Sanders v. Social Security Administration, Commissioner

Filing 14

MEMORANDUM OPINION Signed by Judge William M Acker, Jr on 8/11/16. (SAC )

FILED
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
SOUTHERN DIVISION
TERRANCE SANDERS,
Plaintiff,
v.
CAROLYN W. COLVIN, ACTING
COMMISSIONER OF SOCIAL
SECURITY,
Defendant.

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CIVIL ACTION NO.
2:15-cv-1983-WMA

MEMORANDUM OPINION
Plaintiff Terrance Sanders brings this action pursuant to
42

U.S.C.

§

Commissioner’s

405(g),
final

seeking

decision

judicial

denying

review

his

of

application

the
for

disability insurance benefits and supplemental security income.
Sanders timely pursued and exhausted the administrative remedies
available to him before
Based

on

submitted

the
by

court’s
the

the Social Security Administration.

review

of

parties,

the

the

record
court

and

finds

the

briefs

that

the

Commissioner's decision is due to be affirmed.
I.

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

1

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
each

level

of

administrative

review.

20

C.F.R.

§§

404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v).
First, the Commissioner must determine whether the claimant
is currently engaged in any substantial gainful activity.

If

so, the claimant is not disabled. 20 C.F.R. §§ 404.1520(a)(4),
416.920(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.

404.1520(a)(4)(ii),

416.920(a)(4)(ii).

Third,

the

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

so,

the claimant is disabled. 20 C.F.R. §§

404.1520(a)(4)(iii), 416.920(a)(4)(iii).

If the Commissioner

has not made a conclusive determination after the third step, it

2

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
C.F.R.

§§

404.1545(a)(1),

416.945(a)(1).

Fourth,

the

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
claimant’s

RFC

allows

her

to

perform.

20

C.F.R.

§§

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.
II.

ADMINISTRATIVE DETERMINATION
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).

The ALJ

found

at

that

Sanders

retained

a
3

RFC

to

perform

work

all

exertional levels with the nonexertional limitation that he
could only

perform tasks that did not involve concentrated

exposure to extreme heat, extreme humidity, or sustained direct
sunlight,

however,

Sanders

could

frequently

reach

in

all

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).
III.

DISCUSSION
In this case, Sanders challenges the ALJ’s determination

solely on the basis that in evaluating Sanders’ RFC the ALJ
failed

to

properly

evaluate

the

credibility

of

Sanders’

complaints of pain in accordance with the Eleventh Circuit’s
“pain

standard.”

(Doc.

12

at

4).

Specifically,

Sanders

challenged the ALJ’s finding that:
After
careful
consideration
of
the
evidence,
the
undersigned
finds
that
the
claimant’s
medically
determinable impairments could reasonable be expected to
cause the alleged symptoms; however, the claimant’s
statement concerning the intensity,
persistence and
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

4

disability through his or her own testimony of pain or other
subjective symptoms.” Foote v. Chater, 67 F.3d 1553, 1560 (11th
Cir. 1995).
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
standard

seeks

confirms

the

to

ensure

existence

that

or

objective

likelihood

of

medical
the

pain

evidence
or

other

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”

and

properly concluded that they were not supported by the objective
medical

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
“pain

standard,”

testimony by

an

ALJ

may

still

discredit

a

plaintiff’s

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
5

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
at 1225.
In this case, the ALJ articulated explicit and adequate
reasons

for

discrediting

substantial evidence.

Sanders’

testimony

supported

by

While an ALJ “[may] not disregard an

individual's statements about the intensity, persistence, and
limiting

effects

medical

evidence

of

symptoms

does

solely

not

because

substantiate

the
the

objective
degree

of

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).
A.

Objective medical evidence

While the ALJ acknowledged Sanders’ medical records showed
6

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
of motion,

normal extremity findings, and no focal deficits

aside from some numbness to light touch in his right fingers.
(R. at 646-47).
pain

at

a

While Sanders continued to complain of shoulder

November

2013

follow-up,

helped. (R. at 17, 639).
while

Sanders

continued

to

continued
have

he

acknowledged

Lortab

Finally, in a December 2013 exam,
to

normal

complain
extremity

of

shoulder

testing,

pain,

negative

he
MRI

findings, and a full range of motion (R. at 18, 554-55, 622,
639-40)

where

the

treating

physician

regularly (R. at 554-55, 639-40).

advised

exercising

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
nerve

root

impingement.

(R.

at

18,

567).

Despite

Dr.

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
7

study. (R. at18, 792).

Sanders’ later visit with Dr. Jason

Morris for the nerve conduction study showed no significant
neuropathy.

(R.

at

543,

590).

While

Sanders

consistently

complained of pain, there is substantial and objective medical
evidence to support the ALJ’s findings.
B.

Conservative treatment for pain

While

the

ALJ

acknowledged

that

Sanders

complained

of

shoulder pain, the ALJ did not find these complaints credible in
light of the generally conservative treatment prescribed for his
pain symptoms.

In November 2013, Sanders was prescribed Lortab

and acknowledged that this helped the pain.
In

December

2013,

Sanders’

treating

(R. at 17, 639).

physician

changed

his

medication and prescribed the conservative treatment of using a
tennis ball and warm rice sock to massage his shoulder (R. at
18, 623).

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
deep

tendon

reflexes

(R.

at

18,

570).

While

Sanders

consistently complained of pain, the conservative treatment for
pain constitutes substantial evidence in support of the ALJ’s
findings.

8

C. Effective treatment of CTCL
While the ALJ acknowledges Sanders’ diagnosis of CTCL, the
objective findings and effective treatment of his CTCL support
the

ALJ’s

discrediting

Specifically,
recieved

from

the

of

Sanders’

frequency

April

2012

and

subjective

type

through

of

2014

complaints.

treatment
for

his

Sanders

CTCL

were

inconsistent with the type of limitations Sanders alleged at his
hearing.

(R. at 16, 33-34).

While Sanders testified he only

missed therapy when he was sick or lacked transportation, there
is

no

indication

physicians

and

is

that

he

undercut

appointments. (R. at 17).

reported
by

his

this

to

large

his

number

treating
of

missed

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
topical

steroids.

(R.

at

30,

399-400).

Throughout

2008,

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.
In

February

2011

Sanders

again

reported

he

(R. at 16, 322).
was

only

using

topical steroids and that his CTCL had been stable and minimal

9

since discontinuing PUVA therapy.

(R. at 16, 258-59).

After

an exam showed erythematous plaque on Sanders’ left cheek and
some

pink

or

hyperpigmented

patches

on

his

scalp,

chest,

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
2012.

(R. at 458-62).

In an October 2012 exam, Sanders’ CTCL

was noted to have improved and he was advised to decrease nbUVB
treatments

to

two

times

a

week,

with

the

possibility

of

decreasing treatment to one time a month if the CTCL did not
flare up after the first reduction.

(R. at 16, 453).

Sanders

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).

At

a February 2014 dermatology exam, Sanders reported that the
lesions on his chest appeared a lot smaller, the lesions did not
appear

to be getting worse, and that he felt he was doing

better. (R. at 17, 597, 608).
treatment

in

March

2014

(R.

Sanders did not receive any nbUVB
at

17,

681)

and

at

his

last

dermatology clinic exam in April 2014 Sanders reported that he
felt overall improvement with his CTCL and no symptoms aside

10

from some fatigue and night sweats (R. at 17, 841).

These

medical records relating to Sanders’ CTCL show that he attended
CTCL light therapy once a month or less
597,

608,

631,

672,

677,

681,

841)

(R. at 16-17, 295, 453,
and

yet

despite

infrequency of treatment Sanders showed improvement.

the

Therefore,

Sanders’ effective treatment of CTCL, despite his attendance
infrequency, constitutes substantial evidence in support of the
ALJ’s findings
D.

Work history

Finally,

Sanders’

work

history

supports

discrediting of Sanders’ subjective complaints.

the

ALJ’s

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).
Sanders’

work

history

constitutes

support of the ALJ’s findings.

11

substantial

Therefore,
evidence

in

CONCLUSION
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

12