United States District Court, N.D. Alabama, Middle Division
OWEN BOWDRE, CHIEF UNITED STATES DISTRICT JUDGE.
6, 2013, the claimant, Cynthia Robinson Perigo, applied for
disability insurance benefits under Title II of the Social
Security Act. The claimant alleged her disability began on
June 6, 2012, because of her rheumatoid arthritis,
fibromyalgia, left knee surgery, need of right knee surgery,
back problems, depression, anxiety, and swelling in the
wrists. The Social Security Agency denied the claim on
September 19, 2013. The claimant filed a request for a
hearing before an Administrative Law Judge, and the ALJ held
a hearing on April 15, 2015. (R. 21, 88, 104, 112).
decision dated August 21, 2015, the ALJ found that the
claimant was not disabled as defined by the Social Security
Act and was ineligible to receive Social Security benefits.
The Appeals Council denied the claimant's request to
review the ALJ's decision on December 27, 2016.
Consequently, the ALJ's decision became the final
decision of the Commissioner of Social Security. (R. 1-3,
43). The claimant has exhausted all of her administrative
remedies, and this court has jurisdiction pursuant to U.S.C.
§§ 405(g) and 1383(c)(3). For the reasons stated
below, this court REVERSES AND REMANDS the decision of the
Commissioner to the ALJ for reconsideration.
the ALJ's reasons for discrediting the claimant's
subjective complaints about the limiting effects of her pain
and mental impairments lack substantial
STANDARD OF REVIEW
standard for reviewing the Commissioner's decision is
limited. This court must affirm the ALJ's decision if he
applied the correct legal standards and if substantial
evidence supports his factual conclusions. See 42
U.S.C. § 405(g); Graham v. Apfel, 129 F.3d
1420, 1422 (11th Cir. 1997); Walker v. Bowen, 826
F.2d 996, 999 (11th Cir. 1987).
. . . presumption of validity attaches to the
[Commissioner's] legal conclusions, including
determination of the proper standards to be applied in
evaluating claims.” Walker, 826 F.2d at 999.
This court does not review the Commissioner's factual
determinations de novo. The court will affirm those
factual determinations supported by substantial evidence.
“Substantial evidence” is “more than a mere
scintilla. It means such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.”
Richardson v. Perales, 402 U.S. 389, 401 (1971).
court must keep in mind that opinions such as whether a
claimant is disabled, the nature and extent of a
claimant's residual functional capacity, and the
application of vocational factors “are not medical
opinions . . . but are, instead, opinions on issues reserved
to the Commissioner because they are administrative findings
that are dispositive of a case; i.e., that would direct the
determination or decision of disability.” 20 C.F.R.
§§ 404.1527(d), 416.927(d). Whether the claimant
meets a Listing and is qualified for Social Security
disability benefits is a question reserved for the ALJ, and
the court “may not decide facts anew, reweigh the
evidence, or substitute [its] judgment for that of the
Commissioner.” Dyer v. Barnhart, 395 F.3d
1206, 1210 (11th Cir. 2005). Thus, even if the court
disagrees with the ALJ about the significance of certain
facts, the court has no power to reverse that finding as long
as substantial evidence in the record supports it.
court must “scrutinize the record in its entirety to
determine the reasonableness of the [Commissioner]'s
factual findings.” Walker, 826 F.2d at 999. A
reviewing court must not only look to those parts of the
record that support the decision of the ALJ, but also must
view the record in its entirety and take account of evidence
that detracts from the evidence relied on by the ALJ.
Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir.
claimant's attempt to establish disability through
testimony about her pain and limiting effects of her
impairments must satisfy the Eleventh Circuit's pain
standard. The pain standard requires that the claimant have
an underlying medical condition that either (1) has objective
medical evidence supporting the severity of the pain the
condition causes or (2) the medical condition is of
such severity that it could reasonably be expected to cause
the claimant's pain. Holt v. Sullivan, 921 F.2d
1221, 1223 (11th Cir. 1991).
claimant may use subjective testimony to support her claim of
disability under the pain standard if substantial evidence
supports that testimony. Dyer v. Barnhart, 395 F.3d
1206, 1210 (11th Cir. 2005). In addition to the
claimant's testimony, the ALJ may also consider the
claimant's daily activities, treatment history, and other
relevant factors. Harwell v. Heckler, 735 F.2d 1292,
1293 (11th Cir. 1984); 20 C.F.R. §§ 404.1529(c)(3),
416.929(c)(3). The ALJ may consider the claimant's
ability to perform certain activities of daily living (ADLs),
as well as the impact of such activities on the
claimant's credibility. 20 C.F.R. §§ 404.1529
(c)(3)(i), 416.929(c)(3)(i); see also Macia v.
Bowen, 829 F.2d 1009, 1012 (11th Cir. 1987) (finding
that ADLs may be relevant to the fourth step of the
will also consider any inconsistencies between the
claimant's testimony and other evidence in the record to
determine if the claimant is disabled or not. 20 C.F.R.
§§ 404.1529(c)(4), 416.929(c)(4). If the ALJ
discredits the claimant's subjective testimony, such
discrediting must be obvious to a reviewing court and
adequately reasoned. Dyer, 395 F.3d at 1210. The ALJ
must articulate reasons for discrediting the claimant's
subjective testimony and substantial evidence must support
those reasons. See Brown v. Sullivan, 921 F.2d.1233,
1236 (11th Cir. 1991).
claimant was forty-three years old at the time of the
ALJ's final decision. The claimant has the equivalent of
a high school education and past relevant work as a certified
nursing assistant, cleaner/housekeeper, production line
worker, and cashier. The claimant alleges disability based on
her rheumatoid arthritis, fibromyalgia, left knee surgery,
need of right knee surgery, back problems, depression,
anxiety, and swelling in the wrists. (R. 41-43, 88).
2009 to 2015, Dr. Rommel Go at Med-Assist treated the
claimant for multiple physical ailments and problems starting
with arthritis on February 23, 2009. He prescribed Mobic for
her pain. The claimant returned to Dr. Go on April 23, 2009,
complaining of pain, and he prescribed her Lortab. In her
visit with Dr. Go on August 24, 2009 the claimant said she
heard a popping sound in her right knee when she walked and
it hurt; Dr. Go continued her on Lortab. On October 6, 2009,
Dr. Go diagnosed the claimant with a ligament tear in her
left knee and referred her toorthopedic surgeon Dr. Joseph
Kendra. (R. 355-360).
Kendra saw the claimant on October 16, 2009, diagnosing her
with a possible meniscal tear and posterior lateral complex
injury in her left knee. Dr. Kendra performed an arthroscopy
on the claimant's left knee on October 26, 2009; he
reported no complications and said she was doing well. During
her follow-ups with Dr. Kendra, the claimant revealed that
she still felt some discomfort in her knee at night but
requested that she be allowed to return to work. Dr. Kendra
prescribed her Lortab and encouraged her to do knee
strengthening exercises. (R. 273-75, 309- 10).
December 21, 2009, and May 3, 2011, the claimant returned to
Dr. Go seven times for chronic lower back pain, pain in both
of her knees, painful movements, tingling and numbness in her
hands, and hand pain. Dr. Go prescribed her Lortab and Mobic
to treat the pain. On December 10, 2010, Dr. Go reported
noted the claimant's weak hand grip. (R. 346-54).
August 30, 2011, a doctor at Med Assist diagnosed the
claimant with a ganglion cyst on her right hand and the
claimant requested a referral for her hand pain; the
doctor's report also indicated the claimant had
paraspinal tenderness in her lower spine. The claimant
reported that her current medications worked to control her
symptoms. During her November 11, 2011 appointment with Dr.
Go, the claimant complained of migraines and requested a
referral to Dr. Kendra for her knee pain; Dr. Go prescribed
her Imitrex for her migraines referred her back to Dr.
Kendra. (R.345 -46).
February 9, 2012, after physically examining the claimant and
ordering an MRI, Dr. Kendra determined that the claimant
might have an internal derangement in her right knee and
advised her about an arthroscopy. Dr. Kendra also indicated
that a doctor diagnosed the claimant with rheumatoid
arthritis in 2008 and treated it with Mobic. Dr. Kendra
scheduled the claimant for right knee surgery, but the
claimant testified at the ALJ hearing that she cancelled the
surgery when she lost her job and insurance. (R. 271-72).
March 2, 2012, Dr. Go advised the claimant to have the
arthroscopy on her right knee to alleviate her pain. The
claimant saw Dr. Go for her chronic lower back and knee pain
and migraines on June 8, 2012; she reported that she was
“doing well, ” but Dr. Go reported that she had
paraspinal tenderness around her L5 vertebra. On September 5,
2012, the claimant returned to Dr. Go for back and knee pain
and swelling and pain in her hand; he indicated on her chart
that a Dr. Phillips had diagnosed her with rheumatoid
arthritis in 2007. Dr. Go prescribed further treatments of
Lortab and Mobic for the claimant's arthritis and pain.
her follow-up appointment with Dr. Go on December 3, 2012,
the claimant indicated that she felt no drowsy side effects
of her medication and was able to do activities of daily
living with her pain medication. However, the claimant still
reported experiencing chronic lower back and joint pain. Dr.
Go continued her on Lortab, Imitrex, and Mobic, but also
started the claimant on Neurontin. On March 4, 2013, the
claimant again reported to Dr. Go that she had no side
effects from her medication and that it allowed her to do
daily living activities. But she complained about not losing
weight with diet and exercise alone and wanted to try a new
diet medication. Dr. Go added obesity and dyslipidemia
diagnoses to the claimant's conditions; assessed her
other conditions as unchanged; continued the claimant on her
previous medications; and added a Drisdol cap to treat her
Vitamin D deficiency. (R. 336-41).
4, 2013, the claimant reported to Dr. Go that she experienced
burning sensations in her left arm and asked for a referral
to a rheumatologist for her knee pain; she also reported no
change in her chronic lower back and joint pain. She also
reported that her pain medication allowed her to do
activities of daily living; reduced her pain 30%; and caused
no negative side effects. She asked that her medication
dosages not be reduced. (R. 332-35).
27, 2013, the claimant completed a pain questionnaire for the
Disability Determination Service. She reported experiencing
pain since 2006 and that it primarily affected her back, both
knees and wrists, ankles, and upper left arm. She said her
pain is constant; occurs when she sits, walks, or stands for
too long; and uses her hands to drive or lift items. She
reported taking one 100mg dosage of Neurontin and four 7.5mg
dosage of Hydrocodone a day; this medicine relieved her pain
for about two hours at a time. She also reported that pain
affected her ability to work, sit, stand, walk, write, and
drive. (R. 197-98).
claimant returned to Med Assist on July 2, 2013 for back
pain; reported no new problems; and stated that her
medication adequately controlled her pain. The nurse
practitioner who saw the claimant noted that the claimant
needed close monitoring because of inconsistencies in her
urinalysis results. (R. 331).
1, 2013, the claimant's mother filled out a function
report about the claimant's disability. She wrote that
the claimant did laundry and cleaned the home a couple of
times a week, prepared small meals with the help of her
daughters, and attended church. She also wrote that the
claimant rarely left the house besides attending church,
going to doctor appointments, or grocery shopping. She
reported that she drove the claimant most places and that the
claimant “can't walk good.” She said the
claimant had trouble squatting, walking, bending, and
standing because of her knee pain; she estimated that the
claimant could walk “maybe one hundred yards” and
must rest for twenty minutes afterwards. She said the
claimant could follow instructions, had no problems
concentrating, and gets along well with authority figures;
however, she also stated that the claimant does not handle
changes in routine well and gets mad about her inability to
work and care for herself. (R. 211-16).
14, 2013, the claimant completed a self-function report for
the disability services office. In her self-function report,
the claimant stated that she watched television and was able
to engage in self-care behaviors and activities like bathing,
dressing, and cooking small meals in a microwave, but
experienced pain while doing those activities. Specifically,
she experiences pain while squatting, standing, raising her
arms, and lifting things. She said her pain keeps her awake
at night. The claimant corroborated her mother's report
about the cleaning and leaving the house. She said she
follows direction fine and has no problems with
concentration, but does not handle stress or changes in
routine well; she also reported that she sometimes cried
without reason and had panic attacks. (R. 218-24).
31, 2013, nurse practitioner Tonya Moses at Med Assist noted
in her records that the claimant was taking Mobic for her
arthritis, Imitrex to control migraine headaches, Lortab for
her lower back and knee pain, and Neurontin for nerve pain.
The claimant again reported that her medication caused no
negative side effects; adequately controlled her pain; and
allowed her to do activities of daily living. Nurse
practitioner Tonya Moses warned the claimant about abruptly
stopping medications and reminded her that the goal of ...