Spoon v. Social Security Administration, Commissioner
MEMORANDUM OPINION Signed by Judge Karon O Bowdre on 9/26/13. (SAC )
2013 Sep-26 AM 10:47
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF ALABAMA
WILLIAM D. SPOON,
MICHAEL J. ASTRUE,
Commissioner of the Social,
Social Security Administration,
CIVIL ACTION NO.
On January 30, 2007, the claimant, William D. Spoon, protectively filed for Social
Security Disability Income under Title II of the Social Security Act and Supplemental Security
Income under Title XVI of the Social Security Act. (R. 13, 35). The claimant alleged disability
commencing on October 1, 2005 because of an enlarged heart, artery stints, back and chest
problems, artery blockage, depression, and breathing problems. (R. 36). The Commissioner
denied the claim on April 12, 2007 (R. 46), after which the claimant filed a timely request for a
hearing before an Administrative Law Judge. (R. 51). The ALJ held the hearing on July 18, 2008.
On July 14, 2008, the claimant filed an affidavit alleging additional disabling
impairments of obesity, chronic pain, chronic diarrhea, anxiety, shortness of breath, and fatigue,
stipulating that none of these additional impairments met an impairment in the listing. (R. 193).
During the hearing before the ALJ, the claimant amended the onset date to September 15, 2006
following "res judicata" of a prior claim based upon the same disabilities through September 14,
2006. (R. 711).
In his August 14, 2008 decision, the ALJ found that the claimant was not disabled as
defined by the Social Security Act and, thus, was ineligible for Social Security Disability Income
and Supplemental Security Income. (R. 10). Following a timely appeal, the Appeals Council
denied the claimant's request for a review on November 2, 2011, making the ALJ's decision the
final decision of the Commissioner of the Social Security Administration. (R. 5, 8). The claimant
has exhausted his administrative remedies. This court has jurisdiction pursuant to 42 U.S.C. §§
405(g) and 1383(c)(3). For the reasons stated below, this court affirms the decision of the
II. ISSUES PRESENTED
This court considers the following issues on review: (1) whether the ALJ properly
determined the claimant's alleged depression, anxiety, and chronic diarrhea to be non-severe
impairments; (2) whether the ALJ properly applied the Eleventh Circuit pain standard in
discrediting the claimant's subjective testimony regarding his limitations; and (3) whether the
ALJ correctly assessed the claimant's residual functional capacity as sedentary.
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.
1987). "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 "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 claimant presently unemployed?
(2) Is the claimant's impairment severe?
(3) Does the claimant'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 claimant unable to perform his or her former occupation?
(5) Is the claimant 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.
In determining whether the claimant possesses a severe impairment, the Commissioner
must consider whether the impairment significantly limits the claimant's physical or mental
ability to do basic work activities. 20 C.F.R. §§ 404.1521(a), 416.920(c); see also 20 C.F.R. §
404.921(a), Crayton v. Callahan, 120 F.3d 1217, 1219 (11th Cir. 1997). Basic work activities
(1) Physical functions such as walking, standing, sitting, lifting, pulling, reaching,
carrying, or handling; (2) Capacities for seeing, hearing, and speaking; (3)
Understanding, carrying out, and remembering simple instructions; (4) Use of
judgment; (5) Responding appropriately to supervision, co-workers, and usual
work situations; and (6) Dealing with changes in a routine work setting.
20 C.F.R. §§ 404.1521(b), 416.921(b). A non-severe impairment is so slight and minimal in
effect that it would not be expected to interfere with an individual's work activities, regardless of
the individual's particular circumstances. McDaniel, 800 F.2d at 1031; see also Brady v. Heckler,
724 F.2d 914, 920 (11th Cir. 1984).
In evaluating pain and other subjective complaints, the Commissioner must consider
whether the claimant demonstrated an underlying medical condition, and either "(1) objective
medical evidence that confirms the severity of the alleged pain arising from the condition or (2)
that the objectively determined medical condition is of such a severity that it can reasonably be
expected to give rise to the alleged pain." Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991)
(emphasis added); see also 20 C.F.R. §§ 404.1529, 416.929. The ALJ must articulate reasons for
discrediting the claimant’s subjective testimony regarding his limitations, but is not required to
cite the language of the pain standard in whole or in part. Instead, the ALJ must show through his
discussion that he applied the appropriate standard. Wilson v. Barnhart, 284 F.3d 1219, 1225-26
(11th Cir. 2002).
The responsibility for determining the claimant's RFC rests with the ALJ. 20 C.F.R. §§
404.1546(c), 416.946(c). An RFC assessment involves determining the claimant's ability to do
work in spite of his impairments and in consideration of all relevant evidence. Lewis v. Callahan,
125 F.3d 1436, 1440 (11th Cir. 1997); see also 20 C.F.R. §§ 404.1545(a), 416.945(a). The ALJ
makes this determination by considering the claimant's ability to lift weight, sit, stand, push, pull,
etc. 20 C.F.R. §§ 404.1545(b), 416.945(b). The ALJ determines the claimant's RFC only after
establishing the extent of the claimant's severe impairments. 20 C.F.R. §§ 404.1520(e)-(f),
416.920(e)-(f). A statement from the claimant's treating physician declaring the claimant unable
to work deserves careful consideration in any finding of disability; however, a treating
physician's opinion may be discounted when it is not accompanied by objective medical evidence
or is wholly conclusory. Crawford v. Commissioner, 363 F.3d 1155, 1159 (11th Cir. 2004); see
also Edwards v. Sullivan, 937 F.2d 580, 583 (11th Cir. 1991).
The C.F.R. classifies jobs in the national economy as belonging to one of four levels of
exertion: sedentary, light, medium, or heavy. 20 C.F.R. §§ 404.1567, 416.967. The C.F.R.
defines sedentary work as requiring extended periods of sitting; "lifting no more than 10
pounds;" occasional "lifting or carrying articles like docket files, ledgers, and small tools;" and
occasional "walking and standing." 20 C.F.R. §§ 404.1567(a), 416.967(a). Social Security Rule
83-10 further defines “occasional” to describe up to one-third of the time. A sedentary worker
should not walk or stand more than two hours in an eight hour work day and should sit for
approximately six hours of an eight hour work day. Kelley v. Apfel, 185 F.3d 1211, 1213 n. 2
(11th Cir. 1999).
Plaintiff was forty-two years of age at the onset of the alleged disability and forty-four at
the time of the ALJ hearing. (R. 25). The claimant filed for disability on two previous occasions.
(R. 711). The claimant was inconsistent in reporting his level of education last achieved,
although the record is clear that he did not earn a high school diploma.1 He can read and write in
English and has worked as a "cashier checker" and "stocker or…store's laborer." (R. 709). He
reported that he last worked in November 2005. (R. 172).
In this case, the claimant originally alleged disability because of an enlarged heart, artery
stints, back and chest problems, artery blockage, depression, and breathing problems. (R. 36). On
July 14, 2008, the claimant alleged disability based on additional impairments of high blood
pressure, obesity, chronic pain, chronic diarrhea, anxiety, shortness of breath, and fatigue. (R.
193). At the claimant's hearing, the ALJ summarized the alleged impairments as hypertension,
hypercholesterolemia, morbid obesity, migraine headaches, obstruction sleep apnea, coronary
artery disease status post 1 stent, arterial venous malformation in the right frontal lobe,
depressive disorder with anxiety, bronchitis, laryngitis, esophagitis, and pedal edema. Counsel
During the hearing, the claimant testified that he had only achieved an eighth grade education.
(R. 710). On May 5, 2005, during a consultative examination at Greenwood Pediatrics & Internal
Medicine, the claimant reported completing the tenth grade. During intake at a mental health
facility, he reported having completed eleventh grade. (R. 24).
for the claimant lodged no objections or additional impairments in response to this summary. (R.
712). Although not discussed during the hearing, the ALJ's decision addressed whether the
claimant suffered severe impairments from chronic diarrhea and asthma. (R. 16-17).
The record contains evidence of the claimant's medical history dating back to 1991. The
ALJ referenced the claimant's medical history going back to May 2005. The onset of his current
disability claim is September 15, 2006 as a result of res judicata because of his two previous
disability applications, which were both denied. (R. 13).
The claimant smoked tobacco for at least twenty years, had suffered from hypertension,
obesity, and instances of lumbago since at least 1998, and was hospitalized because of bronchitis
as early as 2002. (R. 255, 271, 323, 357). Since at least 2003, doctors have diagnosed the
claimant with elevated cholesterol, or hypercholesterolemia. (R. 220-221). The claimant first
reported chest pain in 2004. (R. 216). The claimant has received Medicaid since at least 2005, the
same date he began reporting difficulty sleeping. (R. 205, 207).
From May 17, 2006 through his alleged onset date of September 15, 2006, the claimant
sought treatment with Dr. Syed, who became the claimant's treating physician, on seven
occasions: May 17, May 24, June 5, July 6, August 3, August 4, and August 17. During these
visits, Dr. Syed noted the claimant’s hypertension controlled with medication; obesity; normal
muscular skeletal and neurological systems; sleep disturbance issues ripe for a sleep study; and
no shortness of breath except on the May 17 visit. Dr. Syed noted a May 18th x-ray revealed left
ventricle and left atrial enlargement and mild aortic dilatation. Dr. Syed also indicated that the
claimant reported sharp chest pain on May 24 radiating to his left side with minimal exertion.
However, Dr. Syed reported that the claimant had normal heart functioning during the May 24,
July 6, August 3, and August 4 examinations. Dr. Syed noted edema in the claimant’s lower
extremities on May 24 and June 5, but found no edema during the July 6, August 3, and August
17 examinations. (R. 274-75, 279-81, 283-84, 295-99, 356, 419, 422-29).
On August 9, 2006 on referral by Dr. Syed, the claimant met with J. Greg Adderholt, MD,
with Valley Neurosurgery. His interpretation of the MRI suggested a probable tumor, susceptible
to dilation, growing from the meninges in the medial right frontal lobe and possible associated
benign tumor with thick fibrous walls enclosing a vascular, blood filled space (“probable
cavernous meningioma in the medial right frontal lobe” and possible “associated venous
hemangioma”). He did not agree with Dr. Fritts from Helen Keller Hospital that the diagnosis
was a likely arteriovenous malformation. He based his interpretation on the small size of the
tumor, asymptomatic presentation of the claimant, and lack of recent hemorrhage. His
recommendation was no acute intervention unless the claimant suffered uncontrollable seizures
or hemorrhaging. (R. 312-313).
For the remainder of 2006, the claimant followed up with Dr. Syed on September 18 and
December 5, with almost identical findings as discussed for his previous visits. Dr. Syed did
introduce Lunesta to treat suspected sleep apnea; the claimant reported on the December 5 visit
that Lunesta seemed to help him. (R. 410-17).
The claimant also sought treatment with Dr. Syed on January 4 and 18, again with similar
findings. On January 18, 2007, the claimant complained of sudden onset chest pain, as well as
mild back pain. The claimant described chest pain as pressure-like and sharp, located on the left
side of the chest and radiating to the left arm. A chest x-ray from this visit showed a normal,
rather than enlarged, cardiac shadow. The claimant remained obese and hypertensive, with blood
pressure controlled through medication. Auscultation of the lungs showed mild coarseness. The
claimant's back pain did not lessen his range of motion. Dr. Syed found the claimant's abdomen
soft and non-tender, but reported no nausea, vomiting, indigestion, heartburn, or abdominal pain.
Dr. Syed continued to prescribe Lunesta to treat suspected sleep apnea. Dr. Syed also began
prescribing Advicor to manage the claimant's hypercholesterolemia. In consideration of the
claimant's other risk factors, Dr. Syed planned to refer him to a cardiologist. (R. 402-07, 443).
On January 25, 2007, the claimant sought treatment at Helen Keller Hospital on his own
initiative after experiencing abdominal pain. Robert Dunn, MD, a radiologist at Helen Keller
Hospital, interpreted the resulting CT scan as unremarkable and presenting a normal GI tract. (R.
On January 29, 2007, Eliza Coffee Memorial Hospital admitted the claimant, who
complained of prolonged recurrent chest pain radiating to the left arm and associated shortness of
breath. The attending physician on admission, and later, the claimant's treating cardiologist,
Surender Sandella, MD, diagnosed the pain as resulting from acute coronary syndrome, coronary
artery disease, hypertension, tobacco abuse, and a family history of premature coronary artery
disease. The claimant's patient history also indicated chronic diarrhea for the last twenty years.
On January 30, 2007, Dr. Sandella treated the claimant with a combination of medication and
insertion of a bare-metal stent. Dr. Sandella left no notations of permanent restrictions for the
claimant following this procedure. (R. 374-376).
On February 7, 2007, the claimant returned to Dr. Syed for a follow-up visit. The
claimant remained obese and hypertensive, controlling the latter condition through medication.
The claimant's musculoskeletal and ENT systems revealed normal functioning on examination. A
chest x-ray from this visit recorded a normal, rather than enlarged, cardiac shadow. The claimant
reported no back pain. (R. 397-398, 440).
On March 6, 2007, the claimant visited Dr. Sandella for a follow-up visit at the Heart
Health Center. An EKG from this visit indicated sinus bradycardia, indicating a resting heartbeat
under 60 beats per minute. (R. 391).
On March 12, 2007, the claimant visited Dr. Syed for a follow-up visit. The claimant
remained obese and hypertensive. Dr. Syed deemed the claimant completely compliant to therapy
managing his hypercholesterolemia. The claimant's respiratory, cardiovascular, and
musculoskeletal systems revealed normal functioning on examination. (R. 393-396).
On March 16, 2007, the claimant completed a cardiovascular questionnaire submitted to
him by the Disability Determination Service. He indicated that he walks for 15-20 minutes twice
a day to lose weight. He stated walking for this duration causes him chest discomfort and back
pain. The claimant also indicated on the questionnaire suffering from shortness of breath. The
claimant stated that he can relieve shortness of breath by sitting down or undergoing a breath test.
He also stated that he takes medicine to address this symptom. (R. 169-170).
On March 17, 2007, the claimant completed a work history report at the request of the
Disability Determination Service. Detail on this application differs from work history reports
related to the claimant's prior disability applications. However, based on this report, the
claimant's last date of employment is November, 2005. (R. 105-112, 125-127, 172).
The claimant completed an undated daily activities questionnaire at the request of the
Disability Determination Service. He indicated that he cooks and prepares meals, shops
independently for personal needs, performs several household chores while seated, and follows
along with TV and radio programs. The claimant stated that he has regular weekly contact with
friends and relatives outside the home and that he sometimes will watch and care for his
granddaughter. (R. 181-183).
On April 11, 2007, Ms. Johnson, the disability specialist assigned to the claimant's
application, completed a physical summary stating that the only new allegation since the
claimant's last denial on September 14, 2006 was "carido stents." The summary also states that
all other conditions were stable with medication "per the treating physician," whom Ms. Johnson
did not identify. (R. 449).
That same day, Ms. Johnson completed a physical RFC assessment in response to the
claimant's application for disability on January 30, 2007. She listed the primary diagnosis as
coronary artery disease, a secondary diagnosis as essential hypertension, and an additional
alleged impairment of obesity. This RFC recorded occasional and frequent maximum limits
lifting or carrying as 20 pounds and 10 pounds respectively. Ms. Johnson found the claimant
could stand or walk with normal breaks for about six hours in an eight-hour workday; could sit
for about six hours in an eight-hour workday; and had no push or pull restrictions separate from
the maximum weight limits previously listed. Ms. Johnson found occasional postural limitations
for the claimant in climbing a ramp or stairs, balancing, stooping, kneeling, crouching, and
crawling. However, in the final postural limitation category, she found he could never climb a
ladder, rope, or scaffolds. Ms. Johnson found no limitations in the claimant's manipulative
(reaching all directions, gross and fine manipulation, and skin receptors), visual (near and far
acuity, depth perception, accommodation, color vision, and field of vision), and communicative
(hearing and speaking) functioning. Ms. Johnson found the claimant should avoid all exposure to
hazards and concentrated exposure to cold, heat, wetness, humidity, and fumes or odors. Though
she did not explain why, Ms. Johnson found the claimant's statements regarding the severity and
functional limitations of his symptoms only partially credible. (R. 464-469).
On April 11, 2007, following submission of the claimant's physical and mental RFC
assessment, Ms. Johnson, the disability specialist, completed a Vocational Rationale Form.
Based on the content of the physical and mental RFC assessments, Ms. Johnson determined that
the claimant could perform past relevant work of cashier "as it is usually performed in the
national economy." (R. 151, 153).
On May 10 and May 17, 2007, the claimant made follow-up visits to Dr. Syed. On
examination, Dr. Syed noted that the claimant remained obese and that his hypertension was
controlled with Metoprolol and Benazepril; Dr. Syed found contrasting signs in the claimant
across several systems: unremarkable cardiovascular functioning but edema of the bilateral lower
extremity; normal gait and station in the musculoskeletal system but the lower lumbar tender to
palpation without accompanying decreased range of motion; no wheezing, coughing, or shortness
of breath but coarse upper lobes in the respiratory system; and normal appearance and movement
of the ENT system, but bilateral pharyngeal erythema. Furthermore, the claimant reported
treating his continuing sleep disturbance through Lunesta. Dr. Syed deemed the claimant
somewhat compliant to therapy for hypertension and sleep disturbance during the May 10
examination, but commented in his May 17 examination notes that the complainant was
completely compliant with therapy. Although Dr. Syed did not identify a reason for finding the
claimant “somewhat complaint,” he did note that the claimant does not self-monitor his blood
pressure. (R. 577-578). Neurologically, the claimant reported migraine headaches accompanied
by nausea on May 17. (R. 571-572).
On June 6, 2007, the claimant made a follow-up visit to Dr. Syed's office. Dr. Syed noted
that the claimant remained obese and hypertensive, and only somewhat compliant with therapy,
possibly because he was not self-monitoring his blood pressure. Examination showed that the
claimant's cardiovascular, respiratory, and musculoskeletal systems were no different from
previous visit. Examination revealed the claimant's migraine headaches had worsened because of
a new condition of sinusitis. Dr. Syed's examination of the claimant's oropharynx revealed
bilateral pharyngeal erythema and bilateral pustular pharyngeal drainage. The claimant also
reported worsening diarrhea in response to any food consumption. Dr. Syed found the claimant's
abdomen soft and non-tender on examination. (R. 566-568).
On June 8, 2007, the claimant made a follow-up visit to Dr. Syed's office. Per Dr. Syed’s
report, the claimant presented with an improvement of his sinusitis; the absence of coarse upper
lobes on auscultation of the lungs; continuing headache; continuing edema of the bilateral lower
extremity; soft and non-tender abdomen; no mention of lumbar pain or diarrhea; and continuing
treatment of hypertension and depression through medication. (R. 562-563).
Two days later, on June 18, 2007, the claimant made another a follow-up visit to Dr.
Syed's office. At this time, claimant reported recent chest pain that was not present at the time of
the prior visit. The claimant described the pain as pressure-like and sharp on the left side of the
chest. An EKG from this visit shows the claimant with sinus bradycardia. Examination showed
the claimant remained obese and hypertensive, but completely compliant to therapy for
hypertension. Dr. Syed noted the condition had significantly improved. On examination, the
claimant's respiratory, cardiovascular, and musculoskeletal systems showed normal functioning.
The claimant's abdomen remained soft and non-tender. The claimant's test for cardiac enzymes
was negative. The claimant made no mention of headache, lumbar pain, or diarrhea. (R. 553-554,
During a follow-up visit on June 26, 2007 with Dr. Sandella, the claimant reported an
isolated occurrence of chest pain while moving residences but no recurrence since the episode.
An EKG revealed a heartbeat of 45. Dr. Sandella noted the need to schedule a stress test to
evaluate the claimant's bradycardia. He also stated the need to follow-up separate from the stress
test. The claimant testified that the stress test never occurred because Dr. Sandella moved. (R.
However, Dr. Sandella's records show administration of a stress test on July 18, 2007 at
ECMH, with the results indicating a large fixed inferior wall defect. Dr. Sandella determined the
bradycardia to be partially iatrogenic and recorded plans to treat through a dosage adjustment of
metoprolol. The claimant listed his employment status as “disabled” on the hospital intake form.
(R. 603-605, 722).
On July 25 and September 13, 2007, the claimant made follow-up office visits to Dr.
Syed's office. On both visits, the claimants’s respiratory, cardiovascular, and musculoskeletal
systems were normal. An EKG showed unconfirmed sinus bradycardia and a chest x-ray showed
a cardica shadow. Dr. Syed also listed an intention to provide a referral to a pulmonary
specialist, though none was identified with specificity. (R. 537-48, 549-552). A year previously,
at claimant’s May 17, 2006 and June 5, 2006 visits, Dr. Syed made a note to refer the claimant to
Dr. Ridgeway, a pulmonologist, for a sleep study. (R. 279-81, 296-99). Nothing in the record
indicates the claimant met with a pulmonary specialist or that Dr. Syed diagnosed the claimant
with a pulmonary disease. Dr. Syed ceased prescribing Lunesta at the September 13, 2007 visit
and did not prescribe it again before the ALJ hearing. (R. 537-48).
On September 24, 2007, the claimant visited Shoals Hospital complaining of vomiting
blood. The claimant listed COPD, asthma, coronary artery disease, and hypertension on his
medical history. Dr. Ernest Mollohan, O.D., found the claimant’s respiratory, cardiovascular,
gastrointestinal, and neurologic systems to be normal. The medical impression was sinusitis and
upper respiratory infection. On the intake form, the claimant listed his employment status as
“disabled.” (R. 690-692).
On September 25, 2007, the claimant visited Dr. Syed's office. He complained of
sinusitis, shortness of breath (dyspnea), cough, and diarrhea. The claimant’s cardiovascular and
musculoskeletal systems exhibited no signs of abnormality. Dr. Syed found expiratory wheezing
over both lung fields, diminished breath sounds over the entire right lung, and coarse upper lobes
that cleared and improved in response to "breathing treatment." Examination of the claimant's
ENT symptoms revealed bilateral pharyngeal erythema of the oropharynx. A chest x-ray on this
visit showed an enlarged cardiac shadow. (R. 528-530, 533-534).
On October 5, 2007, the claimant reported to Dr. Syed that he had not used medication to
control hypertension, and Dr. Syed deemed the claimant somewhat compliant with ongoing
hypertension. The claimant reported insomnia, cough and shortness of breath. Examination
revealed normal functioning of the claimant's respiratory and cardiovascular systems. The
claimant's abdomen was soft and non-tender. (R. 524-525).
On December 28, 2007, the claimant visited Helen Keller Hospital complaining of chest
discomfort. On the intake form, the claimant also indicated associated shortness of breath,
excessive sweating, and fainting. The claimant admitted to being a smoker, as well as recent user
of cocaine. A chest x-ray showed no pulmonary infiltrate, a complete lack of pulmonary disease,
and "approximately normal" heart size. The claimant then left Helen Keller Hospital after signing
a form acknowledging that he did so against medical advice, despite the hospital's desire to admit
him for observation in case the condition worse. (R. 617, 619, 620, 623).
On January 10, 2008, the claimant visited Dr. Syed's office. Dr. Syed noted that the
claimant had gained 30 pounds. The claimant reported insomnia controlled by Lunesta.
However, the claimant's list of medications did not show any refills of Lunesta through the first
six months of 2008. (R. 195-200A, 515-516, 518).
On January 11, 2008, the claimant visited Shoals Hospital complaining of abdominal
pain. The claimant underwent an abdominal CT scan with and without contrast, as well as a CT
scan of his pelvis. Donald Bowling, MD, a radiologist with Shoals Hospital, found no
abnormalities in the pelvis. The claimant's body habitus impacted the clarity of the abdominal
CT. As a result, Dr. Bowling was unable to clear the pancreas, upper abdomen, or
retroperitoneum. The kidneys appeared generally normal. The liver appeared hypodense while
the spleen looked normal. Dr. Bowling found no abnormally enlarged intestines. (R. 686, 688).
On January 14, 2008, Dr. Sandella completed a seven-month "interval history" report
with the following impressions: chest pain/angina; coronary artery disease with a history of
percutaneous intervention to left anterior descending artery 4 month returned; morbid obesity;
and tobacco abuse. The EKG test recorded a 68, making bradycardia no longer an issue. Dr.
Sandella prescribed Chantix to help end the claimant's smoking habit. The record does not show
the claimant visiting Dr. Sandella again. (R. 646).
Between January 29 and May 19, 2008, the claimant followed-up with Dr. Syed on five
occasions. On each occasion, Dr. Syed reported that the claimant was either somewhat or
completely compliant with his hypertension therapy; and that the claimant continued to be
morbidly obese; that his cardiovascular and musculoskeletal systems were normal; that his
respiratory system was normal, but revealed coarse breath sounds; that his abdomen was soft and
tender. On March 17, the complainant added shortness of breath and headaches as his
symptoms, although Dr. Syed indicated normal respiratory function. On the May 19 visit, the
claimant reported that he had back pain, edema, fatigue, and dyspnea. Dr. Syed noted in the May
19 records that the claimant had normal cardiovasucular functioning except for bilateral carotid
bruit and that he planned to schedule a doppler ultrasound to evaluate this condition.
On May 20, 2008, the claimant visited Helen Keller Hospital for a vertebral doppler
ultrasound to investigate the carotid bruit. Dr. Fritts, a radiologist with Helen Keller Hospital,
interpreted the ultrasound as indicating antegrade flow at normal velocities with no evidence of
significant stenosis or plaque formation. (R. 612).
On May 22, 2008, Dr. Syed referred the claimant to Dan Raju, MD, to assess the
claimant's symptoms of blood in his stool, generalized abdominal pain, alternating watery
diarrhea and constipation, and acid reflux. Dr. Raju's examination found no esophagitis or weight
loss. He found that the claimant suffered from altered bowel habits, gastrointestinal bleeding,
upper abdominal pain, gastroesophogeal reflux disease (GERD), and obesity. Dr. Raju scheduled
an esophagogastroduodenoscopy (EGD) and colonoscopy to assess the source of the
hematochezia and abdominal pain and to develop a subsequent treatment plan. (R. 656, 659).
On May 28, 2008, Dr. Raju performed an EGD and colonoscopy on the claimant at
Shoals Hospital. Dr. Raju found mild antral erythema, irregular z-line, colon polyps, and small
internal hemorrhoids. Following the procedure, Dr. Raju recommended a follow-up in one year,
continued use of the proton pump inhibitor to treat the claimant's GERD, and if the biopsies
came back positive for H. pylori, a regime of antibiotics. The claimant once again listed his
occupation as “disabled” on the hospital intake forms. (R. 651, 662-663).
On June 11, 2008, the claimant visited Dr. Syed for a follow-up visit, complaining of
gastro-esophageal reflux, edema, fatigue, back pain, and dyspnea. Dr. Syed found the claimant
completely compliant to therapy for hypertension and hypercholesterolemia. Dr. Syed noted that
the claimant had lost weight since his previous visit, and was no longer in distress as a result of
his morbid obesity. (R. 626-27). According to the record, claimant weighed 429 pounds, which
was down from his down from his May 19, 2008 weight of 438.4 pounds, but up from his March
17, 2008 weight of 426 pounds. (R. 480, 496, 627). After the examination June 11, 2008, Dr.
Syed noted the claimant’s normal musculoskeletal gait and station, normal cardiovascular
functioning with no presence of edema or carotid bruit, and lessened breath sounds attributable to
the claimant's weight. The claimant's abdomen was soft, non-tender, and obese. The claimant did
not mention any ear, nose, or throat ailments, or problems with diarrhea. (R. 626-27).
On July 16, 2008, Dr. Syed wrote a brief statement on behalf of the claimant expressing
his medical opinion that because of the claimant's "body habitus and medical problems," Dr.
Syed believed "it would be difficult for [the claimant] to work." (R. 643).
According to his notes, Dr. Syed evaluated the claimant four times for indications of
abnormal psychiatric functioning prior to the claimant's visiting a mental health specialist. At
those visits, on May 17, May 24, July 6, and August 3, 2006, the claimant uniformly reported
anxiety and depression. On two of those visits, May 17, and July 6, 2006, Dr. Syed's observations
directly contradicted the claimant's self-description; he found the claimant’s mood, affect,
speech, language, and thought to be normal. From the very first visit, however, Dr. Syed treated
the claimant for these conditions with Lexapro, and, as of August 3, 2006, Wellbutrin. (R.
274-275, 283, 296-297, 299, 427-429).
On August 17, 2006, the claimant visited Bonnie Atkinson, Ph.D., L.L.C., a consulting
psychologist, on referral by the Disability Determination Office of the Social Security
Administration, for a comprehensive psychological evaluation. Dr. Atkinson began her report by
reviewing the claimant's medical history, psychiatric history, psycho-social history, personal
appearance, and behavior. Next, Dr. Atkinson conducted a mental status exam on the claimant. In
her report, Dr. Atkinson described emotional/affective symptoms and summarized the claimant's
adaptive living skills, such as his living situation, capacity to do housework, and hobbies and
social activities. (R. 321-326).
In the final step, Dr. Atkinson offered her clinical judgment. Her prognosis was "good."
Dr. Atkinson found that the claimant had sufficient judgment to make acceptable work decisions
and manage his own funds. Although noting the presence of the claimant's enlarged heart,
morbid obesity, hypertension, and hypercholesterolemia, Dr. Atkinson established a Global
Assessment of Functioning score of 65-70 signifying only mild limitations. This value supported
Dr. Atkinson's conclusion that the claimant did not suffer from severe mental illness or
retardation and that the claimant's mental condition was unlikely to change or improve in the
coming 12 months without an improvement in his physical condition. (R. 326-327).
On the same day that the claimant visited Dr. Atkinson, he paid a visit to Dr. Syed.
Consistent with his observations from August 3, 2006, Dr. Syed's notes showed the claimant to
have an anxious mood, but stated that the treatment plan, and Wellbutrin specifically, was having
its intended effect. (R. 418-419).
On August 28, 2006, the claimant filled out a referral form for intake at Riverbend Center
for Mental Health. The claimant booked an appointment for September 12, 2006, and listed his
presenting problem as “depression” treated by Wellbutrin. Although the claimant had already
filed his second disability application and was awaiting a determination on that claim2, the
claimant listed his employment status as “unemployed, looking” on the accompanying
demographic information page. (R. 371-372).
On September 12, 2006, the claimant enrolled as an outpatient at Riverbend Center for
Mental Health following referral by Dr. Atkinson for depression. On September 15, 2006, the
claimant's amended onset date for disability, a staffer at RCMH completed an integrated
diagnostic summary/review of the claimant's mental health. The staffer stated that the claimant
met the diagnosis and disability criteria for serious mental illness. Supporting that diagnosis, the
staffer cited the claimant’s GAF score of 48 and the claimant's reported symptoms of depression,
crying, isolation, paranoia, decreasing memory, increasing anxiety, and decreasing sleep.
Completing the summary, the staffer found no risk of self-injury or homicidal ideation in the
claimant. The claimant did report seeing an hallucination. The summary is unspecific as to who
The social security administration denied the claimant’s second disability application on
September 14, 2006, only two days after the claimant’s first appointment with RCMH.
made these findings, but at the bottom of the page is an illegible reviewing psychiatrist's
signature, which may belong to Dr. Georgie Stanford with whom the claimant had an
appointment on October 4, 2006. The claimant had also scheduled a follow-up appointment with
staff for September 19, 2006. (R. 33, 362-363, 372).
On September 13, 2006, Frank Nuckols, MD, a consulting psychiatrist, completed a
psychiatric review technique form, without the benefit of RCMH's summary. He found that the
claimant suffered from an adjustment disorder with mixed anxiety and depression that created
moderate function limitations with respect to the claimant's activities of daily living and
maintaining social functioning and mild limitations in maintaining concentration, persistence, or
pace. (R. 339, 346).
Also, Dr. Nuckols completed a mental RFC assessment. He based this assessment on his
psychiatric review technique. Dr. Nuckols found the claimant possessed moderate limitations in
seven categories: 1) the ability to understand and remember detailed instructions; 2) the ability to
carry out detailed instructions; 3) the ability to maintain attention and concentration for extended
periods; 4) the ability to complete a normal work-day and workweek without interruptions from
psychologically based symptoms and to perform at a consistent pace without an unreasonable
number and length of rest periods; 5) the ability to interact appropriately with the general public;
6) the ability to accept instructions and respond appropriately to criticism from supervisors; 7)
the ability to respond appropriately to changes in the work setting. Dr. Nuckols deemed all other
categories as not significantly limited. Dr. Nuckols' functional capacity assessment did not
consider the claimant unable to work. However, Dr. Nuckols considered it necessary for the
claimant to have regular breaks, familiar co-workers, and infrequent contact with the public in
any employment setting. (R. 350-352).
On September 18, 2006, the claimant returned to Dr. Syed reporting anxiety and feelings
of depression. In contrast to recent prior visits, Dr. Syed's notes showed that the claimant
possessed normal mood, speech, and thought process. Nonetheless, Dr. Syed noted that he would
change the claimant's prescription for Lexapro to Effexor. (R. 414-417).
On September 19, 2006, the claimant returned to RCMH for an individual therapy
session. The claimant experienced decreased anxiety, increased coping, and better mood stability
following this session. (R. 598).
On September 21, 2006, the claimant attended group therapy at RCMH. Two different
staff members completed progress notes on the claimant. The first staffer noted that the claimant
was on time and that he was alert and responsive. Collectively, the group reviewed a handout
entitled "Are You Under Stress" and then, individually, completed the Mistaken Beliefs
Questionnaire and reviewed the results. The first staffer noted that the claimant progressed by
sharing his results of his Mistaken Belief Questionnaire with the group as well as what he does to
reduce his stress. The second staffer noted that the claimant learned about identifying stress
triggers, while stating that the claimant displayed signs of assessing and identifying how to cope
with his stress. Both staffers indicated a treatment plan of weekly practice skills in group therapy.
The record has no evidence that the claimant attended another therapy session, group or
individual, until August, 2007. (R. 599-600).
In the interval between the claimant's group therapy visit at RCMH in September, 2006,
and Dr. Nuckols' completion of a second mental RFC assessment in April, 2007, Dr. Syed
observed the claimant's psychiatric state on five separate occasions. At each visit, on December
5, 2006, and January 4, January 18, February 7, and March 12, 2007, Dr. Syed noted the absence
of any indication of abnormal psychiatric functioning. He repeatedly described the claimant as
having normal mood, affect, speech, language, and thought. On March 12, 2007, Dr. Syed added
further detail, noting that the claimant appeared alert; oriented to person, place, and time;
possessed of normal behavior, attention, and concentration; and free from anxiety, depression,
irrational fears, delusions, compulsions, hallucinations, or flight of ideas. (R. 395, 398, 403, 407,
The claimant's self-descriptions varied. In December, 2006, the claimant reported feelings
of anxiety and depression. However, at both visits in January, 2007, the claimant stated he was
satisfied with life and not depressed. By February, 2007, and reiterated at the March, 2007 visit,
the claimant once again reported he suffered from depression and anxiety. (R. 394, 398, 403,
The claimant's medications also varied over this period. The absence of any evidence of
the claimant's visit to Dr. Syed on October 2, 2006 complicates charting this progression.
Nonetheless, the record shows that by the December 5, 2006 visit, the claimant had resumed
taking Lexapro and ceased taking Effexor. On January 4, 2007, Dr. Syed removed the claimant
from Lexapro entirely following the claimant's statement that he was "satisfied with life."
However, at the January 18, 2007 visit, the prescription record once again included Lexapro and
Wellbutrin. On February 7, 2007, Dr. Syed noted treatment for depression and anxiety using
Effexor, but only Lexapro and Wellbutrin appeared in the list of medications. At the March 12,
2007 visit, Dr. Syed dropped Wellbutrin from the listed medications, leaving only Lexapro to
treat the claimant's alleged mental conditions. (R. 396, 398, 400, 403, 405-406, 409, 413).
On April 11, 2007, Dr. Nuckols completed a new psychiatric review technique. He
diagnosed major depressive disorder that was recurrent and severe. Additionally, he cited an
anxiety disorder. In his summary of the functional limitations, Dr. Nuckols found a moderate
limitation in the claimant's ability to maintain concentration, persistence, or pace. Dr. Nuckols
found mild limitations in the area of activities of daily living and maintaining social functioning.
(R. 453, 455, 460).
When Dr. Nuckols completed the mental RFC assessment on April 11, 2007, he found
moderate limitations in the same seven categories: 1) the ability to understand and remember
detailed instructions; 2) the ability to carry out detailed instructions; 3) the ability to maintain
attention and concentration for extended periods; 4) the ability to complete a normal workday
and workweek without interruptions from psychologically based symptoms and to perform at a
consistent pace without an unreasonable number and length of rest periods; 5) the ability to
interact appropriately with the general public; 6) the ability to accept instructions and respond
appropriately to criticism from supervisors; 7) the ability to respond appropriately to changes in
the work setting. Dr. Nuckols concluded that the claimant is able to complete an 8 hour workday
with breaks. He concluded that the claimant had a concentration span of two or more hours for
task completion; that the claimant's interactions with the public should be infrequent; and that
any changes in the claimant's work environment should be infrequent and gradual. (R. 472-474).
Between April and August 2007, the record contains five visits to Dr. Syed that address
the question of whether the claimant possessed abnormal psychiatric functioning. At these visits,
on May 10, May 17, June 6, June 18, and July 25, 2007, the claimant consistently reported
feelings of anxiety and depression. By contrast, at each of the May and June 2007 visits, where
Dr. Syed recorded any evaluation of the claimant's psychiatric state, he described it as
functioning normally. On June 6 and June 18, 2007, Dr. Syed offered the same summary as he
recorded on March 12, 2007: claimant appeared alert; oriented to person, place, and time;
possessed of normal behavior, attention, and concentration; and free from anxiety, depression,
irrational fears, delusions, compulsions, hallucinations, or flight of ideas. Only on July 25, 2007
did Dr. Syed record the claimant as having an anxious mood. This finding compelled Dr. Syed to
refer the claimant to RCMH for additional examination. (R. 550-551, 553-554, 567-568, 571,
On August 6, 2007, the claimant returned to RCMH. Pamela Hardin, a staffer, noted that
the claimant reported an increase in depressive symptoms because of lack of money, an increase
in agitation, and chronic chest pain. The claimant scheduled a follow-up visit with Dr. Stanford
for October 11, 2007, but the record does not contain evidence of this or any future visit with Dr.
Stanford. (R. 586).
Between the claimant's August, 2007 visit to RCMH and his July, 2008 ALJ hearing, the
claimant made twelve additional doctor's visits in which he was evaluated for his alleged
depression. The claimant visited Dr. Syed on September 13, 2007, and again on September 25,
2007. At both visits, the claimant reported himself satisfied with life and not depressed, and Dr.
Syed found no behavioral indicators of the same. (R. 529-530, 537-538).
These visits sandwiched a September 24, 2007 stop at Shoals Hospital for treatment
related to physical symptoms. As part of intake, Dr. Mollohan reviewed and could not find any
evidence that the claimant suffered from depression, anxiety, sleeplessness, hopelessness,
hallucinations, or suicidal thoughts. (R. 691).
On a visit to Dr. Syed on October 5, 2007, however, the claimant described himself as
anxious and depressed. Dr. Syed did not note any external signs of abnormal psychiatric
functioning at this visit. (R. 524). Two months later on December 28, 2007 at Helen Keller
Hospital, as part of the intake form for chest pain, Amorette Miller, MD, assessed the claimant's
psychiatric state, finding normal mood and affect and normal orientation to person, place, and
time. (R. 617).
The claimant reported suffering from anxiety and depression on his next six visits to Dr.
Syed. While the claimant only offered a general statement that he felt anxiety and depression on
his visits on January 10, January 29, and February 13, 2008, the claimant cited specific grounds
for his feelings of anxiety on his February 25, March 17, and May 19, 2008 visits: the
hospitalization of his granddaughter. (R. 480, 497, 501, 507, 511, 515).
Underscoring the reality of the claimant's statements, Dr. Syed found no external signs
that the claimant suffered from anxiety or depression during his visits on January 10, January 29
and February 13, 2008, but noted the claimant as being "very upset" and anxious, but not suicidal
or homicidal, in his records from claimant's visits on February 25, March 17, and May 19, 2008.
(R. 480, 497, 501, 508, 512, 516).
On June 11, 2008, the claimant's final visit to Dr. Syed before his ALJ hearing, the
claimant reported himself as "satisfied with life, not depressed." Consistent with the claimant's
self-description was Dr. Syed's detailed but unremarkable evaluation of external indications of
abnormal psychiatric functioning. The claimant, according to Dr. Syed had "no anxiety or
depression." (R. 627-628).
The ALJ Hearing
After the Commissioner denied the claimant's request for Social Security and
Supplemental Security Income disability benefits, the claimant requested and received a hearing
before an ALJ on July 18, 2008. (R. 46, 51).
At the hearing, the claimant offered testimony in response to questioning from his
attorney and the ALJ regarding his claimed impairments of obesity, edema, lumbago, shortness
of breath, fatigue, coronary artery disease, migraines, tobacco abuse, gastrointestinal distress, and
hypertension while providing contextual testimony regarding his daily activities and sources of
income. (R. 707-722).
The claimant testified to his steps to combat his obesity. At the time of his hearing, he
weighed 423 pounds, down from a high of 438 pounds. The claimant attributed the decline to
changes in diet, such as ending consumption of sugar and bread. Beyond serving as a general risk
factor, the claimant testified that his size prevented him from locating appropriate work attire, as
well as fitting in some chairs. (R. 712-713).
The claimant also testified to the problems edema causes him. He claimed that he
typically suffers from edema of the extremities overnight and that the swelling keeps him from
easily standing, walking about, or being active. Furthermore, to combat his edema, the claimant
testified that his most comfortable position is with his feet propped up above his knees, but that
he only can do so while he is in bed. The claimant did not specify whether he was supine. (R.
The claimant testified that in addition to the edema, more than a few minutes standing
causes him severe back pain. However, the claimant testified that sitting down does not cure his
lumbago, and that after fifteen minutes, the lumbago begins affecting his hips as well. Upon
questioning by the ALJ, the claimant reiterated that excessive periods of sitting cause him back
pain. (R. 713, 721).
The claimant testified that two hours upright would leave him out of breath. The claimant
further testified that household chores, such as sweeping the living room for twenty to thirty
minutes at a time, would leave him out of breath and require him to sit down. The claimant stated
that his shortness of breath negatively impacted his lifestyle as it prevented him from keeping his
home as clean and neat as he liked. The claimant attributed his shortness of breath to asthma,
indicating that his breathing was worse when he was in a room without windows. (R. 714-716,
The claimant testified that he suffered frequent fatigue caused by his inability to sleep
more than two-three hours in a night. (R. 714-715).
The claimant testified at length regarding his heart trouble. The claimant testified that his
cardiologist, Dr. Sandella, instructed him not to lift more than five pounds. The claimant also
testified that recent chest x-rays showed arterial problems that would lead him to visit Dr.
Sandella again soon. During examination by the ALJ, the claimant testified that his heart
problems are partly inherited as both he and his mother share an enlarged heart. The claimant
stated that one consequence of his enlarged heart is that most any trigger will cause chest pain
like "somebody's sticking a knife in [his heart]." Furthermore, the claimant testified that his heart
trouble prevents him from going into direct sunlight. Additionally, the claimant testified his heart
will start racing while he's asleep and keep him from sleeping throughout the night. (R. 716,
The claimant briefly addressed the subject of his migraines, testifying that they occurred
every other day and affected his vision. The claimant testified that his headaches were so bad that
he had to walk elsewhere and stand by himself. (R. 717).
The claimant testified that he had quit smoking two months prior to the hearing. The
claimant testified that he had tried to quit before but that this most recent attempt was the most
successful; he expressed remorse that he had ever started smoking in the first place. (R. 717).
The claimant did not testify specifically about his esophagitis or diarrhea. However, he
did testify regarding his episode of vomiting blood, stating that the hospital was unable to
ascertain the cause for the episode. (R. 719).
The claimant also testified regarding his blood pressure and medication. He stated that he
takes "four pills a day" for his high blood pressure, that it is "almost normal," and that he does
not suffer any side effects from his medication. (R. 721-722).
Interspersed with his various ailments, the claimant offered testimony regarding his
postural limitations, daily activities, living situation, and source of income. The claimant testified
that he could sit down; that he did not know if he could crawl; that he had trouble standing up
from a seated position; and that he was unable to bend down or bend over. The claimant stated
that his impairments regularly interrupt his daily activities because of the way they hinder his
ability to clean and maintain the house. Finally, the claimant testified that although his only
source of income is food stamps, he does not live in government housing. The claimant
additionally testified that he had not completed higher than the 9th grade. (R. 710, 715-716, 722).
Melissa Neel, a vocational expert, testified as to the DOT descriptions of the claimant's
prior relevant work. She described those positions as "light-unskilled" for a cashier checker and
"medium-unskilled" as a stocker or store's laborer. (R. 709).
The ALJ posed a hypothetical to Ms. Neel after the claimant's testimony asking her to
take into account the limitations expressed by the claimant. The ALJ asked Ms. Neel whether any
work existed for someone of the same age, education, and vocational background as the claimant,
confined to sedentary work, and experiencing the same additional restrictions imposed by his
knees and ankle swelling, obesity, and breathing difficulties. The ALJ expressed these additional
limitations as the elimination of commercial driving; moving machinery; all work at open
heights, ladders or other climbing devices; any lower extremity push-pull manipulation; complete
avoidance of exposure to allergens and pulmonary irritants; and occasional restrictions to all
other postural movements, such as climbing a ramp/stairs, balancing, stooping, kneeling,
crouching, or crawling. The ALJ asked Ms. Neel to set aside any mental allegations for the
purposes of this hypothetical. The ALJ asked if the preceding hypothetical would eliminate all
past relevant work of the claimant, to which Ms. Neel answered in the affirmative. (R. 723).
In consideration of the above hypothetical, Ms. Neel identified three possible positions
reflecting sedentary, unskilled labor that exist in significant supply in the national and regional
economy: production workers, inspectors, and small parts assemblers. (R. 724).
Ultimately, the ALJ did not pose a hypothetical question to Ms. Neel requiring her to
consider the claimant's alleged mental impairments.
Finally, the claimant's attorney posed several hypothetical questions to Ms. Neel
regarding the sedentary positions that she had identified. In response to a question regarding
what effect a finding that the claimant would have to elevate his feet "knee high" would have the
claimant’s ability to secure other work, Ms. Neel replied that if this requirement were limited to
break times and lunch, the claimant could still work. But, Ms. Neel stated that if the claimant had
to keep his legs elevated for longer than the time afforded to the claimant on breaks or lunch,
then the claimant would be disabled. (R. 725).
Finally, the claimant's counsel asked Ms. Neel what effect a finding that the claimant
could not work on the same schedule as contained in the job description of the employer would
have. Ms. Neel replied that this scenario would result in the claimant being disabled. (R. 726).
The ALJ's Decision
On August 14, 2008, the ALJ issued a decision finding the claimant was not disabled
under the Social Security Act. (R. 10).
The ALJ determined that the claimant met the insured status requirements of the Social
Security Act with respect to his Title II claim. The ALJ then found that the claimant had not
engaged in substantial gainful activity since the alleged onset of his disability. (R. 16).
Next, the ALJ found that the claimant suffered from the following severe impairments:
hypertension, hypercholesterolemia, morbid obesity, migraine headaches, obstructive sleep
apnea, coronary artery disease status post stent placement, arteriovenous malformation right
frontal lobe, bronchitis, pharyngitis/esophagitis, lumbago, edema (pedal), and tobacco abuse.
However, the ALJ found that neither the claimant's alleged depression nor his chronic diarrhea
constituted a severe impairment. (R. 16).
To support his finding that the claimant's depression was not a severe impairment, the
ALJ gave more weight to the findings of Dr. Atkinson and Dr. Syed's month-to-month patient
descriptions than he gave to Dr. Nuckol's mental RFC assessment and the intake form a staffer at
RCMH completed. The ALJ indicated that he assigned greater weight to those two sources
because Dr. Atkinson examined the patient, while Dr. Nuckols did not, and Dr. Syed regularly
treated the claimant, while Dr. Stanford at RCMH did not. The ALJ noted Dr. Syed's record of
the claimant's lack of suicidal or homicidal ideation, as well as Dr. Syed's observations of the
claimant indicating normal mood, affect, speech, language, thoughts, attention, concentration,
and the corresponding lack of compulsions, irrational fears, or delusions. The ALJ underscored
this point through discussion of the multiple visits at which Dr. Syed found the claimant had no
symptoms of depression, despite his lack of treatment. The ALJ noted that Dr. Atkinson found
only mild limitations in the claimant's daily living activities, maintaining social functioning, and
maintaining concentration, persistence, and pace. The ALJ declared that under the applicable
regulations, if the claimant's mental impairments cause no more than a "mild" limitation in any of
those three functional areas and no limitations in a fourth area inconsistent with the claimant’s
reported symptoms, the impairment qualifies it as a non-severe impairment. (R. 16-17).
To support his finding of chronic diarrhea as a non-severe impairment, the ALJ relied on
the claimant's self-admission that the condition has persisted for 20 years. The ALJ noted that the
claimant worked throughout this period. The ALJ attached particular significance to the medical
records of Dr. Syed that did not reflect a worsening of this condition on those occasions on which
the claimant mentioned it at all. The ALJ also found telling on this point the impressions of Dr.
Raju, who performed a colonoscopy and EGD and found mild symptoms and attributed the
claimant's medical history on the subject of diarrhea to altered bowel habits. Finally, the ALJ
found that the claimant has not alleged limitations as a result of this impairment. (R. 17).
The ALJ concluded, however, that these impairments did not singly or in combination
manifest the specific signs and diagnostic findings required by the Listing of Impairments. The
ALJ supported this decision by referencing the claimant's statement from the pre-hearing order
stipulating that none of the alleged severe impairments met the listings. (R. 18).
The ALJ's decision next addressed the claimant’s RFC. He found that the claimant's RFC
permitted him to engage in sedentary work, with additional restrictions of no commercial
driving; no work around moving machinery and at open heights; no use of ladders or other
climbing devices; and no pushing or pulling with his lower extremities. The ALJ determined that
although the claimant's alleged symptoms might reasonably have been caused by the identified
severe impairments, the stated duration and severity were not credible where they contradicted
the findings of the RFC assessment. In support of his conclusion regarding the unremarkable
"intensity, persistence, and limiting effects" of these symptoms, the ALJ examined in significant
detail the records of Dr. Syed, the claimant’s treating physician; Dr. Sandella, the treating
cardiologist; Dr. Raju, the treating gastroenterologist; and Dr. Adderholt, the treating neurologist.
(R. 15, 19, 22).
On the subject of hypertension, the ALJ noted that the claimant had suffered from this
impairment for many years prior to alleging disability, periods during which the claimant was
engaged in or seeking work. Moreover, the ALJ observed that Dr. Syed's records showed this
condition responded successfully to treatment. In the ALJ's judgment, such facts strongly suggest
that the persistence of this condition does not introduce sufficiently limiting effects that the
claimant might be considered disabled. (R. 23-24).
The ALJ noted that the prescribed medications effectively controlled "multiple
conditions" and that the claimant reported no side effects as a result of his medications. Thus, the
ALJ did not consider hypercholesterolemia to be an adequate basis for alleging disability. (R. 18,
The ALJ found a persistent symptom of obesity in the claimant going back at least five
years. The ALJ reviewed the claimant's testimony regarding his current weight and height and
found it to be deleterious to his medical condition. The ALJ noted, however, that the claimant did
not testify to any functional limitations with specificity beyond difficulty finding clothes and
sitting in some chairs. The ALJ utilized the claimant's answers to various DDS questionnaires
and surveys regarding his daily activities, such as the claimant's ability to do the dishes and make
food, to substantiate his conclusion. Thus, the ALJ determined that the claimant's morbid obesity
was not a practical limitation on the claimant's ability to find work. (R. 22)
The ALJ did not find the allegations of frequent, disabling migraines credible. The ALJ
found that the claimant did not allege migraine headaches as an impairment either in his initial
application nor even just prior to the hearing, but only during his testimony. While the ALJ
conceded the diagnosis of headaches among Dr. Syed's records, the ALJ found their occurrence
merely sporadic. As a consequence, the ALJ found that the claimant's headaches were not of the
"frequency, duration, or intensity" to prevent basic work activities. (R. 22)
In investigating the claimant's reporting of headaches, the ALJ also considered the
neurological evidence for the arteriovenous malformation of the right frontal lobe. The ALJ
found that the MRI did substantiate the existence of a cavernous hemangioma, but gave strong
weight to the examining neurologist, Dr. Adderholt, who found the claimant asymptomatic and
free from evidence of recent hemorrhage. Absent symptoms, the ALJ found the arteriovenous
malformation of the right frontal lobe an inadequate basis for a finding of disability. (R. 22)
The ALJ did not find the allegations of fatigue and sleep apnea convincing in light of the
medical evidence. Although the ALJ cited the claimant's testimony regarding his inability to
sleep, as well as Dr. Syed's diagnosis of "unspecified insomnia," the ALJ found that Dr. Syed had
also prescribed medication to treat the insomnia with some success. The ALJ considered it
significant that the claimant had not purchased or been prescribed medication for insomnia
throughout 2008. Additionally, the ALJ found that the medical record did not support a finding
of daily fatigue, pointing to one visit with Dr. Sandella in June 2007 at which the claimant
appeared "alert." (R. 20).
The ALJ did not find the claimant's testimony regarding the disabling effects of coronary
artery disease post-stent consistent with the medical record on the subject. In particular, the ALJ
determined that the claimant's allegation that he cannot be in direct sunlight is unsupported in the
record. He also noted that the claimant's chest pain is itself an intermittent phenomenon. The ALJ
observed that although Dr. Sandella treated the claimant for coronary artery disease through
insertion of a stent, Dr. Sandella did not consider it a critical or clinically significant disease. The
ALJ did find that Dr. Sandella had diagnosed the claimant with bradycardia but, consistent with
Dr. Sandella's own notes on the subject, determined it to be iatrogenic and correctable via
adjustments in the claimant's medication. Further, the ALJ found that the claimant did not likely
suffer disabling symptoms as a result of his alleged and diagnosed cardiovascular issues because
the claimant did not complete a scheduled follow-up visit in the six months preceding the ALJ
hearing. The ALJ reasoned that were the impairments as severe as alleged, the claimant would
have visited the doctor. Finally, the ALJ did not locate in the record any evidence of permanent
restrictions by Dr. Sandella following the placement of claimant's stents. (R. 21-22).
The ALJ considered the claimant's testimony regarding his alleged asthma inconsistent
with the medical record. The ALJ based his finding on the multiple occasions on which the
claimant himself denied shortness of breath coupled with repeated imaging that was negative for
lung disease. Additionally, the ALJ found that the claimant was capable of managing his
condition through an inhaler and medication. (R. 20-21).
The ALJ found that the claimant had and does suffer from occasional, but recurrent,
upper respiratory infections, such as bronchitis or sinusitis. However, the ALJ concluded that no
physician has found these conditions to be so disabling as to require introduction of restrictive
work environments. The ALJ nonetheless took the claimant's asthma into account in determining
the RFC by restricting the claimant's work environment to one free from "pulmonary irritants."
On the subject of tobacco abuse, the ALJ mentioned that Dr. Sandella's treatment plan for
the claimant included smoking cessation. The ALJ emphasized that the claimant's last visit with
Dr. Sandella was in January, 2008, and the claimant did not cease smoking until two months
before the hearing on July 18, 2008. (R. 21-22).
The ALJ found that the claimant's allegations that lumbago prevented him from
completing sedentary work were inconsistent with the claimant's medical record. For evidence,
the ALJ cited imaging from January 2008 showing no abnormalities in the pelvis, as well as the
records of Dr. Syed that showed tenderness to palpation in his lumbar area, but without any
decrease in range of motion. The ALJ also considered the opinions of the claimant's consulting
examiners, Ms. Henderson and Ms. Johnson, who repeatedly confirmed the initial impression of
no impairment affecting his ability to sit, stand, walk, or carry between ten-twenty pounds. (R.
On the claimant's allegations of edema, the ALJ found that the claimant's condition was
only occasional and, thus, fell short of the standard necessary to impair the claimant's ability to
complete sedentary work. The ALJ relied on the medical records that showed on those occasions
where Dr. Syed or other physicians had found edema, the swelling was minimal and would
frequently fade even when compliance with therapy was low. The ALJ highlighted the sequence
of the claimant's May 2008 visit with Dr. Syed, who found edema and instructed the claimant to
elevate his legs. The ALJ then noted Dr. Raju found no edema two weeks later. Thus, the ALJ
did not deem the need to elevate his legs a persistent condition. As additional evidence in support
of his decision, the ALJ cited the lack of hospitalization or emergency treatment related to edema
and the claimant's strong track record of controlling the condition. (R. 20).
Although the ALJ found pharyngitis/esophagitis to be among the claimant's severe
impairments, he did not discuss any reasons why he did not consider pharyngitis/esophagitis so
disabling as to prevent substantial gainful activity, as he did with the other impairments he
deemed severe. (R. 16).
The ALJ apportioned some of his discussion regarding the claimant's credibility to the
claimant's self-described abilities and activities. The ALJ found that the claimant reported the
ability to "sit for 40 minutes continuously, walk 25 minutes continuously, and stand 15 minutes
continuously" in a questionnaire supplied by the Disability Determination Service in 2006. A
Disability Determination Service cardiovascular questionnaire he filled out in 2007 contained the
admission he can walk four blocks at a stretch. Similarly, the ALJ noted the claimant's ability to
cook, wash dishes, and hold his grandchildren while sitting without incurring shortness of breath.
Likewise, the ALJ noted that at various times the claimant reported to Dr. Atkinson,
RCMH, and Dr. Syed that his daily or weekly activities included walking in the park, dusting,
cleaning house, washing dishes, doing laundry, sweeping, preparing simple meals,
self-grooming, shopping, dressing himself, visiting with family and friends, talking on the
telephone, and watching television and his grandchildren. The ALJ found all of these capabilities
consistent with the demands of sedentary labor, subject to the additional restrictions the ALJ
imposed on account of the claimant's body habitus. Finally, the ALJ considered significant that
on the intake form at a mental health center three days before his alleged onset date, and while he
awaited the results of a previously filed disability claim, the claimant listed himself as
"‘unemployed, looking'" rather than as "disabled." (R. 23).
In comparing the claimant's testimony to the independently compiled medical record, the
ALJ found the claimant's testimony inconsistent, misleading, and not credible. As a case in point,
the ALJ highlighted the widely divergent responses claimant gave to his last level of education:
eighth grade at the ALJ hearing in 2008; tenth grade to examining physicians in 2005 and 2006;
and eleventh grade to a mental health center in 2006. (R. 24).
The ALJ discussed the Medical Source Opinion of Dr. Syed from July 2008 stating that
the claimant was obese and would have difficulty working. The ALJ ultimately gave it little
weight because he found the opinion itself lacking in objective and clinical evidence. Further, the
ALJ observed that the MSO contradicted Dr. Syed's own treatment records showing that the
claimant possessed normal functioning on examination, no functional limitations attributable to
the claimant's morbid obesity, and no functional restrictions imposed by Dr. Syed. The ALJ also
questioned whether Dr. Syed had access to the claimant's medical history with Dr. Sandella or
Dr. Raju, neither of whom imposed functional restrictions on the claimant after performing their
procedures. (R. 24).
The ALJ concluded by describing the sources of his conclusion finding the claimant to
possess a sedentary RFC: the claimant's activities of daily living; the claimant's own statements
of his abilities; the absence of objective medical findings on the claimant precluding sedentary
work; and the absence of evidence indicating the claimant experienced disabling pain. (R.
The ALJ then considered whether the claimant's RFC of sedentary work permitted the
claimant to complete past relevant work. Relying on the testimony of the vocational expert, Ms.
Neel, the ALJ found that the claimant could not complete past relevant work. (R. 25).
The ALJ next made findings regarding the claimant's age, education, and transferability
of job skills. The ALJ found that the claimant was forty-two years old based on the amended
onset date, classifying him as a younger individual; that the claimant had a limited education with
the ability to communicate in English; and that the transferability of job skills was not at issue
because his finding that the claimant was not disabled did not depend on this fact. (R. 25).
The ALJ considered whether the identifiable severe impairments permitted the claimant
to complete any other work in the national economy consistent with the claimant's RFC, age,
education, and work experience. Utilizing the testimony of the vocational expert in conjunction
with his own findings on the claimant's RFC, age, education, and work experience, the ALJ
concluded that the claimant retains the capacity for work as a production worker, inspector, or
small parts assembler. The ALJ found that these jobs exist in significant numbers regionally and
nationally. Therefore, the ALJ concluded that the claimant was not disabled under the Social
Security Act. (R. 15, 26).
This judicial review proceeds in spite of the plaintiff's decision not to file a brief. Current
policy within the Northern District of Alabama is to require an initial brief from all parties unless
the plaintiff proceeds pro se; the claimant has counsel of record in this case. The District Court
Clerk's letter to plaintiff's counsel of April 9, 2012, however, stated that the Northern District of
Alabama did not require a brief to review the decision of the Commissioner. At that time, in the
event of non-filing by the plaintiff, the policy of the Northern District of Alabama was
nonetheless to review the Commissioner's decision with respect to the applicable legal standards
and whether substantial evidence supported the ALJ's factual findings. See, e.g. Mitchell v. Apfel,
1999 U.S. Dist. LEXIS 17549, at *10 (N.D. Ala. 1999). Thus, this court will review the decision
in view of the applicable legal standards and whether substantial evidence supported the factual
Determination of Severe Impairments
The claimant argues that the ALJ did not correctly apply the legal standard, nor support it
with substantial evidence, in determining that the claimant's alleged depression, anxiety, and
chronic diarrhea were not severe impairments. However, this court finds that the ALJ correctly
applied the legal standard and supported it with substantial evidence in determining that the
claimant's alleged depression, anxiety, and chronic diarrhea were not severe impairments.
A severe impairment must cause a significant limitation in the claimant's basic work
activities. 20 C.F.R. § 404.1521(a); 20 C.F.R. § 416.920(c). Basic work activities include, but are
not limited to, physical functions, sensory perceptions, cognition, judgment, social interaction,
and adaptation. 20 C.F.R. § 404.1521(b); 20 C.F.R. § 416.921(b).
The claimant had the burden to produce evidence showing that his depression, anxiety,
and chronic diarrhea caused significant limitations to his basic work activities. After considering
the evidence, the ALJ found just the opposite to be true.
Regarding the claimant’s depression and anxiety, the ALJ noted that the consulting,
examining psychologist, Dr. Atkinson, described the claimant as having an ability to function
with only mild limitations and specifically mentioned her opinion that the claimant could make
acceptable work decisions and manage his own funds. (R. 326). Dr. Syed's examination records
buttress Dr. Atkinson's opinions. On seventeen of the claimant’s twenty-six visits to Dr. Syed
that discussed mental health, Dr. Syed observed no external indications of abnormal mental
functioning. Furthermore, at the claimant's last visit to Dr. Syed before the ALJ hearing, he
reported himself to be satisfied with life. (R. 275, 298, 395, 398, 403, 407, 411, 415, 508, 512,
516, 530, 538, 554, 568, 578, 628). Thus, the record contains more than a scintilla of evidence in
favor of the ALJ's decision that the claimant's depression and anxiety did not produce more than
a mild limitation, consistent with the applicable legal standard.
The ALJ clearly articulated the reasons he preferred Dr. Atkinson's interpretation over
those tendered by Dr. Nuckols and the staffer preparing the RCMH summary. The ALJ noted that
Dr. Atkinson's assessment, although precedent to the claimant's alleged onset date, remained
consistent with the observed findings of later examiners. The ALJ assigned great weight to the
fact that Dr. Atkinson, unlike Dr. Nuckols, examined the claimant. (R. 17).
Additionally, the ALJ remarked that Dr. Nuckols completed his assessment on April 11,
2007, but over a year's worth of visits to Dr. Syed and other health providers followed, the
majority of which corroborate Dr. Atkinson's findings rather than those of Dr. Nuckols.
Although the ALJ only indirectly referenced these incidents, the intake forms from Shoals and
Helen Keller Hospital emergency rooms in September and December 2007 observed no
indications of abnormal psychiatric functioning on the claimant’s visit. Those visits came after
the final word of both RCMH and Dr. Nuckols. (R. 16-17, 617, 628, 691). The ALJ properly
applied the legal standard and substantial evidence supports his finding that the claimant did not
suffer from a severe impairment because of his alleged depression or anxiety.
Similarly, the ALJ correctly found the claimant's allegations of chronic diarrhea as
non-severe. This court finds the ALJ's comparison of the claimant's 20 year history of this
impairment with his concurrent work experience over that time persuasive as an indicator that the
condition, as experienced by the claimant, is at most a mild limitation. Further, the ALJ indicated
that his review of the record did not show any worsening of the condition over the period under
review for this disability claim. To substantiate this finding, the ALJ referenced Dr. Raju's May
22, 2008 examination of the claimant. Dr. Raju concluded that the claimant’s alleged diarrhea
was nothing other than "altered bowel habits." The ALJ further noted that the claimant denied GI
symptoms altogether at the claimant's visit to Dr. Syed the next month. The ALJ applied the
proper legal standard and substantial evidence supports his finding that the claimant’s chronic
diarrhea was not a sever impairment. (R. 17).
Application of the Eleventh Circuit’s Pain Standard
The claimant argues that the ALJ improperly applied the Eleventh Circuit's pain standard
for evaluation of the claimant’s subjective complaints. To the contrary, this court finds that the
ALJ properly applied the Eleventh Circuit’s pain standard and that substantial evidence supports
The pain standard applies when a claimant attempts to establish disability through his
own testimony of pain or other subjective symptoms. Holt, 921 F.2d at 1223. The standard
requires the claimant to have demonstrated an underlying medical condition accompanied by
either objective medical evidence establishing the severity of the claimant's pain resulting from
that condition, or a finding that the underlying condition itself is so severe as to make the
allegations of pain credible. Holt, 921 F.2d at 1223. The Eleventh Circuit does not require that
the ALJ make specific reference to the language of the pain standard, but only requires him to
show through his discussion that he applied the appropriate legal standard. Wilson, 284 F.3d at
1225-26. If the ALJ chooses to discredit the claimant's testimony, he must articulate specific
reasons for so doing. Id. at 1225.
The ALJ found little objective evidence to support the severity of the claimant's lumbago
or hip pain, or even the existence of an underlying medical condition. As recently as January,
2008, a pelvic x-ray from Shoals hospital reported unremarkable findings. Thus, medical imaging
did not identify a condition severe enough to support a finding of disabling pain. The clinical
record does not support this finding either. The ALJ cited a 2005 consultative examination that
found no objective evidence that would prevent the claimant from sitting, standing, or walking,
nor lifting or carrying between 10-20 pounds. The ALJ’s review of Dr. Syed's clinical
observations similarly turned up no significant abnormalities of the lumbar region beyond
tenderness to palpation never accompanied by loss of range of motion. His records regularly and
consistently described normal gait and range of motion with otherwise normal musculoskeletal
functioning. (R. 19-20).
Paralleling the allegations of lumbago and hip pain, the ALJ did not find objective
medical evidence supporting the disabling nature of the claimant's migraines and headaches. The
ALJ established that the claimant did not allege an impairment of migraine headaches at the time
of his initial application in January, 2007, nor even just prior to his hearing in June 2008.
Although the claimant sporadically reported headaches to Dr. Syed in 2006 and 2007, the ALJ
deemed more significant the 2006 findings of Dr. Adderholt, a neurosurgeon, who relied on
medical imaging to find the claimant asymptomatic. (R. 19, 21).
While the ALJ's discussion of the claimant's medical record in the context of the
claimant's alleged headaches, back, and hip pain satisfies the Eleventh Circuit's standard, the ALJ
took the additional step of articulating why the claimant has dubious credibility generally. At the
ALJ hearing, the claimant reported ceasing his education in eighth grade. The record shows the
claimant reported higher levels of education, even telling RCMH he had achieved an eleventh
grade education. The level of education is an important determination in evaluating the claimant's
ability to perform work in the national economy. The ALJ reasonably noted that the claimant's
misleading and inconsistent testimony on an objective matter cast into question the claimant's
credibility regarding his subjective complaints. (R. 24).
The ALJ, without referencing the specific language of the pain standard, nonetheless
demonstrated through his discussion that he had considered the entirety of the claimant's medical
record and had discredited the claimant’s subjective testimony based on specific, articulated
reasons. Therefore, the ALJ properly applied the pain standard when he discredited the
claimant’s subjective testimony regarding the limiting effects of his headaches, back, or hip pain.
Determination of the Claimant's RFC
The claimant argues that the ALJ's assessment of the claimant's residual functional
capacity was inconsistent with the findings of the disability specialist and the record as a whole,
including the medical records of the claimant's treating cardiologist, gastroenterologist,
neurologist, and internist. On the contrary, this court finds that the ALJ cited substantial evidence
consistent with the entirety of the record in reaching his determination that the claimant
possessed a RFC to perform sedentary work.
To possess a RFC to do sedentary work, the claimant must be capable of extended
periods of sitting; lifting up to 10 pounds; occasionally lifting or carrying docket files, ledgers,
and small tools; and occasionally walking or standing. 20 C.F.R. § 404.1567(a); 20 C.F.R. §
416.967(a). Under Social Security Rule 83-10, “occasional” means up to one-third of the time. A
typical eight hour day for a sedentary worker should not require more than two hours walking or
standing and six hours of sitting. Kelley v. Apfel, 185 F.3d 1211, 1213 n. 2 (11th Cir. 1999). A
Medical Statement Opinion from the claimant's treating physician declaring the claimant unable
to work deserves careful consideration in any finding of disability, however, an ALJ may
discount a treating physician's opinion where it is wholly conclusory. Crawford, 363 F.3d at
The claimant's disability specialist, Ms. Johnson, found in completing the claimant's
physical RFC assessment that the claimant could frequently lift up to 10 pounds and occasionally
lift up to 20 pounds. These restrictions fall comfortably within the sedentary maximum.
Similarly, Ms. Johnson found that the claimant could stand or walk for up to six hours in an
eight-hour workday, far surpassing the regulatory limit of two hours for sedentary work. The
claimant's maximum of six hours seated in an eight-hour workday also fits within the regulatory
guidelines. Finally, Ms. Johnson found only occasional postural or environmental limitations
other than an inability to climb scaffolding or ladders, the need for total avoidance of hazards,
and the need to avoid concentrated exposure to fumes, odors, gases and other consequences of
poor ventilation. (R. 465-468). Notably, Ms. Johnson did not list any manipulative restrictions,
but the ALJ still provided for a restriction on the claimant's pushing and pulling with his lower
extremities. (R. 18). At the ALJ hearing, a conversation between the vocational expert and the
ALJ made clear that the ALJ implemented this limitation in response to the claimant's knees and
ankles swelling. (R. 723-724).
The medical record also supports the ALJ's RFC assessment. As discussed, the record
does not support Dr. Sandella, Dr. Raju, or Dr. Adderholt as having imposed permanent
restrictions upon the claimant, although the claimant testified that Dr. Sandella had told him he
could not lift more than five pounds. Without support in the record, and in light of the lessened
credibility of the claimant as a result of his inconsistent testimony regarding his education, the
ALJ reasonably determined that the 5 pound alleged restriction is not credible. Thus, the ALJ's
RFC assessment of a sedentary exertional level is consistent with the medical record as
developed by Drs. Sandella, Raju, and Adderholt. (R. 18, 21-22).
Dr. Syed produced a medical statement opinion regarding the claimant's ability to work
stating that he believed "it would be difficult for the claimant to work due to his body habitus and
medical problems." (R. 645). The ALJ found Dr. Syed's medical statement opinion conclusory
and contradicted by the claimant's entire medical history, a permissible ground for ignoring the
opinion of a treating physician. Moreover, while the ALJ included specific postural restrictions
in his RFC designed to accommodate the claimant's morbid obesity, Dr. Syed’s allusions to the
claimant’s "medical problems" provide no basis for assessing the source of Dr. Syed’s medical
opinion. (R. 22). As the ALJ pointed out, the record is unclear as to whether Dr. Syed knew the
other physicians had imposed no restrictions. Other than the opinion two days prior to the ALJ
hearing, the ALJ could not find any evidence in the record that Dr. Syed had himself imposed
any permanent functional restrictions. (R. 24).
By taking into consideration the entire record of the claimant in determining the
claimant's RFC, the ALJ relied on substantial evidence to support his finding of a sedentary
exertional level in lieu of the requested disability, while justifiably disregarding the conclusory
medical statement opinion of Dr. Syed.
For the reasons as stated, this court concludes that the decision of the Commissioner is
supported by substantial evidence and is to be AFFIRMED. The court will enter a separate order
to that effect simultaneously.
DONE and ORDERED this 26th day of September, 2013.
KARON OWEN BOWDRE
UNITED STATES DISTRICT JUDGE
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