cause of his ina bility to relate to people in a normal way. The administrative law judge gave “very little weight” to Day’s report, howev er, on the ground that a mere nurse is not an “acceptable medical source,” and that Day had seen Voigt on only a few occasions and had given him a pretty high GAF score, and further that as mentioned earlier “if the claimant were as limited as indicated in [Day’s] opinion, the claimant would No. 14 2303 11 need to be institutionalized and/or have frequent inpatient treatment. These inconsistencies render the opinion less per suasive, and it is due very little weight.” These were not adequate reasons for rejecting Day’s re port and therefore turning down Voigt’s application for dis ability benefits. As for Day’s not being an “acceptable medi cal source,” the administrative law judge failed to note that “evidence from other sources,” including nurse practition ers, may be used to “show the severity of [the applicant’s] impairment(s) and how it affects [his or her] ability to work.” 20 C.F.R. §§ 404.1513(a), (d), (d)(1), 416.913(a), (d), (d)(1); see also SSR 06 3p. As for the number of visits, Day had examined Voigt eight times in two years and the admin istrative law judge did not say that the visits were too infre quent to have enabled Day to assess the trend (first up, then down) in Voigt’s condition. Most questionable of all is the judge’s statement that if Day’s description of Voigt’s symp toms were accurate he would have to be institutionalized or hospitalized (if hospitalization is what the administrative law judge meant by “inpatient treatment”). Cymbalta may have enabled Voigt to keep out of mental or other hospitals; the question is whether it enables him, despite acute difficul ties that Cymbalta has not dispelled in dealing with other human beings, to obtain gainful employment. The administrative law judge committed the further error of thinking that how one uses his time at home is compelling evidence of whether or not one is employable. See Beardsley v. Colvin, supra, 758 F.3d at 838; Bjornson v. Astrue, 671 F.3d 640, 647 (7th Cir. 2012); Garrison v. Colvin, 759 F.3d 995, 1016 (9th Cir. 2014). Voigt apparently spends much of his time at a computer conducting research on his medical problems 12 No. 14 2303 and playing video games. The administrative law judge cit ed treatment notes, and testimony, that indicated that Voigt is “able to persist at activities like online research,” and en joys “playing computer games—for hours.” But whether Voigt’s online research or playing such games is inconsistent with his having severe back pain would depend on the pre cise nature of the pain, how comfortable the chair he sits on while using the computer is, and what his alternatives are— he can’t spend all day standing or lying down even if sitting is painful. These issues were not explored. Nor did the administrative law judge explain his as sumption that doing limited online research or playing vid eo games online requires the same concentration as is re quired for full time employment. In Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000), we expressed skepticism about an administrative law judge’s assertion that “ability to watch television for several hours indicates a long attention span.” Playing a video game is less passive, hence more intellectu ally challenging, than watching television. But the adminis trative law judge did not consider the extent to which expe rience in playing video games would equip Voigt for any of the jobs that he might otherwise be incapable of performing. And finally the administrative law judge fully credited the vocational expert’s testimony. He did this even though the testimony did not explain the source of the expert’s esti mate of the number of jobs that Voigt could perform, and even though the inclusion of “security guard” among those jobs should have nudged the administrative law judge to explore the expert’s basis for thinking that someone with Voigt’s psychiatric problems would be able to perform such a job without danger to himself and others. Nurse Day had No. 14 2303 13 noted Voigt’s “problems with irritability and [with his] sometimes explosive behavior.” Among the people he doesn’t get along with are police officers—which doesn’t augur well for success as a security guard. The administrative law judge said that “the vocational expert’s testimony is consistent with the information con tained in the Dictionary of Occupational Titles,” but as we and others have explained, the DOT does not contain infor mation on which to base an estimate of the number of avail able jobs of a particular kind. Browning v. Colvin, supra, 766 F.3d at 709; Herrmann v. Social Security Administration, 772 F.3d 1110, 1113–14 (7th Cir. 2014); Brault v. Social Security Administration, Commissioner, 683 F.3d 443, 446–47 (2d Cir. 2012) (per curiam); Guiton v. Colvin, 546 Fed. App’x 137, 143– 45 (4th Cir. 2013) (concurring opinion); Coppernoll v. Astrue, 2009 WL 1773132, at *8 (W.D. Wis. June 23, 2009); Jon C. Du bin, “Overcoming Gridlock: Campbell After a Quarter Century and Bureaucratically Rational Gap Filling in Mass Justice Adjudication in the Social Security Administration’s Disability Programs,” 62 Administrative L. Rev. 937, 964–71 (2010); Peter J. Lemoine, “Crisis of Confidence: The Inade quacies of Vocational Evidence Presented at Social Security Disability Hearings (Part II),” Social Security Forum, Sept. 2012, p. 1. As we said in the Browning case, we “have no idea what [is] the source or accuracy of the number of jobs that voca tional experts (including the one in this case, whose esti mates the administrative law judge accepted without com ment) claim the plaintiff could perform that exist in the plaintiff’s area, the region, or the nation. There is no official source of number of jobs for each job classification in the 14 No. 14 2303 Dictionary of Occupational Titles, and while there are unoffi cial estimates of jobs in some categories, the vocational ex perts do not in general, and the vocational expert in this case did not, indicate what those data sources are or vouch for their accuracy. And many of them estimate the number of jobs of a type the applicant for benefits can perform by the unacceptably crude method of dividing the number of jobs in some large category (which may be the only available da ta) by the number of job classifications in the category, even though there is no basis for assuming” that there is the same number of jobs in each narrow category. 766 F.3d at 709 (emphasis added). There is no indication that the estimate of the number of jobs that the applicant in this case could fill (if the administrative law judge’s estimate of his capacity to work is correct, as it may very well not have been) is any more accurate than it was in Browning. The judgment of the district court is reversed and the case remanded to that court with instructions to remand it to the Social Security Administration for further proceedings consistent with this opinion. We do not say that Voigt is in fact totally disabled from gainful employment, however— only that he’s entitled to a more careful analysis of his claim by the Social Security Administration.
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