Sanders v. Social Security Administration, Commissioner
MEMORANDUM OPINION Signed by Judge William M Acker, Jr on 8/11/16. (SAC )
2016 Aug-11 PM 03:06
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
CAROLYN W. COLVIN, ACTING
COMMISSIONER OF SOCIAL
CIVIL ACTION NO.
Plaintiff Terrance Sanders brings this action pursuant to
disability insurance benefits and supplemental security income.
Sanders timely pursued and exhausted the administrative remedies
available to him before
the Social Security Administration.
Commissioner's decision is due to be affirmed.
STATUTORY AND REGULATORY FRAMEWORK
To qualify for social security benefits, a non-elderly
claimant must, inter alia, show that he is disabled. 42 U.S.C.
§§ 423(a)(1)(D), 1381a (2012). A person is disabled if he 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.” 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A) (2012).
To determine if a claimant is disabled, the Social Security
Administration employs a five-step process, which is followed at
First, the Commissioner must determine whether the claimant
is currently engaged in any substantial gainful activity.
so, the claimant is not disabled. 20 C.F.R. §§ 404.1520(a)(4),
Second, the Commissioner must determine whether
the claimant has “a severe medically determinable physical or
mental impairment” expected to result in death or to last at
least one year.
If not, the claimant is not disabled. 20 C.F.R.
Commissioner must determine if any of the claimant’s impairments
meets or exceeds the requirements of an impairment within the
Listing of Impairments, found at 20 C.F.R. Part 404, Subpart P,
Appendix 1. If
the claimant is disabled. 20 C.F.R. §§
If the Commissioner
has not made a conclusive determination after the third step, it
must assess the claimant’s Residual Functional Capacity (“RFC”).
20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4).
The RFC measures
the claimant’s ability to work in spite of her impairments. 20
Commissioner must determine if the claimant’s RFC allows her to
perform her past relevant work. If so, the claimant is not
disabled. 20 C.F.R. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv).
Fifth, the Commissioner must determine whether there exist a
significant number of jobs in the national economy that the
404.1520(a)(4)(v), 404.1560(c), 416.920 (a)(4)(v), 416.960(c).
If a significant number of such jobs exist, the claimant is not
disabled; if not, he is disabled. Id.
In this case, the ALJ found that Sanders has not engaged in
substantial gainful activity (R. at 13) and that he has the
following severe impairments: cutaneous T cell lymphoma stage
III (“CTCL”), degenerative disc disease of the cervical spine,
and right arm radiculopathy (R. at 13).
The ALJ further found
however that Sanders did not have an impairment or combination
of impairments that met or equaled those listed in 20 C.F.R. §
404 and its accompanying appendices. (R. at 14-15).
exertional levels with the nonexertional limitation that he
perform tasks that did not involve concentrated
exposure to extreme heat, extreme humidity, or sustained direct
directions, including overhead, with the right, non-dominant
extremity. (R. at 15-19).
Finally, the ALJ found that Sanders
could perform his past relevant work. (R. at 19-20, 44-45).
Based on these findings, the ALJ determined that Sanders was not
disabled and denied his application. (R. at 20).
In this case, Sanders challenges the ALJ’s determination
solely on the basis that in evaluating Sanders’ RFC the ALJ
complaints of pain in accordance with the Eleventh Circuit’s
challenged the ALJ’s finding that:
determinable impairments could reasonable be expected to
cause the alleged symptoms; however, the claimant’s
statement concerning the intensity,
limiting effects of these symptoms are not entirely
credible for the reasons explained in this decision.
(R. at 16).
Eleventh Circuit precedent “requires that an ALJ apply a
three part ‘pain standard’ when a claimant attempts to establish
disability through his or her own testimony of pain or other
subjective symptoms.” Foote v. Chater, 67 F.3d 1553, 1560 (11th
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). The
subjective symptoms complained of by the plaintiff.
In this case, the ALJ evaluated the credibility of Sanders’
complaints under the Eleventh Circuit’s “pain standard”
properly concluded that they were not supported by the objective
evidence or that the objectively determined medical
condition was of such severity that it could be reasonably
expected to give rise to the alleged pain. (R. at 15-19).
Yet even if the plaintiff's testimony could satisfy the
articulating explicit and adequate reasons for
doing so where such articulation is supported by substantial
evidence. Foote, 67 F.3d at 1561–62; Hale v. Bowen, 831 F.2d
1007, 1012 (11th Cir. 1987).
"Failure to articulate the reasons
for discrediting subjective testimony," or a failure to support
those reasons by substantial evidence, "requires, as a matter of
law, that the testimony be accepted as true." Wilson, 284 F.3d
In this case, the ALJ articulated explicit and adequate
While an ALJ “[may] not disregard an
individual's statements about the intensity, persistence, and
impairment-related symptoms alleged by the individual . . . [a]
report of minimal or negative findings or inconsistencies in the
objective medical evidence is one of the many factors [an ALJ]
must consider.” SSR 16-3p, Titles II and XVI: Evaluation of
Symptoms in Disability Claims, March 28, 2016. (emphasis added).
Here the ALJ based its findings on not only the objective
findings in the medical evidence of record, but also on the
conservative treatment Sanders received his pain, the recent
record evidence indicating Sanders’ CTCL was stable even after
inconsistent treatment with light therapy, and Sanders’ work
history. (R. at 16-19).
Objective medical evidence
While the ALJ acknowledged Sanders’ medical records showed
complaints relating to shoulder pain since September 2013 (R.at
17, 652, 658), contemporaneous exams showed normal extremity
testing and generally normal neurological testing (R. at 653)
alongside an x-ray showing only mild degenerative changes, with
no evidence of acute fracture or sublaxation (R. at 17, 556-57).
A follow-up exam in October 2013 showed Sanders had normal range
normal extremity findings, and no focal deficits
aside from some numbness to light touch in his right fingers.
(R. at 646-47).
While Sanders continued to complain of shoulder
helped. (R. at 17, 639).
Finally, in a December 2013 exam,
findings, and a full range of motion (R. at 18, 554-55, 622,
regularly (R. at 554-55, 639-40).
In February 2014, one of
Sanders’ treating physicians, Dr. Warren Blackburn, noted that
he did not see a need for a non-VA consultation for Sanders’
shoulder pain as MRI tests did not show clinically important
Blackburn’s note, in March 2014 Sanders visited Dr. Martin
Jones, yet Dr. Jones did not see anything
that would cause
Sanders’ arm pain while still recommending a nerve conduction
study. (R. at18, 792).
Sanders’ later visit with Dr. Jason
Morris for the nerve conduction study showed no significant
complained of pain, there is substantial and objective medical
evidence to support the ALJ’s findings.
Conservative treatment for pain
shoulder pain, the ALJ did not find these complaints credible in
light of the generally conservative treatment prescribed for his
In November 2013, Sanders was prescribed Lortab
and acknowledged that this helped the pain.
(R. at 17, 639).
medication and prescribed the conservative treatment of using a
tennis ball and warm rice sock to massage his shoulder (R. at
In a January 2014 exam following this conservative
treatment recommendation, Sanders had normal extremity testing,
a full range of motion (R. at 614), and a same day neurosurgical
consultation showing that he had 4/5 right upper extremity motor
strength, full 5/5 strength in his upper extremity, and normal
consistently complained of pain, the conservative treatment for
pain constitutes substantial evidence in support of the ALJ’s
C. Effective treatment of CTCL
While the ALJ acknowledges Sanders’ diagnosis of CTCL, the
objective findings and effective treatment of his CTCL support
inconsistent with the type of limitations Sanders alleged at his
(R. at 16, 33-34).
While Sanders testified he only
missed therapy when he was sick or lacked transportation, there
appointments. (R. at 17).
Even when Sanders was unemployed, he
continued to miss therapy treatments. (R. at 17).
In January 2008, Sanders began undergoing PUVA therapy (a
type of light therapy used to treat skin conditions) and using
treatment notes indicate the PUVA therapy was effective and his
doctors advised that he continue this therapy three times a
week. (R. at 16, 342, 395-96).
Yet in November 2009, Sanders
reported he had stopped PUVA therapy by February 2009 and was
using only topical steroids to treat his CTCL.
(R. at 16, 322).
topical steroids and that his CTCL had been stable and minimal
since discontinuing PUVA therapy.
(R. at 16, 258-59).
an exam showed erythematous plaque on Sanders’ left cheek and
shoulders, and back, Sanders was advised to restart PUVA therapy
three thimes a week.
(R. at 16, 259).
Upon complaints of an
upset stomach relating to the PUVA therapy, Sanders was switched
to nbUVB therapy.
(R. at 16, 295).
Sanders underwent this
treatment three times a week from April 2012 through October
(R. at 458-62).
In an October 2012 exam, Sanders’ CTCL
was noted to have improved and he was advised to decrease nbUVB
decreasing treatment to one time a month if the CTCL did not
flare up after the first reduction.
(R. at 16, 453).
continued treatment twice a week through December 2013, did not
undergo any treatment in January 2014, and underwent treatment
only once in February 2014. (R. at 17, 631, 672, 677, 681).
a February 2014 dermatology exam, Sanders reported that the
lesions on his chest appeared a lot smaller, the lesions did not
to be getting worse, and that he felt he was doing
better. (R. at 17, 597, 608).
Sanders did not receive any nbUVB
dermatology clinic exam in April 2014 Sanders reported that he
felt overall improvement with his CTCL and no symptoms aside
from some fatigue and night sweats (R. at 17, 841).
medical records relating to Sanders’ CTCL show that he attended
CTCL light therapy once a month or less
(R. at 16-17, 295, 453,
infrequency of treatment Sanders showed improvement.
Sanders’ effective treatment of CTCL, despite his attendance
infrequency, constitutes substantial evidence in support of the
discrediting of Sanders’ subjective complaints.
While the ALJ
acknowledged that Sanders stopped working, it was not due to his
impairments or from missing too much work to attend CTCL light
therapy, but instead was because the
Sanders closed. (R. at 18, 32-33).
company that employed
Sanders testified that when
he was employee, he needed to miss work on the days he received
light therapy treatment, yet this testimony is undercut by the
fact that Sanders infrequently attended these therapy sessions.
(R. at 17).
Further, Sanders testified that these light therapy
treatments lasted only 5-15 minutes. (R. at 17).
support of the ALJ’s findings.
Because the ALJ’s determination is supported by
substantial evidence, the Commissioner’s final decision is due
to be affirmed. A separate order will be entered.
DONE this 11th day of August, 2016.
WILLIAM M. ACKER, JR.
UNITED STATES DISTRICT JUDGE
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