Raines v. Social Security Administration, Commissioner
MEMORANDUM OPINION Signed by Chief Judge Karon O Bowdre on 8/21/15. (SAC )
2015 Aug-21 AM 09:41
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF ALABAMA
JEROME KYLE RAINES,
CAROLYN W. COLVIN,
Social Security Administration,
CIVIL ACTION NO.
On February 4, 2011, the claimant, Jerome Kyle Raines, filed a Title II application for
disability insurance benefits and a Title XVI application for supplemental security income. (R.
10). Each claim alleged disability beginning on February 1, 2009 because of diabetes mellitus.
(R.53-54). The Commissioner denied the claim on April 5, 2011 on the basis that the claimant’s
condition was not severe enough to prevent him from working. (R. 55)
On May 19, 2011, the claimant timely requested a hearing before an ALJ. (R. 58). ALJ
Neil Sullivan held a hearing on November 14, 2012. (R. 24). The ALJ denied the claimant’s
application in a letter dated December 18, 2012, (R. 7), finding that the claimant was not disabled
because he could perform light work with some restrictions. (R. 17-18). The claimant filed a
request for review by the Appeals Council on January 17, 2013, (R. 5), and the Appeals Council
denied the claimant’s request for review on June 25, 2014. (R. 1). Having exhausted his
administrative remedies, the claimant now properly appeals the ALJ’s decision, and this court
has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). The claimant filed this appeal
on August 13, 2014. (Doc. 1). For the reasons stated below, this court AFFIRMS the decision of
II. ISSUES PRESENTED
Because the claimant is not represented by counsel, the court did not require him to
submit a brief. Because he filed no brief, this court construes his issues to include (1) whether the
ALJ properly applied the pain standard, and (2) whether the ALJ properly considered the reasons
for the claimant’s noncompliance with medical treatment.
III. STANDARD OF REVIEW
The standard for reviewing the Commissioner’s decision is limited. This court must
affirm the Commissioner’s decision if the Commissioner applied the correct legal standards and
if the factual conclusions are supported by substantial evidence. 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.
“No...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 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, 401 (1971).
The 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 the 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.
The 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 look
only 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. 1986).
IV. LEGAL STANDARD
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the
person cannot “engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result in death or which has lasted or
can be expected to last for a continuous period of not less than 12 months...” 42 U.S.C. §
423(d)(1)(A). To make this determination, the Commissioner employs a five-step, sequential
(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); 20 C.F.R.§§ 404.1520, 416.920.
A Commissioner evaluating a claimant’s pain or other subjective complaints must first
consider whether the claimant demonstrated an underlying medical condition. Holt v. Sullivan,
921 F.2d 1221, 1223 (11th Cir. 1991); see also Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th
Cir. 2002); 20 C.F.R. § 404.1529. If the claimant demonstrates an underlying medical condition,
the Commissioner must then determine if any objective medical evidence confirms the severity
of the alleged pain, or if the underlying medical condition has been objectively confirmed and is
so severe that one could reasonably expect it to give rise to the alleged pain. Id. Subjective
testimony can satisfy the pain standard if the testimony is supported by medical evidence. Foote
v. Chater, 67 F.3d 1553, 1561 (11th. Cir. 1995).
If discrediting subjective testimony, the ALJ must explicitly discredit the testimony and
must articulate sufficient reasons for doing so. See Hale v. Bowen, 831 F.2d 1007, 1011 (11th
Cir. 1987); see also SSR 96-7p, 1996 4. (“The determination or decision must contain specific
reasons for the finding on credibility, supported by the evidence in the case record, and must be
sufficiently specific to make clear to the individual and to any subsequent reviewers the weight
the adjudicator gave to the individual’s statements and the reasons for the weight...”).
reasons articulated for discrediting the claimant’s testimony may include the claimant’s daily
activities. Harwell, 735 F.2d at 1293. However, if the ALJ does not articulate reasons, the court
must accept the claimant’s testimony as true. Holt, 921 F.2d at 1236.
Refusal by a claimant 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). If the ALJ relies solely 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. Id. If the
ALJ does not substantially or solely base his finding of nondisability on the claimant’s
noncompliance, he does not commit a reversible error by failing to consider the claimant’s
financial situation. Id.
The claimant was fifty years old at the time of the ALJ’s decision, (R. 10, 54), and is a
high-school graduate, who took two college classes while on active duty in the Army. (R. 29-30).
He has prior relevant work experience as a warehouse worker, (R.40-41), and alleges disability
beginning on February 1, 2009 resulting from diabetes mellitus. (R. 10).
The claimant has a long history of diabetes and related problems in his medical record
from the Veterans Administration Medical Center from 2004 to 2012. On April 19, 2004, the
claimant went to the emergency room at the VA to check his blood sugar because his feet were
numb and tingling. The emergency room notes indicate that the claimant had not checked his
blood sugar in two months. The notes indicate that claimant smelled of alcohol, and that claimant
reported drinking 18 beers per day for 20 years. The nurse recommended that he stop drinking
alcohol. The claimant returned for a follow-up the next day, and Dr. James Balart gave the
claimant medications for his diabetes, educated him about diabetes, and recommended that the
claimant follow up with the Outpatient Substance Abuse Clinic (OSAC) at the VA. (R. 746-58).
The claimant continued to regularly visit the VA for general care related to his diabetes
through 2012. On June 8, 2004, the claimant met with a dietician to adjust his diet. (R. 725). At a
routine visit for his diabetes on February 3, 2005, he admitted to noncompliance with dietary
restrictions, drinking multiple sodas at work and failing to have his labs checked as instructed.
(R. 687). On March 12, 2005, the claimant complained of neuropathy, and Dr. Andrew Barreto, a
neurology resident, noted his diabetes as the cause, but indicated that the claimant’s history of
heavy alcohol use may also have contributed. The claimant indicated that his problems had
improved since he began taking his medicine. (R. 681-84). On May 5, 2005, Dr. Barreto
indicated that his neuropathy was “severe, but not activity limiting.” (R. 678).
On November 13, 2005, the claimant went to the emergency room at the VA following a
syncopal episode, and his blood sugar measured 400. He reported that he drank five beers before
briefly losing consciousness and that his family members helped him to the emergency room. (R.
652). The claimant returned for a follow-up on December 15, 2005, and Dr. Barreto indicated
that he was in stable condition and that his diabetic neuropathy was not activity limiting. (R.
On June 20, 2006, the claimant reported that he left work because he was vomiting and
that he went to the emergency room at the VA to be cleared to return to work. His blood sugar
was 341 at work and 377 while in the emergency room. (R. 617). The claimant reported that he
had not taken any of his diabetes medicine, and hospital records indicated that he smelled of
alcohol. (R. 614).
At a routine doctor’s appointment at the VA on August 1, 2008, the claimant reported
having more problems with his diabetes after starting a manual labor job. Dr. Jennifer Sohn
indicated that his hypoglycemic episodes could be because of his work, eating less often, and
possible noncompliance with medication. (R. 517-19). At a routine appointment for his diabetes
on August 26, 2008, the claimant’s blood sugar measured 568, and he reported that he had not
checked his sugar for several days because his home monitor’s battery was dead. (R. 509). In a
follow-up appointment for his diabetes on September 4, 2008, a nurse commented that the
claimant had numerous issues to address, including “compliance with medications.” (R. 496).
At a routine visit on April 21, 2009, a nurse at the VA suggested a referral to a weight
loss program outside of the VA, but the claimant refused. (R. 470-71). On October 21, 2009, the
claimant requested and received a new glucometer; he was unable to attend a class for training on
its use because his son was ill, and he refused to view a video on how to operate the monitor. (R.
On December 10, 2009, the claimant went to the emergency room at the VA when a
neighbor saw him unconscious in his front yard. The claimant said he had eaten a smaller than
usual breakfast, and admitted to typically drinking eight beers per day. He was released later that
day. (R. 437-38).
At a follow-up appointment at the VA on December 23, 2009, clinical pharmacist
Tommy Burnett noted that his problems were “most likely [due to] the patient skipping meals as
well as not following a diabetic diet.” (R. 424). Burnett recommended meeting with a dietician,
but the claimant declined. At this time, the claimant admitted to drinking sweet tea and regular
soda, as well as not restricting his carbohydrate intake and eating candy. (R. 422). The claimant
missed an appointment with Mr. Burnett on January 7, 2010, and he acknowledged only partial
compliance with his medication at another pharmacy appointment on February 1. (R. 419-21).
The claimant missed scheduled pharmacy appointments on March 1 and 23, 2010. (R. 416).
On September 10, 2010, the claimant saw Dr. Terrence Shaneyfelt at the VA for a routine
visit and he noted his “concern for noncompliance.” (R. 400). During the same visit, the claimant
reported to have had one episode of hypoglycemia in six months, which was because he had not
eaten with his medication, and he denied any other hypoglycemic events. (R. 397). Claimant
failed to attend a scheduled appointment at the clinic on October 21 and at the pharmacy on
October 22, 2010. (R. 394).
At a routine visit on January 7, 2011, the claimant admitted to drinking four beers daily,
and Dr. Michael Gates noted that claimant was in the “contemplation phase” of alcohol
abstinence. Dr. Gates also noted his “concern for noncompliance” with claimant’s diabetes
treatment. (R. 383-84).
On January 25, 2011, the Outpatient Substance Abuse Clinic (OSAC) at the VA admitted
claimant, although he stated that he did not have an alcohol problem, but was at OSAC “because
of another legal matter.” Claimant said that he would be unable to attend OSAC sessions because
of work obligations. (R. 369-74).
Claimant had cataract extraction surgery because of his diabetic retinopathy on January
28, 2011 with no complications. (R. 213-14). At a follow-up appointment one week later, his
vision had improved. (R. 360).
On March 22, 2011, Dr. David Aarons performed a consultative medical exam on the
claimant at the request of the Social Security Administration. (R. 760). Dr. Aarons recognized
that the claimant had lost consciousness three times over the last year, calling his diabetes
“poorly controlled, but better than it was.” (R. 763). Dr. Aarons also noted neuropathy of the
lower extremities bilaterally in his diagnosis. He noted that the claimant walked into the exam
room without assistance, sat comfortably, got on and off the exam table, and was able to remove
his shoes and put them back on. (R. 761). Dr. Aarons concluded that the claimant’s general
findings, motor strength, muscle bulk, and tone were “within normal limits.” (R. 763). Nothing
in Dr. Aaron’s report indicated any functional limitations. (R. 760-63).
On April 5, 2011, Dr. Robert Heilpern evaluated the claimant’s medical records at the
request of the Social Security Administration and noted that the claimant’s diabetes “is not
adequately controlled by his medication.” However, he also pointed out that the claimant’s other
conditions “do not have significant limiting effects” and that he “remains somewhat functional
and would be expected to perform some work related activities.” Additionally, Dr. Heilpern
noted that the claimant’s statements about his condition were “partially credible” based on his
symptoms and activities of daily living. (R. 770).
On May 3, 2011, the claimant underwent surgery for an anal fistula and perineal abscess.
(R. 1038). Later that month at a routine doctor’s appointment to check up on his diabetes, the
claimant’s medical record indicates that his diabetes was gradually improving. (R. 1016). A nurse
noted that he was not at risk of falling. (R. 1031).
The claimant went to the hospital with a urinary tract infection on July 13, 2011. His
record from this stay indicates that he was “noncompliant with medications” for his diabetes. The
claimant reported to have stopped drinking alcohol. (R. 783-86). At a follow-up appointment for
his diabetes on January 4, 2012, the claimant reported that he was drinking two to three beers per
day. (R. 790). His medical report indicates “poor compliance with taking insulin as prescribed”
and “poor compliance with lifestyle modifications/practices.” (R. 834).
On January 25, 2012, the claimant missed an appointment with the Medication
Management Clinic at the VA. He missed another appointment at the VA pharmacy on February
7. (R. 827-28).
The ALJ Hearing
After the Commissioner denied the claimant’s request for disability benefits, the claimant
requested and received a hearing before an ALJ. (R. 24). At the hearing, the claimant testified
that he was a high school graduate; that he took two college courses while in the Army; and that
he could read and perform basic math. He testified that he did not suffer any service-related
injury while in the Army. (R. 29-30).
The claimant testified that he had not worked since February 1, 2009, but that he
occasionally did yard work. He said that he briefly collected unemployment benefits, and that he
had previously collected Workers’ Compensation benefits in 2007 when he had broken his wrist
on the job. While being examined by his attorney, the claimant testified that he was terminated
from his job in February 2009 because he was too sick to work. According to the claimant, he
was experiencing dizziness, tiredness, and he had passed out on one occasion. The claimant
emphasized his fatigue, and claimed that it gave him no ability to function. He testified that he
had good days and bad, and that, on bad days, he struggled to go up and down stairs and he spent
most of his time resting. He stated that he had about five bad days per week. (R. 31-35).
The claimant stated that he experienced painful neuropathy in his legs and feet, and that
he occasionally took medicine for the neuropathy, but he did not like to take the medicine. He
described his pain as a seven on a scale from zero-to-ten. He testified that the pain occasionally
hurt his ability to concentrate, but that he could pay attention for a two-hour long movie. (R. 3536).
When asked about his noncompliance with medication and treatment, the claimant
explained that he was on a “sliding scale” where he would take a varying amount of medication
depending on his blood sugar. The claimant testified that he ran this system by his doctor, but did
not specify which doctor had given him these instructions. He mentioned that he has had several
doctors, and some were better than others. (R. 37-39).
The claimant testified that he previously worked in a warehouse in shipping and
receiving. He stated that this job kept him on his feet most of the time, and that he frequently had
to lift objects that weighed about 50 pounds. He testified that he was fired from this job because
his employer had one man die on the job and did not want to risk another employee dying. After
his termination, he applied for two or three different jobs, but claimed that he was not hired
because potential employers viewed him as a risk. The claimant testified that he applied to work
at Piggly Wiggly, at an auto shop doing body work, with a contractor doing light remodeling, and
most recently at Lowe’s. When questioned by his attorney, the claimant stated that, if an
employer hired him, he would probably have a hard time going to work on some days. (R. 4045).
The claimant described that on a typical day, he cooks breakfast for his wife, and he
occasionally washes dishes, sweeps, and mops the floor. He stated that he had no hobbies besides
doing puzzles, and that he rarely left his home. (R. 43-44).
A vocational expert, Ms. Norma Strickland, testified concerning the type and availability
of jobs that the claimant was able to perform. Ms. Strickland testified that the claimant’s past
relevant work included being a warehouse worker, which is classified as medium and unskilled.
The ALJ asked Ms. Strickland to assume a hypothetical individual with the claimant’s age,
education, and work experience, who was limited to a full range of exertionally light work; could
not climb ladders, ropes, or scaffolds; could frequently climb ramps or stairs; could frequently
stoop, kneel, crouch, crawl, or balance; would be required to change from a standing position to
sitting position once per hour; and should avoid the use of hazardous machinery, operational
control of moving machinery, and unprotected heights. Ms. Strickland testified that such an
individual could not perform any of the claimant’s past work, but that such an individual could
work at several jobs that exist in significant numbers in Alabama and in the national economy,
such as a storage facility rental clerk (2000 jobs in Alabama, 100,000 nationally), a shipping and
receiving weigher (400 jobs in Alabama, 27,000 nationally), or a routing clerk (1000 jobs in
Alabama, 73,000 nationally). The ALJ further limited the hypothetical individual to one with the
above limitations, but was limited to exertionally sedentary activity. Ms. Strickland testified that
such an individual could work as a ticket taker (1000 jobs in Alabama, 70,000 nationally), small
parts assembler (500 jobs in Alabama, 28,000 nationally), or package sealer (250 jobs in
Alabama, 22,000 nationally), all of which are jobs that exist in significant numbers in Alabama
and the national economy. (R. 46-49).
The ALJ’s Decision
On December 18, 2012, the ALJ issued a decision finding that the claimant was not
disabled under the Social Security Act from February 1, 2009 through the date of the decision.
(R. 18). First, the ALJ found that the claimant met the insured status requirements of the Social
Security Act through December 31, 2012 and had not engaged in substantial gainful activity
since February 1, 2009. (R. 12).
Next, the ALJ found that the claimant had the severe impairments of diabetes mellitus
and diabetic neuropathy. He found these impairments to be severe because the evidence indicated
that they caused more than minimal work-related functional limitations for at least twelve
months. The ALJ found that the claimant’s other health problems of hypertension,
hyperlipidemia, erectile dysfunction, scrotal abscess, boils, a wrist fracture, and diabetic
retinopathy were not severe impairments because the record contained little evidence that they
caused more than minimal work-related functional limitations. (R. 12-13).
To illustrate that these other impairments were not severe, the ALJ set forth the
claimant’s treatment history for diabetic retinopathy and pointed out that none of the claimant’s
health care providers noted that the claimant had any functional limitation because of his vision.
The ALJ noted that doctors provided medication and education to remedy each of these other
issues, indicating that they were not severe. (R. 13).
The ALJ then determined that the claimant did not have an impairment or a combination
of impairments that meets or medically equals the severity of one of the listed impairments in 20
C.F.R. Part 404, Subpart P, Appendix 1. The ALJ pointed to the fact that the claimant received
conservative treatment for his diabetes as evidence that the claimant did not meet the requirement
for listing 9.00. (R. 13).
Next, the ALJ determined that the claimant had the residual functional capacity to
perform exertionally light work, with the additional limitations that the claimant cannot climb
ladders, ropes, or scaffolds; can only occasionally climb ramps or stairs; can only frequently
stoop, kneel, crouch, crawl, or balance; can change from a standing position to a sitting position
at least every hour; and should avoid concentrated exposure to the use of hazardous machinery,
operational control of moving machinery, and unprotected heights. To come to this conclusion,
the ALJ considered both the claimant’s allegations of limitation and the available medical
evidence, eventually determining that the claimant’s allegations were less than entirely credible.
The ALJ noted that the claimant had a history of poorly controlled diabetes and diabetic
neuropathy in the legs and feet. However, the ALJ emphasized that the claimant had a history of
not taking his medications as prescribed and not maintaining a proper diabetic diet. The ALJ
pointed out that, when the claimant was compliant with treatment recommendations, his
symptoms severely diminished. The ALJ pointed to several instances when the claimant was at
the hospital with problems related to his diabetes, and, at each time, the claimant was
noncompliant with his treatment. Before considering medical opinion evidence, the ALJ noted
that, throughout the claimant’s records from 2009 to 2012, he had no reported physical or
cognitive limitations. (R. 14).
Next, the ALJ considered the medical opinion evidence of consultative Drs. David
Aarons and Robert Heilpern. The ALJ stated that he found these opinions to be “generally
credible” because “the combination of [the] evidence strongly supports the conclusions reached
by Drs. Aarons and Heilpern.” The ALJ explained that Dr. Aarons performed a physical and did
not include any significant finding of functional limitation, except for the claimant’s diabetic
neuropathy. Additionally, the ALJ noted that Dr. Heilpern found that the claimant was capable of
performing exertionally light work, and that the claimant’s cataract surgery in January 2011 had
resolved the claimant’s visual impairment. (R. 15).
Ultimately, the ALJ determined that the claimant’s statements were not credible for four
reasons. First, he noted that the claimant’s doctors provided generally conservative treatment,
which is not indicative of a significant functional limitation. Second, the ALJ noted that the
medical opinion evidence of Dr. Aarons and Dr. Heilpern did not corroborate the claimant’s
complaints of a significant and profound limitation. Third, the ALJ pointed out that the claimant
had applied for several jobs during the time that he was supposedly disabled, indicating that he
believed he was capable of working. Finally, the ALJ pointed out that the claimant was capable
of performing a range of activities of daily living, such as watching television, completing
puzzles, and cleaning the house by mopping and sweeping the floor. Because of all these reasons,
the ALJ found the claimant’s allegations to be less than credible. Considering these allegations
alongside the claimant’s medical record, the ALJ found that the evidence supported the
limitations in the residual functional capacity statement set forth above. (R. 16).
Finally, the ALJ considered the vocational expert’s testimony and concluded that, given
his residual functional capacity, age, education, and work experience, the claimant was capable
of finding a job that exists in significant numbers in the national economy. The ALJ gave the
examples of rental clerk (30001 jobs in Alabama, 100,000 jobs nationally), shipping and
receiving clerk (400 jobs in Alabama, 27,000 jobs nationally), and routing clerk (1000 jobs in
Alabama, 73,000 jobs nationally). Therefore, the ALJ issued a finding of “not disabled.” (R. 1718).
The claimant filed his appeal pro se and did not file a brief. However, the claimant has a
duty to prove his own case and provide evidence in support of his disability claim. “[T]he
claimant bears the burden of proving that he is disabled, and, consequently, he is responsible for
producing evidence in support of his claim.” Ellison, 355 F.3d at 1276; see also 20 C.F.R. §
416.912(c) (stating “You must provide medical evidence showing that your have an
impairment(s) and how severe is it during the time you say you are disabled.”).
Here, the claimant, stating that he disagrees with the ALJ’s decision and that he is unable
to obtain work, gives no specific reason to overturn the decision. In place of any specific issue
raised by the claimant, the court will consider (1) whether the ALJ properly applied the pain
standard, and (2) whether the ALJ properly considered the claimant’s noncompliance with
Issue 1: The ALJ’s application of the pain standard
In this case, the ALJ, applying the Eleventh Circuit’s pain standard, discounted the
claimant’s subjective complaints regarding his limitations. This court finds that the ALJ properly
applied the pain standard and substantial evidence supports his findings.
The Vocational Expert testified that 2000 jobs as a rental clerk exist in Alabama. This
discrepancy is immaterial to the conclusion that the job exists in significant numbers.
A Commissioner evaluating a claimant’s pain or other subjective complaints must first
consider whether the claimant demonstrated an underlying medical condition. Holt, 921 F.2d at
1223. Then, the Commissioner must determine if any objective medical evidence confirms the
severity of the alleged pain. Id. Subjective testimony can satisfy the pain standard if the
testimony is supported by medical evidence. Foote, 67 F.3d at 1561.
If the ALJ discredits subjective testimony, he must explicitly discredit the testimony and
articulate sufficient reasons for doing so. See Hale, 831 F.2d at 1011. The reasons articulated for
discrediting the claimant’s testimony may include the claimant’s daily activities. Harwell, 735
F.2d at 1293. However, if the ALJ does not articulate reasons, the court must accept the
claimant’s testimony as true. Holt, 921 F.2d at 1236.
In the present case, the ALJ found that the claimant’s impairments “could reasonably be
expected to cause the alleged symptoms; however, the claimant’s statements concerning the
intensity, persistence and limiting effects of these symptoms are not entirely credible.” (R. 18).
Specifically, he gave four reasons for discrediting the claimant’s characterization of his physical
capabilities: (1) his doctors’ conservative treatment and lack of indication of a functional
limitation; (2) the medical opinion evidence that did not validate the claimant’s complaint of
significant and profound limitations; (3) evidence of the claimant applying for jobs; and (4) the
claimant’s activities of daily living. (R. 16).
The claimant’s medical history from 2004 through 2012 supports the ALJ’s first reason
for discrediting the claimant’s subjective testimony. During the claimant’s doctor’s appointments
for his diabetes and diabetic neuropathy, his doctors prescribed the claimant medication and
occasionally suggested weight loss or adjusting his diet. At no time did any doctor indicate any
functional limitation related to the claimant’s diabetes. The ALJ correctly found that these
records are inconsistent with the claimant’s testimony that he has no ability to function and that
he often must spend all day resting in bed.
Second, the medical opinion evidence on which the ALJ relied to discredit the claimant’s
subjective complaints exists in the reports of Dr. Aarons and Dr. Heilpern. Specifically, the ALJ
noted Dr. Aarons’ indication that the claimant’s general findings were “within normal limits,”
and his lack of any functional limitation of the claimant in his report. (R. 763). The ALJ relied on
Dr. Heilpern’s note that the claimant “remains somewhat functional and would be expected to
perform some work related activities.” (R. 770). Again, the ALJ accurately noted that this
medical evidence is not consistent with the claimant’s testimony that he is unable to work.
Next, the ALJ discounted the claimant’s subjective complaints based on the fact that the
claimant indicated that he was applying for jobs throughout the time period that he alleged he
was disabled. These jobs included working as a contractor doing light remodeling, working in a
body shop, and working as a grocery store stocker. (R. 42). While the claimant said that he was
not confident that he would be able to perform these jobs if he were hired, his application
indicates that he believed he was capable of performing the duties of several jobs. The ALJ
correctly found that the claimant’s capacity to work in a body shop or do light remodeling is
inconsistent with the disabling limitations that he alleges.
Finally, the ALJ discounted the claimant’s subjective complaints based on his activities
of daily living. The ALJ mentioned that he performs household chores, watches televison, and
completes puzzles.2 In addition to these activities, the claimant admitted to doing yard work. (R.
16, 31). These activities of daily living weigh against the claimant because he alleges that he has
significant limitations that prevent him from working, but he is still capable of maintaining his
home by sweeping and mopping the floor and doing yard work. The claimant alleges that he has
no ability to function and that, on as many as five days a week, he stays in bed nearly all day. (R.
34-35). These subjective complaints are inconsistent with the claimant’s activities of daily living,
particularly his mopping, sweeping, and doing yard work. The ALJ correctly found that, if the
claimant is capable of performing these activities of daily living, he is capable of performing job
duties as well.
Ultimately, each of these reasons support the ALJ’s finding that the claimant was not
credible and provide a sufficient basis for the ALJ to discredit the claimant’s testimony regarding
the effects of his alleged symptoms. The court finds that the ALJ correctly applied the pain
standard, and substantial evidence supports his decision on this issue.
Issue 2: The ALJ’s consideration of claimant’s noncompliance with medical treatment
The ALJ considered the claimant’s noncompliance with medical treatment in denying
him disability benefits. While the claimant has a history of noncompliance with medical
treatment, he filed this action in forma pauperis; lives in subsidized housing, and has been unable
to pay numerous traffic tickets. For these reasons, the claimant could argue that the ALJ failed to
consider his noncompliance in light of his poverty. This court finds that the ALJ properly
This court is unsure why the ALJ considered that the claimant’s sedentary activities of
watching television and completing puzzles reduced the reliability of claimant’s testimony that
he could not work. At most, watching television demonstrates the ability to keep one’s eyes
focused. Considering watching television to make the claimant more capable of performing work
considered the claimant’s noncompliance with his medical treatment notwithstanding his
Refusal by a claimant to follow prescribed medical treatment without good reason will
preclude a finding of disability, although poverty may excuse failure to follow prescribed medical
treatment. Ellison, 355 F.3d at 1275. If the ALJ does not substantially or solely base his finding
of nondisability on the claimant’s noncompliance, the ALJ does not commit reversible error by
failing to consider the claimant’s financial situation. Id.
In this case, the ALJ did not solely or substantially base his decision on the claimant’s
noncompliance. The ALJ considered all of the claimant’s medical history, and pointed to several
reasons other than claimant’s noncompliance for finding his allegations only partially credible.
(R. 16). Additionally, he referenced the medical opinion evidence that found that claimant had no
significant limitations that would prevent him from working. (R. 15). In light of these alternative
reasons for finding that the claimant had no disability, the ALJ clearly did not base his finding
solely or substantially based on the claimant’s noncompliance.
Poverty could have a bearing on the claimant’s ability to abide by prescribed medical
treatment, but nothing in the record indicates that such circumstances exist here. When asked
about his noncompliance at the hearing, the claimant explained that he was using a “sliding
scale” to determine when to administer his insulin, and he claimed that one of his doctors
endorsed this approach. (R. 37-39). However, the claimant’s medical records indicate on
numerous occasions that the claimant did not comply with his treatment. Most importantly here,
the claimant never suggested that he could not afford his treatment. The record does contains
evidence that the claimant was living in poverty; he lived in subsidized housing; and did not
drive a car because of unpaid traffic tickets. (R. 28). However, claimant also indicated that he
received all of his medical treatment through the VA, so the ALJ was aware that the claimant
likely had no difficulty affording his treatment. (R. 33).
Ultimately, however, the ALJ determined that the record suggested the claimant’s
symptoms and limitations were not of such severity for him to be unable to work. That is, his
finding was not based solely or substantially on claimant’s noncompliance. For this reason, the
court finds that the ALJ properly considered the claimant’s noncompliance with medical
treatment in finding that the claimant has no disability.
For the reasons stated above, this court concludes that substantial evidence supports the
Commissioner’s decision. Accordingly, this court AFFIRMS the decision of the Commissioner.
The court will enter a separate order to that effect simultaneously.
DONE and ORDERED this 21st day of August, 2015.
KARON OWEN BOWDRE
UNITED STATES DISTRICT JUDGE
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