Roden v. Social Security Administration, Commissioner
MEMORANDUM OPINION Signed by Judge Karon O Bowdre on 9/24/13. (SAC )
2013 Sep-24 PM 03:40
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF ALABAMA
LINDA J. RODEN,
MICHAEL J. ASTRUE,
Commissioner of the Social,
) CIVIL ACTION NO. CV-11-KOB-3080-S
The claimant, Linda Roden, applied for supplemental security income benefits under Title
XVI of the Social Security Act on June 6, 2008 and for disability insurance benefits Title II of the
Social Security Act on July 15, 2008. The claimant alleges disability commencing on November 21,
2007 because of wrist drop with a history of fracture of C2 on the right wrist, carpal tunnel syndrome
in the right wrist and hand, residuals of staph infections in the left pelvis and thigh, a history of
lumbar fractures, headaches, and chronic and severe pain. (R. 158-70). Upon initial review, the
Commissioner denied both applications. (R.15). The claimant filed a timely request for a hearing
before an Administrative Law Judge, and the ALJ held a hearing on March 3, 2010. (R. 52). In a
decision dated July 7, 2010, the ALJ found that the claimant was not disabled as defined by the
Social Security Act and, thus, was ineligible for supplemental security income. (R. 9). On June 23,
2011, the Appeals Council denied the claimant’s request for review; consequently, the ALJ’s
decision became the final decision of the Commissioner of the Social Security Administration. (R.
1). The claimant has exhausted her administrative remedies, and this court has jurisdiction pursuant
to 42 U.S.C. §§ 405(g) and 1631(c)(3). For the reasons stated below, this court affirms the decision
of the Commissioner.
II. ISSUES PRESENTED
The claimant presents the following issues for review: (1) whether the ALJ was correct in
assigning more weight to Dr. Gill, a consulting examining physician, than to Dr. Walker, a
treating physician; (2) whether the ALJ properly applied the Eleventh Circuit’s pain standard in
assessing the credibility of the claimant’s subjective testimony; and (3) whether the ALJ correctly
found that the claimant could perform his past relevant work given the ALJ’s RFC
III. STANDARD OF REVIEW
The standard of review of the Commissioner’s decision is a limited one. This court must
find the Commissioner’s decision conclusive if it is supported by substantial evidence. 42 U.S.C.
§ 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997). “Substantial evidence is more
than a scintilla, but less than a preponderance. It is such relevant evidence as a reasonable person
would accept as adequate to support a conclusion.” Richardson v. Perales, 401 U.S. 389, 401
(1971). A reviewing court may not look only to those parts of the record that support the decision
of the ALJ, but instead 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 (11th Cir.
1986). “[The court must] . . . scrutinize the record in its entirety to determine the reasonableness
of the [Commissioner’s] . . . factual findings . . . No similar presumption of validity attaches to
the [Commissioner’s] . . . legal conclusions, including determination of the proper standards to
be applied in evaluating claims.” Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
IV. LEGAL STANDARD
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the
person 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....”
To make this determination the Commissioner employs a five-step, sequential evaluation
process. See 20 C.F.R. §§ 404.1520, 416.920.
(1) Is the person presently unemployed?
(2) Is the person’s impairment severe?
(3) Does the person’s impairment meet or equal one of the specific impairments
set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?
(4) Is the person unable to perform his or her former occupation?
(5) Is the person unable to perform any other work within the economy?
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).
Absent a good showing of cause to the contrary, the ALJ must accord substantial or
considerable weight to the opinions of treating physicians. Lamb v. Bowen, 847 F.2d 698, 703
(11th Cir. 1988). The ALJ must credit the opinions of treating physicians over those of
consulting physicians unless good cause exists for treating the opinions differently. Lewis v.
Callahan, 125 F.3d 1436, 1440-41 (11th Cir. 1997). The ALJ may discount a treating physician's
report when it is not accompanied by objective medical evidence or is wholly conclusory.
Crawford v. Commissioner, 363 F.3d at 1159. Where the ALJ articulated specific reasons for
failing to give the opinion of a treating physician controlling weight and those reasons are
supported by substantial evidence, the ALJ commits no reversible error. Moore v. Barnhart, 405
F.3d 1208, 1212 (11th Cir. 2005)
In evaluating pain and other subjective complaints, the ALJ must consider (1) whether the
claimant demonstrated an underlying medical condition, and either (2) objective medical
evidence that confirms the severity of the alleged pain arising from that condition or (3) that the
objectively determined medical condition is of such a severity that it can reasonably be expected
to give rise to the alleged pain. Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991) (emphasis
added); see also Wilson v. Barnhart, 284 F.3d 1219, 1225-1226 (11th Cir. 2002); 20 C.F.R. §
If the ALJ discredits the claimant’s subjective testimony, he must discredit it explicitly,
and articulate explicit and adequate reasons for doing so. Failure to articulate the reasons for
discrediting subjective pain testimony requires, as a matter of law, that the court accept the
testimony as true. Foote v. Chater, 67 F.3d 1553, 1561-62 (11th Cir. 1995). The ALJ may
consider the claimant’s daily activities in evaluating and discrediting complaints of disabling
pain. Harwell v. Heckler, 735 F.2d 1292, 1293 (11th Cir. 1984).
The claimant bears the burden of demonstrating that he cannot return to his past relevant
work. Lucas v. Sullivan, 918 F.2d 1567, 1571 (11th Cir. 1990). If the claimant is unable to do
past relevant work, the examiner determines whether, in light of the claimants’s residual
functional capacity, age, education, and work experience, the claimant can perform other work.
Wilson v. Barnhart, 284 F.3d 1219, 1227 (11th Cir. 2002). The ALJ may determine whether the
claimant has the ability to perform other work in the national economy by use of a vocational
expert. Phillips v. Barnhart, 357 F.3d 1232, 1239 (11th Cir. 2004). The ALJ must articulate
specific jobs that the claimant is able to perform, and substantial evidence must support this
finding. Id. For a vocational expert’s testimony to constitute substantial evidence, the ALJ must
pose a hypothetical question that comprises all of the claimant’s impairments. Vega v. Comm. of
Social Security, 265 F.3d 1214, 1220 (11th Cir. 2001).
The claimant is a high school graduate and was 60 years old at the time of the
administrative hearing. (R. 57). Her past work experience includes employment as a service entry
clerk and an invoice control clerk. (R. 208). The claimant ceased working full-time in May 2005,
when her employer dismissed her because the company was going bankrupt. At the time of the
hearing, she worked between 17 and 18 hours a week as part of an occupational training program
for senior citizens. At the time of the hearing, her primary responsibilities in the training program
consisted of entering payroll information into a computer. (R.63-69). The claimant alleged that
she was unable to work because of right wrist drop with a history of fracture of C2 and possible
mild carpal tunnel syndrome; residuals of staph infections in the pelvis and thigh; and a history
of lumbar fractures on x-rays; however, on appeal, the claimant only contested the ALJ’s
findings regarding the impact of her wrist drop. (R. 15, Pl.s’ Br. 5-9).
On December 3, 1975, the claimant sought treatment at the emergency room of Parkway
Medical Center Hospital following a serious car accident. She remained in the hospital for the
following month. Dr. J.B. Wiley, the treating physician, observed that the claimant sustained
fractures to ribs 5, 7, and 8 on the left side and a fracture in the left scapula. (R. 514).
Nothing exists in the record pertaining to the claimant’s medical history between January
1976 and October of 1983. From October 1983 through November 1983, the record contains
medical evidence regarding the claimant’s continued back pain and a surgery to treat staph
infection in the claimant’s left thigh and pelvis.
The record contains no medical information from the period between November of 1983
to March 20, 2000, when the claimant began treatment with Dr. Larry Parker at SportsMed
Orthopedic Surgery and Spine Center. The claimant reported that she injured her back lifting a
picnic table four weeks prior, causing back pain that was followed by significant pain in her right
leg. Dr. Parker stated that the claimant’s MRI showed a calcified herniated disc at L5-SI and
what appeared to be a significant acute spinal herniation at L4-5. Dr. Parker diagnosed the
claimant with lumbar radiculitis in her left lower extremity. The claimant’s physical examination
revealed “a very positive straight leg raise on the right side,” a positive contra lateral straight leg
raise, and symmetrical reflexes. Dr. Parker noted that the claimant’s back was not tender and that
she had a “good range of motion in both hips,” but that she walked with an antalgic gait. He also
noted that she had a slight weakness in her extensor hallucis longus manual muscle test (EHL).
He treated the claimant’s symptoms with an epidural steroid injection and prescribed medication
for pain. (R. 270).
On April 13, 2000, the claimant saw Dr. Parker for a follow up visit. Dr. Parker’s notes
from this visit indicate that the claimant’s epidural steroid injections “improved her symptoms
quite nicely.” He released her from her follow-up appointment and allowed her to return to work
the following Monday. He also prescribed Y-Gesic for pain. (R. 269). The record does not
contain any information concerning the claimant’s medical history for the period of time between
April 2000 and April 2005.
On April 7, 2005, the claimant saw Dr. Easton Norwood, a neurologist at Decatur
General Hospital, for treatment of a possible epileptic episode. Dr. Norwood conducted an EEG
to investigate the source of the claimant’s headaches and to determine whether the claimant was
epileptic. The EEG was normal with no apparent signs of epilepsy. He referred the claimant to
Dr. Philip Neely, a radiologist, who conducted X-rays on the claimant’s chest that showed an old
rib fracture but no evidence of active disease. Dr. Neely also conducted an MRI of the claimant’s
brain that showed an old injury with encephalomacia, or cerebral softening, on the right frontal
lobe of the brain and a “little bit of increased signal on FLAIR images of the area.” Dr. Neely
concluded that the image otherwise was normal. (R. 271-273).
On April 11, 2005, the claimant again saw Dr. Easton Norwood, claiming that she began
to notice pain or weakness in her right hand several years after a car accident while working in a
plant. She stated that she became unable to extend her right wrist completely. The claimant said
that after changing jobs, the pain subsided but that the wrist drop had been consistently present
ever since. She elaborated that in the past she could not use her hand at all and that her wrist
continued to drop, but that all other function had returned to normal. Dr. Norwood’s examination
revealed that the claimant possessed normal strength in the left arm and that her wrist extensor
grading was 4/5, fairly strong. He also concluded that the claimant had a restricted range of
motion and was unable to completely extend her right wrist. He noted that a slight weakness
possibly existed in the extensor pollicis but that he did not find any other intrinsic hand muscle
weakness. Dr. Norwood also stated that the right thenar bulk, the portion of the hand connected
to the thumb, was slightly diminished compared to the left but that no fasciluation was present.
The claimant had good pinprick association over the hands and had reflexes of 1+ at the biceps
and wrists. He also noted that Tinel’s sign, a way to detect irritated nerves, was minimally
present at the right wrist. When diagnosing the claimant with wrist drop, Dr. Norwood
mentioned that the “right wrist drop is old and may not show any active neurologic process.” He
stated that further plans for treatment would be dependent upon the results of a nerve conduction
study. (R. 285-286).
Dr. Norwood ran the nerve conduction study on May 26, 2005. The test detected slow
nerve conduction in both the index finger to wrist and the palm to wrist segments of the median
nerve of the right hand with normal sensory nerve conduction proximal to the wrist. The other
results were normal. Following the test Dr. Norwood diagnosed the claimant with “right wrist
drop, pain, possible carpal tunnel syndrome.” Dr. Norwood noted that his diagnosis of carpal
tunnel syndrome was based solely upon sensory slowing and that no definite evidence of radial
neuropathy bilaterally was present. (R. 287-288).
On September 6, 2005, the claimant sought treatment from Dr. Scott Harris, a physician
at the Community Free Clinic of Decatur Morgan County, for pain in her right wrist and possible
arthritis. Dr. Harris referred the claimant to another treatment center for testing.1 (R. 408). No
record of these tests exist in the record.
On November 5, 2007, Dr. Daniel Andress, an emergency room physician, admitted the
claimant, who was complaining of swelling and pain in the left thigh, to the emergency
department of Huntsville Hospital. (R.308). Dr. Andress diagnosed the claimant with a staph
infection in her leg. Dr. Andress drained the effected area. He also prescribed 20 Septra DS to be
The handwriting indicating to where Dr. Harris referred the patient is illegible.
taken once every 12 hours. (R.313-315).
Dr. Suji Mathew treated the claimant, who was complaining of an infection in the left
thigh, at Decatur General Hospital later on November 8, 2007. The claimant informed Dr.
Mathew that she had a leg infection for the past three weeks. The record mentioned the
claimant’s extensive history of staph infection, noting that she once developed a staph infection
in her pelvis that lasted for several months. Dr. Mathew diagnosed the claimant with severe
cellulitis/abscess of the left leg, hypothyroidism, and a month-old staph infection in the pelvis.
(R. 563). Dr. Mathew found that the claimant had three abscesses over the posterior aspect of her
left thigh. He observed that the area had “begun to drain copious amounts of pus, easily over 2-3
cups full.” He sent the fluids collected to the lab for a culture. He also noted the scar on the
claimant’s lumbosacral area from a previous back surgery. (R. 321-322).
Dr. Robert C. Walker, the surgeon who treated the claimant during her hospital visit,
reported that on November 8, 2007, the claimant complained that she experienced difficulty
walking over the past month but that the claimant’s family stated that she had previously been
“very active and functional.” Dr. Walker also mentioned in his report that the claimant had been
to the emergency department four to five times because she was in pain caused by her leg
abscess. On November 9, 2007, Dr. Walker performed an irrigation and debridement procedure
that entailed suctioning the infection from the leg and packing the wounds with Betadine
impregnated Kerlix. (R. 434-435).
After receiving the lab results, Dr. Mathew diagnosed the claimant as having severe
cellulitis and abscess of the left leg, hypothyrodism, and a history of staphylococcus infections.
Dr. Mathew discharged the patient on November 23, 2007. In his discharge report, he stated that
one of the wounds began draining spontaneously and noted that Dr. Walker, “did some more
incision and irrigation and debridement as she still had significant undrained purulence.” Dr.
Mathew reported that the claimant had done well post-surgery and the he instructed her to use a
wound VAC to keep her wound clean. He also prescribed Bactrim DS for a week. (R. 322-323).
HGA Homecare of Decatur, a program that specializes in post-operative in-home care
and family training, admitted the claimant on November 26, 2007. (R.335). Registered nurse
Dainell Hicks filled out an assessment of the patient’s condition at the beginning of her care. (R.
363). The assessment stated that the claimant was homebound because she had an unsteady gait,
had poor balance and needed assistance with her wound VAC. (R.341). The assessment also
specified that the claimant was in constant pain that varied in intensity and that this pain
prevented her from resting well at times. At the time of her intake into the program, Nurse Hicks
noted that the claimant walked only occasionally during the day for only short distances and that
she spent the majority of her time in a bed or chair. (R. 347-348). The report noted that the
claimant had no major mobility limitations. The report did note, however, that the claimant
experienced weakness, stiffness, and unequal grasp and that she was limited functionally by her
endurance and ambulation. Nurse Hicks noted at the time of the claimant’s admission into the
program that the claimant had difficulties balancing while walking, had decreased muscular
coordination, and required the use of a cane or walker. (R.356-357).
The intake assessment included a detailed inventory pertaining to the claimant’s ability to
complete various personal-care tasks. Nurse Hicks reported that the claimant was capable of
dressing herself and grooming herself if grooming utensils were within her reach. The claimant
was able to take care of basic hygiene needs with minimal assistance and could prepare light
meals. The claimant could not drive but could ride in a car. She was able to do light
housekeeping and laundry. The claimant was unable to go shopping but was capable of arranging
for a home delivery. (R. 358-360). Nurse Hicks assessed the claimant’s overall rehabilitation
potential as being “good.” (R. 363).
Following the claimant’s discharge, Dr. Walker kept track of her post-surgical healing at
his practice at Surgical Associates of North Alabama. On November 29, 2007, Dr. Walker
removed the patient’s wound VAC. He described the wound as healing “very nice” and as
“granulating and shrinking and filling in.” He commented that he was very pleased with her
progress. (R. 433). Also on November 29, 2007, the HGA Homecare Nurse2 recorded in her
nursing progress notes that the claimant experienced limited range of motion, had decreased
strength and endurance, and required a walker for ambulation. (R. 367). She also noted that the
claimant described having wound-site pain at a level of 1 on the 0-10 pain severity scale. An
HGA Homecare nurse filled out progress notes again on December 2, 2007. On this date, the
notes indicate that the claimant continued to require a walker and had decreased strength and
endurance, but that the claimant noted that she experienced less pain, ranking her pain as a 0. (R.
On December 4, 2007, Nurse Hicks reported that the claimant’s ambulation, strength and
endurance functions remained the same, but that the claimant described her wound-site pain as
increasing to a level of 2. (R. 371). On December 11, 2007, the claimant told Nurse Hicks that
neither her strength, endurance and ambulation abilities nor level of pain had changed since
Where the court does not indicate the nurse’s name, the name does not appear in the
December 4, 2007. (R. 374).
On December 14, 2007, Dr. Walker reported that the wound looked “excellent” and that
the claimant no longer needed a wound VAC. He stated that the claimant “will return to work
whenever she is ready to go.” (R. 432).
On December 18, 2007, the claimant saw Nurse Practitioner Charles Misori of Southern
Rural Healthcare Consortium in Decatur. Nurse Misori stated that the claimant came in to the
office with swelling of the left hip. He stated that the claimant did not have a fever and that the
hospital blood count reading showed that the claimant did not have an infection. (R. 552).
On December 19, 2007, the claimant returned to Dr. Walker at Surgical Associates of
North Alabama. Because the claimant’s greater trochanter, a portion of the femur, was slightly
enlarged, Dr. Walker performed an ultrasound and sent 2-3 cc of pus accumulated through
aspiration to the lab for culture. On December 21, 2007, the culture came back negative for
staph, and Dr. Walker again determined the wound to be healing healthily. (429-430). The HGA
Homecare nursing progress notes from December 23, 2007, concluded that the claimant
continued to have decreased strength and endurance and continued to require a walker for
ambulation. The nurse left the pain scale blank. (R. 377).
On January 2, 2008, HGA Homecare of Decatur discharged the patient. (R. 338). Nurse
Hicks completed a discharge report. Nurse Hicks stated that at the time of the discharge, the
patient lived alone in an apartment. The patient experienced a tolerable burning pain daily, but
not constantly. Nurse Hicks stated that the claimant ranked this pain at a severity of 1 out of 10,
claimed the medication decreased the pain, and stated that cleaning the wound increased the pain.
The claimant had decreased strength at the time of her release, but her endurance was normal and
she no longer required a walker. (R. 380-382). Nurse Hicks noted that the claimant was able to
dress herself, take care of her basic hygiene needs, walk, and climb stairs. The claimant could
independently prepare her own meals, take care of all housekeeping and cleaning tasks, drive and
shop independently. (R. 388-390). The discharge summary concluded that the claimant’s
recovery goals had been met, that the claimant had improved in functional status, and that the
claimant was no longer homebound. (R. 394). The summary noted that the claimant continued to
require some assistance with wound care. (R. 396).
On January 3, 2008, the claimant saw Dr. Walker for a follow-up. Dr. Walker expressed
that the claimant was “very happy with her progress” and that he was also pleased with her
healing. He did report, however, that the wound on the back of her thigh was continuing to
granulate. He treated this granulation with silver nitrate. He also mentioned that the claimant had
already returned to her job at the Morgan County Archives. (R. 428). Dr. Walker filled out a
medical source opinion assessing the claimant’s abilities on January 3, 2008. In this opinion, he
stated that the claimant could only stand for 1-2 hours a day; sit for 1-2 hours a day; and walk for
1-2 hours a day. Dr. Walker cited the claimant’s large wound on her left thigh as the clinical
basis for his assessment. He communicated that the claimant could only occasionally lift or carry
15 or fewer pounds. He also cited the healing wound on her left thigh as the reason for this
restriction. Dr. Walker asserted that the claimant could perform the following functions
occasionally: pushing; pulling; using her right or left arm or leg; climbing; balancing; stooping;
kneeling; crouching; crawling; reaching overhead; handling; fingering; talking and hearing. Dr.
Walker also listed several restrictions on the types of environments in which the claimant could
work. He noted that she could never work in extreme cold or heat or in an area exposed to fumes,
noxious odor, dusts, mists, gases or poor ventilation. Dr. Walker stated that the claimant could
occasionally work in areas with high humidity and vibration. Dr. Walker also stated that the
claimant could drive automotive equipment occasionally. (R. 549-550).
On January 16, 2008, the claimant saw Dr. Walker for another follow-up visit. While he
described the wound as continuing to heal, he noted that granulation remained a problem. He
treated it again with silver nitrate. (R. 427).
On January 30, 2008, the claimant returned for a follow up visit with Dr. Walker, who
asserted that the wound was “essentially healed” but continued to treat a small non-epitheliazed
area with silver nitrate. During her visit, the claimant complained of pain in her leg that seemed
to radiate from her back. Dr. Walker suggested that the pain could be sciatica because it extended
beyond the knee. Dr. Walker scheduled a follow-up visit two weeks later.
On February 7, 2008, the claimant saw both Nurse Practitioner Misori and Dr. Matthews
at Southern Rural Healthcare Consortium in Decatur. Misori’s assessment in his treatment notes
stated, in its entirety, “cellulitis.” (476-477). Dr. Matthew’s noted that the patient reported
significant impairment but that the wound was healing well. (R. 551).
On February 14, 2008, Dr. Walker declared the wound to be completely healed and
recommended that the claimant use her legs to strengthen the muscles. He did not schedule a
return visit for the claimant but stated that she would return only if needed. (R. 424).
On March 11, 2008, the claimant visited the Community Free Clinic of Decatur-Morgan
County to have the site of her previous staph surgery checked for infection. The physician on
duty3 noted a scar and a slight pinkness, but pronounced that the claimant was healing well. (R.
The name of the physician is illegible.
On May 27, 2008, the claimant again returned to the Community Free Clinic of DecaturMorgan County for treatment. Nurse Practitioner Casey West diagnosed the claimant with right
wrist and knee pain. The claimant noted that Motrin sometimes alleviated her wrist pain. Dr.
Wesley observed no obvious visible injuries. (R.403).
On July 8, 2008, the claimant visited Dr. Walker at Surgical Associates of North
Alabama complaining of pain in her left leg. The claimant specified that the pain occurred
primarily when she bent her leg and flexed it at the hip. Dr. Walker examined the patient and
concluded that “she has absolutely no evidence of infection. There is no swelling, no fluctuance,
no redness, and no tenderness. Her wound is completely healed and everything looks completely
normal. . . .” He reassured the claimant that she did not have an infection. He reasoned that
because she had a positive straight leg raising most of the claimant’s pain was likely a result of
sciatica. He recommended that the claimant do stretching exercises. (R. 423).
The claimant saw Dr. Kenneth Bramlett, an orthopaedic surgeon, at the Orthopaedic
Sports Medicine Clinic of Alabama for the first time on July 14, 2008. Her chief complaint was
bilateral hands, the inability to use both hands together in an effective way. Dr. Bramlett stated
that the claimant reported having ongoing wrist pain that had lasted for several years and was
worsening over time. He also noted that the claimant wore a wrist brace and was becoming more
left-hand dominant by demand. Upon examination, Dr. Bramlett found that on her right side, the
claimant had a good range of motion in her shoulder; good rotator cuff function; good palm up
palm down strength; and full extension with hyper extension in her elbow. He noted that her
wrist had the ability to “go to 0 and neutrally position the wrist,” but that the wrist did have some
weakness and did droop. He also noted that the claimant had the ability to squeeze bilaterally
“pretty effectively.” He concluded that function of the right wrist was “reasonable” and that
dorsal extension of the wrist was the biggest problem. Dr. Bramlett ordered more tests and gave
the working diagnosis of radial palsy versus cervical irritation with dorsal extension and wrist
weakness of the right side. (R. 444- 445). He recommended a dorsal orthoplast wrist splint. (R.
Chris Smith, an occupational therapist working out of the same practice, saw the claimant
on the same day, July 14, 2008. During the appointment, the claimant assessed the pain level in
her hands as being a 5 out of 10 and described a tightness in the flexors with extension. She
reported noticing the wrist pain in approximately 2003. Upon examination of the right hand’s
range of motion, Mr. Smith determined that the claimant was capable of full fisting and
extending the MP and IP joints fully for a limited time before actively flexing the wrist and
fingers. Regarding the right wrist’s range of motion, Mr. Smith noted that the claimant’s flexion
was within functional limitations but that function was limited to neutral activity. In his
assessment, Mr. Smith noted back and neck arthritis in addition to wrist pain. Mr. Smith created
a treatment plan to increase the claimant’s extension each visit and to begin functional wrist
extension strengthening. He scheduled a follow-up appointment with the claimant for the
following week. (R. 446).
On September 16, 2008, Dr. Marlin F. Gill filled out a consultative disability examination
report at the Disability Determination Service’s request. Dr. Gill first noted that the claimant’s
gait was normal and that she walked without assistance. He also reported that her neck appeared
to be normal aside from a scar from a previous tracheotomy. He stated that the neck was not
tender but the claimant complained of pain with neck movement. He reported that he claimant
could flex to 40 degrees, extend to 10 degrees, and rotate 20 degrees laterally. Dr. Gill also
examined the claimant’s arms, hands, and wrists. He stated that the claimant’s arms appeared
normal and that the claimant used both arms with no limitations and had a full range of motion in
both shoulders and elbows. He concluded that her arms were neurovascularly intact and that
muscle strength was 5/5 bilaterally. Dr. Gill indicated that the claimant’s right wrist and hand
showed obvious wrist drop and that she had “no ability to extend her wrist at all.” Dr. Gill
reported that the claimant retained the ability to close her right hand into a fist with a grip
strength of 3-4/5 and that she could oppose her thumb and all fingertips slowly. He found the left
wrist and hand were normal.
Dr. Gill observed that the claimant’s back looked normal aside from an incision scar in
the low left lumbar area just above the SI joint. He did not notice any tenderness but stated that
the claimant articulated that she experienced mild discomfort with lumbar movement. The
claimant was capable of bending forward to an 80 degree angle from a standing position then
moving back into an erect posture. She could also rotate 10 degrees bilaterally.
Dr. Gill found the appearance of the claimant’s legs to be normal and symmetrical, but he
noted the presence of a large scar on the proximal posterior of the left thigh. He reported that
when lying flat on her back, she could lift her legs off the exam table with a strength of 5/5 in the
right leg and 4/5 in the left leg. From the standing position, she could squat all the way down
then stand back up using the table for balance. She could walk across the room on her tiptoes and
heels with no difficulty.
He noted that the claimant was healthy neurologically and that she was alert and oriented.
He stated that her speech was clear and understandable and that she engaged in normal
conversation. Dr. Gill took note of her right wrist drop but observed no other focal difficulties.
On September 19, 2008, Dr. H. Gordon Mitchell completed a consultative physical
residual functional capacity assessment at the request of the Disability Determination Services.
He found that the claimant had the following physical limitations: could occasionally lift up to 20
pounds and frequently lift 10 pounds; could stand and/or walk for 6 hours in an 8 hour workday
with normal breaks; could sit for 6 hours in an 8 hour workday with normal breaks; could push
and pull with her right upper extremities in a limited manner; could frequently balance; could
stoop, kneel, and crouch; could only crawl and climb a ramp or stairs occasionally; could never
climb a ladder, rope or scaffold; and could handle, finger and feel objects without any limitation
but was limited in her ability to reach. (R. 462-464). Dr. Mitchell noted that the claimant had no
visual or communicative limitations. In addition to her physical limitations, Dr. Mitchell found
that the claimant had several environmental limitations and should avoid concentrated exposure
to extreme cold, extreme heat, wetness, humidity, vibration, fumes odors, gases, or poor
ventilation. Dr. Mitchell advised the claimant to avoid all exposure to dangerous machinery and
unprotected heights. (R.464-465).
The claimant went to the Community Free Clinic of Decatur-Morgan County on February
17, 2009, to seek treatment for left hip and leg pain and “red streaks” on the left hip. Nurse
Practitioner Casey West treated the claimant. The claimant reported that the pain was chronic and
constant but that taking Motrin before bed seemed to help alleviate the pain. Nurse Practitioner
West diagnosed the patient as having chronic hip and leg pain. (R. 482).
The ALJ Hearing
After the commissioner denied the claimant’s request for supplemental security income
and disability insurance benefits, the claimant requested and received a hearing before and ALJ
on March 3, 2010. (R. 54). At the hearing, the claimant testified that at the time of the hearing
she participated in a senior training program. The claimant earned $6,300 a year through the
program in 2008. (R. 57-58). She stated that she worked 17 to 18 hours each week, that she
received minimum wage as compensation, and that she began the program in October of 2006.
The claimant explained that, through the program, she was able to work a flexible
schedule and that she did not have set hours when she had to be at work. The claimant testified
that the program encouraged her to work Monday, Tuesday and a half day Wednesday each
week, but she stated, “working that schedule just absolutely does me in.” She stated that she did
not think that she would be able to work a 40 hour work week. The claimant noted that she was
permitted to work as little as “a couple of hours” or “no hours” each week depending upon her
physical capabilities. She testified that as part of the training program, she had been working at
the North Central Alabama Regional Council of Government (NARCOG) center since the
preceding May. She explained that while she was participating in training, the program was
actively searching for full-time employment for her. (R. 63-67).
The claimant admitted letters from two of her supervisors in the program. The letters
described the program and the claimant’s functional limitations. The claimant presented a letter
written by John Allison of the Morgan County Archives on January 30, 2008. The letter stated
that Morgan County Archives allowed the claimant to take time off for health reasons and that
she took time off from October 31, 2007 until January 2, 2008. The letter noted that her duties
were limited in accordance with her physical abilities and that she was allowed to work at the
pace at which she was able. The letter stated, “Due to old injuries, she has limited use of her right
hand and occasional bouts with back, hip, and leg pain.” Mr. Allison noted in the letter that they
allowed the claimant to move from her desk whenever necessary and that she was not required to
do moderate or heavy lifting. (R.182).
The claimant also submitted a letter from Lona Johns, a project director at NARCOG,
dated February 17, 2008. In her letter, Ms. Johns explains that the program is not a job and that
participants are placed in community service assignments at government agencies or at non-profit
organizations. The letter noted that the claimant taught herself to print with her left hand because
she lost use of her right hand. The letter also noted that the claimant did an excellent job but that
she took a longer time to complete reports than other employees. The letter stated that because of
her condition, the claimant would not be a candidate for permanent employment. (R. 260).
The claimant testified that she did not think she had missed any work days in the past
month. She stated that she never missed entire days because of her condition but that she did
sometimes end up going into work later in the day than she intended because of pain. She stated
that she had to go to work late three or fewer times each month. She explained that the flexibility
of the program’s schedule allowed her to wake up, take her pain medicine, and wait for it to
become effective before going into work. She testified that the first thing that she did every
morning was put her heating pad on her back then take some mild pain medication. (R. 65-66).
She testified that the responsibilities of her current job in the program included entering
employee’s hours worked into a computer system. (R. 68). She said that she did “some payroll
and computer work with one hand” and that she was able to work in the program despite being
“slow” because her supervisors gave her unlimited time to complete assigned tasks. She stated
that she could use a computer but that she had to “sort of hunt and peck” using one hand. (R. 5859).
The claimant testified about her responsibilities at her previous jobs. She stated that at her
most recent previous job, she entered payable invoices into the computer from 1999 to 2005. The
claimant articulated that she left that job when her employer laid her off while experiencing
financial issues that eventually led to the company’s bankruptcy. The claimant testified that she
did not believe that the lay off was based on the quality of her performance, but she stated that
she did not think she was performing as well at the end of her employment as she was when she
started. She noted that her employer made adjustments for her by being flexible with her
schedule and by giving her more tasks she could perform with her left hand. (R. 68-70).
She testified that from 1987 to 1996 she was an invoice control clerk. She described her
responsibilities in that job as primarily consisting of entering information into a computer. (R.
The claimant reported that she experienced lower back pain. She described her back as
constantly hurting but stated that the pain was not always severe. She noted that she had to move
carefully and avoid lifting things. She testified that she hurt her back a couple of times exiting
her truck. The claimant testified that since her staph surgery in 2007, she experienced left hip and
leg pain while she was sitting. She noted that her staph infections were reoccurring. She stated
that she had six surgeries, two of which she considered to be major. She stated that her last
outbreak of staph was in November 2007. She articulated that she did not take recurring
antibiotics for the pain but that she believed the staph infections caused several long-term effects.
The claimant reported “trouble” with the muscle in her left leg and “pain and twinges like
you’d stick your finger in a socket.” She stated that the pain was distracting at work because it
forced her to change positions every 30 minutes. She testified that she could stand in one place
for approximately one hour and reported that she had no problems walking or balancing. She
stated that her right wrist condition precluded her from lifting objects weighing more than 10 or
15 pounds, but clarified that she generally could not pick up heavy things because she was not
strong enough. She said that she did not bend over to avoid injuring her back and that her left leg
condition made it impossible for her to squat. (R. 74-77).
The claimant testified that she was able to drive a Ford Ranger truck with an automatic
transmission around Decatur. She specified that she had to drive with her left hand and use her
right arm to raise the steering wheel when she was on a “straight away.”(R. 58). The claimant
stated that she was able to take care of all of her personal grooming, bathing, and dressing
without assistance, but indicated that she had to button clothing, fix her hair, and apply makeup
using her left hand. She stated that her curved right hand was “perfect” for brushing her teeth and
that in some situations she found her drop wrist to be helpful. (R.78).
The claimant testified that arthritis pain in her neck and shoulder would hinder her from
working a 40 hour work week. She stated that she experienced neck pain and noted that she
broke her neck in 1975. She testified that after several surgeries and some recuperation, she was
able to go back to work. The claimant said that the pain had grown worse since the surgery and
that the pain was worse when she was in one position for a long period of time. She complained
that when she was in front of a computer for too long, the arthritis pain in her neck and shoulder
caused her head to hurt. She testified that she was able to partake in the senior training program
only because they regularly allowed her to take breaks that exceeded 20-30 minutes. She stated
that she was able to drive because she could use her neck to turn and look behind her as long as
she was sitting still and also because she could use her side mirrors to check behind her. The
claimant testified that she used stemic powder and a heating pad to relieve pain, but that she did
not take any prescription pain medicine stronger than ibuprofen. (R. 67-72).
The claimant testified that she began having wrist pain in September of 2005 and that it
grew worse over time. She said that the condition progressed to a level that rendered her unable
to work in 2007, the year she filed her first disability claim. She stated that she only was able to
eat with her left hand and that while her left-hand was not her dominant hand, it was becoming
“better than it was” with more frequent use. (R. 70-71). She noted that she could not use her right
hand because it “turns back in.” She showed her wrist to the court and stated that it “droops” and
that she found it “hard to control anything.” She testified that she wore a brace that held her hand
straight. She stated that the brace made her more functional “in a way” but it prevented her from
moving any part of her hand except her fingers. She testified that she could not bend her wrist
back and forth while wearing the brace. She stated that she was supposed to wear the brace 24
hours a day, 7 days a week. The claimant testified that she was not wearing the brace at the time
of the hearing because she wished to show the court her wrist, but mentioned that she had the
brace with her and would put it on immediately after the hearing. She testified that she
experienced pain in the bone of her wrist that travels down her hand into her thumb and middle
finger. She described the pain as stopping half way between her wrist and elbow. (R. 58-61).
The claimant testified that she had a hard time picking up anything and that when she
tried to grip a pencil, she gripped it too tightly. She stated that she could not write with her right
hand and that she could not drink from a coffee mug without her hand “turning.” She stated that
she had no control over the movement. (R.62).
A vocational expert, Patsy Bramlett, testified concerning the type and availability of jobs
that the claimant could perform. Ms. Bramlett classified the claimant’s previous positions
according to the Dictionary of Occupational Titles (DOT). Ms. Bramlett stated that in the past,
the claimant had worked as an invoice control clerk and an accounting clerk. She also indicated
that the claimant’s work through the senior training program was a combination of two positions:
data entry clerk and payroll clerk. She testified that invoice control clerk is a sedentary,
semiskilled position. She testified that accounting clerk is a sedentary, skilled position. She
reported that both data entry clerk and payroll clerk are sedentary, semi-skilled positions. (R. 80).
When asked whether the claimant obtained transferable skills in the course of her
employment, Ms. Bramlett responded that the claimant gained the following skills: ability to
work in customer service and deal professionally with the general public; ability to keep records
and compile data; ability to keep up with sales and hours worked; ability to prepare computer
input forms and enter data into computer files; financial detail and invoice payment skills; and
ability to deal with wage information. Ms. Bramlett concluded that these skills would transfer to
other sedentary or light jobs. (R. 81).
To assess the claimant’s capacity, the ALJ asked Ms. Bramlett to assess the abilities of a
hypothetical individual. The ALJ described the hypothetical individual as a 60-year-old woman
with the claimant’s prior work history who could do the following: frequently climb ramps and
stairs, balance, stoop kneel and crouch; occasionally lift and carry 20 pounds; occasionally pull
10 pounds; stand or walk with no breaks a total of 6 hours a day; sit with normal breaks for a
total of 6 hours a day; has use of the right upper extremity to push and pull for no more than one
third of the day; cannot work on ladders, ropes or scaffolds; occasionally use the right upper
extremity to reach; should avoid concentrated exposure to extreme cold and heat, wetness and
humidity, vibrations, fumes, odors, dust, gasses, and poor ventilation; and cannot work around
hazardous machinery or unprotected heights. (R.81-82).
Ms. Bramlett responded that an individual possessing all of the hypothetical
characteristics would be able to perform all of the claimant’s past work. She also testified that
other jobs were available that someone with the hypothetical characteristics would be able to
perform. She stated that such an individual could work as a general clerk or administrative clerk,
both of which are classified as sedentary and semi-skilled. Ms. Bramlett testified that
approximately 800 such jobs exist in the state of Alabama and 47,000 exist in the nation. She
stated that the hypothetical individual could also work as a customer service representative,
which is a sedentary, skilled position. She stated that 1,200 customer service jobs exist in
Alabama and around 65,000 exist in the entire nation. Ms. Bramlett concluded that the claimant
could also work in a receptionist-type position, which is classified as sedentary and semi-skilled.
She stated that approximately 2,400 jobs exist in the state and 128,000 exist nationally. (R. 8283).
The claimant’s attorney also questioned the vocational expert. The attorney asked Ms.
Bramlett if any of the jobs she cited would allow the claimant to work flexible hours “in that you
could basically work whatever hours you showed up to work.” Ms. Bramlett responded that all of
the jobs she cited would typically be jobs that required one to work full time and that the cited
jobs would entail having a set schedule and mandatory attendance. She estimated that for a
daytime job, the hours would likely be 8:00 am - 5:00 pm or similar. (R. 83-84).
The claimant’s attorney asked Ms. Bramlett for an estimation of an acceptable absentee
rate in the jobs she recommended based on the hypothetical. Ms. Bramlett responded that based
on studies she read, one day a month would generally be the limit. The claimant’s attorney asked
Ms. Bramlett if the claimant would be able to perform the suggested jobs if she had no fine
manipulation ability in either hand. Ms. Bramlett indicated that having no fine manipulation
ability in either hand would eliminate the possibility of performing any of the jobs she previously
suggested. The attorney then asked Ms. Bramlett which of the jobs would be eliminated if one
could use her dominant hand as primarily just a “help hand.” Ms. Bramlett replied that the
administrative clerk and general clerk jobs would be eliminated as they require bilateral
The ALJ asked Ms. Bramlett several questions to clarify her responses to the claimant’s
attorney’s questions. In her answers, Ms. Bramlett indicated that the receptionist job would
require one to be able to occasionally reach and handle, but would never require one to finger or
feel, which is defined as the use of the fingertips to feel the size shape, temperature, or texture of
an object, with either hand. Ms. Bramlett testified that the customer service representative job
requires occasional reaching and handling, frequent fingering, and no feeling. She also stated that
customer complaint clerk, a sedentary skilled job, requires occasional reaching, handling, and
fingering but that no feeling is required for that position. Ms. Bramlett testified that
approximately 900 customer complaint clerk jobs exist within the state of Alabama and 47,000
exist within the nation. (R. 84-86).
The ALJ’s Decision
On July 7, 2010, the ALJ issued a decision finding that the claimant was not disabled
under the Social Security Act. (R. 12). First, the ALJ found that the claimant had not engaged in
substantial gainful activity since the alleged onset of her disability. Next, the ALJ found that the
claimant’s right wrist drop with history of fracture of C2 and possible mild right carpal tunnel on
the right, residuals of recurrent staph infections in the left pelvis and thigh, history of lumbar
fractures, and headaches qualified as severe impairments. The ALJ noted that the record also
showed a history of hypertension and hypothyroidism. He concluded, however, that these
impairments were not severe. The ALJ noted that despite being unmedicated, the claimant’s
hypertension was generally controlled and that no evidence existed to indicate that the
hypothyroidism resulted in anything beyond mild functional limitations. The ALJ found that the
claimant’s impairments did not singly or in combination manifest the specific signs and
diagnostic findings required by the Listing of Impairments. (R. 15).
The ALJ found that the claimant had the residual functional capacity required to perform
light work as defined in 20 CFR 404.167 and 416.967(b) subject to the following restrictions:
occasionally lift and/or carry, including upward pulling, up to 20 pounds; frequently lift or carry
up to 10 pounds; stand and/or walk with normal breaks for a total of about 6 hours in an 8-hour
workday; sit with normal breaks for a total of 6 hours out of an 8-hour workday; occasionally,
push or pull with the right arm; occasionally climb ramps and stairs; frequently, balance, stop,
kneel, and crouch; cannot work on ladders, ropes or scaffolds; occasionally reach in all directions
with the right arm; must avoid concentrated exposure to extreme cold and heat, wetness,
humidity, vibration, fumes, odors, dust, gases, and poor ventilation; cannot work around
hazardous machinery or unprotected heights; frequently perform fine fingering with both
The ALJ stated that, although the claimant had been “unable to work” since November
2007, she was participating in the Senior Community Service Employment Program’s worktraining program at the time of her disability application. The ALJ noted that the claimant was
able to perform a wide range of sedentary to light activities including dusting, laundry, fixing
simple meals, shopping, dressing, bathing, and grooming. He also noted that although the
claimant was right hand dominant, she was able to use her left hand. (R. 16).
The ALJ came to the conclusion that the claimant’s neck and back injuries would not
prevent the claimant from doing light work. The ALJ determined that although the claimant was
in a car accident in 1975 and suffered fractures to her scapula, several ribs, and several vertebrae,
her musckoscelatal problems had resolved well. He cited the claimant’s mostly consistent
employment from 1985 to 1996 and from 1999 to 2005 as evidence of her recovery. The ALJ
noted that although the claimant sustained lumbar radiculis as a result of lifting a picnic table in
2000, she was able to return to work. He also noted that Dr. Parker reported the claimant to be
quite nicely improved following an orthopedic steroid injection. The ALJ considered an x-ray
from November of 2007 that showed that the claimant had only a mild compression fracture at
L1 and otherwise no fractures and good alignment. He also noted that the claimant did not report
any lower back problems in the course of her home healthcare treatment in 2007. The ALJ also
considered that Dr. Gill found that the claimant had a full range of motion and that her back was
unremarkable in his 2008 examination. (R. 18).
The ALJ considered the claimant’s wrist condition. He noted that it began in 2005 and
that Dr. Norwood was the first physician to diagnose the issue. The ALJ noted that Dr. Norwood
found 4/5 wrist strength and “only possibly slight muscle weakness in the hand and no intrinsic
hand muscle weakness.” He also noted that the claimant had only a minimally positive Tinel’s
sign. The ALJ noted Dr. Norwood’s findings that the nerve conduction tests were normal except
for slow sensory in the index finger to wrist to palm. The ALJ stated that Dr. Norwood
interpreted the test results to be indicative of carpal tunnel syndrome based solely on sensory
slowing and that Dr. Norwood stated that no definite radial neuropathy existed in either hand.
The ALJ took into consideration that although the claimant had been alleging disability from
November 2007, no further evidence of a wrist condition exists in the record before July 2008,
when a physician noted its existence but offered no medical conclusions. (R.18-19).
The ALJ noted that the claimant made no mention of her hand condition when she was
being treated for staph in November 2007 or in any of the numerous home health-care visits
made following her surgery. The ALJ took note that the home healthcare nurses reported that the
claimant accomplished various activities that would require at least some dexterity including
grooming, dressing, bathing, toileting, driving, and shopping. The ALJ concluded that the
claimant’s reports of her functional limitations were inconsistent with Dr. Norwood’s reports that
the claimant had a wrist strength of 4/5 and that she only had the inability to fully extend the
right wrist in 2005. The ALJ also stated that he found it notable that, although in September of
2008, Dr. Gill stated that during his examination he found that the claimant had “no ability to
extend the wrist at all” he also noted that she could close her right hand into a fist with a grip
strength of 3-4/5 and that her left hand was normal. The ALJ concluded that her grip strength and
ability to form a fist suggested that despite the wrist drop, the claimant had the ability to use the
hand for frequent fingering and was capable of manipulation with both hands. (R. 19).
The ALJ noted that Dr. Bramlett reported “that despite ‘some weakness’ and drooping of
the wrist, the claimant had the ability to ‘squeeze bilaterally pretty effectively’ and that only
dorsal extension of the wrist was noted as a problem.” The ALJ reasoned that the findings of
both Dr. Mathews and Dr. Bramlett supported Dr. Gill’s findings. The ALJ also mentioned that
the claimant reported daily activities including washing small loads of laundry, shopping,
performing basic personal hygiene, and grooming to the extent of wearing earrings. The ALJ also
noted the claimant’s ability to fill out lengthy, detailed forms neatly and legibly with her nondominant hand. He concluded that based on the evidence, the claimant’s only real disability in
her upper extremity is the right wrist drop that should not affect fine manipulation. (R. 19-20).
The ALJ also concluded that although the claimant had a significant history with staph
infections, she had recovered. The ALJ referenced notes from home healthcare that indicate that
the claimant returned to work with her doctor’s permission. The ALJ also referenced Dr.
Matthews’ February 2008 report that stated that the claimant’s wounds from her November 2007
staph surgery were completely healed. The ALJ also pointed out Dr. Walker’s July 2008 report
regarding the claimant’s leg pains, in which Dr. Walker noted no apparent signs of infection. The
ALJ stated that visits to Dr. Matthew’s office in September 2008 and July 2009 also revealed that
the claimant did not have an active infection. (R. 20-21).
The ALJ stated that he gave little weight to Dr. Walker’s assessment in January of 2008
that stated that the claimant could only sit, stand, or walk for six hours out of an eight hour
business day, could only lift fifteen or fewer pounds, and was subject to other limitations. The
ALJ explained his decision to give little weight to the assessment by stating that Dr. Walker’s
records neither gave a reasonable explanation for these limitations nor offered evidence to
support such limitations. The ALJ noted that Dr. Walker’s later findings did not support the
existence of such limitations. Dr. Walker’s records from February 2008 indicated that no
evidence of tenderness or infection existed, and his records from July 2008 noted that the
claimant’s leg was completely normal aside from a leg-raising test. (R.21).
The ALJ noted letters from the claimant’s supervisors at the Morgan County Archives in
January 2008 and the North-Central Alabama Regional Council of Governments in February
2010 that indicated that the claimant was limited in her functional capacity and would not be a
candidate for full-time employment. However, the ALJ stated that he gave theses letters little
weight because they were not made by individuals with medical expertise and because he
concluded the functional limitations mentioned in the letters were largely self-imposed. (R. 21).
The ALJ stated that he gave great weight to Dr. Gill’s September 2008 state agency
medical consultant opinion that concluded that the claimant could perform a wide range of light
work with the restrictions previously set forth in the ALJ’s decision. The ALJ explained that he
gave Dr. Gill’s opinion great weight because it was consistent with the claimant’s full medical
records as well as with the claimant’s self-reported activities and abilities. (R.21).
The ALJ concluded that the claimant was capable of performing past relevant work as an
invoice control clerk and as a service entry clerk because neither position requires the
performance of activities precluded by the claimant’s residual functional capacity. The ALJ noted
that the vocational expert stated that the claimant could perform her past jobs with a RFC of light
work with restrictions, including the restriction to frequent fine functional fingering. The ALJ
found that Ms. Bramlett’s testimony was consistent with the Dictionary of Occupational Titles.
The ALJ also found that the claimant could perform the other jobs the vocational expert
suggested in her testimony. The ALJ concluded that, even if the claimant was limited to
occasional fingering with the right hand, she could still perform the customer service customer
complaint clerk jobs. (R. 23).
1. The ALJ properly gave the testimony of Dr. Gill, an examining consulting physician,
more weight than the testimony of Dr. Walker, a treating physician.
The claimant alleges that the ALJ improperly gave the testimony of Dr. Gill, a consulting
examining physician, greater weight than Dr. Walker, a treating physician; therefore, the medical
evidence of record would be contrary to the ALJ’s finding that the claimant was able to perform
past relevant work. (Pl.’s Br. 7). The court, however, finds that the ALJ gave adequate reasons
supported by substantial evidence for his decision to give Dr. Gill’s testimony more weight; thus,
his decision to give greater weight to Dr. Gill’s testimony was proper.
An ALJ must give the opinion of a treating physician considerable weight, unless he has
good reason not to accord the opinion substantial weight. Lamb v. Bowen, 847 F.2d 698, 703
(11th Cir. 1998). Unless a good reason exists for alternative treatment, the ALJ must give more
credit to the opinions of treating physicians than to the opinions of consulting physicians. Lewis
v. Callahan, 125 F.3d 1436, 1440-41 (11th Cir. 1997). If a physician’s report is entirely
conclusory or is not accompanied by objective medical evidence, the ALJ may discount its
weight. Crawford v. Commissioner, 363 F.3d at 1159 (11th Cir. 2004). The ALJ does not commit
a reversible error so long as he notes a specific reason supported by substantial evidence for not
giving a treating physician’s testimony controlling weight. Moore v. Barnhart, 405 F.3d 1208,
1212 (11th Cir. 2005).
This court finds that the ALJ properly assessed the medical testimony provided by Dr.
Walker and Dr. Gill. The ALJ stated that he gave greater weight to the examining consulting
physician, Dr. Gill’s, assessment of the claimant’s physical limitations than to the treating
physician, Dr. Walker’s assessment. Although the ALJ gave a consulting physician’s greater
weight than a treating physicians, he cited valid reasons for doing so. The ALJ stated that Dr.
Walker provided no rationale for the limitations in his assessment, aside from “large healing
wound on the left leg.” The ALJ articulated that the claimant’s wound would not account for
many of the restrictions Dr. Walker stated, including the restrictions pertaining to the claimant’s
arm use and hearing. The ALJ also reviewed the records from the claimant’s previous visits with
Dr. Walker and noted that no evidence existed in the notes from those visits to support the
limitations Dr. Walker gave the claimant.
The contents of Dr. Walker’s notes in the record, in fact, support the ALJ’s opinion. The
ALJ noted that in December of 2007, Dr. Walker reported that the claimant’s wound was healing
healthily and that the site of the surgery tested negative for infection. (R. 429-430). In January
2008, Dr. Walker noted that he was happy with the progress of the claimant’s healing. (R. 380382). The ALJ also specifically cited a later opinion by Dr. Walker declaring the patient’s leg
wounds to be completely healed as a reason for devaluing his earlier assessment. (R. 21).
The ALJ noted that Dr. Gill’s opinion, in contrast, was supported by “the full
examination and treating record as well as with reported activities and abilities.” (R. 21). The
ALJ cited the claimant’s self-report that stated that she was able to take care of her personal
hygiene needs and household chores and her ability to fill out detailed forms as supporting Dr.
Gill’s findings. The ALJ also noted that Dr. Matthew’s September 2008 physical examination
showing normal motor function and normal reflexes and Dr. Bramlett’s July 2008 finding that
the claimant could squeeze bilaterally effectively supported Dr. Gill’s opinion. (R. 19-21). The
ALJ correctly found Dr. Walker’s assessment was conclusory and contradicted by his later
reports and that Dr. Gill’s was supported by substantial evidence. This court finds that the ALJ
applied the proper legal standard in assessing the credibility of Drs. Walker and Gill and
substantial evidence supports his decision.
2. The ALJ properly applied the Eleventh Circuit’s pain standard in assessing the
credibility of the claimant’s subjective testimony.
The claimant argues that the ALJ improperly found the claimant’s subjective testimony
regarding her inability to utilize her hand to be unfounded. The court disagrees and finds that the
ALJ properly utilized the pain standard to assess the credibility of the claimant’s subjective
The pain standard applies when a claimant attempts to establish disability through her
own testimony of pain or other subjective symptoms. The pain standard requires (1) evidence of
an underlying medical condition and either (2) objective medical evidence that confirms the
severity of the alleged pain arising from that condition or (3) that the objectively determined
medical condition is of such a severity that it can be reasonably expected to give rise to the
alleged pain. Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991) (emphasis added). The ALJ
must give explicit and valid reasons for discrediting a claimant’s subjective testimony to avoid
having the testimony accepted as true. Brown v. Sullivan, 921 F.2d at 1236. The ALJ may look to
the claimant’s daily activities as a factor in discrediting complaints of disabling pain. Harwell v.
Heckler, 735 F.2d 1292, 1293 (11th Cir. 1984).
In this case, the ALJ conceded that the claimant suffers from underlying medical
conditions capable of generating pain; however, he found that the entirety of the medical
evidence failed to support the claimant’s alleged severity of pain. As to her back pain, the ALJ
noted that the claimant suffered a back injury in December of 1975, but articulated the following
reasons for disregarding the claimant’s subjective testimony concerning her limitations: the
claimant’s ability to work full time from July 1987 to December 1996 and from January 1999 to
May 2005; the claimant’s ability to return to work after injuring herself lifting a picnic table in
2000; Dr. Parker’s report calling the claimant “nicely improved” following an orthopedic steroid
injection in 2000; an x-ray from November 2007 that showed that the claimant had only a mild
compression fracture and otherwise good alignment; notes from home healthcare in 2007 that did
not mention back pain; and Dr. Gill’s 2008 finding that the claimant had a full range of motion in
The court finds that the ALJ also properly discredited the claimant’s subjective testimony
regarding her wrist pain. The ALJ specifically articulated the following reasons for his
determination concerning her wrist: Dr. Norwood’s 2005 finding that the claimant had 4/5 wrist
strength, only slight muscle weakness, a minimally positive Tinel’s sign, and close to normal
nerve conduction tests; Dr. Norwood’s report interpreting the claimant’s test results to be
indicative of carpal tunnel based solely on sensory slowing and indicated no definite radial
neuropathy in either arm; the fact that although the claimant had been alleging disability since
November 2007, no medical evidence of the wrist drop condition exists between Dr. Norwood’s
initial assessment in 2005 until July 2008 even though the claimant sought medical treatment
during that time; the fact that the claimant did not mention her wrist condition to either
emergency room staff or the home healthcare nurses when she was treated for staph in 2007; the
home healthcare nurses’ reports that the claimant could complete tasks requiring dexterity; Dr.
Gill’s 2008 assessment that the claimant could close her right hand into a fist and had a fairly
strong grip; Dr. Bramlett’s report that the claimant could squeeze bilaterally effectively and that
dorsal extension was her only significant problem; and the claimant’s statements that she was
able to complete household chores and groom herself to the extent of wearing earrings. (R. 1920).
The ALJ also concluded that the pain the claimant reported was inconsistent with her
history of staph infections. The ALJ noted that the home healthcare nurse’s notes from 2007, Dr.
Walker’s notes from 2008, and Dr. Matthew’s notes form September 2008 and July 2009 all
indicated that the claimant had recovered from her infections.
Based on the ALJ’s explicit findings and articulated reasons for discrediting the
claimant’s subjective testimony, this court concludes that the ALJ properly applied the Eleventh
Circuit’s pain standard and that substantial evidence supports his decision.
3. The ALJ appropriately determined that the claimant could perform past relevant work
given his RFC determination.
The claimant argues that the ALJ erred in finding that the claimant’s past relevant work
was available to an individual with the claimant’s residual capacity. This court disagrees and
finds that the ALJ was correct in finding that given the claimant’s RFC, the claimant could
perform both her past relevant work and the other available work cited by the vocational expert.
To receive a disability determination the claimant must prove that she cannot return to his
past relevant work. Lucas v. Sullivan, 918 F.2d 1567, 1571 (11th Cir. 1990). If the claimant
proves that she cannot return to her past relevant work, the ALJ must determine whether the
claimant can perform other work based on her functional capacity, age, education, and work
experience. Wilson v. Barnhart, 284 F.3d 1219, 1227 (11th Cir. 2002). The ALJ may utilize a
vocational expert to determine whether the claimant can perform other work. Phillips v.
Barnhart, 357 F.3d 1232, 1239 (11th Cir. 2004). The ALJ must list specific jobs that he finds the
claimant is able to perform and his findings must be supported by substantial evidence. For the
ALJ’s testimony to constitute substantial evidence, the ALJ must present the vocational expert
with a hypothetical question that lists all of the claimant’s impairments. Vega v. Comm. of Social
Security, 265 F.3d 1214, 1220 (11th Cir. 2001).
This court finds that the ALJ abided by the proper procedures for determining what work
the claimant could perform. First, the claimant did not meet her burden of producing substantial
evidence to show that she could not perform her past relevant work. As stated in the preceding
issue, the ALJ correctly gave substantial weight to medical testimony stating the claimant’s
functional restrictions and properly discredited the claimant’s subjective testimony regarding her
wrist condition. Thus, the ALJ correctly assigned the claimant a RFC of light work with special
Also, the vocational expert testified that, with the claimant’s residual functional capacity
of light work with limitations, the claimant could perform all of her past relevant employment.
Based on the vocational expert’s testimony, the ALJ found the claimant to be capable of
performing her past work. (R. 34).
Despite the fact that the ALJ was not required to go any further in his analysis after
determining that the claimant was capable of performing her past work, he asked the vocational
expert, in the correct hypothetical format, what other jobs someone with the residual functional
capacity of the claimant could perform. The vocational expert replied that the claimant could
work as a general clerk or as a customer service clerk, jobs that exist in substantial number both
in the state and the nation. (R. 34-35).
The claimant also argues that all of the jobs the vocational expert recommended involve
frequent fine manipulation and fingering; therefore, the claimant would not be capable of
performing such work. (Pl. Br. 6). This court finds this argument to be without merit for two
reasons. First, the ALJ properly found that frequent fine manipulation and fingering was within
the claimant’s residual functional capacity. Second, the claimant’s arguments have no factual
basis. Not every job that the vocational expert listed as available to the claimant required
frequent fingering and manipulation. Ms. Bramlett testified that the receptionist job did not
require any fine fingering and that the customer complaint job required only occasional fine
manipulation. (R.85-86). This court finds that substantial evidence supports the ALJ’s findings
on this matter.
The claimant also argues that the ALJ ignored Ms. Bramlett’s testimony that concluded
that if the claimant could only use the right hand as a helper hand, she would be incapable of
performing both past relevant work and the other work Ms. Bramlett cited. (Pl. Br. 6). The court
finds this argument unpersuasive. The vocational expert did not testify that limited use of the
right hand would preclude the claimant from any relevant work. While Ms. Bramlett stated that
the inability to use any hand for fine manipulation would eliminate all of the jobs she
recommended, she stated that the limitation of using the right hand as a helper hand would
exclude the claimant only from performing the administrative clerk and general clerk jobs. The
claimant could still perform the receptionist job and customer complaint clerk job that the
vocational expert listed if she were limited to using her right hand as a helper hand. (R. 84-86).
In conclusion, this court finds that the ALJ properly determined that significant jobs were
available for an individual with the claimant’s residual functional capacity.
For the reasons as stated, this court concludes that the decision of the Commissioner is
supported by substantial evidence and is to be AFFIRMED.
DONE and ORDERED this 24th day of September, 2013.
KARON OWEN BOWDRE
UNITED STATES DISTRICT JUDGE
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