Wade v. Social Security Administration, Commissioner
Filing
14
MEMORANDUM OPINION. Signed by Judge Madeline Hughes Haikala on 8/6/2019. (JLC)
FILED
2019 Aug-06 PM 03:10
U.S. DISTRICT COURT
N.D. OF ALABAMA
UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
SOUTHERN DIVISION
ELIZABETH WADE,
}
}
Plaintiff,
}
}
v.
}
}
ANDREW SAUL, Commissioner of }
the Social Security Administration,1 }
}
Defendant.
}
Case No.: 2:18-cv-00801-MHH
MEMORANDUM OPINION
Pursuant to 42 U.S.C. § 405(g), Elizabeth Wade seeks judicial review of a
final adverse decision of the Commissioner of Social Security. The Commissioner
denied her claim for a period of disability and disability insurance benefits. After
careful review, the Court reverses the Commissioner’s decision.
I.
PROCEDURAL HISTORY
Ms. Wade applied for a period of disability and disability insurance benefits
on March 27, 2015. (Doc. 6-3, p. 23; Doc. 6-6, p. 2). Ms. Wade alleges that her
1
The Court asks the Clerk to please substitute Andrew Saul for Nancy A. Berryhill as the proper
defendant pursuant to Rule 25(d) of the Federal Rules of Civil Procedure. See Fed. R. Civ. P.
25(d) (When a public officer ceases holding office that “officer’s successor is automatically
substituted as a party.”); see also 42 U.S.C. § 405(g) (“Any action instituted in accordance with
this subsection shall survive notwithstanding any change in the person occupying the office of
Commissioner of Social Security or any vacancy in such office.”).
disability began June 19, 2014. (Doc. 6-5, p. 74; Doc. 6-6, p. 2). The Commissioner
initially denied Ms. Wade’s claim. (Doc. 6-3, p. 23; Doc. 6-7, p. 2). Ms. Wade
requested a hearing before an Administrative Law Judge (ALJ). (Doc. 6-3, p. 23;
Doc. 6-7, p. 9). The ALJ issued an unfavorable decision. (Doc. 6-3, pp. 20, 38).
The Appeals Council declined Ms. Wade’s request for review (Doc. 6-3, p. 2),
making the Commissioner’s decision final for this Court’s judicial review. See 42
U.S.C. § 405(g).
II.
STANDARD OF REVIEW
The scope of review in this matter is limited. “When, as in this case, the ALJ
denies benefits and the Appeals Council denies review,” the Court “review[s] the
ALJ’s ‘factual findings with deference’ and [his] ‘legal conclusions with close
scrutiny.’” Riggs v. Comm’r of Soc. Sec., 522 Fed. Appx. 509, 510-11 (11th Cir.
2013) (quoting Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001)).
The Court must determine whether there is substantial evidence in the record
to support the ALJ’s findings. “Substantial evidence is more than a scintilla and is
such relevant evidence as a reasonable person would accept as adequate to support
a conclusion.” Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir.
2004). In making this evaluation, the Court may not “decide the facts anew, reweigh
the evidence” or substitute its judgment for that of the ALJ. Winschel v. Comm’r of
Soc. Sec. Admin., 631 F.3d 1176, 1178 (11th Cir. 2011) (internal quotations and
2
citation omitted). If the ALJ’s decision is supported by substantial evidence, then
the Court “must affirm even if the evidence preponderates against the
Commissioner’s findings.” Costigan v. Comm’r, Soc. Sec. Admin., 603 Fed. Appx.
783, 786 (11th Cir. 2015) (citing Crawford, 363 F.3d at 1158).
With respect to the ALJ’s legal conclusions, the Court must determine
whether the ALJ applied the correct legal standards. If the Court finds an error in
the ALJ’s application of the law, or if the Court finds that the ALJ failed to provide
sufficient reasoning to demonstrate that the ALJ conducted a proper legal analysis,
then the Court must reverse the ALJ’s decision. Cornelius v. Sullivan, 936 F.2d
1143, 1145-46 (11th Cir. 1991).
III.
SUMMARY OF THE ALJ’S DECISION
To determine whether a claimant has proven that she is disabled, an ALJ
follows a five-step sequential evaluation process. The ALJ considers:
(1) whether the claimant is currently engaged in substantial gainful
activity; (2) whether the claimant has a severe impairment or
combination of impairments; (3) whether the impairment meets or
equals the severity of the specified impairments in the Listing of
Impairments; (4) based on a residual functional capacity (“RFC”)
assessment, whether the claimant can perform any of his or her past
relevant work despite the impairment; and (5) whether there are
significant numbers of jobs in the national economy that the claimant
can perform given the claimant’s RFC, age, education, and work
experience.
Winschel, 631 F.3d at 1178.
3
In this case, the ALJ found that Ms. Wade meets the insured status
requirements through December 31, 2019. (Doc. 6-3, p. 26). Ms. Wade has not
engaged in substantial gainful activity since June 19, 2014, the onset date. (Doc. 63, p. 26). The ALJ determined that Ms. Wade suffers from the following severe
impairments: history of adhesions with pelvic/abdominal pain, history of lumbar
spondylosis with stenosis with L4 and L5 decompressive laminectomies and
foraminotomies with back pain and sciatica, degenerative joint disease of the knee,
and chronic lymphocytic leukemia in remission. (Doc. 6-3, p. 26). 2 The ALJ found
that Ms. Wade suffers from the following non-severe physical impairments:
hyperlipidemia, vitamin D deficiency, tobacco use disorder, abscesses with
cellulitis, benign colon polyp, sigmoid diverticulosis, hemorrhoids, hiatal hernia
with mild erosive esophagitis, diffuse gastritis, history of MRSA infection, irritable
bowel syndrome, history of breast reduction surgery, history of bladder sling times
two, TMJ syndrome, and headaches. (Doc. 6-3, p. 30). The ALJ determined that
2
“[T]he phrase ‘spondylosis of the lumbar spine’ means degenerative changes such as
osteoarthritis of the vertebral joints and degenerating intervertebral discs (degenerative disc
disease) in the low back.” https://www.emedicinehealth.com/spondylosis/article_em.htm (last
visited July 3, 2019). Lowe back stenosis is “a narrowing of the spinal canal, compressing the
nerves
traveling
through
the
lower
back
into
the
legs.”
https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Lumbar-SpinalStenosis (last visited July 30, 2019). A decompressive laminectomy “is the most common type of
surgery
done
to
treat
lumbar
(low
back)
spinal
stenosis.”
https://www.uwhealth.org/health/topic/surgicaldetail/decompressive-laminectomy-for-lumbarspinal-stenosis/aa122359.html (last visited July 30, 2019). A foraminotomy is a surgery that
“enlarges the area around one of the bones in [a person’s] spinal column. The surgery relieves
pressure on compressed nerves.” https://www.hopkinsmedicine.org/health/treatment-tests-andtherapies/foraminotomy (last visited July 30, 2019).
4
Ms. Wade’s anxiety, somatic symptom disorder, and depressive disorder with
dysthymic syndrome are non-severe mental impairments. (Doc. 6-3, pp. 31, 33).
Based on a review of the medical evidence, the ALJ found that Ms. Wade does not
have an impairment or combination of impairments that meets or medically equals
the severity of any of the listed impairments in 20 C.F.R. Part 404, Subpart P,
Appendix 1. (Doc. 6-3, p. 33).
The ALJ determined that Ms. Wade has the RFC to perform medium work as
defined in 20 C.F.R. § 404.1567(c) except with occasional stooping and crouching;
no right lower extremity pushing or pulling; and no climbing. (Doc. 6-3, p. 34).
“Medium work involves lifting no more than 50 pounds at a time with frequent
lifting or carrying of objects weighing up to 25 pounds.” 20 C.F.R. § 404.1567(c).
The ALJ concluded that Ms. Wade is able to perform her past relevant work as a
licensed practical nurse, work that Ms. Wade previously did in a nursing home,
because this position does not require work-related activities precluded by Ms.
Wade’s RFC. (Doc. 6-3, p. 38; Doc. 6-5, p. 80). 3 Accordingly, the ALJ determined
3
At the administrative hearing, Ms. Wade explained that when she worked at the nursing home,
she specialized in completing and sending minimum data sets (MDSs) to Medicare and Medicaid
for payment. (Doc. 6-5, p. 80). “MDS is part of the federally mandated process for clinical
assessment of all residents in Medicare and Medicaid certified nursing homes. This process
provides a comprehensive assessment of each resident's functional capabilities and helps nursing
home staff identify health problems.” https://www.cms.gov/research-statistics-data-andsystems/computer-data-and-systems/minimum-data-set-3-0-public-reports/index.html
(last
visited July 30, 2019). The MDS position involved sitting for computer work and standing and
walking for assessing patients. (Doc. 6-5, pp. 80-81). Ms. Wade occasionally would fill in as a
5
that Ms. Wade has not been under a disability within the meaning of the Social
Security Act. (Doc. 6-3, p. 38).
IV.
ANALYSIS
Ms. Wade argues that she is entitled to relief from the ALJ’s decision because
the ALJ did not properly evaluate her claim under the Eleventh Circuit pain standard.
(Doc. 11, p. 5). Based on its review, the Court finds that the record does not contain
substantial evidence to support the ALJ’s negative credibility determination as it
pertains to the ALJ’s conclusion that Ms. Wade can perform medium work. 4
The Eleventh Circuit pain standard “applies when a disability claimant
attempts to establish disability through his own testimony of pain or other subjective
symptoms.” Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991); Coley v.
Comm’r of Soc. Sec., No. 18-11954, 2019 WL 1975989, at *3 (11th Cir. May 3,
2019). When relying upon subjective symptoms to establish disability, “the claimant
must satisfy two parts of a three-part test showing: (1) evidence of an underlying
medical condition; and (2) either (a) objective medical evidence confirming the
floor nurse. (Doc. 6-5, p. 81). The floor nurse position involved pushing a cart, giving out
medicine, and taking care of patients. (Doc. 6-5, p. 81).
4
The administrative record for Ms. Wade’s case is extensive. Large portions of the record do not
pertain to the relevant disability period (Doc. 6-11; Doc. 6-12; Doc. 6-13, p. 26-44, 75-83, 97-112;
Doc. 6-14, p. 12-13; Doc. 6-15, p. 2-16, 60-89; Doc. 6-19, p. 10-11, 29-39; Doc. 6-30, p. 4-45, 83)
or to Ms. Wade’s severe impairments (Doc. 6-13, p. 19-22, 50-62; Doc. 6-15, p. 10-16, 23-31, 3654, 64-81; Doc. 6-17, p. 44-48; Doc. 6-24, p. 28-73; Doc. 6-25, p. 12-20; Doc. 6-26, p. 8-14; Doc.
6-30, p. 4-45, 54-58, 63-65, 74-75).
6
severity of the alleged [symptoms]; or (b) that the objectively determined medical
condition can reasonably be expected to give rise to the claimed [symptoms].”
Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002) (citing Holt, 921 F.2d at
1223); Chatham v. Comm’r of Soc. Sec., No. 18-11708, 2019 WL 1758438, at *2
(11th Cir. Apr. 18, 2019) (citing Wilson). If the ALJ does not demonstrate “proper
application of the three-part standard[,]” reversal is appropriate. McLain v. Comm’r,
Soc. Sec. Admin., 676 Fed. Appx. 935, 937 (11th Cir. 2017) (citing Holt).
A claimant’s credible testimony coupled with medical evidence of an
impairing condition “is itself sufficient to support a finding of disability.” Holt, 921
F.2d at 1223; see Gombash v. Comm’r, Soc. Sec. Admin., 566 Fed. Appx. 857, 859
(11th Cir. 2014) (“A claimant may establish that he has a disability ‘through his own
testimony of pain or other subjective symptoms.’”) (quoting Dyer v. Barnhart, 395
F.3d 1206, 1210 (11th Cir. 2005)). If an ALJ rejects a claimant’s subjective
testimony, the ALJ “must articulate explicit and adequate reasons for doing so.”
Wilson, 284 F.3d at 1225; Coley, 2019 WL 1975989, at *3. As a matter of law, the
Secretary must accept the claimant’s testimony if the ALJ inadequately or
improperly discredits it. Cannon v. Bowen, 858 F.2d 1541, 1545 (11th Cir. 1988);
Kalishek v.Comm'r of Soc. Sec., 470 Fed. Appx. 868, 871 (11th Cir. 2012) (citing
Cannon); see Hale v. Bowen, 831 F.2d 1007, 1012 (11th Cir. 1987) (“It is established
in this circuit if the Secretary fails to articulate reasons for refusing to credit a
7
claimant’s subjective pain testimony, then the Secretary, as a matter of law, has
accepted that testimony as true.”).
When credibility is at issue, the provisions of Social Security Regulation 163p apply. SSR 16-3p provides:
[W]e recognize that some individuals may experience symptoms
differently and may be limited by symptoms to a greater or lesser extent
than other individuals with the same medical impairments, the same
objective medical evidence, and the same non-medical evidence. In
considering the intensity, persistence, and limiting effects of an
individual’s symptoms, we examine the entire case record, including
the objective medical evidence; an individual’s statements about the
intensity, persistence, and limiting effects of symptoms; statements and
other information provided by medical sources and other persons; and
any other relevant evidence in the individual’s case record.
SSR 16-3p, 2016 WL 1119029, at *4.
Concerning the ALJ’s burden when
discrediting a claimant’s subjective symptoms, SSR 16-3p clarifies:
[I]t is not sufficient . . . to make a single, conclusory statement that “the
individual’s statements about his or her symptoms have been
considered” or that “the statements about the individual’s symptoms are
(or are not) supported or consistent.” It is also not enough . . . simply
to recite the factors described in the regulations for evaluating
symptoms. The determination or decision must contain specific reasons
for the weight given to the individual’s symptoms, be consistent with
and supported by the evidence, and be clearly articulated so the
individual and any subsequent reviewer can assess how the adjudicator
evaluated the individual’s symptoms.
SSR 16-3p, 2016 WL 1119029, at *10. Additionally, in evaluating a claimant’s
reported symptoms, an ALJ must consider the following factors:
(i) [the claimant’s] daily activities; (ii) [t]he location, duration,
frequency, and intensity of [the claimant’s] pain or other symptoms;
8
(iii) [p]recipitating and aggravating factors; (iv) [t]he type, dosage,
effectiveness, and side effects of any medication [the claimant] take[s]
or ha[s] taken to alleviate . . . pain or other symptoms; (v) [t]reatment,
other than medication, [the claimant] receive[s] or ha[s] received for
relief of . . . pain or other symptoms; (vi) [a]ny measures [the claimant]
use[s] or ha[s] used to relieve . . . pain or other symptoms (e.g., lying
flat on your back, standing for 15 to 20 minutes every hour, sleeping on
a board, etc.); and (vii) [o]ther factors concerning [the claimant’s]
functional limitations and restrictions due to pain or other symptoms.
20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3); Leiter v. Comm’r of Soc. Sec., 377 Fed.
Appx. 944, 947 (11th Cir. 2010).
The ALJ found that Ms. Wade’s medical records and daily activities do not
support her testimony regarding her subjective pain and limitations. (Doc. 6-3, pp.
35-37). An ALJ may discount a claimant’s pain based on conflicting evidence in
medical records and in reports of daily activities. See Crow, 571 Fed. Appx. at 808
(“Given Crow’s quick and sustained improvement using prednisone, and daily
activity that indicated a greater capacity for work than alleged, the ALJ made a
clearly articulated credibility finding that was supported by substantial evidence.”)
(citing Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir. 1995)); Loveless v. Massanari,
136 F. Supp. 2d 1245, 1249-1250 (N.D. Ala. 2001) (affirming the ALJ’s decision to
discredit the claimant’s subjective pain testimony because it did not align with the
claimant’s objective medical evidence and reported daily activities). Accordingly,
the Court first examines Ms. Wade’s testimony and then compares her testimony to
the medical evidence in the record and to the evidence relating to her daily activities.
9
A. Ms. Wade’s Testimony
At the administrative hearing on August 2, 2017, Ms. Wade testified that she
was 58 years old. (Doc. 6-5, pp. 69, 78, 79). Ms. Wade stopped working in 2014
because she did not recover well from a surgical procedure (pelvic), and she began
experiencing back problems which required additional surgery. (Doc. 6-5, pp. 7475). Ms. Wade stated that she suffered from back, abdominal, and knee pain, and
she lacked energy. (Doc. 6-5, pp. 75, 78).5 Ms. Wade stated that her pain and fatigue
prevented her from working. (Doc. 6-5, pp. 75, 78). Ms. Wade was using a pain
management plan to treat her pain, taking oxycodone (20 mg) four times daily. (Doc.
6-5, p. 76).6 Medication helped Ms. Wade manage her pain, but she reported that
medication did not eliminate her pain. (Doc. 6-5, p. 76).
On a scale of one to ten – with ten being pain so severe a person would need
to go to the emergency room – at the administrative hearing, Ms. Wade rated her
pain as a six with rest and medication. (Doc. 6-5, p. 76). Ms. Wade stated that her
pain increased to eight with activity. (Doc. 6-5, p. 76). Ms. Wade stated that she
was most comfortable in a recliner and reclined “four and a half to five hours” daily
to manager her pain. (Doc. 6-5, p. 77). Ms. Wade has received pain injections for
5
Ms. Wade’s leukemia is currently in remission. (Doc. 6-5, p. 78). Still, she has to be careful
about sores and infection. (Doc. 6-5, p. 78).
6
Doctors
prescribe
oxycodone
“to
treat
moderate
to
severe
https://www.goodrx.com/oxycodone-acetaminophen/images (last visited June 28, 2019).
10
pain.”
her back and knees. (Doc. 6-5, p. 78). Ms. Wade stated that the last knee injections
before the administrative hearing helped a little bit, but other pain procedures did
not. (Doc. 6-5, p. 78).
Ms. Wade and her husband have three children ages ten, six, and five. (Doc.
6-5, p. 76). Ms. Wade does household chores with a lot of help from her husband.
(Doc. 6-5, p. 76). Her oldest child helps too. (Doc. 6-5, p. 77).
Ms. Wade breaks up chores because of her pain: “Yeah, it takes a little bit,
you know. I’ll go and I’ll sweep … then I go and I rest because it’ll stir my back
up.” (Doc. 6-5, p. 76). Ms. Wade drives her children to and from school, which is
a quarter mile from home. (Doc. 6-5, p. 76). She drives herself and her children to
doctor’s appointments.
(Doc. 6-5, pp. 76-77).
Ms. Wade testified that she
occasionally shops for groceries, but her “husband does the most part.” (Doc. 6-5,
p. 77).
B. Medical Records
Ms. Wade maintains that the ALJ did not consider the totality of her medical
records when making his determination about her credibility, and she argues that the
medical records that the ALJ overlooked are consistent with her pain testimony.
(Doc. 11, p. 7); see Chambers v. Astrue 671 F. Supp. 2d 1253, 1258 (N.D. Ala. 2009)
(An ALJ “cannot pick and choose among a doctor’s records to support his own
conclusion.”). The record supports Ms. Wade’s argument. The ALJ identified
11
pieces of objective evidence which, in isolation, call into question Ms. Wade’s
testimony about the intensity of her pain. But the ALJ ignored evidence that
undermines his conclusion that Ms. Wade can perform medium work.
The ALJ discussed Ms. Wade’s medical records from the Alabama Pain
Physicians, The Birmingham Pain Center (BPC), Dr. Jack Denver, Dr. Joanne
Rossman of Alabama Oncology, and Dr. Dallas Russell covering the disability
period from June 2014 to May 2017. (Doc. 6-3, p. 27-29). The ALJ determined that
medical records support Ms. Wade’s reported impairments, but the records do not
indicate a disabling degree of pain or limitations. (Doc. 6-3, p. 34-35).7 The ALJ
stated that the records show that Ms. Wade’s “pain has improved with treatment[.]”
(Doc. 6-3, p. 35). That is true. The ALJ also relied on Ms. Wade’s testimony that
medication has helped with pain. (Doc. 6-3, p. 35). That is true too, but that does
not mean that substantial evidence supports the ALJ’s finding that Ms. Wade can
perform medium work.
Ms. Wade’s medical records indicate that she had pelvic surgery in 2012 to
remove a mass. (Doc. 6-12, p. 84). In August of 2013, Ms. Wade’s primary care
physician, Dr. Livingston, referred her to the Alabama Pain Physicians for pelvic
7
In Early v. Astrue, 481 F. Supp. 2d 1233 (N.D. Ala. 2007), a district court determined that an
ALJ’s similarly worded interpretation of the pain standard’s third prong was improper. See Early,
481 F. Supp. 2d at 1238. The third prong requires the ALJ to evaluate whether “‘the objectively
determined medical condition is of such severity that it can be reasonably expected to give rise to
the alleged pain.’” Early, 841 F. Supp. 2d at 1238 (quoting Foote, 67 F.3d at 1560).
12
pain. (Doc. 6-12, pp. 83, 84). Post-surgery scar tissue was causing Ms. Wade
“aching, stabbing, sharp, shooting, [and] throbbing” pain primarily in her left pelvic
region. (Doc. 6-12, p. 84). Ms. Wade described her pain as seven generally and
nine at worst.
(Doc. 6-12, p. 84).
“[S]itting, standing, physical activity,
coughing/sneezing . . . . [and] [s]tretching” worsened Ms. Wade’s pain. (Doc. 6-12,
p. 84). Medication and lying down in a fetal position helped Ms. Wade’s pain. (Doc.
6-12, p. 84). The Alabama Pain Physicians also treated Ms. Wade for knee pain in
2013. (See Doc. 6-12, pp. 93, 94) (October 3, 2013 treatment record referencing
pelvic and knee pain); (Doc. 6-12, pp. 99, 100) (October 25, 2013 treatment record
referencing pelvic and knee pain).
The Alabama Pain Physicians continued to treat Ms. Wade for pelvic pain in
2014. In January 2014, medication had improved Ms. Wade’s pelvic pain by 65%.
(Doc. 6-12, pp. 31, 32). Ms. Wade’s ability to perform daily activities had increased.
(Doc. 6-12, p. 32). Ms. Wade reported no severe side effects from her medication.
(Doc. 6-12, p. 39).
Ms. Wade also reported back pain in 2014. (See Doc. 6-12, pp. 46, 47)
(February 11, 2014 treatment record referencing abdominal and back pain); (Doc. 612, pp. 52, 53) (March 5, 2014 treatment record referencing abdominal and back
pain); (Doc. 6-12, pp. 58, 59) (April 1, 2014 treatment record referencing abdominal
and back pain). In March of 2014, Dr. Martin, a pain doctor, gave Ms. Wade a
13
lumbar transforaminal epidural steroid injection. (Doc. 6-12, pp. 89, 92).8 Ms.
Wade’s back pain score did not change after the procedure. (Doc. 6-12, p. 91). Dr.
Martin scheduled Ms. Wade for a pudendal nerve block. (Doc. 6-12, p. 92). 9 Dr.
Martin gave Ms. Wade another ESI in April 2014. (Doc. 6-12, p. 75). Ms. Wade
reported a pain score of seven and a half before the injection and a four afterwards.
(Doc. 6-12, p. 76).
In June of 2014, Ms. Wade’s condition deteriorated. She was experiencing
constant pelvic pain. (Doc. 6-12, pp. 77, 78). Medication reduced Ms. Wade’s pain
by 40%. (Doc. 6-12, p. 78). Ms. Wade described her pain as “aching, sharp, burning,
throbbing and deep.” (Doc. 6-12, p. 78). “[A]ctivity, inactivity, sitting, standing,
walking, twisting, [and] bending” aggravated Ms. Wade’s pain. (Doc. 6-12, p. 78).
Ms. Wade reported no symptoms associated with her pain. (Doc. 6-12, p. 78).
Despite the pain, Ms. Wade’s ability to work and perform daily activities had
improved. (Doc. 6-12, p. 78).
8
“Epidural Steroid Injections (ESIs) are a common method of treating inflammation associated
with low back related leg pain, or neck related arm pain. In both of these conditions, the spinal
nerves become inflamed due to narrowing of the passages where the nerves travel as they pass
down or out of the spine.” https://www.spine.org/KnowYourBack/Treatments/InjectionTreatments-for-Spinal-Pain/Epidural-Steroid-Injections (last visited July 2, 2019).
9
“The pudendal nerve is found in the pelvis.”
maps/pudendal-nerve#1 (last visited July 2, 2019).
14
https://www.healthline.com/human-body-
In October 2014, Ms. Wade had back surgery to address her degenerative disc
disease and spinal canal narrowing. (Doc. 6-13, p. 6). During a November 2014
visit with Dr. Chambers, a physician with UAB’s Neurosurgery Clinic, Ms. Wade
reported that she was doing well after her back surgery and that her “preoperative
leg pain [had] resolved.” (Doc. 6-13, p. 7). But Ms. Wade was experiencing
“intermittent, moderately severe (7/10) left low back pain with occasional
‘heaviness’ in her lower extremities.” (Doc. 6-13, p. 7).
Ms. Wade’s primary care physician, Dr. Livingston, referred Ms. Wade to Dr.
Chang with the BPC for an evaluation. (Doc. 6-17, pp. 14, 19). During her new
patient visit with Dr. Chang in January 2015, Ms. Wade reported that her back and
leg pain were worse than her pelvic and right knee pain. (Doc. 6-17, p. 14).
Although surgery had improved her back pain, Ms. Wade had fallen and reinjured
her back in November 2014. (Doc. 6-17, p. 14). Afterwards, Ms. Wade’s back pain
was “constant” and “stabbing, shooting, dull[ing], aching, pressure [causing],
burning and tingling in quality.” (Doc. 6-17, p. 14). Ms. Wade rated her pain “as 8
out [of] 10 currently” and “rang[ing] from a best of 5 out of 10 to a worst of 10 out
of 10 in intensity[.]” (Doc. 6-17, p. 14).
Ms. Wade described having “persistent deep pelvic pain over time” after
multiple abdominal procedures and knee pain for several years after tearing a
ligament. (Doc. 6-17, p. 14). Ms. Wade stated that she had experienced weakness
15
and occasional buckling in her right knee. (Doc. 6-17, p. 14). Ms. Wade did not
recall receiving knee imaging or injections for pain. (Doc. 6-17, p. 14).
Based on her medical history and clinical evaluation, Dr. Chang found that
Ms. Wade “suffers from chronic pain from multiple locations.” (Doc. 6-17, p. 18).
Dr. Chang identified post-laminectomy syndrome, lumbar spondylosis, lumbar disc
degeneration, thoracic neuritis, right knee joint pain, and chronic pain syndrome as
sources of Ms. Wade’s pain. (Doc. 6-17, p. 6).10
Dr. Chang developed a plan to address Ms. Wade’s back and leg pain. (Doc.
6-17, p. 18). Dr. Chang started Ms. Wade on several medications including Amrix
(a muscle relaxant), Cymbalta (a pain reliever and anti-depressant), “Oxycontin
15mg BID [twice daily,] and Percocet 10mg 325mg BID [twice daily] for
breakthrough [pain].” (Doc. 6-17, p. 18). 11
Dr. Chang and other BPC personnel treated Ms. Wade throughout 2015 and
part of 2016. (See Doc. 6-16, p. 2) (listing 2015 BPC dates); (Doc. 6-22, p. 2)
10
Neuritis is “an inflammatory or degenerative lesion of a nerve marked especially by pain[.]”
https://www.merriam-webster.com/dictionary/neuritis (last visited July 30, 2019). Thoracic refers
to the spinal nerves within the thoracic region—the “cavity in which the heart and lungs lie[.]”
https://www.merriam-webster.com/medical/thoracic%20nerve (last visited July 30, 2019);
https://www.merriam-webster.com/dictionary/thorax (last visited July 30, 2019).
11
“Amrix (cyclobenzaprine hcl) is a muscle relaxant used together with rest and physical therapy
to treat skeletal muscle conditions such as pain or injury.” https://www.rxlist.com/amrix-sideeffects-drug-center.htm (last visited June 20, 2019). Cymbalta or duloxetine treats chronic back
pain, depression, and anxiety.
https://www.webmd.com/drugs/2/drug-91491/cymbaltaoral/details (last visited June 20, 2019).
16
(submitting BPC records from 2015 through 2016). Ms. Wade underwent an
epidural steroid injection for back pain in February 2015. (See Doc. 6-16, pp. 3945, 47-48, 50) (documents related to February 4, 2015 pain procedure).
In March 2015, Ms. Wade reported to Dr. Chang that “Cymbalta was not
relieving any of her pain.” (Doc. 6-16, p. 19). Dr. Chang adjusted Ms. Wade’s
medications by substituting Topamax for Cymbalta and returning her to Celexa.
(Doc. 6-16, p. 19). Ms. Wade underwent a nerve block procedure. (See Doc. 6-16,
pp. 15, 21, 24-25) (documents related to March 25, 2015 pain procedure).
Ms. Wade left a message in May 2015 that “her pain medication was not
working” and requested an appointment. (Doc. 6-16, p. 3). The medical record does
not indicate whether Dr. Chang saw Ms. Wade or adjusted her pain medication after
this call.
During a visit in August 2015, Ms. Wade rated her pain as a seven out of ten.
(Doc. 6-23, p. 45). Ms. Wade reported no problems with the effectiveness of her
pain medications. (See Doc. 6-23, p. 45) (circling “Excellent” and indicating that
“meds [and] rest” make pain better on August 11, 2015 intake form). In the
beginning of September 2015, Ms. Wade’s pain level had increased to nine. (Doc.
6-23, p. 35). Ms. Wade was experiencing a good degree of effectiveness with her
medications. (Doc. 6-23, p. 35) (circling “Good” and indicating that “med[s] [and]
rest” make pain better on September 10, 2015 intake form). Later in September, Ms.
17
Wade’s pain level remained a nine. (Doc. 6-23, p. 20). Still, Ms. Wade had no
concerns about her medications. (See Doc. 6-23, p. 20) (circling “Excellent” and
indicating that “meds” make pain better on September 28, 2015 intake form).
During an October 2015 visit, Ms. Wade again reported her pain level as a
nine. (Doc. 6-23, p. 10). Ms. Wade rated the effectiveness of her medications as
good. (See Doc. 6-23, p. 10) (circling “Good” and indicating that “meds” make pain
better on October 19, 2015 intake form). Ms. Wade described her pain as eight and
a half in November 2015. (Doc. 6-22, p. 96). Ms. Wade’s medications were above
good in terms of effectiveness. (See Doc. 6-22, p. 96) (circling area in between
“Good” and “Excellent” and indicating that “meds [and] rest” make pain better on
November 16, 2015 intake form).
In December 2015, Ms. Wade’s pain had decreased to an eight. (Doc. 6-22,
p. 86). Ms. Wade reported that her medications were good at relieving pain. (See
Doc. 6-22, p. 86) (circling “Good” and indicating that “meds [and] rest” make pain
better on December 15, 2015 intake form).
Ms. Wade’s BPC intake records from 2016 contain similar descriptions of her
pain. (See Doc. 6-22, p. 74) (reporting eight and a half as current level, five as best,
and nine as worst; circling “Good” and indicating that “meds [and] rest” make pain
better on January 13, 2016 intake form); (Doc. 6-22, p. 63) (reporting eight as current
level, six as best, and nine as worst; circling “Good” and indicating that “meds, rest[,
18
and] heat” make pain better on February 11, 2016 intake form); (Doc. 6-22, p. 52)
(reporting seven as current level, five as best, and nine as worst; circling “Good” and
indicating that “meds [and] rest” make pain better on March 10, 2016 intake form).
Dr. Chang noted during the March 2016 visit that Ms. Wade’s “pain [is] stable on
current treatment regime.” (Doc. 6-22, pp. 54, 57).
Ms. Wade rarely reported side effects from her medications. (See Doc. 6-23,
p. 45) (circling “Sleepiness” and listing “edema” and “cough” as side effects); (Doc.
6-23, p. 35) (checking “NONE”); (Doc. 6-23, p. 20) (circling “NONE”); (Doc. 6-23,
p. 10) (circling “NONE”); (Doc. 6-22, p. 96) (checking “NONE” but also noting
“RT OTHER” urination issue); (Doc. 6-22, p. 86) (checking “NONE”); (Doc. 622, p. 74) (checking “NONE”); (Doc. 6-22, p. 63) (checking “NONE”); (Doc. 6-22,
p. 52) (checking “NONE”).
In May 2016, Mallory Booth, a BPM certified physician assistant, saw Ms.
Wade. (Doc. 6-22, p. 6). Ms. Booth noted that Ms. Wade had an antalgic gait. (Doc.
6-22, p. 9). 12 Still, Ms. Wade walked without a limp or an assistive device. (Doc.
6-22, p. 9). Ms. Booth provided the following assessment:
Patient has consistently had compliance issues, and was told at the last
visit that we will be holding a “zero tolerance” policy with her. We
were unable to count all her medication since some of her pills were
crushed. In just the past few visits, she has been overtaking her meds
12
Antalgic means “marked by or being an unnatural position or movement assumed by someone
to minimize or alleviate pain or discomfort (as in the leg or back)[.]” https://www.merriamwebster.com/medical/antalgic (last visited June 28, 2019).
19
or have had them stolen by friends/family. The controlled substance
agreement that she (and all patients) signed at her new patient [visit]
explains that she is responsible for all lost, stolen, or damaged
medication. Since her medication today was partly damaged, and we
cannot adequately determine compliance, we have no choice but to
discontinue opioids. She was given a list of other pain management
providers around, and instructed how to titrate off the medication she
has now. Clonidine rx’d for withdrawal side effects if she suffers from
any. She asked to try Lyrica. She had issues with edema in the past
with Lyrica, so we will start her out on 50mg 1qd [once daily] for a
week (and titrate down off [T]opamax by 50mg 1qd for 7 days). She
will then increase the Lyrica by 1 pill qd for a week until she can
tolerate Lyrica 50mg QID [four times daily]. If she has issues with
edema, we can go back to the [T]opamax.
(Doc. 6-22, p. 9).
Dr. Chang expressed similar concerns about Ms. Wade’s non-compliance
with opiate treatment:
Ms. Wade has demonstrated compliance issues as detailed above on
multiple occasions. We have till [sic] this point tried to establish
parameters under which she may have been successful, if she were only
able to comply with . . . those boundaries, but she has not been able to
do so. Today, we have no choice but to discontinue the controlled
medications. We can continue to prescribe her non-opiate pain
medications and employ interventional procedures. However, at this
point, there really is no recourse in terms of restarting her opiates in the
future.
(Doc. 6-22, p. 9).
Ms. Wade stopped treatment with the BPC and began seeing Dr. Denver for
pain management in October 2016. (Doc. 6-20, p. 26; Doc. 6-21, pp. 2-6). Ms.
Wade continued to report pelvic, back, and knee pain. (Doc. 6-21, p. 2). Ms. Wade
rated her pelvic pain as a seven to eight and her back pain as a seven. (Doc. 6-21, p.
20
2). Ms. Wade reported that her back surgery did not provide much help. (Doc. 621, p. 2). She described her knee pain as “aching, grinding, and tight.” (Doc. 6-21,
p. 2).
In November 2016, Dr. Denver prescribed Ms. Wade oxycodone (15 mg) for
pain management. (Doc. 6-20, pp. 21, 23). Ms. Wade reported in December 2016
that the oxycodone gave her two and a half hours of relief “with 50% pain
reduction.” (Doc. 6-20, p. 16). She noted that the oxycodone “is not more effective
than Percocet 10 mg.” (Doc. 6-20, p. 16). Neither medication provided Ms. Wade
“enough relief.” (Doc. 6-20, p. 16). Ms. Wade rated her pain as a seven with six the
best, seven the average, and eight the worst. (Doc. 6-20, p. 16). Despite her pain,
Ms. Wade reported “caring for 3 children” and “constantly cleaning the house and
cooking.” (Doc. 6-20, pp. 16-17).
During a visit in early January 2017, Ms. Wade’s pain level was eight. (Doc.
6-20, p. 11). Ms. Wade reported fluctuating pain over the 30 preceding days with
six as the best, seven as the average, and eight as the worst. (Doc. 6-20, p. 11). Dr.
Denver’s assessments included chronic intractable pain, pelvic and perineal pain,
back pain, and degenerative disc disease. (Doc. 6-20, p. 12). Dr. Denver increased
Ms. Wade’s oxycodone strength from 15 to 20 mg to better manage Ms. Wade’s
pain. (Doc. 6-20, pp. 11, 12).
21
Ms. Wade described her sleep as “not restful.” (Doc. 6-20, p. 11). Ms.
Wade’s pain “mildly limited sexual activity and hobbies[;] moderately limit[ed]
walking[,] bending[,] lifting[,] and sitting[;] and severely limit[ed] running[,] stair
climbing[,]and working.” (Doc. 6-20, p. 11).
At the end of January 2017, Ms. Wade reported that three was her “[c]urrent
pain score” and that she had “much better control now with her current medications.”
(Doc. 6-20, p. 3). During the month of January 2017, three was Ms. Wade’s best
pain level, four was the average, and eight was the worst. (Doc. 6-20, p. 3). Ms.
Wade expressed being “definitely better” on oxycodone (20 mg) four times daily
with the exception of some pain waking her up at night. (Doc. 6-20, p. 3); (see also
Doc. 6-20, p. 5) (noting that “[d]osing to 20 mg of oxycodone has definitely
improved [back] pain control . . . . [except for] some breakthrough pain in the middle
of the night”).
Ms. Wade’s pain continued to “mildly limit[]walking, sitting, sexual activity,
and hobbies; moderately limit[] bending[,] lifting, and stair climbing; and severely
limit[] running and working.” (Doc. 6-20, p. 3). “Activity and stress increased
pain.” (Doc. 6-20, p. 3). “Medications and rest decreased pain.” (Doc. 6-20, p. 3).
Dr. Denver recommended physical therapy and believed “a therapeutic
exercise program could provide the difference to improve pain control.” (Doc. 6-
22
20, p. 5). Ms. Wade responded that she lacked “time or money to pursue this.” (Doc.
6-20, p. 5).
In March 2017, Dr. Denver continued to treat Ms. Wade for chronic pain.
(Doc. 6-21, p. 22). Ms. Wade reported six as her pain level with a best of four, an
average of six, and a worst of eight and a half. (Doc. 6-21, p. 22). Ms. Wade’s pain
increased with activity and decreased with rest and medications. (Doc. 6-21, p. 22).
Ms. Wade described “aching and burning” pain “with some stabbing in both knees
as well as in the lower abdominal region.” (Doc. 6-21, p. 22). Ms. Wade felt
“aching[,] stabbing and burning in [her] lower back with radiation into the lower left
extremity.” (Doc. 6-21, p. 22).
Ms. Wade returned to Dr. Denver in May 2017 for chronic lower back pain
and degenerative joint disease. (Doc. 6-30, p. 58). Dr. Denver reported that
oxycodone relieved Ms. Wade’s pain by 60% for hours without side effects. (Doc.
6-30, p. 58). Ms. Wade continued to take tizanidine (4 mg) for lower back pain
without side effects. (Doc. 6-30, pp. 58, 60).13
Dr. Rossman is an oncologist who treated Ms. Wade’s chronic lymphocytic
leukemia (CLL) of B-cell type. (Doc. 6-18, pp. 16, 18). In March 2015, Dr.
Rossman reported that Ms. Wade has “had CLL for probably 10 years and will likely
13
“Tizanidine is a short-acting muscle relaxer. It works by blocking nerve impulses (pain
sensations) that are sent to [a person’s] brain.” https://www.drugs.com/tizanidine.html (last visited
July 3, 2019).
23
never need therapy for it.” (Doc. 6-18, p. 33). Dr. Rossman noted during a followup visit in March 2016 that Ms. Wade’s CLL had been in remission since October
2015. (Doc. 6-18, p. 16).
In August 2016, Ms. Wade contacted Dr. Rossman’s office and explained she
was having trouble affording visits to the pain clinic. (Doc. 6-21, p. 53). Dr.
Rossman’s office contacted the pain clinic, obtained more information, and left a
voicemail message for Ms. Wade. (Doc. 6-21, p. 53). Ms. Wade called Dr.
Rossman’s office back and indicated that she would “call the pain clinic [to] see if
[it] will work with her on payments so she can go.” (Doc. 6-21, p. 53). As of March
2017, Dr. Rossman found no evidence that Ms. Wade’s chronic CLL had progressed.
(Doc. 6-30, pp. 51, 52).
Ms. Wade saw Dr. Russell in February 2017 for a consultative examination at
the Commissioner’s request. (Doc. 6-21, p. 8). Dr. Russell diagnosed Ms. Wade
with chronic back pain, left leg sciatica, chronic abdominal pain, dysesthesias,
chronic pelvic and perineal pain, multiple abdominal procedures with scar tissue,
chronic lymphocytic leukemia, MRSA infection in the past, gastritis, irritable bowel
syndrome, right knee injury with PCL injury, breast reduction surgery, bladder sling
(two times); abscesses (three times); tobacco use, TMJ syndrome, immunoglobulin
24
deficiency, depression, and headaches. (Doc. 6-21, p. 11).14
Dr. Russell identified back and pelvic pain as two of Ms. Wade’s chief
complaints. (Doc. 6-21, p. 8). Ms. Wade reported that her back pain “is pretty much
constant” and “can be sharp and aching in nature.” (Doc. 6-21, p. 8). Ms. Wade
indicated that back surgery had not been helpful. (Doc. 6-21, p. 8). When Ms. Wade
turned her back, she had “a crunching-like sensation.” (Doc. 6-21, p. 8). “[F]airly
frequently[,]” Ms. Wade’s back pain would “radiate[] down the left leg all the way
to the foot that is sharp in nature.” (Doc. 6-21, p. 8). Dr. Russell found that this back
pain limited Ms. Wade’s ability to carry, lift, walk, and stand. (Doc. 6-21, p. 8). Ms.
Wade rated her back pain with medications as six out of ten; without medication as
about an eight. (Doc. 6-21, p. 8).
Ms. Wade reported having constant abdominal and pelvic pain. (Doc. 6-21,
p. 9). Ms. Wade rated this pain as a seven with medication and a nine without
medication. (Doc. 6-21, p. 9). Sometimes that pain was “a deep, aching sensation
particularly in the left lower quadrant”; other times it was “sharp and stabbing[.]”
(Doc. 6-21, p. 9).
14
Ms. Wade’s chronic lymphocytic leukemia is the likely source of her recurrent MRSA infection
(Methicillin-Resistant Staphylococcus Aureus). (Doc. 6-18, p. 33). Temporomandibular Joint
Syndrome, or TMJ, causes pain in the jaw joint and pain in the muscles that control the jaw. See
https://www.mayoclinic.org/diseases-conditions/tmj/symptoms-causes/syc-20350941 (last visited
May 28, 2019).
25
Dr. Russell reported that Ms. Wade had no trouble getting on and off the
examination table and had normal strength. (Doc. 6-21, pp. 10, 11). Dr. Russell
found that Ms. Wade’s range of motion in her back and her gait were abnormal.
(Doc. 6-21, p. 10). Dr. Russell observed tenderness in Ms. Wade’s right knee and
back. (Doc. 6-21, p. 10).
Dr. Russell concluded that Ms. Wade’s fine motor skills, handling, fingering,
gripping, feeling, and reaching were normal. (Doc. 6-21, p. 11). Dr. Russell
determined that Ms. Wade “would be sensitive to environmental exposures” and
would have difficulty or trouble with carrying, lifting, pushing, pulling, sitting,
standing, walking, climbing, stooping, bending, crawling, kneeling, and crouching.
(Doc. 6-21, p. 11). In a “Medical Source Statement of Ability To Do Work-Related
Activities (Physical)” form, Dr. Russell reported that Ms. Wade could occasionally
lift and carry up to ten pounds, but never lift or carry more than ten pounds. (Doc.
6-21, p. 15). Dr. Russell restricted the hours that Ms. Wade could sit without
interruption to two; stand and walk without interruption to one. (Doc. 6-21, p. 16).
During a full work day, Ms. Wade could sit for four hours, stand for three, and walk
for two. (Doc. 6-21, p. 16). Dr. Russell limited to occasionally Ms. Wade’s ability
to use her hands to push or pull. (Doc. 6-21, p. 17).
Though Dr. Russell found that Ms. Wade was unable to perform more than a
range of sedentary work, the ALJ rejected Dr. Russell’s opinion as inconsistent with
26
other medical records and reported daily activities. (Doc. 6-3, p. 37). 15 But there
are no other medical records that describe the amount of weight that Ms. Wade can
carry or the number of hours she can stand. The ALJ reasoned that because the
Alabama Pain Physicians, the BPC, and Dr. Denver did not restrict Ms. Wade’s
physical functioning, Dr. Russell’s findings were inconsistent with “the claimant’s
longitudinal treating medical records[.]” (Doc. 6-3, p. 37).
Eleventh Circuit precedent does not permit an ALJ to discredit an
uncontradicted finding based only on silence in medical records. As the Eleventh
Circuit has instructed “[s]uch silence is equally susceptible to either [disability]
inference, therefore, no inference should be taken.” Lamb v. Bowen, 847 F.2d 698,
703 (11th Cir. 1988); see also Walden v. Schweiker, 672 F.2d 835, 839 (11th Cir.
1982) (“An administrative law judge may not arbitrarily reject uncontroverted
medical testimony.”) (citing Goodley v. Harris, 608 F.2d 234 (5th Cir. 1979)).16
The ALJ relied on no medical opinion in concluding that Ms. Wade could
physically handle medium work. See Graham v. Bowen, 786 F.2d 1113, 1115 (11th
15
“Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or
carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as
one which involves sitting, a certain amount of walking and standing is often necessary in carrying
out job duties. Jobs are sedentary if walking and standing are required occasionally and other
sedentary criteria are met.” 20 C.F.R. § 404.1567(a).
16
In Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc), the Eleventh
Circuit adopted as binding precedent all decisions of the former Fifth Circuit handed down prior
to October 1, 1981.
27
Cir. 1986) (reversing because the ALJ substituted his lay opinion about the
claimant’s gait for the medical evidence showing more than a moderate limitation);
Storey v. Berryhill, ___ Fed. Appx. ___, No. 17-14138, 2019 WL 2480135, at *8
(11th Cir. June 13, 2019) (citing Graham and observing that “it is generally improper
for an ALJ to substitute his own judgment for that of a medical expert because ALJs
are not medical experts”). The vocational expert testified that medium work would
require two hours of uninterrupted standing and/or walking and usually eight hours
for an entire shift. (Doc. 6-5, p. 87). Dr. Russell’s opinion indicates that Ms. Wade
cannot fulfill the physical demands of medium work, and there are no medical
records that suggest that she can perform medium work. Consequently, the ALJ’s
decision to give Dr. Russell’s opinion “little weight” finds little support in the record.
(Doc. 6-3, p. 37).
Here, the Court finds that the totality of the objective medical evidence
substantiates Ms. Wade’s credibility. Ms. Wade’s medical records demonstrate that
she had pelvic surgery to remove a mass which caused scaring, she underwent
surgery and other procedures to address her back pain, and she suffers from
degenerative back and knee conditions. See Kent v. Sullivan, 788 F. Supp. 541, 544
(N.D. Ala. 1992) (“When all the evidence is considered Mr. Kent was clearly
suffering from several medically determined impairments that could reasonably be
expected to produce the pain he described.”). For years, Ms. Wade sought treatment
28
to relieve her pelvic, back, and knee pain. See Collins v. Astrue, No. 2:06-CV-365FTM-DNF, 2008 WL 477802, at *6 (M.D. Fla. Feb. 19, 2008) (“The Plaintiff’s back
problems have been documented throughout the record and by accepted diagnostic
tests.”); see also Moody v. Barnhart, 295 F. Supp. 2d 1278, 1284 (N.D. Ala. 2003)
(“Without question severe degenerative disc disease can cause disabling pain.”)
(citing Jenkins v. Sullivan, 906 F.2d 107, 109 (4th Cir. 1990) (noting that
degenerative disc disease is a condition that could reasonably be expected to produce
disabling pain)); Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987) (“cervical
nerve root compression syndrome . . . scoliosis and degenerative disc disease” are
impairments that could reasonably be expected to cause . . . pain”)).
The objective evidence shows that Ms. Wade has experienced some relief with
medication. (See Doc. 6-9, pp. 69-79) (pharmacy records from 2015 to 2017
documenting regular oxycodone refills). But the improvement in Ms. Wade’s
chronic pain has not been linear—Ms. Wade’s pain has fluctuated. For example,
Ms. Wade experienced some pain relief after Dr. Denver increased her oxycodone
to 20 mg in January 2017. Ms. Wade reported a pain score of three. By March 2017,
Ms. Wade’s pain level had returned to a six. Ms. Wade’s records contain evidence
that Ms. Wade may have addiction issues relating to her opioid pain medication, but
no physician has suggested that Ms. Wade does not need significant pain treatment.
29
The ALJ did not identify objective medical evidence that indicates that Ms.
Wade is exaggerating her subjective symptoms to the extent that she is able—
despite her severe pelvic, back, and knee impairments—to perform medium work,
lifting up to 50 pounds and regularly lifting up to 25 pounds. See Stricklin v. Astrue,
493 F. Supp. 2d 1191, 1197 (N.D. Ala. 2007) (“That the plaintiff’s medications were
helping relieve his symptoms does not follow to the ALJ’s conclusion that the
plaintiff’s symptoms were reduced to the point w[h]ere he could maintain full-time
employment.”) (alternation added); see also SSR 96-8p, 1996 WL 374184, at *1
(“Ordinarily, RFC is an assessment of an individual’s ability to do sustained workrelated physical and mental activities in a work setting on a regular and continuing
basis. A ‘regular and continuing basis’ means 8 hours a day, for 5 days a week, or
an equivalent work schedule.”). Thus, the objective evidence does not support the
ALJ’s determination that Ms. Wade’s pain does not preclude medium work. Cf.
Smith v. Califano, 637 F.2d 968, 972 (3d Cir. 1981) (“An ALJ may not make purely
speculative inferences from medical reports.”).
C. Daily Activities
When examining daily activities, an ALJ must consider the record as a whole.
See, e.g., Parker v. Bowen, 793 F.2d 1177, 1180 (11th Cir. 1986) (faulting the
Appeals Council’s finding that claimant’s “daily activities . . . have not been
significantly affected” when the Appeals Council “ignored other evidence that her
30
daily activities have been significantly affected”); Martz v. Comm’r of Soc. Sec., 649
Fed. Appx. 948, 957 (11th Cir. 2016). The Eleventh Circuit has recognized that
“participation in everyday activities of short duration” will not prevent a claimant
from proving disability. Lewis v. Callahan, 125 F.3d 1436, 1441 (11th Cir. 1997).
Instead, “[i]t is the ability to engage in gainful employment that is the key, not
whether a Plaintiff can perform chores or drive short distances.” Early v. Astrue,
481 F. Supp. 2d 1233, 1239 (N.D. Ala. 2007); see, e.g., Flynn v. Heckler, 768 F.2d
1273, 1275 (11th Cir. 1985) (claimant who “read[s], watch[es] television,
embroider[s], attend[s] church, and drive[s] an automobile short distances . . . .
performs housework for herself and her husband, and accomplishes other light duties
in the home” still may suffer from a severe impairment); Smith, 637 F.2d at 971-72
(“[S]poradic or transitory activity does not disprove disability.”).
Ms. Wade argues that the ALJ improperly evaluated her daily activities
because he did not discuss “her limiting description of them.” Horton v. Barnhart,
469 F. Supp. 2d 1041, 1047 (N.D. Ala. 2006). The ALJ summarized the daily
activity evidence this way:
The claimant reported in her function report that she cared for children,
prepared meals, did housework, drove daily, shopped in stores, and
watched television. In addition, the claimant reported no problems with
her memory, completion of tasks, concentration, understanding,
following instructions, or getting along with others. She reported that
she could pay attention as long as needed (no problems), could finish
what she started, and could follow instructions very well. The claimant
reported to Dr. Neville [a consultative psychologist] that she cared for
31
children, cooked, did laundry, drove, and shopped for groceries.
Although the claimant testified that she spent up to five hours each day
in a recliner, and had a significant[] limitation of ability to lift, carry,
sit, stand, and walk, these allegations are not consistent with her treating
medical records or with the activities she has previously reported. In
addition, her treating medical records do not indicate that she had had
significant medication side effects. The claimant’s reported daily
activities are not consistent with disabling pain or limitations.
(Doc. 6-3, pp. 36-37; Doc. 6-17, p. 48).
The ALJ’s discussion of the daily activity evidence omits several limitations
which Ms. Wade described in her testimony at the administrative hearing. For
example, Ms. Wade indicated that on a normal morning, she “sit[s] down until [she]
ha[s] energy to do anything” and that during the day she is “usually sitting.” (Doc.
6-9, p. 30). Ms. Wade’s husband regularly brings something home for dinner or
cooks. (Doc. 6-9, pp. 30, 32). Ms. Wade provides simple breakfast and lunch items
for her children and no longer prepares complete meals. (Doc. 6-9, pp. 32, 31).
Ms. Wade watches her children when they are home and her husband is at
work. (Doc. 6-9, p. 31). Ms. Wade dresses her children during the week and her
husband does that on the weekends. (Doc. 6-9, p. 31). Ms. Wade takes her children
to doctor appointments. (Doc. 6-9, p. 31). At night, Ms. Wade bathes her children.
(Doc. 6-9, pp. 30, 31). Her husband dries them off, helps them with their pajamas,
and tucks them into bed. (Doc. 6-9, pp. 30, 31). Ms. Wade’s husband takes care of
their animals. (Doc. 6-9, p. 31).
32
Ms. Wade cannot do yard work because it aggravates her back, knee, and
abdominal pain. (Doc. 6-9, pp. 32, 33). Ms. Wade also lacks energy for outside
work. (Doc. 6-9, p. 33). Ms. Wade cleans for up to two hours daily for one room.
(Doc. 6-9, p. 32). Ms. Wade washes one to two loads of laundry two to three days
weekly. (Doc. 6-9, p. 32). Ms. Wade washes dishes twice weekly. (Doc. 6-9, p.
32).
Ms. Wade buys groceries and items for her children. (Doc. 6-9, p. 33). She
shops biweekly, and the process takes her two hours. (Doc. 6-9, pp. 33, 34). Ms.
Wade visits her mother weekly. (Doc. 6-9, p. 34). Ms. Wade’s hobbies and interests
include reading, watching television, and playing computer games. (Doc. 6-9, p.
34).
Having considered the full scope of Ms. Wade’s daily activities, the Court
finds that caring for her herself and her children with her husband’s help, driving,
shopping biweekly, making simple meals, performing household chores with
limitations, visiting her mother weekly, reading, watching television, and playing
games “do not rule out the presence of disabling pain” that would preclude her from
performing medium work.” Horton, 469 F. Supp. 2d at 1046. “The ability to watch
television, do occasional shopping, or perform other sporadic activities does not
mean” Ms. Wade can do medium work. Horton, 469 F. Supp. 2d at 1046; see also
Lewis, 125 F.3d at 1441 (The claimant’s “participation in everyday activities of short
33
duration, such as housework or fishing, [did not] disqualify[y] [him] from disability
or [was] inconsistent with the limitations recommended by [his] treating
physicians.”).
Consequently, substantial evidence does not support the ALJ’s
negative credibility determination.
V.
CONCLUSION
The Court remands the Commissioner’s decision for further administrative
proceedings consistent with this memorandum opinion finding that the medium
work RFC is not supported by substantial evidence. The conclusion that Ms. Wade
can lift up to 50 pounds and frequently lift or carry 25 pounds is not supported by
substantial evidence.
The Court does not find that Ms. Wade is disabled within the meaning of the
Social Security regulations. The Court expresses no opinion in that regard. The ALJ
must determine whether Ms. Wade may be capable of light or sedentary work. The
record contains testimony from the vocational expert regarding Ms. Wade’s ability
to perform sedentary work and the transferability of her nursing skills. (Doc. 6-5,
pp. 82-89). The ALJ must examine the evidence and determine whether there are
jobs in the economy that Ms. Wade can perform.
DONE this 6th day of August, 2019.
_________________________________
MADELINE HUGHES HAIKALA
UNITED STATES DISTRICT JUDGE
34
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