United States District Court, N.D. Alabama, Southern Division
OWEN BOWDRE CHIEF UNITED STATES DISTRICT JUDGE
13, 2014, at the age of 19, the claimant, Larry Wade Grammer,
protectively applied for child's insurance benefits and
supplemental security income based on disability. (R.76, 88).
In both applications, the claimant alleged disability
commencing on May 9, 2007 (at the age of 12), because of
migraines, epilepsy, and bipolar disorder. (R. 34). The
Commissioner denied the initially on July 17, 2014. The
claimant then filed a timely request for a hearing before an
Administrative Law Judge, and the ALJ held a hearing on
October 3, 2016. (R. 32).
decision dated February 7, 2017, the ALJ found that the
claimant was not disabled as defined by the Social Security
Act, and, was, therefore ineligible for social security
benefits. (R. 25). On October 4, 2017, the Appeals Council
denied the claimant's request for review. (R. 1).
Consequently, the ALJ decision became the final decision of
the Commissioner of the Social Security Administration. The
claimant has exhausted his administrative remedies, and this
court has jurisdiction pursuant to 42 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 properly considered indigent circumstances as an
excuse for failure to follow prescribed medical
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 [ALJ'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 ALJ's factual determinations de novo. The
court will affirm those factual determinations that are
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, 402 (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 were to
disagree 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 [ALJ]'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 refusal to follow prescribed medical treatment
without good cause will preclude a finding of disability. 20
C.F.R. § 404.1530(b). However, poverty may excuse
failure to follow prescribed medical treatment. Ellison
v. Barnhart, 355 F.3d 1272, 1275 (11th Cir. 2003). When
the ALJ does not significantly rely on the claimant's
noncompliance, the ALJ's failure to consider evidence
regarding the claimant's inability to afford his
prescribed treatment does not constitute reversible error.
Id.; Bellew v. Acting Comm'r of Social
Sec., 605 Fed.Appx. 917, 921 (11th Cir. 2015). But when
the ALJ significantly relies on a claimant's
noncompliance as grounds to deny disability benefits and the
record indicates that the claimant could not afford
prescribed medical treatment, the ALJ must make a
determination regarding the claimant's ability to afford
treatment. Ellison, 355 F.3d at 1275.
claimant alleges an onset date of May 9, 2007 at the age of
twelve years old. (R. 76, 88). The claimant stated that his
seizures began as a child after he was struck in the head
with a rock. (R. 447). The claimant applied for CIB and SSSI
benefits at the age of nineteen, and he was twenty-two years
old at the time of the ALJ's final decision in 2017 in
2017. (R. 34). The claimant has a seventh grade education and
no past relevant work (R. 39-41, 17, 42). The claimant
alleges disability based on epilepsy, migraine headaches, and
bipolar disorder. (R. 34).
November 22, 2013, the claimant visited Dr. Jan Mathisen at
the Alabama Department of Rehabilitation Services:
Children's Rehabilitation Center (“the
Rehabilitation Center”). Dr. Mathisen noted that the
claimant was having a seizure approximately every 4-6 weeks;
these seizures were “not significantly severe at this
point, ” but that the claimant was not driving because
of his “ongoing events”; and the claimant's
family was concerned that he had been staying up late and
sleeping throughout the day. At the time of this visit, the
claimant was taking Zonisamide at 100mg, 4 at bedtime;
Depakote 500 mg, 3 at bedtime; Lamotrigine 100 mg at bedtime;
and Diastat 10mg for breakthrough seizures. Dr. Mathisen
continued these medications but increased the Lamotrigine to
50mg in the morning and 100mg at night for two weeks and
prescribed 100mg of Trazodone to help regulate the
claimant's sleep pattern. Aside from these issues and
adjustments, Dr. Mathisen recorded the claimant's general
health as “quite good.” (R. 290).
Sunday, April 20, 2014, the claimant suffered a seizure that
lasted for 3-4 minutes, but he did not visit a doctor.
However, the claimant informed Dr. Mathisen about the recent
seizure during the claimant's appointment on April 25,
2014. Additionally, during this appointment, Dr. Mathisen
noted that the claimant continued to have breakthrough
seizures, and as a result was unable to find a job. Dr.
Mathisen also stated that the claimant was not compliant with
his medications and that some of the seizures were because of
the claimant's non-compliance; however, Dr. Mathisen also
stated that the claimant had a history of chronic epilepsy
and that the claimant's seizures persisted even when the
claimant was compliant with his medication. Finally, Dr.
Mathisen noted that the claimant was still having issues
sleeping and prescribed 100mg of Trazodone. (R. 289).
than a month later, on May 6, 2014, the claimant visited Dr.
Diana Paulk at Garrett Counseling & Consulting
(“GCC”) complaining of recent suicidal thoughts.
The claimant stated that he was depressed and angry. The
claimant stated that he attempted suicide on two occasions.
The claimant explained that he once attempted to shoot
himself, but the gun did not fire; the second time, the
claimant planned to hang himself but “got tired of
thinking about it.” The claimant also stated that he
drank sometimes and would smoke more if he could afford the
habit. Dr. Paulk discussed the impact that alcohol can have
on depression and compiled a list detailing the
claimant's problems, which included abandonment, anger,
depression, disability, employment, impulsivity, legal
problems, memory loss, mood swings, relationships, and
self-esteem. Finally, the claimant told his therapist that he
would like to find employment, and that he had attempted to
use the Opportunity Center Program with little luck. (R.
after the claimant's first counseling session, he visited
the Jackson Medical Center on May 15, 2014 with a chief
complaint of seizures. The record indicates that the claimant
was unconsciousness, confused upon waking up, and shaking all
over. The claimant also suffered an injury from biting his
tongue during the seizure. Jacksonville Medical Center
treated with Tylenol and Depakote and discharged the
claimant. (R. 294-296).
recovering from the previous seizure, the claimant had his
second session at GCC on May 22, 2014. The claimant appeared
neat and showed no signs of hostility or anger during the
session. The claimant stated that he completed his homework
from the last session, and that he had used some of the
suggested methods to calm himself down when necessary. The
counselor and claimant scheduled the claimant's next
appointment for May 28, 2014. (R. 352).
claimant did not attend his appointment scheduled for May
28th. As a result, on June 4, 2014, Ms. Nicole Burgess, an
intern from GCC spoke with the claimant's grandmother
about the claimant's missed appointment. Additionally,
the grandmother asked questions about the claimant's
insurance payment and stated that she would make sure that
the claimant attended his next appointment on June 9, 2014.
6, 2014, the claimant spoke with someone at GCC about the
cost of the sessions. That individual at GCC told the
claimant about other counseling agencies that have sliding
scale payment options; stated that it would continue to offer
services to the claimant through its intern, Ms. Burgess;
encouraged the claimant to follow up with the local mental
health clinic to learn about income based services; and
stated that its counselors would help the claimant transition
when necessary. (R. 348).
planned, the claimant met with Ms. Burgess on June 9,
2014. During the appointment, the claimant
stated that he was sad because Father's Day was
approaching and he would not be able to see his son. The
claimant also stated that he did not have any anger issues
over the previous week. Outside of these two disclosures, the
claimant was unwilling to participate and continuously stated
that he did not feel like talking. Finally, the session notes
indicate that the claimant had lost his health insurance, but
that GCC would continue to provide free services until the
claimant got an appointment with a free local clinic. (R.
claimant returned to GCC for another session with Ms. Burgess
on June 19, 2014. Ms. Burgess noted that the claimant
appeared well-groomed and neat. She also noted that the
claimant appeared shy as he stared at the floor and fidgeted
his hands during the session. The claimant stated that his
visit with his father on Father's Day went well; that he
had no anger issues since the last session; but that he did
not make attempts to get to ...