Robert H. DESROSIERS, Plaintiff-Appellant, v. SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant-Appellee

PREGERSON, Ciruit Judge,

concurring:

I concur, but wouldadd the following to the discussion of the Medical-Vocational Guidelines.

Initially, a claimant bears he burden of proving that he or she is disabled. Howard v. Heckler, 782 F.2d 1484, 1486 (9th Cir.1986). A claimant makes a prima facie showing of disability by proving that he or she cannot perform his or her past work. Gallant v. Heckler, 753 F.2d 1450, 1452 (9th Cir.1984). Once this is shown, the burden of proof shifts to the Secretary to show that the claimant can perform “other work” considering his or her residual func- tional capacity, age, education, and work experience. Id. at 1456 . The “other work” *578 must be available in the national economy in “significant numbers,” 20 C.F.R. § 404.1560 (b)(3) (1987), but the opportunities may lie either in the region where the claimant lives or in several other regions in the country, § 404.1566(a). The full five-step process of determining disability is described at 20 C.F.R. § 404.1520 .

Desrosiers made a prima facie showing of disability by proving that he was not capable of performing his past work. As a result, the burden shifted to the Secretary to show that Desrosiers was not disabled because he could perform other work in the national economy. There are two ways that the Secretary can make such a showing: (1) The Secretary can take the testimony of a vocational expert, and (2) the Secretary can use the Medical-Vocational Guidelines.

Before 1978, the Secretary always used vocational experts to establish the availability of suitable jobs in the national economy. Heckler v. Campbell, 461 U.S. 458, 461 , 103 S.Ct. 1952, 1954 , 76 L.Ed.2d 66 (1983). Vocational experts were, and still are, used in the following manner. The vocational expert is called to testify at a disability hearing. At the hearing, the AU uses a series of hypothetical questions to “set out all of the claimant’s impairments” for the vocational expert’s consideration. Gamer v. Secretary of Health & Human Services, 815 F.2d 1275, 1279 (9th Cir.1987) (citation omitted). The AU’s depiction of the claimant’s disability must be accurate, detailed, and supported by the medical record. Id. at 1279-80 ; Gallant, 753 F.2d at 1456 . The AU is responsible for resolving questions of credibility when there is conflicting medical evidence. Gamer, 815 F.2d at 1280 . The vocational expert is then called upon to “translate[ ] factual scenarios in to realistic job market probabilities” by testifying, on the record, to what kinds of jobs the claimant still can perform and whether there is a sufficient number of those jobs available in the claimant’s region or in several other regions of the economy to support a finding of “not disabled.” Id. (citing Sample v. Schweiker, 694 F.2d 639, 643 (9th Cir.1982)).

In 1978, the Secretary adopted a matrix system (the Medical-Vocational Guidelines) for disposing of cases that involve substantially uniform levels of impairment. 20 C.F.R. pt. 404, subpt. P, app. 2 (1987). The Medical Vocational Guidelines in table form (these tables are commonly referred to as “the grids”) present various combinations of the factors the Secretary must consider in determining the availability of other work. These factors include residual functional capacity, age, education, and work experience. For each combination, the tables direct a finding of either “disabled” or “not disabled.” See id. This generalized approach encourages the Secretary to treat like cases alike and to streamline the administrative process. Campbell, 461 U.S. at 461-62 , 103 S.Ct. at 1954-55 .

Because the tables are merely an administrative tool to resolve individual claims that fall into standardized patterns, there are strict limits on when the Secretary may rely on the Guidelines. “[T]he AU may apply the Secretary’s medical-vocational guidelines (the grids) in lieu of taking the testimony of a vocational expert only when the grids accurately and completely describe the claimant’s abilities and limitations.” Jones v. Heckler, 760 F.2d 993, 998 (9th Cir.1985) (emphasis added); see also Kail v. Heckler, 722 F.2d 1496, 1497-98 (9th Cir.1984). 1116 grids may be used as a reference point for decisionmaking when they do not accurately and completely describe a claimant’s residual functional capacity, age, education, or work experience. However, under those circumstances “the Secretary may not rely on the grids alone to show the availability of jobs for the claimant.” Jones, 760 F.2d at 998 . The Secretary must also hear the testimony of a vocational expert. Perminter v. Heckler, 765 F.2d 870, 872 (9th Cir.1985). When the Secretary is required to call a vocational expert, the Guidelines “provide an overall structure” and a "frame of reference” within which the vocational expert must evaluate and the AU must decide individual cases. 20 C.F.R. pt. 404, subpt. P, app. 2, § 200.00(d) (1987). If either a vocational expert’s testimony or an AU’s decision appears to be inconsistent with the *579 overall structure provided by the Guidelines, a claimant may challenge the testimony or the decision on that basis.

A claimant’s disability level may fail to fit within the Guidelines in one of two ways. The Guidelines contain three tables: One for claimants who can perform “sedentary work,” 20 C.F.R. pt. 404, subpt. P, app. 2, table 1 (1987); one for claimants who can perform “light work,” id. table 2; and one for claimants who can perform “medium work,” id. table 3. There is no table for claimants who can perform “heavy work” because “an impairment which does not preclude heavy work (or very heavy work) would not ordinarily be the primary reason for unemployment, and generally is sufficient for a finding of not disabled, even though age, education, and skill level of prior work experience may be considered adverse.” 20 C.F.R. pt. 404, subpt. P, app. 2, § 204.00 (in short, anyone who can perform heavy work, as that category is defined by the social security system, is probably employable). Each table’s designated level of work capacity has a technical definition that is phrased in terms of strength limitations. See 20 C.F.R. § 404.1567 . 1 If a claimant’s strength limitations differ from the technical definitions of sedentary, light, or medium work — for example the claimant falls somewhere between sedentary and light work — then the claimant is said to have exertional limitations that are not described by the grids. 20 C.F.R. pt. 404, subpt. P, app. 2 § 200.00(d), (e) (1987). If a claimant has an impairment that limits his or her ability to work without directly affecting his or her strength, that claimant is said to have a non-exertional (not strength-related) limitation that is not covered by the grids. Id. Examples of non-exertional limitations are mental, sensory, postural, manipulative, or environmental (e.g. inability to tolerate dust or fumes) limitations. § 200.00(e). We have often noted that pain may be a non-exertional limitation. See, e.g., Howard, 782 F.2d at 1486 n. 1.

The Medical-Vocational Guidelines do not accurately and completely describe Desrosiers’ residual functional capacity to work because he suffers both pain and postural limitations not covered by the grids.

Pain may serve as either an exertional or a non-exertional limitation. Pain is an ex-ertional limitation when it directly affects a claimant’s strength (for example, when the neurological sensation of pain literally prevents a claimant’s muscles from lifting an object). Pain is a non-exertional limitation when it does not affect a claimant’s strength, but nonetheless affects a claimant’s ability to work (for example, when a claimant’s muscles enable him or her to lift an object, but the claimant is so distracted by the pain that he or she realistically cannot perform the work).

It is not necessary to decide whether Desrosiers’ pain limitations are exertional or non-exertional; in either case, they serve as limitations not covered by the Guidelines. The California workers’ compensation reports of Drs. Woodard and Gaskell indicate that Desrosiers will experience moderate to severe pain with prolonged lifting, bending, stooping, pulling, pushing, climbing, or virtually any sustained physical activity. The definition of light work used by the social security disability system includes this kind of repeated movement. If Desrosiers’ pain acts as a *580 strength limitation, then he does not have the strength capacity to perform the full range of light work. If his pain functions as a non-exertional limitation, then it was improper to use the Guidelines because Desrosiers’ non-exertional pain limitation significantly affects his ability to work and renders him unable to perform the full range of light work. Under either approach, the Guidelines do not accurately or completely describe Desrosiers’ disability.

Desrosiers also has non-exertional postural limitations not covered by the Guidelines. He cannot lift his left arm above ninety degrees. Nor can he repeatedly stoop or bend. Given the fact that light work under the social security disability system contemplates repeated lifting of ten pounds in any position, it is clear that Des-rosiers’ postural limitations also prevent him from performing the full range of light work.

On the basis of the medical record before the Secretary, Desrosiers can perform work that does not require prolonged lifting, bending, stooping, pulling, pushing, or climbing, and does not require the use of his left upper extremity above shoulder level. This residual functional capacity is not captured by the description of light work used in the Medical-Vocational Guidelines. At best, Desrosiers’ limitations place him somewhere between light and sedentary work. Therefore, the Guidelines should not have been applied, and the Secretary erred by using the Guidelines to declare that Desrosiers is not disabled and by failing to call a vocational expert.

The Secretary argues that Desrosiers can perform “light work” because he can perform some of the jobs that qualify as light work. This approach is not permissible.

The Secretary may base a finding of “not disabled” on the fact that a claimant can perform some, although not all, light work only if such a finding is supported by both the medical evidence and the testimony of a vocational expert. See Perminter, 765 F.2d at 872 ; Kail, 722 F.2d at 1497-98 . To make such a finding, however, the Secretary is required to call a vocational expert and hear testimony as to whether the claimant can perform enough light jobs in the national economy to warrant a finding of “not disabled.” See Kail, 722 F.2d at 1498 (emphasis added); 20 C.F.R. § 404.1560 (b)(3) (1987) (“If we find that you can no longer do the work you have done in the past, we will determine whether you can do other work (jobs) which exists in significant numbers in the nation’s economy.”). The reason for this requirement is that the Secretary may use the Medical-Vocational Guidelines to find that a claimant is not disabled only when the general categories of disability employed by the Guidelines — such as “sedentary work” or “light work” — accurately and completely describe the claimant’s physical limitations. 20 C.F.R. pt. 404, subpt. P, app. 2 § 200.00(d) (1987) (“If an individual’s specific profile is not listed within [the Medical-Vocational Guidelines], a conclusion of disabled or not disabled is not directed."); Jones, 760 F.2d at 998 (“The AU must not apply the [Medical-Vocational Guidelines] mechanically in borderline cases or where claimant’s possess limitations that are not factored into the guidelines.”). If a claimant’s limitations do not exactly coincide with the categories used by the Guidelines, the Secretary must take the testimony of a vocational expert to prove the existence of jobs in the national economy that the claimant can perform. Jones, 760 F.2d at 998 (“If the [Guidelines] fail accurately to describe a claimant’s particular limitations, the Secretary may not rely on the [Guidelines] alone to show the availability of jobs for the claimant.”). The Secretary may not avoid the process of consulting a vocational expert by using the Guidelines as though the claimant had the residual functional capacity for the full range of “light work” if in fact the claimant can perform only some types of light work.

Light work includes jobs that require the repeated lifting and carrying of up to ten pounds or the repeated pushing and pulling of arm or leg controls. The medical evidence and Desrosiers’ testimony demonstrate that he will experience moderate to severe pain with prolonged activity of this kind. Therefore, Desrosiers cannot per *581 form the full range of light work, and the use of the Guidelines to declare that Desro-siers was not disabled was improper.

. Sedentary work "involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met." 20 C.F.R. § 404.1567 (a) (1987).

Light work "involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities.” Id. § 404.1567(b).

Medium work "involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds." Id. § 404.1567(c).