United States Court of Appeals For the First Circuit
No. 19-1712
AMANDA SACILOWSKI,
Plaintiff, Appellee,
v.
ANDREW SAUL, COMMISSIONER OF SOCIAL SECURITY,
Defendant, Appellant.
APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF RHODE ISLAND
[Hon. John J. McConnell, Jr., Chief U.S. District Judge]
Before
Thompson, Stahl, and Barron, Circuit Judges.
Aaron L. Weisman, U.S. Attorney, with whom Michael J. Pelgro, Regional Chief Counsel, Social Security Administration, and Lisa G. Smoller, Special Assistant U.S. Attorney, Social Security Administration, Office of the General Counsel, were on brief, for appellant. Stephen P. Maguire was on brief for appellee.
May 15, 2020 THOMPSON, Circuit Judge. Andrew M. Saul, Commissioner
of Social Security, appeals the district court's order 1) finding
that Amanda Sacilowski is disabled as defined under 20 C.F.R.
§ 404.1520 and therefore 2) awarding her benefits. Both parties
rely heavily on this court's decision in Seavey v. Barnhart, 276
F.3d 1 (1st Cir. 2001); the Commissioner to argue that like in
Seavey, the court should remand the case as "essential factual
issue[s] ha[ve] not been resolved." Id. at 11. While Sacilowski
contends no factual issues need further resolution, and that this
is the "unusual case" the court in Seavey described "where the
proof of disability is overwhelming or where the proof is very
strong and there is no contrary evidence," such that an award of
benefits would be proper. Id. We now review the record on a clean
slate to determine whether there is "overwhelming" or "very strong"
evidence of Sacilowski's disability, without any "contrary
evidence," id., to justify an award of benefits. We find that
there is, and so we affirm.
BACKGROUND
"The Social Security Administration is the federal
agency charged with administering both the Social Security
disability benefits program, which provides disability insurance
for covered workers, and the Supplemental Security Income program,
which provides assistance for the indigent aged and disabled."
Id. at 5 (citing 42 U.S.C. §§ 423, 1381a). A claimant seeking
- 2 - disability benefits must prove that she is unable "to engage in
any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected
to result in death or which has lasted or can be expected to last
for a continuous period of not less than 12 months." 42 U.S.C.
§§ 423(d)(1)(A); see also § 1382c(a)(3)(A). Once a claimant
applies for benefits, the Social Security Act provides that the
Commissioner's factual determinations of an entitlement to
benefits "shall be conclusive" if the findings are "supported by
substantial evidence." 42 U.S.C. § 405(g).
Sacilowski was 34 years old when she filed applications
for Social Security Disability Benefits and Supplemental Security
Income on June 23, 2015. She is a high school graduate and has
not worked since 2012. Before that, she worked as a customer
service representative for two different banks and then for a
children's retail company, the latter of which required her to
answer calls and retrieve certain physical items from inventory on
occasion. She was released from that last job due to her health
issues.
The Commissioner denied Sacilowski's applications, and
on January 20, 2016, Sacilowski requested that an Administrative
Law Judge ("ALJ") make an independent assessment of her claim. An
ALJ employs a five-step test to determine if an individual is
disabled within the meaning of the Social Security Act. 20 C.F.R.
- 3 - § 416.920. The test asks questions that are sequential and
iterative, such that the answer at each step determines whether
progression to the next is warranted: (Step 1) whether the
claimant is currently engaging in substantial gainful activity; if
not, (Step 2) whether the claimant has a severe impairment; if so,
(Step 3) whether the impairment meets or medically equals an entry
in the Listing of Impairments; if not, (Step 4) whether the
claimant's residual functional capacity ("RFC") is sufficient to
allow her to perform any of her past relevant work; and if not,
(Step 5) whether, in light of the claimant's RFC, age, education,
and work experience, she can make an adjustment to other work
available in the national economy. See 20 C.F.R. §§
404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v) (2012). A claimant
bears the burdens of production and persuasion at steps one through
four. Freeman v. Barnhart, 274 F.3d 606, 608 (1st Cir. 2001). At
step five, the Commissioner must come forward with evidence of
jobs in the national economy that the claimant is able to perform.
Id. (citing Arocho v. Sec'y of Health & Human Servs., 670 F.2d
374, 375 (1st Cir. 1982)).
At the ALJ hearing on September 30, 2016, Sacilowski,
Sacilowski's husband, and an impartial Vocational Expert ("VE")
testified. Sacilowski spoke about her background, work history,
and medical conditions preventing her from working. The latter
focused on her migraine headaches and bladder ailments. She
- 4 - explained that she experienced two to three migraines a week and
described the incapacity her migraines generated and the treatment
she was receiving at the time. As to her bladder ailments, she
testified about the pain she experienced while urinating, the
treatment she received for the pain, and that starting about three
to four months before the hearing, she was urinating so frequently
that she kept a "commode at the foot of [her] bed just in case she
[couldn't] make it up the stairs to use the restroom [at home]."
Sacilowski's husband corroborated her testimony. The VE
then explained that someone with Sacilowski's impairments could
work in jobs involving "light cleaning," "sales," and "general
office" work. He then testified about the ramifications of
frequent absenteeism on the ability to hold down "full-time
competitive employment":
[ALJ]: And if a hypothetical Claimant is unable to tolerate customary work pressure, this would be with absences of at least four times per month, would that restriction, would that rule out all full-time competitive employment? [VE]: Yes, it would. [ALJ]: What would be the cut off for absenteeism that's accepted by the employers. [VE]: Once a month, and that's problematic in terms of maintaining a job. [ALJ]: And if someone's unable to sit, stand or walk for eight hours total over an eight hour work day, obviously that precludes full- time employment is that correct? [VE]: Correct, Your Honor. [ALJ]: And if someone had to lay down with their legs up to at least waist level between two and four hours in an eight hour work day,
- 5 - and then be off-task in that time period, would that preclude full-time competitive employment? [VE]: Yes, it would.
Before rendering a decision, the ALJ also reviewed various
documents: Sacilowski's earnings records and work history, her
medical records ranging from 2013 to 2016, including multiple
records from her treating physician, Dr. Wilson, and the state
agency physicians' evaluations of the record evidence.1
Ultimately, the ALJ concluded that Sacilowski's bladder
ailments were "non-severe" at Step 2, because they had "been
managed with medication with no ongoing, secondary functional
limitations that would cause more than a minimal effect on her
ability to perform basic, work-related tasks for a period of twelve
months or more." He found Sacilowski's migraines (and fibromyalgia
and depression) to be "severe" impairments (Step 2), but that these
"severe" impairments did not "meet the severity listing" of a
listed impairment, and so Sacilowski had the RFC to perform a
limited range of light work (Step 3), as defined by 20 C.F.R. §§
404.1567(b) and 416.967(b),2 although not any past relevant work
(Step 4).
1 We offer more on these documents later in the discussion when we detail the evidence of Sacilowski's impairments. 2 The Commissioner conceded that the ALJ erred at Step 3
when he determined that Sacilowski's migraines could not meet the
- 6 - The ALJ therefore moved onto Step 5, and relying on the
VE's testimony about what jobs would be available to someone with
Sacilowski's impairments, determined that Sacilowski could perform
certain jobs in the national economy, such as cleaning, sales, or
general office work. The ALJ noted that even though Sacilowski's
"medically determinable impairments could reasonably be expected
to produce the . . . alleged symptoms . . . ,[her] statements
concerning the intensity, persistence and limiting effects of
these symptoms are not entirely consistent with the medical
evidence and other evidence in the record." Therefore the ALJ
agreed with the Commissioner's decision to deny benefits, finding
that Sacilowski was not disabled as defined under the Social
Security Act between March 25, 2015, the alleged onset of
disability, to December 20, 2016, the date of the ALJ decision
("Relevant Time Period").
Sacilowski requested review of the ALJ's decision by the
Appeals Council, which the Appeals Council denied. This cleared
the way for Sacilowski to file a complaint on January 2, 2018 in
federal court challenging the ALJ's findings.
District Court Judge McConnell referred the case to
Magistrate Judge Almond, who reviewed Sacilowski's motion to
severity of an already-listed impairment. Because our decision will remedy any impact of this error, we need not address it.
- 7 - reverse the Commissioner's decision and the Commissioner's motion
to affirm, and then held a hearing during which he asked each
side's attorney to present their two strongest arguments.
Sacilowski's attorney explained that his client's bladder
condition was still developing and worsening at the time of the
ALJ hearing, and there wasn't enough medical evidence in the record
to make a proper decision on its severity. He also argued that
the ALJ should have found that the frequency and severity of
Sacilowski's migraines would cause Sacilowski to be absent from
work at least once a month, and therefore preclusive of full-time
employment, as explained by the VE to the ALJ. What underscored
both these arguments was Sacilowski's attorney's complaint that
the ALJ did not give Dr. Wilson's opinions enough weight. On the
other side, the Commissioner argued that there was support in the
record to render Sacilowski's bladder ailments not severe and that
the ALJ was correct to find that Sacilowski's migraines were stable
and would not interfere with her ability to do the work suggested
by the VE. The Commissioner also noted that Dr. Wilson's opinion
was unreliable as inconsistent with his treatment notes.
With this, the magistrate judge issued a Report &
Recommendation ("R&R") finding that substantial evidence did not
support the ALJ's denial of benefits, and therefore recommended
reversing the Commissioner's decision and remanding the case to
the ALJ for further development of the facts related to
- 8 - Sacilowski's medical impairments, in particular her migraines and
bladder condition, and their impact on Sacilowski's potential
absenteeism. The magistrate judge found that the ALJ had "not
directly address[ed] Dr. Wilson's opinion regarding [Sacilowski's]
probable absenteeism, or [her] self-reports and the medical
records documenting multiple migraine headaches per week," and
although the ALJ "discuss[ed] some of this evidence," he "never
directly addresse[d] the credibility of the reported frequency or
the impact of such migraines on [Sacilowski's] attendance and
ability to sustain fulltime employment." To that end, he noted
that although the "state agency consulting physicians had access
to the majority of medical records documenting [Sacilowski's]
migraine history, they completed a physical RFC assessment that
did not specifically assess the issue of absenteeism." As to
Sacilowski's bladder ailments, the magistrate judge found that the
ALJ's determination that they were "non-severe" was based on
opinions from state agency physicians rendered on October 20, 2015
and January 6, 2016, even though it was "undisputed that
[Sacilowski's] bladder issues required ongoing treatment
throughout 2016." He therefore recommended that the "updated
medical evidence should be further evaluated by a medical expert
to determine if the bladder conditions meet the Step 2 severity
threshold and duration requirement, and for further consideration
- 9 - of the functional limitations arising out of [Sacilowski's]
urinary issues."
On March 29, 2019, Sacilowski filed a limited objection
to the magistrate judge's R&R, requesting that benefits "be awarded
on the record as it stands," or "that the remand order include a
direction that it be assigned to a different ALJ." The
Commissioner filed no objection.
This next went to the district court, which agreed with
the magistrate judge's findings, but diverted on the final outcome,
where it bypassed the need for further fact-finding and instead on
April 8, 2019, found Sacilowski "disabled and awarded benefits."
The Commissioner filed a motion for reconsideration; the district
court denied this, stating that the record and law fully supported
its finding in favor of Sacilowski. The Commissioner timely
appealed, asking this court to reverse the district court's
judgment and order that reversed the Commissioner's decision and
awarded Sacilowski benefits, and "remand[] for further
administrative proceedings."
After oral argument in this appeal, we remanded the case
to the district court for elaboration on its findings, to enable
our "meaningful appellate review," Supermercados Econo, Inc. v.
Integrand Assurance Co., 375 F.3d 1, 3 (1st Cir. 2004), and the
district court entered a fleshed out order on February 12, 2020.
The district court explained that the ALJ had
- 10 - failed to adequately account for limitations related to [Sacilowski's] migraines and bladder problems in her [RFC] Assessment. Specifically, the ALJ failed to address the issue of absenteeism by [Sacilowski] due to the frequency and impact of migraines on her as documented by her treating primary care physician [who] . . . opined that [Sacilowski's] symptoms would be severe enough to cause more than four absences from work per month and the Vocational Expert . . . testified at a hearing before the ALJ that absences of four times a month would rule out full-time competitive employment. Without good cause, the [ALJ] did not give substantial weight to this evidence. A remand was thus unnecessary as the evidence before the ALJ established that [Sacilowski] was disabled and entitled to benefits.
Order at 2, Sacilowski v. Saul, No. 18-CV-0001-JJM-LDA (D.R.I.
Feb. 12, 2020). The parties submitted supplemental briefs in
response to this district court order.
On appeal, the parties do not dispute that a remand is
necessary. But they dispute what should happen upon remand:
whether, as the Commissioner argues, the ALJ should be required to
conduct further fact-finding into Sacilowski's alleged disability,
or, as Sacilowski urges, the Commissioner should award Sacilowski
benefits for the Relevant Time Period. The Commissioner contends
that the district court did not have the "overwhelming evidence"
needed to support a finding of disability and award benefits, and
therefore unresolved factual issues warrant further development on
remand. In particular, he argues that "there [i]s conflicting
evidence in the record regarding Sacilowski's migraines," evidence
- 11 - on the severity of the bladder ailments requires "further
development," and Dr. Wilson's opinion contained "little specific
support or explanation for his extreme opinion."
Sacilowski responds that there was "overwhelming
evidence" to support the award of benefits and seeks affirmance of
the district court's order.3 Sacilowski relies on testimony from
the ALJ hearing, Dr. Wilson's opinions, and medical reports on her
migraines and bladder ailments. Sacilowski argues that the ALJ
erred in finding that she could work despite the severity and
frequency of her migraines and her bladder ailments were not severe
based on the outdated RFC determinations.
STANDARD OF REVIEW
We now dig into the parties' arguments and the full
record before us, reviewing the district court's reversal de novo,
and "use the same standard to review the correctness of the
Commissioner's decision as does the district court: that is,
whether the final decision is supported by substantial evidence
and whether the correct legal standard was used." Seavey, 276
F.3d at 9 (citing 42 U.S.C. § 405(g)); see also Ward v. Comm'r of
Social Security, 211 F.3d 652, 655 (1st Cir. 2000). We
3 Sacilowski argues, in the alternative, that if this court remands for further fact-finding by an ALJ, it should reassign the case to a different ALJ. Because we affirm the district court's award of benefits, this point is moot.
- 12 - determin[e] whether the ALJ deployed the proper legal standards and found facts upon the proper quantum of evidence[;] . . . [t]he ALJ's findings of fact are conclusive when supported by substantial evidence, 42 U.S.C. § 405(g), but are not conclusive when derived by ignoring evidence, misapplying the law, or judging matters entrusted to experts.
Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999) (citation
omitted).
Under the Social Security Act, courts are empowered "to
enter, upon the pleadings and transcript of the record, a judgment
affirming, modifying, or reversing the decision of the
Commissioner of Social Security, with or without remanding the
cause for a rehearing." 42 U.S.C. § 405(g); Seavey, 276 F.3d at
8-9; Garrison v. Colvin, 759 F.3d 995, 1019 (9th Cir. 2014)
("[E]very Court of Appeals has recognized that in appropriate
circumstances courts are free to reverse and remand a determination
by the Commissioner with instructions to calculate and award
benefits" (awarding benefits and citing Seavey and comparable
cases from other circuits)). "Courts have generally exercised
this power when it is clear from the record that a claimant is
entitled to benefits." Garrison, 759 F.3d at 1019; see also
Seavey, 276 F.3d at 11-12.
OUR TAKE
We find that there is ample evidence in the record,
particularly related to the severity and frequency of her migraine
- 13 - headaches and worsening bladder ailments,4 to render Sacilowski
disabled for the Relevant Time Period and justify an award of
benefits.
We start with the migraine headaches. To the ALJ,
Sacilowski testified that she experienced migraine headaches two
to three times a week and upon onset they lasted "a day and a half
or so" and caused her to "stay in [her] room . . . put something
over [her] eyes, [and] lie down" each time. She explained that
they became so severe that, towards the end of 2014, she had been
prescribed Botox injections for relief. And Sacilowski's medical
records confirm this. They show that she was experiencing chronic
migraines as early as March 2014. At an appointment with a
neurologist in September 2014, she reported severe migraine
headaches that occurred "20-25x per month . . . [sometimes]
multiple headaches in the same day, but sometimes one per day,"
and "about 4x per month" they could last from "a few hours up to
3 days," and would leave her immobilized. Her severe migraines at
that time were accompanied by nausea and sensitivity to light and
exertion. Her medical records confirm that in January 2015, she
was receiving Botox shots for her migraines, but they were yet to
4While we find the severity and frequency of Sacilowski's migraine headaches on their own enough to render Sacilowski disabled during the Relevant Time Period, we include a discussion of her deteriorating bladder ailments which were progressively making her overall condition worse during the same time frame.
- 14 - be effective. As of July 21, 2015, Dr. Griffith, a neurologist,
noted that Sacilowski was experiencing three to four migraines per
week and that "she had Botox in May and it [had] helped some."
Dr. Griffith shared this finding with Dr. Wilson, Sacilowski's
treating physician, describing the migraines as "frequent, chronic
and refractory." On August 12, 2015, Sacilowski followed up with
Dr. Wilson and reported that her migraines were "down since
starting Botox," and Dr. Wilson described her migraines as
"stable." As of February 16, 2016, she reported to Dr. Wilson
that her "migraines [were] about the same, meds had been adjusted,
still getting [B]otox per routine at neuro." On March 23, 2016,
neurologist Dr. Gordon noted that Sacilowski's "headaches seem to
get better for about two and half months after Botox, but the last
two weeks [had] been quite difficult for her with migraines every
day," and in fact she had a migraine on the day of that visit to
Dr. Gordon. And in a report on August 3, 2016, another
neurologist, Dr. Hickey, noted that the Botox "helps [Sacilowski]
– gets headache 2-3 migraines a week on this" and that the
"headaches had not changed in quality."
Sacilowski also testified to the ALJ about her bladder
ailments, including difficult-to-manage frequency and urgency
related to, and pain while, urinating. She testified that she
endured "bladder injections" every two weeks for the pain from Dr.
Rardin, a urogynecologist, who had been treating her since March
- 15 - 2016. And her medical records confirm not only this testimony,
but that her bladder ailments were plaguing her as early as May
2015. On a visit to Dr. Wilson on May 14, 2015, Sacilowski reported
that she was "urinating more than normal" and that she had "pain
in her front lower abdomen" before urinating, and "pain while
urinating," all of which she had been experiencing "for about a
year" at that point. Sacilowski's bladder leakage worsened over
the course of 2016, occurring up to one to two times per day:
Records from August 4, August 17, and September 15, 2016 show this.
They also show that her bladder injections had started on August
4, 2016, that she had three of these procedures over the course of
six weeks, and that she was still on occasion unable to reach the
bathroom in time for relief.
The record also includes multiple reports from Dr.
Wilson, Sacilowski's treating physician, who coordinated her
treatment with other physicians, such as neurologists for her
migraines and urologists for her bladder issues. The various
medical reports from Dr. Wilson in the record also indicate that
he reviewed and was familiar with Sacilowski's family, social, and
medical history; medication list; allergy history; and problem
list.
The record also contains Dr. Wilson's answers to four
separate medical questionnaires from February 13, August 19, May
15, and November 14, 2014. Though these fall before the Relevant
- 16 - Time Period, they evince Sacilowski's progressively deteriorating
condition and resultant inability to work.5 They indicate mild to
significant functional limitations as early as February 2014,
including but not limited to the following activities for which
limitations persisted through all four questionnaires: "standing," "walking,"
"sitting," "handling/feeling/manipulating," "ability to perform at a
consistent pace," "ability to maintain concentration," and "ability to
perform activities within a schedule and maintain regular
attendance." Dr. Wilson also opined in these forms as to
Sacilowski's ability to "engage in employment, education, or
skills training," finding that in February 2014 she could engage
in such activity for "[less than] 10" hours per week and "[less
than] 4" hours per day. By November 2014, these numbers were down
to "0-2" hours per week and per day. And on September 1, 2016,
Dr. Wilson completed a physical capacity questionnaire in which he
made the following findings: Sacilowski could sit for one to two
hours and stand and walk up to 15 minutes each in an eight-hour
day; Sacilowski would need to lie down for two to four hours in an
eight-hour day; and Sacilowski would miss more than four days of
5 The Commissioner contends that because "Dr. Wilson concluded that Sacilowski's symptoms had only existed at the severity indicated in his opinion since August 1, 2016," his opinion cannot support an award of benefits for the entire Relevant Time Period. But Dr. Wilson's earlier answers to the 2014 medical questionnaires make clear that Sacilowski's condition was debilitating even before the Relevant Time Period, and deteriorating throughout it.
- 17 - work a month. According to this questionnaire, these "symptoms
and limitations" applied as early as August 1, 2016. And recall
that the VE testified to the ALJ that regular absences of even
once a month would likely preclude full-time competitive
employment.
The Commissioner does not provide any evidence to rebut
any of the foregoing. The record contains no evidence to directly
contradict Sacilowski's testimony about her ailments and their
frequency and severity, nor the medical reports supporting them.
The Commissioner argues that there is "conflicting evidence in the
record regarding Sacilowski's migraines," and that "there is also
evidence suggesting that Sacilowski's migraines were not disabling
during the [Relevant Time Period]." But the "evidence" he cites
is unpersuasive. He argues that "Sacilowski's physicians []
concluded in July 2015, March 2016, and August 2016 that Botox had
reduced the frequency of her migraines," but does not provide any
evidence that a reduction in frequency mitigated the severity of
the migraines, nor their debilitating effects. The Commissioner
also claims that the "state agency physicians, who considered
Sacilowski's impairments including migraines, found she could
perform a range of light work and did not specify a need for
absences due to migraines or other impairments." However, and as
the magistrate judge pointed out, there is no indication in the
record that the state agency physicians were ever asked to even
- 18 - consider Sacilowski's impairments' impact on absences. We
therefore find that the Commissioner has provided no "contrary
evidence," Seavey, 276 F.3d at 11, to directly rebut any of the
multiple pieces of evidence that comprise the substantial and
"overwhelming" evidence, id., of disability in this case. See,
e.g., Gonzalez Maldonado v. Sec'y of Health & Human Servs., 996
F.2d 1209, *3 (1st Cir. 1993) ("[S]ince there are no contrary
medical reports as to the severity of claimant's mental impairment,
the ALJ's finding that there was no evidence to support allegations
of a significant emotional illness in the relevant period is not
supported by substantial evidence.")
And as to the bladder issues, the ALJ found the ailment
to be "non-severe" based on opinions from the state agency
physicians rendered on October 20, 2015 and January 6, 2016, before
Sacilowski's bladder condition had significantly worsened, and
ignored other medical reports, available in the record, supporting
her progressively deteriorating bladder ailments. But even a
finding of non-severity does not relieve an ALJ of his obligation
to consider a non-severe impairment's impact on a claimant's
overall medical condition. See Stephenson v. Halter, No. Civ. 00-
391-M, 2001 WL 951580, at *2 (D.N.H. Aug. 20, 2001) (finding the
ALJ required to "consider the combined effect of all . . .
impairments without regard to whether any such impairment, if
considered separately, would be of sufficient severity" (quoting
- 19 - 40 C.F.R. § 404.1523)); SSR 96–8p, 1996 WL 374184 at *5 (July 2,
1996) ("In assessing RFC, the adjudicator must consider
limitations and restrictions imposed by all of an individual's
impairments, even those that are not 'severe.' While a 'not
severe' impairment(s) standing alone may not significantly limit
an individual's ability to do basic work activities, it may --
when considered with limitations or restrictions due to other
impairments -- be critical to the outcome of a claim."). Reviewing
the record afresh as we do, we find that Sacilowski's bladder
impairment would have exacerbated her overall and already-
debilitated medical condition, further supplementing the
"overwhelming" evidence of disability here. Seavey, 276 F.3d at
11.
The Commissioner also discredits Dr. Wilson's opinions,
in particular the September 1, 2016 finding of absenteeism,
claiming that it was disconnected from Sacilowski's migraine
headaches and otherwise inconsistent with Dr. Wilson's
determinations that certain of Sacilowski's medical conditions
were "normal."6 But the Commissioner provides no reason why such
6 The Commissioner explains: "For example, in August 2015, the doctor observed that Sacilowski's strength, coordination, and gait were normal. Dr. Wilson also found in February 2016 that Sacilowski's neck and musculoskeletal range of motion, coordination, and reflexes were normal. Four months later, the doctor assessed that Sacilowski's neurological examination was grossly normal. Moreover, one month before he completed his
- 20 - findings by Sacilowski's treating physician, combined with Dr.
Wilson's previous absenteeism determinations from 2014, contradict
his 2016 absenteeism finding. For one, a claimant may have the
capacity to engage in certain daily, "home activities," Garrison,
759 F.3d at 1016, but still be unable to function in a workplace
environment. See id. ("ALJs must be especially cautious in
concluding that daily activities are inconsistent with testimony
about pain, because impairments that would unquestionably preclude
work and all the pressures of a workplace environment will often
be consistent with doing more than merely resting in bed all
day."). And Dr. Wilson's longtime familiarity with Sacilowski and
her ailments allows us to find that his absenteeism determination
reinforces the already-"overwhelming" evidence of disability in
this case. See Purdy v. Berryhill, 887 F.3d 7, 13 (1st Cir. 2018)
("The relevant legal standard for a claim filed before March 27,
2017 (as [Sacilowski's] was) is the rule that a treating
physician's opinion is controlling if it is 'well-supported by
medically acceptable clinical and laboratory diagnostic techniques
and is not inconsistent with the other substantial evidence in
[the] case record.' And even if not deemed controlling, a treating
physician's opinion is entitled to weight that reflects the
physician's opportunity for direct and continual observation."
opinion, Dr. Wilson concluded that Sacilowski's gait appeared normal, and her neurological examination was grossly normal."
- 21 - (quoting 20 C.F.R. § 416.927(c)(2)) (second alteration in
original)).
Finally, the Commissioner disregarded "Sacilowski's own
allegations [as] not enough to establish disability," but he gives
us neither any evidence to directly rebut Sacilowski's testimony
(which was corroborated by her husband), nor any reason to question
its credibility, and so we take her statements as true. See Da
Rosa v. Sec'y of Health & Human Servs., 803 F.2d 24, 26 (1st Cir.
1986) (finding that an ALJ's decision to discredit testimony "must
be supported by substantial evidence and the ALJ must make specific
findings as to the relevant evidence he considered in determining
to disbelieve the [claimant]"); Nguyen, 172 F.3d at 35–36; see
also Garrison, 759 F.3d at 1019 ("[W]here there are no outstanding
issues that must be resolved before a proper disability
determination can be made, and where it is clear from the
administrative record that the ALJ would be required to award
benefits if the claimant's excess pain testimony were credited, we
will not remand solely to allow the ALJ to make specific findings
regarding that testimony. Rather, we will . . . take that
testimony to be established as true." (quoting Varney v. Sec'y of
Health & Human Servs., 859 F.2d 1396, 1401 (9th Cir. 1988)).
Having reviewed the full record, comprising the
transcript of the ALJ hearing, the ALJ's decision, the full
administrative record that includes employment and medical records
- 22 - from 2013 through September 9, 2016, the transcript of the
magistrate judge hearing, the magistrate judge's R&R, and the
district court's orders, we find that the severity and frequency
of Sacilowski's migraine headaches and bladder ailments would have
caused her to be absent from work at least once a month during the
Relevant Time Period, which, according to the VE's testimony, would
have precluded full-time competitive employment. We therefore
find that there is "overwhelming" evidence in the record to support
a finding of disability and an award of benefits, see Seavey, 276
F.3d at 11-12; see also Holohan v. Massanari, 246 F.3d 1195, 1210
(9th Cir. 2001) ("[A] remand for further proceedings is unnecessary
if the record is fully developed and it is clear from the record
that the ALJ would be required to award benefits."); Davis v.
Shalala, 985 F.2d 528, 534 (11th Cir. 1993) ("This court . . .
[may] remand the case for an entry of an order awarding disability
benefits where the Secretary has already considered the essential
evidence and it is clear that the cumulative effect of the evidence
establishes disability without any doubt."); Garrison, 759 F.3d at
1023, and so we affirm the district court's order.
Costs to Appellee.
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