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King v. Berryhill

United States District Court, M.D. Alabama, Northern Division

January 16, 2018

ANGELA M. KING, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner, Social Security Administration, Defendant.



         On June 12, 2013, Plaintiff Angela M. King applied for supplemental security income under Title XVI of the Social Security Act, alleging a disability onset date of January 1, 2013. King's applications were denied at the initial administrative level. King then requested a hearing before an Administrative Law Judge (“ALJ”). On November 14, 2014, the ALJ held a hearing and on April 21, 2015, he denied King's claim. King requested a review of the ALJ's decision by the Appeals Council, which denied her request on September 9, 2016. As a result, the ALJ's decision became the final decision of the Commissioner of the Social Security Administration (the “Commissioner”) as of September 9, 2016.

         The case is now before the court for review pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Under 28 U.S.C. § 636(c)(1) and Rule 73 of the Federal Rules of Civil Procedure, the parties have consented to the full jurisdiction of the undersigned United States Magistrate Judge. Based on a careful review of the parties' submissions, the relevant law, and the record as a whole, the court concludes that the decision of the Commissioner is due to be REVERSED and this matter REMANDED for further proceedings consistent with this opinion.


         The court reviews a Social Security appeal to determine whether the Commissioner's decision “is supported by substantial evidence and based upon proper legal standards.” Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997). The court will reverse the Commissioner's decision if it is convinced that the decision was not supported by substantial evidence or that the proper legal standards were not applied. Carnes v. Sullivan, 936 F.2d 1215, 1218 (11th Cir. 1991). The court “may not decide the facts anew, reweigh the evidence, or substitute its judgment for that of the Commissioner, ” but rather “must defer to the Commissioner's decision if it is supported by substantial evidence.” Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1997) (citation and internal quotation marks omitted). “Even if the evidence preponderates against the Secretary's factual findings, [the court] must affirm if the decision reached is supported by substantial evidence.” Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990). Moreover, reversal is not warranted even if the court itself would have reached a result contrary to that of the factfinder. See Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991).

         The substantial evidence standard is met “if a reasonable person would accept the evidence in the record as adequate to support the challenged conclusion.” Holladay v. Bowen, 848 F.2d 1206, 1208 (11th Cir. 1988) (quoting Boyd v. Heckler, 704 F.2d 1207, 1209 (11th Cir. 1983)). The requisite evidentiary showing has been described as “more than a scintilla, but less than a preponderance.” Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). The court must scrutinize the entire record to determine the reasonableness of the decision and cannot “act as [an] automaton[] in reviewing the [Commissioner's] decision.” Hale v. Bowen, 831 F.2d 1007, 1010 (11th Cir. 1987). Thus, the court must consider evidence both favorable and unfavorable to the Commissioner's decision. Swindle v. Sullivan, 914 F.2d 222, 225 (11th Cir. 1990).

         The court will reverse the Commissioner's decision on plenary review if the decision applies incorrect law or fails to provide the court with sufficient reasoning to determine that the Commissioner properly applied the law. Id. (citing Keeton v. Dep't of Health & Human Servs., 21 F.3d 1064, 1066 (11th Cir. 1994)). There is no presumption that the Commissioner's conclusions of law are valid. Id.


         To qualify for disability benefits, a claimant must show the “inability 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); 42 U.S.C. § 416(i). A physical or mental impairment is “an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrated by medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3). King bears the burden of proving that she is disabled, and she is responsible for producing evidence to support her claim. See Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003).

         A determination of disability under the Social Security Act requires a five-step analysis. 20 C.F.R. § 404.1520(a). The Commissioner must determine in sequence:

(1) Is the claimant presently unable to engage in substantial gainful activity?
(2) Is the claimant's impairment(s) severe?
(3) Does the claimant's impairment(s) satisfy or medically equal one of the specific impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?
(4) Is the claimant unable to perform her former occupation?
(5) Is the claimant unable to perform other work given her residual functional capacity, age, education, and work experience?

See Frame v. Comm'r, Soc. Sec. Admin., 596 F. App'x 908, 910 (11th Cir. 2015). “An affirmative answer to any of the above questions leads either to the next question, or, on steps three and five, to a finding of disability. A negative answer to any question, other than step three, leads to a determination of ‘not disabled.'” McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986) (quoting 20 C.F.R. § 416.920(a)-(f)). “Once the finding is made that a claimant cannot return to prior work the burden of proof shifts to the Secretary to show other work the claimant can do.” Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir.1995) (citing Gibson v. Heckler, 762 F.2d 1516 (11th Cir. 1985)).


         King was 37 years old at the time of the ALJ's decision. R. 105. She is single with three children, but lives without her children in a boarding house for people with developmental disabilities in Montgomery, Alabama. R. 64. She did not complete high school but attended special education classes through the eleventh grade. R. 48-49. She claims to suffer from schizophrenia, depression, arthritis, and fibromyalgia. R. 46. In the past, King worked as a cashier, an assembler, a cook, and a poultry worker. R. 37, 89, 215 & 217. She last worked as an assembler at STS Filing and at a chicken-processing plant in 2012. R. 32 & 203.

         Following an administrative hearing, the ALJ found that King did not suffer from any severe impairments in isolation, but that the following combination of her impairments is “possibly severe” under 20 C.F.R. § 404.1520(c): “status post hydrothermal endometrial ablation and questionable Fibromyalgia, questionable schizophrenia, paranoid type; generalized anxiety disorder, not otherwise specified; dissociative disorder, not otherwise specified; and depressive disorder, not otherwise specified (20 CFR 416.920(c)).” R. 28. However, the ALJ concluded at step three of the analysis that King's impairments, even in combination, did not meet or medically equal the severity of any of the impairments listed in the applicable regulations. R. 29. The ALJ further found, at steps four and five, that King has the residual functional capacity (“RFC”) to perform light work, [1]

except the claimant can stand and/or walk at least two hours without interruption and a total of at least six hours over the course of an eight-hour workday. The claimant can sit at least two hours without interruption and a total of at least six hours over the course of an eight-hour workday. The claimant cannot climb ladders, ropes, poles or scaffolds. The claimant can occasionally climb ramps and stairs. The claimant can frequently use her upper extremities for reaching overhead. The claimant can frequently use her lower extremities for pushing, pulling and the operation of foot controls. The claimant can frequently balance, stoop, kneel and crouch. The claimant can occasionally crawl. The claimant can occasionally work in humidity, wetness, and extreme temperatures. The claimant cannot work in poorly ventilated areas. The claimant cannot work at unprotected heights. The claimant cannot work with operating hazardous machinery. The claimant can frequently work while exposed to vibration. The claimant cannot operate motor vehicles. The claimant can perform simple, routine and repetitive work activity with the following exceptions. The claimant cannot perform work activity that requires her response to rapid and/or frequent multiple demands. The claimant can respond appropriately to supervision; however, she is better suited for and can perform work activity requiring only occasional supervision. The claimant can frequently interact with coworkers so long as interaction is casual. The claimant is limited to work activity that does not require interaction with the public.

R. 30. Ultimately, the ALJ concluded that King could perform both her past relevant work as an assembler and other jobs that exist in the national economy. R. 37. He therefore concluded that King was not disabled within the meaning of the Social Security Act from June 12, 2013 through the date of his decision, and he denied King's claim. R. 38.

         On May 7, 2014, Sreelekha Banerjee, M.D., King's treating physician, completed a report of his opinions regarding King's limitations. Overall, Dr. Banerjee observed that King's limitations with regard to several areas of mental functioning were “extreme, ” which is defined as a “complete loss of ability in the named activity” such that the individual “cannot sustain performance during an 8-hour workday.” R. 344-45. Dr. Banerjee indicated that King's limitations were extreme in the following categories of functioning: impaired ability to relate to others; restriction of activities of daily living; and the ability to maintain concentration, pace, and attention for periods of at least two hours. R. 344. Dr. Banerjee also observed that King's limitations were extreme with respect to her ability to follow directions, respond appropriately with supervisors and coworkers, handle customary work pressures, respond appropriately to changes in the work environment, and use good judgment on the job. R. 344. Finally, Dr. Banerjee found that King suffered extreme limitations in performing complex, repetitive, or varied tasks and behaving in an emotionally stable manner. R. 345. Ultimately, Dr. Banerjee diagnosed King with schizophrenia, paranoid type; depressive disorder; and generalized anxiety disorder. See R. 343.

         Dr. Banerjee regularly treated King at the Montgomery Area Mental Health Authority. On May 17, 2013, Dr. Banerjee noted that King was “doing well” with the psychotropic medications she was prescribed, but that she was having trouble sleeping. R. 288. Otherwise, King reported no side effects from her medication, no hallucinations or paranoia, and no suicidal or homicidal ideation. R. 288. Similarly, King had no side effects, delusions, paranoia, or suicidal or homicidal ideations in February of 2013, although Dr. Banerjee did record that her insight was “poor” and her judgment “impaired.” R. 290.

         On August 22, 2013, Dr. Alan M. Babb examined King at his office in Montgomery. R. 303. Dr. Babb had not been provided with any of King's prior medical records, but noted that she reported having been diagnosed with schizophrenia. R. 303. Most of Dr. Babb's physical findings were unremarkable, though he recorded that King was “very reserved, withdrawn, and depressed.” R. 304. Dr. Babb's impressions included a psychiatric disorder, depression, and an anxiety disorder. R. 305. He concluded by stating that King's case would “be judged on psychiatric reasons and not for any specific medical reasons” and that the mental health records “need to be obtained to be able to give a clearer and precise history of what mental health issues [King] has and what their expectations are.” R. 306.

         Two days later, on August 24, King was referred to Dr. Kristin R. Tubre, a licensed clinical psychologist. R. 309. Dr. Tubre first noted that King “may not have put forth adequate effort” and might have “exaggerated her symptoms” during her examination and interview. R. 309. Therefore, Dr. Tubre's findings with regard to King's level of functioning should be “interpreted with caution.” R. 309. King reported to Dr. Tubre that she was diagnosed with schizophrenia in 2012 and had hallucinations, crying spells, isolation, paranoia, and a split personality. R. 310. Her hallucinations included a person named “Christine” and several small children. R. 310. King spoke to them during the interview. R. 310. She reported that her psychotropic medications did not decrease the hallucinations and that her medications caused her to be lethargic. R. 310. King reported having been sexually abused by her father as a child, as she also reported to both Dr. Babb and Dr. Banerjee. R. 310. King stated that she lived with a “male friend” who helped her care for herself, and that she depended “heavily on her friend for assistance with hygiene and food.” R. 311. She nevertheless testified at the hearing that she lived at a boarding house for people with developmental disabilities, that the male friend did not live with her, and that only her family cared for her. R. 74.

         Dr. Tubre found that King's “thought processes were not within normal limits, ” and that she displayed difficulty with thought content and interpreting proverbial statements. R. 311. She also struggled with attention and concentration and with spelling certain words forward and backward. R. 311. Her short-term memory was “impaired” and her “level of cognitive ability appeared to be in the borderline range of intellectual functioning.” R. 312. Dr. Tubre noted that, during the examination, King's mood fluctuated and she reported experiencing both auditory and visual hallucinations. R. 312. Ultimately, Dr. Tubre concluded that, despite the fact that King may have exaggerated her symptoms, she is “moderately to severely impaired” in her ability to comprehend, remember, and carry out instructions as well as to “respond appropriately to supervision, co-workers and work pressures in a work setting.” R. 312. Her diagnostic impressions where that King had paranoid-type schizophrenia and fibromyalgia. R. 312. Dr. Tubre concluded by recommending additional psychological testing “to rule out malingering.” R. 312.

         King also saw Dr. Albert Lester in 2013 and 2014. These records, however, are almost entirely illegible, with the exception of a few individual words. See R. 348-54. Thus, the court is able to discern little of significance from Dr. Lester's treatment notes, and encourages King's counsel to submit records that are legible (and preferably typewritten) in the future to aid the court in its review. In her brief, King represents to the court that Dr. Lester diagnosed her with fibromyalgia and prescribed Lortab and Lyrica to treat her pain. See Doc. 12 at 5-6.


         King presents three issues on appeal: (1) that the ALJ erred by improperly acting as both judge and physician; (2) that the ALJ failed to provide King with a full, fair, and unbiased evaluation of her claim; and (3) that the Appeals Council erred by denying King's request for review in light of the additional medical evidence she submitted. Because the court agrees with each of ...

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