Unpublished Disposition, 872 F.2d 427 (9th Cir. 1987)

MEMORANDUM^** 

Lela Holloman appeals from the district court's affirmance of the Secretary's decision that she was not entitled to Social Security disability benefits because her medical condition was not disabling.

Holloman was born on March 28, 1958 and was 25 years old when she filed her current SSI application in February 1985. A previous SSI application was denied in 1976. Holloman's only past relevant work experience consisted of four months as a short order cook in 1980. Holloman alleges that she is disabled because of epidermolysis bullosa, an inherited chronic noninflammatory skin disease which causes lesions on her skin. Holloman stated at the administrative hearing that two of her brothers and a sister also have the disease. She stated that blisters appear on her skin when it is chilled by a cool breeze, swimming, defrosting the refrigerator, or being in an air conditioned room. Holloman completed the seventh grade and can read and write, but cannot add or subtract. She did not continue her education because the air conditioning in the classroom aggravated her skin condition. Holloman testified that she left her job as a short order cook in 1980 because the air conditioning system in the restaurant caused her skin to break out. She stated that the lesions are worst during the winter, and from October through March she tries not to leave the house.

In a letter dated March 23, 1978 Dr. Stuart Jacobs reported that Holloman was the third member of her family to exhibit the blistering disorder. Dr. Jacobs then diagnosed her condition as familial cryofibrinogenemia. He reported that Holloman was unable to work in a cold environment from December, 1977 to April, 1978.

Dr. Stuart Jacobs referred Holloman to Dr. Paul Jacobs, a professor of clinical dermatology at the Stanford University Medical Center, for consultation on June 30, 1978. A physical examination at Stanford revealed no negative dermatological findings. Laboratory tests there showed Holloman to have normal plasma cryofibrinogen, and a "ice cube" test for sensitivity of her skin to cold was within normal limits.

Holloman was examined by Dr. Paul Brown on March 13, 1985 at the request of the state agency. Dr. Brown's examination revealed five small lesions near the right elbow, and evidence of multiple past lesions around Holloman's knees, thighs and buttocks. Dr. Brown believed that Holloman had a moderate functional impairment.

The administrative law judge requested a report from Dr. Roland Hart, a dermatologist, who treated Holloman on March 24, 1981 and again on February 15, 1985. Dr. Hart stated that at the time of the 1985 visit Holloman had multiple bleeding lesions on both thumbs and on her legs.

The ALJ also sent Holloman's medical records to Dr. S. Friedman, a medical advisor, to determine whether or not Holloman met the criteria for presumptive disability. In a report dated January 22, 1986 Dr. Friedman indicated that Holloman clearly had a recurrent dermatologic disease, but that it was unclear how disabling the condition was. Dr. Friedman questioned Holloman's statement that the lesions were aggravated by cold, noting the negative ice cube test at Stanford, and the finding that Holloman's blood serum did not contain cryoglobulins. Dr. Friedman concluded that he could not state whether Holloman met the criteria for disability without documentation by a physician as to the frequency of her attacks, their locations, and response to therapy.

The ALJ found that Holloman's condition was exacerbated by cold environments and pregnancy, but found her limited only from working in an unusually cold environment. The ALJ rejected Holloman's testimony on the effect of air conditioning on her skin because he found no medical evidence to support her contention that air conditioning exacerbated her condition, and the ice cube test had failed to produce a positive result. The ALJ rejected Holloman's testimony as to the frequency of her skin lesions, noting that Holloman had infrequently sought medical treatment and concluding that her lesions either responded well to treatment or were not so severe as to be disabling.

On review of the ALJ's decision in the district court, Holloman submitted two new reports by Dr. Hart in support of her motion for remand. In a report dated January 21, 1987 Dr. Hart noted that epidermolysis bullosa is not curable, and generally involves frequent recurrences. He indicated that Holloman had experienced multiple episodes of blistering, including some in which the skin became infected, and stated that she was unable to work during those episodes. He stated that Holloman should "definitely be considered for the possibility of disability, especially during those times in which her skin disorder is very active." In a second letter dated February 24, 1987, Dr. Hart described Holloman's condition at the time of her most recent visit, when she had blisters on her thighs, buttocks and feet, and stated that slight traumas to Holloman's skin would probably be a major factor in triggering episodes of blistering.

The magistrate concluded that there was substantial evidence to support the Secretary's determination that Holloman was not disabled. We disagree. The Secretary's decision that Holloman is not disabled is not supported by substantial evidence. We remand to the Secretary for additional consideration of Holloman's claim in light of the new evidence presented by Dr. Hart. On this record viewed as a whole it appears that Holloman met her burden of establishing a prima facie case of disability by showing that she was not able to return to her past employment. Once the claimant meets that burden, the burden shifts to the Secretary to show that Holloman can perform other types of work existing in the national economy, given her residual functional capacity, age, education, and work experience. Gallant v. Heckler, 753 F.2d 1450, 1452 (9th Cir. 1984); 20 C.F.R. Sec. 404.1520(f), 404.1560-.1568 (1988).

The uncontradicted medical evidence is that Holloman suffers from epidermolysis bullosa, an incurable genetic skin disorder which causes painful lesions to break out at regular intervals. While the Stanford tests did not confirm that cold is an aggravating factor in these outbreaks, as Holloman believes, the tests did nothing to throw Dr. Hart's diagnosis into question. Dr. Hart's recent letters indicate that slight traumas to the skin may cause outbreaks and this information should be considered by the Secretary on remand in determining whether there are jobs existing in the national economy which Holloman can perform in spite of her impairment. The record does not support the Secretary's conclusion that Holloman's only functional impairment resulting from her recurrent and apparently incurable skin disorder was that she could not work in an unusually cold environment. Because the Secretary's decision was not supported by substantial evidence, we remand to the Secretary for reconsideration. On remand the Secretary should reexamine the evidence to determine Holloman's residual functional capacity to engage in substantial gainful activity.

REVERSED AND REMANDED.