F I L E D

United States Court of Appeals

Tenth Circuit

PUBLISH

MAY 30 2003

UNITED STATES COURT OF APPEALS

PATRICK FISHER

TENTH CIRCUIT

Clerk

SARAH ANGEL,
Plaintiff-Appellant,
No. 02-7072

v.
JO ANNE B. BARNHART,
Commissioner of Social Security,
Defendant-Appellee.

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF OKLAHOMA
(D.C. No. CIV-01-188-P)
Submitted on the briefs:
Kyle J. Saunders of Saunders and Saunders, Ada, Oklahoma, for PlaintiffAppellant.
Sheldon J. Sperling, United States Attorney, Tina M. Waddell, Regional Chief
Counsel, Michael McGaughran, Deputy Regional Chief Counsel, and James A.
Garrett, Assistant Regional Counsel, Office of the General Counsel, Social
Security Administration, Dallas, Texas, for Defendant-Appellee.

Before SEYMOUR , KELLY , and LUCERO , Circuit Judges.

KELLY , Circuit Judge.

Plaintiff-appellant Sara Angel appeals from the district courts order

affirming the Commissioners denial of her application for disability insurance
benefits and supplemental security income benefits under the Social Security
Act. 1 We exercise jurisdiction under 42 U.S.C. 405(g) and 28 U.S.C. 1291.
We review the Commissioners decision to determine whether the factual findings
are supported by substantial evidence and whether the correct legal standards
were applied.

See Barnett v. Apfel , 231 F.3d 687, 689 (10th Cir. 2000).

Angel claims that she has been disabled for the relevant time period of
July 24, 1997, through December 31, 1999

as a result of back and bladder

impairments. After Angels application for benefits was initially denied, a

de novo hearing was held before an administrative law judge (ALJ). In a decision
dated January 21, 2000, the ALJ determined, at step three of the five-part
sequential evaluation process for determining disability, that Angels back
impairment did not meet or equal the impairment listing for vertebrogenic
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument.

The ALJ determined that this is the relevant time period for determining
whether Angel was disabled, and Angel is not challenging the ALJs
determination in this appeal. Like the ALJ, we will examine medical evidence
generated prior to July 24, 1997, only for purposes of establishing a baseline
from which to evaluate [Angels] medical status. Aplt. App. at 36.

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disorders of the spine, listing 1.05C.

See 20 C.F.R. Pt. 404, Subpt. P, App. 1,

1.05C (1999). The ALJ then determined at step four of the evaluation process
that Angel was not disabled. First, the ALJ concluded that, while Angel suffers
from severe back and bladder impairments, she has the residual functional
capacity to perform a wide range of light work subject to the limitations of
lifting no more than 10 pounds on a frequent basis and no more than a maximum
of 20 pounds, standing or walking for no more than 2 hours at a time, or for
longer than 6 hours during an eight hour day, only occasional stooping, and a
need to self catheterize her bladder for 10 [to] 15 minutes every 2 to 2 hours
during the work day.

Aplt. App. at 37-38. Second, based on the testimony of

the vocational expert concerning the residual functional capacity necessary to

perform her past relevant work, the ALJ determined that Angel was capable of
performing her past relevant work as an insurance clerk, receptionist, accounts
payable clerk, senior office assistant, convenience store clerk, and barmaid.
Id. at 38.
In February 2001, the Appeals Council denied Angels request for review
of the ALJs decision. Angel then filed a complaint in the district court. In

The ALJ did not specify the sources he relied on to determine Angels
physical limitations, but it appears that he relied primarily on the report prepared
by Dr. Vallis D. Anthony.
See Aplt. App. at 298-305. Dr. Anthony was retained
by the Commissioner to evaluate Angels medical records.
See Aplee. Br. at 5.

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March 2002, the district court entered an order affirming the ALJs decision
denying Angels application for benefits. This appeal then followed.
In this appeal, Angel claims that: (1) the ALJ erred at step three in
rejecting the opinion of her treating osteopath, Dr. Schneider, that her back
impairment meets or equals listing 1.05C; (2) the ALJ erred at step four by failing
to address all of the relevant evidence in the record concerning the process she
must undergo to catheterize herself; (3) the ALJ erred at step four by failing to
provide sufficient reasons for rejecting her testimony and her treating physicians
opinions regarding the limitations imposed by her back pain and problems;
and (4) she does not have the residual functional capacity to perform her past
relevant work.
Having thoroughly reviewed the record and the pertinent legal authorities,
we conclude that the ALJs finding at step three that Angels back impairment
does not meet or equal listing 1.05C is supported by substantial evidence in the
record. However, we agree with Angel that the ALJ erred at step four by failing
to address all of the relevant evidence in the record concerning the process she
must undergo to catheterize herself. We also agree with Angel that the ALJ erred
at step four by failing to provide sufficient reasons for rejecting her testimony and
her treating physicians opinions regarding the limitations imposed by her back
pain and problems. Accordingly, we reverse the order of the district court
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affirming the ALJs decision denying benefits, and we remand this matter for
further proceedings before the ALJ.

1. Listing 1.05C.
Listing 1.05C provides as follows:
C. Other vertebrogenic disorders (e.g., herniated [disk], spinal
stenosis) with the following persisting for at least 3 months
despite prescribed therapy and expected to last 12 months.
With both 1 and 2:
1. Pain, muscle spasm, and significant limitation of motion in
the spine; and
2. Appropriate radicular distribution of significant motor loss
with muscle weakness and sensory and reflex loss.
20 C.F.R. Pt. 404, Subpt. P, App. 1, 1.05C (1999).

Although the listing does

not define the term vertebrogenic disorder, another section of the listing
regulations, which specifically cross-references 1.05C, states that it includes
disorders that result in impairment because of distortion of the bony and
ligamentous architecture of the spine or impingement of a herniated [disk] or
bulging annulus on a nerve root.

Id. at 1.00B.

Given the nature of our remand, we do not address Angels claim that she
does not have the residual functional capacity to perform her past relevant work,
and we leave that issue for the ALJ to reconsider on remand.

Listing 1.05C was revised in 2002, and it is now listing 1.04.

20 C.F.R. Pt. 404, Subpt. P, App. 1, 1.04 (2002).

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See

Angels treating osteopath, Dr. Schneider, testified at the hearing before the
ALJ that Angel met or equaled listing 1.05C. According to Dr. Schneider,
[Angel] actually meets number one. Number two on that, the bladder
dysfunction and her lack of tenacity or lack of reflex there, I think she meets it or
equals that criteria. Aplt. App. at 68. As this quote makes clear, Dr. Schneider
only addressed the two sub-parts of listing 1.05C, and she did not specifically
address the threshold issue under the listing of whether Angel suffered from
a vertebrogenic disorder of the spine during the relevant time period of July 24,
1997 through December 31, 1999. Further, there is no evidence in the record
that Angel suffered from a vertebrogenic disorder of the spine during the relevant
time period.
The record shows that Angel injured her back in a work-related incident in
October 1994, and she underwent a right hemilaminectomy and disk excision in
May 1995 to repair a herniated disk at L5-S1.

Id. at 154-56, 158-59. An MRI

subsequently taken in February 1997 showed no definite evidence of any recurrent

disk herniation at L5-S1.

Id. at 202. Although the February 1997 MRI did show

disk degeneration at L5-S1 and a mild bulging of the disc at L4-5, an

electromyogram (EMG) performed at the same time showed no definite evidence
of active lumbar radiculopathy in Angels lower extremities.

Id. at 201. Based

on the EMG results, Dr. Benner, Angels neurosurgeon, reported to her at the time
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that there were no signs of any nerve root damage or irritation in the area of her
prior surgery.

Id. at 177.

During her testimony at the hearing before the ALJ in November 1999,
Dr. Schneider testified that it was her belief that Angel probably had a new
herniated disk at L4-L5.

Id. at 64. Dr. Schneider admitted, however, that she did

not have any objective medical evidence to support her testimony.

Id. at 72. In

fact, an MRI taken in December 1998 showed no evidence of a herniated disk at

L4-L5 or elsewhere on Angels lumbar spine.

Id. at 208. On January 25, 2000,

a little over a month after the hearing before the ALJ, Dr. Schneider referred
Angel for another MRI, and that MRI also showed no evidence of a herniated disk
in Angels lumbar spine.

Id. at 387.

In her brief on appeal, Angel has admitted that her back problems do not
satisfy listing 1.05C standing alone.

See Aplt. Br. at 14. To overcome this failure

of proof, Angel argues that the ALJ erred by failing to consider her bladder
problem in combination with her back problems in determining whether she met
The December 1998 MRI also showed no evidence of spinal stenosis.
Aplt. App. at 208.

See

The Appeals Council made the January 25, 2000 MRI a part of the
administrative record, and it considered it in reviewing the ALJs decision.
See
Aplt. App. at 14, 16, 387. Even though the MRI was performed four days after
the ALJ issued his decision, we may consider it as part of the record on appeal
since it provides material evidence relating to the period before the ALJs
decision. See ODell v. Shalala , 44 F.3d 855, 858-59 (10th Cir. 1994).

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or equaled listing 1.05C.

Id. at 14-15. We disagree. At most, Angel has only

shown that her urologist, Dr. Forrest, has opined that her bladder problem most
likely arises from old spinal cord disease, Aplt. App. at 385, and that the bladder
problem is more than likely associated with nerve changes present within the
spinal cord causing the resulting hypotonicity of the bladder,

id. at 390. 8 Angel

has failed, however, to put forth any specific medical evidence linking her
bladder problem to a vertebrogenic disorder of the spine such as the herniated
disk she sustained in October 1994.

Id. at 177 (medical record of Dr. Benner

noting that he did not have an explanation for [Angels] increased bladder
problems, at least not in the context of [her 1995] back surgery), 385 (medical
record of Dr. Forrest noting that Angel was diagnosed as having a neurogenic
bladder in late 1993 or early 1994, and that he could not speak to the point of
any changes in her bladder function before or after [the 1995] spinal cord surgery,
as these are not objectively documented). Thus, we hold that the ALJs
determination that Angel does not meet or equal listing 1.05C is supported by
substantial evidence in the record.

The medical records of Dr. Forrest at pages 385 and 390 of appellants
appendix were made a part of the administrative record by the Appeals Council,
and the Appeals Council considered the records in reviewing the ALJs decision.
See Aplt. App. at 14, 16, 385, 390. We may consider the records as part of the
record on appeal since they provide material evidence relating to the period
before the ALJs decision.
See ODell, 44 F.3d at 858-59.

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2. Bladder Impairment.
In performing his step four analysis, the ALJ ignored and failed to address
Dr. Schneiders testimony at the hearing, which is supported by her medical
records, that Angel needs a sterile environment in which to catheterize herself due
to the risk of infection.

See Aplt. App. at 65, 218, 344. This omission is

significant because, following Dr. Schneiders testimony, the vocational expert

(VE) testified, in response to a hypothetical question posed by Angels counsel,
that the requirement of providing Angel with a sterile environment, which would
basically require that she have a personal, or private, bathroom, would have a
negative impact . . . [and] would [not] preclude all employment, but it would be
rather significant in reducing the occupational base.

Id. at 77.

Dr. Schneiders testimony, and the related testimony of the VE, is

supported by substantial medical evidence in the record showing that Angel is
at high risk of contracting recurrent urinary tract infections.

Id. at 261-67,

273-74, 276, 328-29, 332-33, 385, 390. We therefore agree with Angel that the
ALJs failure to address the testimony is reversible error.

See Drapeau v.

Massanari , 255 F.3d 1211, 1213 (10th Cir. 2001) (noting that ALJ must provide
specific and legitimate reasons for disregarding opinion of treating physician,
and that ALJ is required to give controlling weight to a treating physicians
well-supported opinion, so long as it is not inconsistent with other substantial
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evidence in the record);

Campbell v. Bowen , 822 F.2d 1518, 1523 n.6 (10th Cir.

1987) (noting that ALJ may not ignore unfavorable answer by VE that is
supported by substantial evidence). Thus, we remand this matter with directions
for the ALJ to address Dr. Schneiders testimony regarding the requirement of a
sterile environment, and the related testimony of the VE, and reconsider whether
the requirement precludes Angel from performing her past relevant work.
Although Angel has not raised the issue in this appeal, we also note that the
ALJ ignored and failed to address: (1) Angels testimony at the hearing that it
takes her twenty to thirty minutes to complete the catheterization process, as
opposed to the ten to thirty minutes posited by the ALJ in his hypothetical to the
VE, 9 see Aplt. App. at 53, 58, 76; and (2) the VEs testimony that, if Angel needs
up to thirty minutes to catheterize herself, then the time she would be required to
devote to the process during the work day is inconsistent with typical employer
expectations, id. at 77. Because of the potential significance of this testimony to
the step four determination, the ALJ should address it as part of the step four
analysis on remand.

We note that Dr. Schneiders records from 1997 and 1998 state that Angel
needed only ten to fifteen minutes to complete the catheterization process.
See
Aplt. App. at 218, 344. However, Dr. Schneider was not questioned about this
issue at the hearing before the ALJ. As a result, it is unclear based on the current
record whether Dr. Schneider would oppose Angels testimony that it actually
takes her twenty to thirty minutes to complete the process.

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3. ALJs Credibility and Treating Physician Determinations.

At the hearing before the ALJ, Angel testified that, as a result of her back
pain and problems, she can lift no more than a gallon of milk and she can only
stand, sit, or walk for fifteen to twenty minutes at a time.
consistent with the testimony and opinions of Dr. Schneider.

Id. at 54-55. This is

Id. at 67, 336-37,

339-40. However, the ALJ found that Angels testimony was not credible and
that Dr. Schneiders opinions were not supported by the medical evidence in the
record. Angel argues that the reasons put forth by the ALJ for rejecting her
testimony and the opinions of Dr. Schneider are not supported by the record.
We agree.
With respect to the credibility of Angels subjective complaints regarding
her back pain and problems, the ALJ found that they were not fully credible
because, but not limited to, the objective findings, or the lack thereof, by treating
and examining physicians, the lack of medication for severe pain, the frequency
of treatments by physicians and the lack of discomfort shown by the claimant at
the hearing. Id. at 37. The ALJ also found that Angels credibility is
diminished because the objective medical evidence shows a significant lack of
continuous treatment for her back and her treating physician, Dr. Schneider, did
not refer her to a specialist.

Id. With respect to Dr. Schneiders opinions, the

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ALJ gave them a reduced weight because they are not supported by any objective
testing, x-rays, CT scans, MRIs, or even physical examinations.

Id.

The ALJs findings are not supported by substantial evidence in the record
because the record shows that: (1) Angel had objective findings of back problems
in the form of degenerative disk disease, one or more bulging disks, and scar
tissue documented by the MRIs taken in 1997, 1998, and 2000,

id. at 202, 208,

387, and there is no dispute that she had a herniated disk and steroid atrophy in
1995, id. at 154-59, 163-64, 167, 169; (2) Angel has been taking prescribed pain
medication for several years; (3) Angel has been seeing Dr. Schneider for
treatment of her back pain and problems for several years, although, as
Dr. Schneider conceded at the hearing before the ALJ, her treatment has primarily
involved providing prescriptions for pain medication,

id. at 70-73; and (4) Angel

has seen two specialists to evaluate her continuing back pain and problems (her
neurosurgeon, Dr. Benner, and an orthopedic surgeon, Dr. Bazih),

id. at 177-78,

210-11.
The ALJ may be correct that the level of treatment Angel has received for
her back pain and problems is inconsistent with her and Dr. Schneiders claims
regarding the severity of her back impairment. But, in the absence of a more
thorough analysis and more specific findings by the ALJ, the ALJ cannot ignore
the dispositive issue of whether Angels objectively documented back problems
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were capable of producing the pain and physical limitations that she and
Dr. Schneider were alleging as of the time of the hearing before the ALJ.

See

Thompson v. Sullivan , 987 F.2d 1482, 1488-90 (10th Cir. 1993) (noting that ALJ
must determine whether a claimants subjective allegations of pain are supported
by objective medical evidence in the record, and setting forth criteria that ALJ
must consider to determine whether a claimant has pursued and/or received
medical treatment that is consistent with subjective allegations). Accordingly, we
conclude that the ALJs conclusory findings are an insufficient basis for rejecting
Angels testimony and Dr. Schneiders opinions, and we remand the step four
issue of whether Angels back impairment prevents her from performing her past
relevant work to the ALJ for reconsideration. We note, however, that [n]o
particular result is dictated,

id. at 1493, and we remand this matter only to assure

"that the correct legal standards are invoked in reaching a decision based on the
facts of this case," Huston v. Bowen , 838 F.2d 1125, 1132 (10th Cir. 1988).
The order of the district court is REVERSED, and this case is REMANDED
to the district court with instructions to remand the case to the Commissioner for
further proceedings before the ALJ.

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