Bond v. Social Security Administration, Commissioner

Filing 18

MEMORANDUM OPINION Signed by Chief Judge Karon O Bowdre on 8/22/17. (SAC )

FILED
2017 Aug-22 PM 03:31
U.S. DISTRICT COURT
N.D. OF ALABAMA

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
NORTHWESTERN DIVISION
PAMELA BOND,
CLAIMANT,
v.

NANCY A. BERRYHILL,
ACTING COMMISSIONER OF
SOCIAL SECURITY,
RESPONDENT.

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CIVIL ACTION NO. 3:16-CV-00603-KOB

MEMORANDUM OPINION
I. INTRODUCTION
On February 22, 2012, the claimant, Pamela Bond, protectively applied for disability and
disability insurance benefits under Titles II and XVI of the Social Security Act. (R. 237). In both
applications, the claimant alleged disability beginning on September 10, 2009, because of
sarcoidosis, atypical microbacteria, and neuropathy. (R. 273). The Commissioner denied the
claims initially on September 19, 2012, and again on reconsideration on February 8, 2013. (R.
175, 184). The claimant filed a timely request for a hearing before an Administrative Law Judge,
and the ALJ held a hearing on August 7, 2014. (R. 38).
In a decision dated October 22, 2014, the ALJ found that the claimant was not disabled
under the Social Security Act and thus not entitled to social security benefits. (R. 27). On
February 12, 2016, the Appeals Council denied the claimant’s request for review. (R. 1). The
ALJ’s decision thus became the final decision of the Commissioner. The claimant has exhausted
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her administrative remedies, and this court has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and
1383(c)(3). For the reasons stated below, this court reverses the decision of the Commissioner
and remands the case to the Commissioner for further proceedings.
II. ISSUE PRESENTED
The claimant presents the following issue for review:
(1) whether substantial evidence supports the ALJ’s decisions to assign little weight to
treating sources Dr. Jack Lichtenstein, rheumatologists; Dr. Daniel Hexter, neurologist;
and Dr. Kioumarce Yazdani, internist.
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 claims.” Walker,
826 F.2d at 999. This court does not review the Commissioner’s factual determinations de novo.
The court will affirm those factual determinations that are supported by substantial evidence.
“Substantial evidence” is “more than a mere scintilla. It means such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402
U.S. 389, 401 (1971).
The court must keep in mind that opinions such as whether a claimant is disabled, the
nature and extent of a claimant’s residual functional capacity, and the application of vocational
factors “are not medical opinions, . . . but are, instead, opinions on issues reserved to the
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Commissioner because they are administrative findings that are dispositive of a case; i.e., that
would direct the determination or decision of disability.” 20 C.F.R. §§ 404.1527(d), 416.927(d).
Whether the claimant meets the listing and is qualified for Social Security disability benefits is a
question reserved for the ALJ, and the court “may not decide facts anew, reweigh the evidence,
or substitute [its] judgment for that of the Commissioner.” Dyer v. Barnhart, 395 F.3d 1206,
1210 (11th Cir. 2005). Thus, even if the court were to disagree with the ALJ about the
significance of certain facts, the court has no power to reverse that finding as long as substantial
evidence in the record supports it.
The court must “scrutinize the record in its entirety to determine the reasonableness of the
[Commissioner]’s factual findings.” Walker, 826 F.2d at 999. A reviewing court must not look
only to those parts of the record that support the decision of the ALJ, but also must view the
record in its entirety and take account of evidence that detracts from the evidence relied on by
the ALJ. Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986).
IV. LEGAL STANDARD
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the
person cannot “engage in any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to result in death or which
has lasted or can be expected to 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 evaluation process:
(1) Is the person presently unemployed?
(2) Is the person’s impairment severe?
(3) Does the person’s impairment meet or equal one of the specific
impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?
(4) Is the person unable to perform his or her former occupation?

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(5) Is the person unable to perform any other work within the
economy?
An affirmative answer to any of the above questions leads either to
the next question, or, on steps three and five, to a finding of
disability. A negative answer to any question, other than step
three, leads to a determination of “not disabled.”
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986) 1; 20 C.F.R. §§ 404.1520, 416.920.
V. FACTS
The claimant was forty-five years old at the time of the ALJ’s final decision (R. 89); had
completed some college (R. 42); had past relevant work as a seal coat technician, billing
manager, and medical billing specialist (R. 104); and alleges disability based on sarcoidosis,
atypical microbacteria, and neuropathy. (R. 273).
Physical and Mental Impairments
Dr. Mark Mossey admitted the claimant to Anne Arundel Medical Center in Maryland on
September 10, 2009. Examinations found a 1.7 centimeter mass in the claimant’s left lung, and a
biopsy showed that the mass was a non-caseating granuloma. Further exams identified large
hypodense lesions in the left and right lobes of the liver. (R. 388-397).
The claimant visited Dr. Kioumarce Yazdani on October 8, 2009 complaining of
difficulty swallowing. Dr. Yazdani noted that the claimant had non-caseating granulomas and
was experiencing pain after eating. (R. 645). The claimant saw Dr. Yazdani again on November
17, 2009 (complaining of incontinence and pain after eating); on December 14, 2009
(complaining of tender bowels); and on March 18, 2010 (for tests showing small colonic polyps).
(R. 387, 645).

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McDaniel v. Bowen, 800 F.2d 1026 (11th Cir. 1986) was a supplemental security income case (SSI). The same
sequence applies to disability insurance benefits. Cases arising under Title II are appropriately cited as authority in
Title XVI cases. See, e.g., Ware v. Schweiker, 651 F.2d 408 (5th Cir. 1981) (Unit A).

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On October 22, 2009, Dr. Stephen Cattaneo saw the claimant for a consultation. Dr.
Cattaneo noted that the claimant's symptoms and objective testing could represent sarcoidosis, a
disease characterized by inflammatory masses, or granulomas, in different parts of the body. On
November 11, 2009, Dr. Cattaneo admitted the claimant to Anne Arundel Medical Center for
surgery to remove the lung nodule, which was successful. On December 3, 2009, Dr. Cattaneo
wrote to Dr. Yazdani, the claimant’s internist, regarding the claimant’s further treatment. Dr.
Cattaneo expressed that the claimant reported intermittent back and abdominal pain; that she had
not eaten well and was inactive in her daily activities; and that he encouraged the claimant
increase her activity. (R. 373-78, 380-84).
Dr. Cattaneo referred the claimant to Dr. Glen Gibson, a surgical oncologist, who
examined the claimant on April 8, 2010. Dr. Gibson noted lack of increase in size of the
claimant’s liver masses and stated that the liver lesions were not contributing to her severe
decline in general functional ability that manifested in September 2009. (R. 405).
On April 22, 2010, Anne Arundel Medical Center admitted the claimant because of
complaints of leg pain without injury. Dr. David Todd performed spinal x-rays which showed
scoliosis. The claimant returned to Dr. Yazdani on April 23, 2010, complaining of leg pain and
on May 2, 2010, Dr. Yazdani completed a summary of the claimant's condition to that point. He
noted that the claimant exhibited degenerative disc disease, non-caseating granulomas, frequent
back pain, and chronic diarrhea. (R. 496, 646).
On June 18, 2010, the claimant visited Dr. Karenga Lemmons, an internist, for a second
opinion on referral from Dr. Yazdani. Dr. Lemmons noted bilateral leg pain radiating down
ankles with numbness that had been present for six months prior. Dr. Lemmons further noted

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that the claimant appeared stressed and lacked understanding of her treatment history.
Additionally, the claimant had 5/5 motor skills and a normal gait. (R. 426-28).
On July 28, 2010, the claimant saw Dr. Reena Thomas on referral from Dr. Lemmons for
the reported numbness in her legs. Dr. Thomas stated that electrodiagnostic evidence showed
chronic spinal root irritation, but no electrodiagnostic evidence of a myopathy 2 or large fiber
peripheral neuropathy. 3 (R. 407, 498, 782-84).
The claimant returned to Dr. Lemmons’ office on several occasions from June 30, 2010
to October 25, 2010 for follow-up with a nurse practitioner, Sharon Cave. The claimant
consistently reported chronic left leg pain and numbness, intermittent pain in her right leg and
left forearm, and swelling in her left leg. (R. 429-33).
The claimant presented for an infectious disease consultation with Dr. Rahki Krishnan on
July 22, 2010, which showed caseating and noncaseating granulomas. Dr. Krishnan referred the
claimant to the Johns Hopkins Sarcoidosis Clinic, and the claimant presented on November 3,
2010 for Dr. Edward Chen to evaluate her for possible sarcoidosis. The claimant reported
experiencing burning pain in both legs. Dr. Chen observed significant generalized fatigue; no
red, hot, or swollen joints; and normal gait and stance. Dr. Chen described the claimant's
ailments and prognosis as a nodular variant of pulmonary sarcoidosis. Further, he recommended
reassessment of the claimant's liver and spleen; a consultation with a gastroenterologist; repeated
gadolinium MRIs to assess the claimant’s leg pain; an echocardiogram to screen for pulmonary
hypertension; and a sleep study. (R. 412-415, 782-83).
The claimant again returned to NP Cave in Dr. Lemmons’ office on November 8, 2010
for a follow-up. The claimant reported that she was becoming fatigued between four to five in

2
3

Muscle disease in which the muscle fibers do not function properly.
Damage to the large peripheral nerves.

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the afternoon each day, at which time she would sleep until two in the morning; further, she
stated that she was using a walker. The claimant had an MRI on November 9, 2010, which
showed signs of scoliosis, disc protrusions, and a high intensity zone. (R. 434).
The claimant followed up with Dr. Krishnan, the infectious disease consultant, on
November 11, 2010. Dr. Krishnan stated that the final diagnosis was sarcoidosis and that the
claimant should follow up further with Johns Hopkins. The claimant presented on November 16,
2010 for the sleep study recommended by Dr. Chen, which showed no significant sleep-related
breathing disorder. (R. 504-08, 784).
On November 19, 2010, the claimant presented to Anne Arundel Medical Center for a
right ankle fracture. The hospital referred the claimant to Dr. Edward Holt, an orthopedist, for
further treatment. The claimant visited Dr. Holt for a foot and ankle exam on November 26,
2010. Per the claimant, she developed pain with weight bearing and turned abruptly, causing her
right fibula to fracture. Dr. Holt recommended surgery to repair the claimant's fractured ankle,
and performed an open reduction and internal fixation of the ankle fracture on December 1,
2010. (R. 510-11, 514, 586).
The claimant returned to Dr. Chen on December 7th, 2010 for test results. Dr. Chen
indicated that per the MRI results the claimant’s liver showed signs of hemangioma and a
multicystic condition. Further, Dr. Chen indicated the claimant had clear signs of vitamin D
deficiency; extensive degenerative changes in her mid-back; and disc problems in her lower
back. He further recommended that the claimant visit a back specialist. (R. 416-17).
The claimant followed up with Sharon Cave, NP on December 17, 2010. The claimant
again stated that she was using a walker, and NP Cave listed sciatica 4 as a diagnosis. (R. 435).

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Leg pain radiating along the sciatic nerve.

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The claimant returned on January 10, 2011 complaining of worsening leg pain, back pain, and
depression. (R. 416-417, R. 435-36).
The claimant returned to Dr. Holt’s office numerous times from December 2010 to
September 2011, primarily for follow-up and management of her healing ankle fracture. Dr.
Speciale, an associate of Dr. Holt, noted on January 11, 2011 that the claimant used a walker
prior to her injury. Dr. Holt reported the claimant complained of pain in her knee that began
without any injury on February 1, 2011. On March 29, 2011, Dr. Holt noted a lack of progress in
the claimant’s post-surgery rehabilitation and continued pain, and prescribed a walking boot. The
claimant returned to Anne Arundel Medical Center on May 5, 2011, for removal of the deep
implants in her right ankle and repair of the peroneus brevis tendon. Dr. Holt switched the
claimant from the boot to an ankle brace on June 14, 2011.
The claimant visited Dr. Holt for the last time on September 6, 2011. The claimant
reported that her ankle was no longer painful and that she was ambulating comfortably; however,
she further reported leg weakness. After evaluating the claimant's right ankle, Dr. Holt cleared
her for full activity. (R. 565-582).
On referral from Dr. Chen, the claimant visited Dr. Carlos Pardo-Villamizar on February
9, 2011 for evaluation of neurological problems possibly related to the claimant's sarcoidosis. Dr.
Pardo-Villamizar noted that the claimant demonstrated an abnormal gait secondary to an antalgic
position and mild weakness. The doctor further noted that the claimant's condition was consistent
with either radiculopathy 5 or meralgia paresthetica; 6 however, overresponsive reflexes indicated
another possible spinal cord abnormality. (R. 601-02).

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Compressed nerve in the spine.
Numbness or pain in the outer thigh because of injury to the nerve from the spinal column to the thigh.

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In a note summarizing the claimant’s visit on February 14, 2011, Dr. Jack Lichtenstein,
the claimant’s rheumatologist, stated that the claimant's case was "very confusing"; that she
became sick while in the military and her records were incomplete; that her ankle fracture
occurred spontaneously; that Dr. Chen diagnosed her with sarcoidosis but did not treat her; that
the claimant felt poorly and was frustrated by the lack of medical answers for her condition; that
her legs were weak; that she used a rolling walker; and that he suspected she might have an
atypical form of tuberculosis. Dr. Lichtenstein further stated that he would consider treatment
options, but at that time he had no reason to treat her with further medications. In a note dated
April 13, 2011, Dr. Lichtenstein noted that the claimant had leg pains and swelling; that she had
a history of sarcoidosis; that she had leg pain and weakness; that she used a rolling walker; and
that she was being followed by several doctors. He further stated that he believed the leg
weakness to be "primarily neurological." (R. 692, 694-95).
On referral from Dr. Yazdani, the claimant returned to Dr. Gibson on April 8, 2011. Dr. Gibson
stated that the claimant was failing to improve and was in need of surgical evaluation. Further,
Dr. Gibson believed that the claimant’s liver lesions were not the cause of her malaise.
At the request of Dr. Ellen McInerney, her primary care physician, the claimant visited
Dr. Howard Young, a pulmonologist, on April 20, 2011. Dr. Young stated that the claimant had a
presumptive diagnosis of sarcoidois with swollen lymph nodes and lung lesions with caseating
and non-caseating granulomas. Dr. Young further stated that the claimant needed further
evaluation. (R. 656-657, 792-93).
The claimant visited Dr. Daniel Hexter, a neurologist, at the request of Dr. Lichtenstein
on July 8, 2011. Electrodiagostic tests showed no evidence of peripheral neuropathy; however,

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Dr. Hexter could not rule out small fiber neuropathy. Further, Dr. Hexter noted severe pain
during the examination, and suspected the claimant might have meralgia parestetica. (R. 536).
On July 20, 2011, Dr. Lichtenstein wrote to Dr. McInerney, stating that the claimant was
receiving physical therapy, which caused the claimant pain; that she used a walker but was
capable of walking without the walker; that he was not clear why the claimant had so much leg
pain and weakness; and that the claimant's back problems were not significant. On August 11,
2011, Dr. Lichtenstein again wrote to Dr. McInerney, stating that the claimant's condition was
stable; that her legs were weak; that he was "not exactly clear" why the claimant required a
walker to ambulate; and that he did not know why her pain had increased. He further indicated
that he did not see a point to changing medication and that he was leaving it to the claimant to
decide whether to continue physical therapy, which she stated was causing pain. (R. 689-90).
The claimant returned to Dr. Young on August 18, 2011. She reported that her coughing
had subsided but she had difficulty breathing when active outside. Dr. Young stated that the
claimant was doing well from a clinical pulmonary standpoint.
On September 19, 2011, the claimant received a splint after spraining her wrist from Dr.
Shushan, an associate of Dr. Holt. No apparent injury precipitated the sprian, much like with her
ankle fracture. (R. 653-54, 796-97).
The claimant returned to Dr. Pardo-Villamizar for a follow-up visit on September 21,
2011. She reported daily headaches as well as abnormal and burning sensations in her right
thigh. Dr. Pardo-Villamizar noted that her symptoms were highly suggestive of meralgia
paresthetica. The claimant still exhibited radiculopathic pain. (R. 598-99.)
On November 16, 2011, Dr. Lichtenstein sent a letter to Drs. McInerney, Young, Holt,
and Hexter, and stated that the claimant had a diagnosis of sarcoidosis with caseating and non-

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caseating granulomas; unexplained trace swelling and weakness in her legs; and a right ankle
fracture with several surgeries. Dr. Lichtenstein stated that the claimant was "stable" but had no
energy, and that he recommended she be more active; further, he stated that Dr. Holt, who
treated her for the ankle fracture, would be the one to clear her for more activity. (R. 688).
The claimant returned to Dr. Yazdani for a follow-up on November 22, 2011. Dr.
Yazdani noted that the claimant had sarcoidosis and enlarged thoracic lymph nodes and that she
walked with support of a wheelchair. The claimant continued care with Dr. Yazdani, with twenty
visits over the next two years. Over that time, the claimant primarily reported pain in her back,
arms, legs, chest and joints; abdominal pain, nausea, and diarrhea; and fatigue. Dr. Yazdani also
prescribed the claimant Prednisone, but discontinued the treatment because of side effects. (R.
647-49, 741-42, 768.)
Similarly, the claimant repeatedly visited Dr. Lichtenstein until October 2012. On April
13, 2012, the claimant reported that she was experiencing pain in the joints, back, arms, and legs.
Dr. Lichtenstein gave the claimant a Methotrexate injection. On April 20, 2012, the claimant
again reported pain, but Dr. Lichtenstein noted that the Methotrexate and Prednisone together
were making the claimant feel much better.
On April 27, 2012, on referral from Dr. Yazdani, the claimant visited Kure Pain
Management, where Dr. Doris Cope diagnosed the claimant with degenerative disc disease and
lumbar radiculopathy. Dr. Cope gave the claimant an epidural injection for the pain; however,
Dr. Lichtenstein stated that the claimant suffered from increased leg pain as a result. The
claimant returned to Kure Pain Management on May 11, and Dr. Cope repeated that the claimant
was crying and very emotional. Dr. Cope recommended that the claimant be treated for anxiety
and receive counseling for her lower back pain.

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The claimant returned to Dr. Lichtenstein on May 28 and July 27, receiving Methotrexate
injections and complaining of pain. The claimant presented at the hospital on October 7, 2012,
complaining of shortness of breath and painful breathing. The hospital notes further indicated
that the claimant was previously diagnosed with asthma and was prescribed an Albuterol inhaler,
which is often used to treat asthma. (R. 956-60). On October 16, 2012, the claimant returned
complaining of difficulty breathing; Dr. Lichtenstein noted that she was “feeling well except for
asthma,” despite noting pain, and also noted clear breathing sounds. He further prescribed oral
Methotrexate in lieu of an injection. (R. 676-87, 711-13, 760-63).
On July 20, 2012, the claimant underwent X-rays of her right foot and ankle by Dr.
Charul Saini at the request of the state agency, which indicated mild enlargement in the right
foot; mild bone loss in the ankle joint; and cortical thickening 7 and mild lucency at the distal
fibula consistent with a healed fracture deformity. (R. 716).
On June 7, 2012, state agency examiner Dr. Gurcharan Singh reviewed the claimant’s
records. Dr. Singh diagnosed the claimant with peripheral neuropathy and found that the
claimant could lift and carry twenty pounds occasionally and ten pounds frequently; stand and
walk six hours in an eight-hour work day; sit for six hours in an eight-hour work day; and push
or pull without limitation. He further found that the claimant could frequently climb ramps and
stairs; occasionally climb ladders, ropes, and scaffolds; frequently balance and stoop, and
occasionally kneel, crouch, and crawl. On August 13, 2012, a second state agency examiner, Dr.
Judy Kleppel reviewed substantially similar information as Dr. Singh and came to the same
conclusion. (R. 72-74, 100-06).
On August 8, 2012, the claimant's strength and range of motion were personally assessed
by Dr. Sarah White at the request of the state agency. Dr. White found that the claimant had a
7

Thickening of the outer layer of the bone.

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full pain-free range of motion in all joints and extremities. She further found the claimant had
grade five grip strength, with no limitation in the use of her hands, arms, or fingers. Dr. White
concluded that although the claimant had a history of her legs giving way and decreased
sensation to light touch in her thighs, that the claimant could exert twenty pounds of force
occasionally and ten pounds of force frequently; could sit, stand, walk, carry, and handle objects
up to twenty pounds; could speak and hear conversationally without impairment; and could drive
and travel without restriction. (R. 727-731).
On September 4, 2012, the claimant filled out a form requesting information about her
daily life and mental status. The claimant stated that her sleep varied greatly, sometimes sleeping
eighteen hours and sometimes not at all; that she never attempted suicide; and that she had
difficulties with memory because of sarcoidosis, but could follow simple instructions. The
claimant went to a psychologist, Dr. Sara Phillips, at the request of the state agency for a mental
status evaluation on September 14, 2012. The psychologist reported that the claimant had
memory and concentration problems as well as a history of depression. (R. 735-39).
On January 16, 2013, the claimant completed a pain questionnaire at the request of the
state agency. The claimant stated that her pain began in September 2009, and was located in her
head, shoulders, arms, chest, upper and mid back, upper thigh, mouth, lower leg bones, ankles,
abdomen, and eyes. The claimant stated that she would wake up in pain, end the day in pain, and
several times during the day the pain would exceed her normal pain level. The claimant stated
that her pain had abruptly changed her daily activities. She stated that before the onset of the
pain, she was running two miles per day; after the onset of the pain, she progressively worsened
from being unable to walk around the block to being unable to walk to the end of the driveway.
She added that her pain was constant, with no pain-free moments. (R. 326-328).

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In her “Function Report – Adult,” also completed on January 16, 2013, the claimant
described her daily life in detail. She stated that she could dress, care for her hair, and use the
toilet without assistance, but sometimes needed help feeding herself, bathing, and caring for her
pets. Further, she needed reminders to take medication, and could cook only “simple” meals with
assistance. The claimant indicated that her condition affected her ability to lift, walk, climb,
squat, kneel, stand, hear, see, understand, follow instructions, recall, complete tasks, and
concentrate. She stated specifically she could not climb stairs at all, had lost significant memory,
and required frequent rest when walking. On January 16, 2013, the claimant additionally
completed a “Fatigue Questionnaire” at the request of the state agency. She stated that she took a
four to six hour nap per day, but at times slept most of the day; and that she regularly drove her
son to and from work. (R. 329-40).
On February 1, 2013, the claimant’s records were reviewed by state agency examiner Dr.
Gregory Parker. Dr. Parker found that the claimant could lift and carry twenty pounds
occasionally and ten pounds frequently; stand and walk six hours in an eight-hour work day; sit
for six hours in an eight-hour work day; and push or pull without limitation. He further found
that the claimant could occasionally climb ramps, stairs, ladders, ropes, and scaffolds; and could
frequently balance and stoop, kneel, crouch, and crawl. (R. 141-143).
The claimant’s records were also evaluated by Linda Duke, Ph.D., for a state agency
mental residual functional capacity assessment on February 6, 2013. Dr. Duke found that the
claimant was moderately limited in her ability to carry out detailed instructions; maintain
attention and concentration for extended periods; and interact appropriately with the general
public. Dr. Duke further indicated that the claimant should interact with the general public

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infrequently; could understand, remember, and carry out short, simple instructions; and could
concentrate for a reasonable period of time. (R. 144-45).
On August 14, 2013, the claimant returned to Dr. Hexter, her neurologist, complaining of
memory loss. Dr. Hexter stated that he believed that the claimant’s cognitive complaints were
likely caused by a combination of her medications, depression, and insomnia, but that her normal
mental status exam was reassuring. He further stated that neurocognitive testing would be
necessary to better evaluate her cognitive complaints. Dr. Hexter conducted computerized
neurocognitive testing on August 22, 2013, in which the claimant scored in the lower third
percentile generally, and scored “very low” in the complex attention and memory areas. Dr.
Hexter stated that the scores supported a diagnosis of mild cognitive impairment. Further, her
score of thirty on the Autism Spectrum Rating Scale indicated a high likelihood of adult ADHD
and her score of fourteen on the Epworth Sleepiness Scale suggested a significant sleep disorder.
A brain MRI performed on August 23, 2013 and an electroencephalogram performed on August
26, 2013 showed no abnormalities. (R. 1058-60).
The claimant presented on August 19, 2013 to Dr. David Moller, a pulmonary specialist,
at Johns Hopkins for a self-referred consultation. Dr. Moller reviewed the claimant’s cumulative
records, noting continued abdominal pain, burning pains spreading from the claimant’s leg to
right calf, occasional stabbing chest pains and difficulty breathing, fatigue, and continued use of
a walker because of her legs giving out. Dr. Moller concluded that the claimant’s sarcoidosis was
multisystemic, rather than pulmonary, as a result of previous lung biopsies and indications of
intrathoracic lymph node involvement. Dr. Moller stated that he suspected skin, salivary gland,
and liver involvement with possible small fiber neuropathy, gastric dysmotility, or active
neurosarcoidosis. Dr. Moller further noted that hepatic sarcoidosis was possible, and that

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extreme fatigue and constitutional symptoms were characteristic of hepatic sarcoidosis. Dr.
Moller further recommended starting the claimant on a low dose of Prednisone in addition to
Methotrexate. (R. 844-48).
On October 15, 2013, Dr. Hexter completed a “Mental Impairment Questionnaire” and
“Medical Opinion Re: Ability To Do Work-Related Activities” at the request of the Social
Security Administration, Dr. Hexter stated that the claimant suffered from depression and
attention deficit disorder; further, he stated that she exhibited persistent disturbances of mood,
decreased energy, and easy distractibility. Dr. Hexter cited the claimant’s normal Mini-Mental
State Examination and the results of computerized neurocognitive testing, showing “significant
problems in concentration, executive function” to support those diagnoses and impairments. Dr.
Hexter stated additionally that the claimant had marked difficulty in remembering locations and
work-like procedures; understanding, remembering, and carrying out simple instructions;
maintaining attention and concentration over extended periods; performing activities on
schedule; punctuality and regular attendance; working in coordination or in proximity to others
while avoiding distraction; making simple work-related decisions; interacting appropriately with
the general public; and accepting instruction and criticism from supervisors. Further, Dr. Hexter
indicated that the claimant had moderate difficulty in getting along with coworkers without
distracting them or exhibiting extreme behaviors; maintaining socially appropriate behavior; and
responding appropriately to changes in the work setting. Dr. Hexter concluded that the claimant
was not capable of performing a full time job eight hours per day, five days per week, on a
regular and continuing basis; that the claimant could stand and walk for less than two hours; that
the claimant could sit without limitation; that the claimant could lift and carry twenty pounds on
a frequent basis; that the claimant would not need freedom to shift at will between sitting and

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standing; and that the claimant would not need to lie down at unpredictable times during the
eight-hour workday. Dr. Hexter further stated that the claimant suffered from burning numbness
and chronic pain, exhibited an antalgic gait, and that the claimant would be absent from work
more than three times per month because of her condition. (R. 870-73).
On October 23, 2013, Dr. Yazdani also completed a “Medical Opinion Re: Ability To Do
Work-Related Activities” at the request of the Social Security Administration. Dr. Yazdani stated
that the claimant was not capable of performing a full time job eight hours per day, five days per
week, on a regular and continuing basis; that the claimant could stand and walk for less than two
hours; that the claimant could sit for less than two hours; and that the claimant could lift and
carry less than ten pounds on an occasional basis. Dr. Yazdani left blank the maximum amount
the claimant could carry on a frequent basis, and stated that the questions of whether the claimant
needed freedom to shift between sitting and standing or whether the claimant needed to lie down
at unpredictable times during the workday were not applicable. Dr. Yazdani further stated that
the claimant suffered from nerve pain, chronic obstructive pulmonary disorder, shortness of
breath, and pain generally, and that the claimant would be absent from work more than three
times per month because of her condition. (R. 869).
On October 23, 2013, Dr. Lichtenstein completed a “Medical Opinion Re: Ability To Do
Work-Related Activities.” Dr. Lichtenstein stated that the claimant was not capable of
performing a full time job eight hours per day, five days per week, on a regular and continuing
basis; that the claimant could stand and walk for less than two hours; that the claimant could sit
for less than two hours, that the claimant could lift and carry less than ten pounds on an
occasional or frequent basis; that the claimant would need freedom to shift at will between sitting
and standing; and that the claimant would need to lie down at unpredictable times during the

17

eight-hour workday. Dr. Lichtenstein further stated that the claimant suffered from joint pain,
nerve pain, and numbness in her arms and legs because of her sarcoidosis, and that the claimant
would be absent from work more than three times per month because of her condition. (R. 927).
The ALJ Hearing
At the claimant’s hearing before the ALJ on August 7, 2014, the claimant testified that
her disability claim was based on sarcoidosis and unspecified related issues. (R. 45). She stated
that at the time of the hearing, she lived with her sister. (R. 42).
The claimant testified that she could not climb three stairs without difficulty; could not
ambulate outside her house without a walker; and could not ambulate inside her house without a
cane. She testified that her legs would give out unpredictably, forcing her to use a walker to
avoid falling in public. She further claimed that she suffered from recurring migraines, rumbling
in her ears, and painful breathing. Additionally, the claimant testified that she experienced pain
when walking, and increased pain when changing the positions of her body between sitting,
reclining, and propping. Furthermore, the claimant stated that neurological testing had showed
“cognitive something” as a mental issue and that, for a long time, she was told that her
medications were the cause of any mental problems. However, she further stated that her pain in
her legs would return “full force” if she did not take her medication, and that even with her
medication she would wake up screaming because of the pain. (R. 42-47).
The claimant stated that she was taking Gabapentin (for leg pain) at the maximum
dosage, Zoloft, and Amitriptyline. She added that she had tried Lyrica but it made her legs swell
to the point that she could not walk. Per the claimant, other pain medications, such as morphine,
caused allergic reactions; accordingly, her doctors prescribed anti-inflammatories to help reduce

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the pain. The claimant also stated that her medications had significant side effects, including
causing extreme fatigue, shakiness, and nausea. (R. 48-49).
The claimant described a significantly impaired daily life. According to the claimant,
most activities of daily living caused her extreme fatigue and forced her to rest. The claimant
testified that sweeping, laundry, and cooking each caused her immediate fatigue. She further
stated that she spent six hours of her eight-hour day lying down. Additionally, she had difficulty
sleeping, and would often not sleep for two days then sleep for eighteen hours straight. Although
she would sometimes sleep for eight hours in a night on a “good night,” she stated that she would
be tired upon waking up. If she went out to a grocery store, she stated that she had to rest the day
before and three days after because of the level of exertion required. She further stated that she
visited the grocery store at least once per week, even for a couple of items, so that she was not
stuck at home constantly. (R. 52).
The claimant stated that she can sit for thirty minutes without having to change positions;
that she can stand in one place for no more than “a couple minutes”; and that she can walk
approximately two grocery store aisles before needing to rest. She additionally stated that she
elevates her legs when sitting. (R. 52-53).
The claimant testified that she has a weight-lifting restriction of either ten or twenty
pounds from a previous shoulder injury, but could not lift that much now. She stated that lifting a
gallon of water was difficult for her. Further, she stated that she had difficulty with postural
movements, such as bending, stooping, and crouching; also, she testified that she could not get
back up if she bent down, and that any repetitive overhead pushing or pulling caused her arms to
“give out.” She added that using her left arm was more difficult than her right arm. Further, the

19

claimant stated that she would experience pain when manipulating objects, as well as “bone
movement in her left wrist.” (R. 53-55).
According to the claimant, she could take care of her personal needs such as bathing and
grooming with difficulty. She further stated that everything she did regularly around her house
forced her to stop and rest afterwards. Although she used a computer and read regularly in the
past, she stopped performing those activities prior to the hearing, and had no other hobbies. (R.
55-56).
The claimant stated that she had difficulty with concentration and focus, stating that she
could pay attention but did not always understand. She further added that she had memory
difficulties, and that she would often check her calendar for appointments in the morning and
forget about the appointment later in the day. (R. 56-57).
A vocational expert, Mina Alexander-Schwartz, testified regarding the type and
availability of jobs the claimant could perform. Ms. Alexander-Schwartz testified that the
claimant’s past relevant work was medical billing manager, classified as skilled with a sedentary
exertion level; billing manager, classified as skilled with a sedentary exertion level; asphalt
sealer, classified as unskilled with a light exertion level; and construction inspector, classified as
skilled with a light exertion level. (R. 59-60).
The ALJ asked Ms. Alexander-Schwartz to assume a hypothetical individual of the same
age and educational background as the claimant, with the same work history, and the residual
functional capacity to perform a range of light work. The hypothetical individual was further
limited to sitting six hours of an eight-hour workday and standing or walking for a total of six
hours an eight-hour workday. The hypothetical individual could occasionally climb ramps, stairs,
ladders, ropes, or scaffolds, and could frequently balance, stoop, kneel, crouch, and crawl. The

20

hypothetical individual could not work under concentrated exposure to extreme temperatures,
machinery, heights, or other hazards. Further, the hypothetical individual could not work under
any exposure to fumes, odors, dust, gases, or poor ventilation. The hypothetical individual also
could not follow more than one to two step instructions and could maintain attention and
concentration for extended periods on a limited basis. (R. 60-61).
Ms. Alexander-Schwartz testified that the hypothetical individual could not perform any
of the claimant’s past work. However, the hypothetical person could perform other work that
existed in significant numbers in the national economy. Ms. Alexander-Schwartz stated that the
hypothetical individual could work as a mail sorter, with 100,000 jobs available nationally and
2,700 locally; as a pricer marker, with 1,800,000 jobs available in nationally and 34,000 locally;
and as a light assembler, with 198,000 jobs available in nationally and 3,600 locally. Ms.
Alexander-Schwartz stated that each of the three jobs named were classified as light work. (R.
61).
The ALJ then asked Ms. Alexander-Schwartz to consider a hypothetical individual with
the same limitations as the first hypothetical, but limited to sedentary work. Ms. AlexanderSchwartz stated that the second hypothetical individual could work as an information clerk, with
900,000 jobs available nationally and 20,000 locally; as an order clerk, with 200,000 jobs
available nationally and 2,000 locally; and as a clerical addresser, with 96,000 jobs available
nationally and 2,000 locally. Ms. Alexander-Schwartz stated that each of the three jobs named
were classified as sedentary work. (R. 61).
The claimant’s attorney asked Ms. Alexander-Schwartz to consider a hypothetical
individual with the same limitations as the second hypothetical, but additionally restricted to
standing, walking, or sitting less than two hours in an eight-hour workday; sitting and standing at

21

will; lying down at unpredictable times during the day for up to six hours; carrying less than ten
pounds occasionally or frequently; and being absent more than three days per month from any
employment. Ms. Alexander-Schwartz stated that no jobs existed in significant numbers in the
national economy for that hypothetical individual. (R. 63).
The ALJ’s Decision
On October 22, 2014, the ALJ issued a decision finding that the claimant was not
disabled under the Social Security Act. (R. 27). First, the ALJ found that the claimant met the
insured status requirements of the Social Security Act through March 31, 2014, and had not
engaged in substantial gainful activity from her alleged onset date of September 10, 2009. (R.
13).
Next, the ALJ found that the claimant had the severe impairments of sarcoidosis, status
post-right ankle fracture, degenerative disc disease, obesity, and depression. The ALJ further
noted that the claimant alleged additional impairments, included but not limited to a benign brain
tumor, benign liver hemangiomas, and possible rheumatoid arthritis; however, the ALJ stated
that the alleged additional impairments did not cause a significant decline in the claimant’s
functional ability that was supported by the medical evidence of record. (R.13-14).
The ALJ next found that the claimant did not have an impairment or combination of
impairments that met or medically equaled the severity of one of the listed impairments in 20
C.F.R. Part 404, Subpart P, Appendix 1. The ALJ considered whether the claimant met the
criteria for Listing 3.02 for chronic obstructive pulmonary insufficiency. The ALJ concluded that
the medical evidence of the claimant’s sarcoidosis did not show impaired respiratory function
sufficient to meet the criteria for Listing 3.02. Next, the ALJ considered whether the claimant
met the criteria for Listing 11.14, peripheral neuropathy, and determined that the claimant had

22

not demonstrated peripheral neuropathy with disorganization of motor function. The ALJ next
considered whether the claimant met the criteria for Listing 1.06, nonunion of fracture, and
determined that the objective imaging did not show a fracture that met the criteria of Listing
1.06. Further, the ALJ considered if the claimant’s degenerate disc disease met the criteria for
Listing 1.04, and found no evidence of the specifically listed medical conditions in Listing 1.04.
The ALJ additionally considered the effect of the claimant’s obesity on the claimant’s ability to
perform routine activities in the work environment in combination with her other impairments as
per SSR 02-1p. Next, the ALJ compared the effects of the claimant’s mental impairment with the
“paragraph B” and “paragraph C” criteria, and found that those effects did not rise to the level of
“marked” as required by Paragraphs B and C and, thus, that the claimant did not meet Listing
12.04. (R. 14-15).
The ALJ concluded that the claimant possessed the residual functional capacity (RFC) to
perform sedentary work with both physical and mental limitations, The claimant could
occasionally lift ten pounds; frequently lift less than ten pounds; could stand or walk for up to
two hours of an eight-hour workday; could sit for six hours during an eight-hour workday; could
occasionally climb; could frequently balance, stoop, kneel, crouch, and crawl; could perform
jobs with up to two step instructions; and could interact with the public occasionally to
frequently. The ALJ further stated that that the claimant could not work around fumes, odors,
dusts, gases, and poor ventilation, and was limited in maintaining attention and concentration for
extended periods. (R. 16).
The ALJ considered the claimant’s symptoms and relevant medical records in making the
RFC determination. The ALJ found that, although the claimant’s impairments could be
reasonable expected to cause the symptoms alleged, the claimant’s statements only partially

23

credible regarding the intensity, persistence, and limiting effects of the alleged symptoms and
gave them little weight, stating that the claimant’s symptoms were “disproportionate” to the
objective and clinical evidence. The ALJ pointed to the claimant’s conservative sarcoidosis
treatment, with no surgical intervention aside from biopsies in 2009; successful management of
the claimant’s sarcoidosis symptoms by medication; and positive leg strength and gait despite
alleged leg pain. The ALJ noted that the claimant was a regular cigarette smoker until seven
months prior to the hearing, with Dr. Chen indicating that the claimant’s shortness of breath was
likely caused by smoking and weight gain; the ALJ found the claimant’s continued smoking
suggestive of less limiting symptoms than alleged.(R. 21).
The ALJ additionally noted that the claimant showed no residual issues from her 2010
right ankle fracture and had never received surgery or a recommendation for surgery to treat her
degenerative disc disease. The ALJ further found that the claimant’s obesity, alone and in
combination with her other impairments, would not limit her more physically than reflected in
her RFC determination. (R. 21-22).
The ALJ stated that although the claimant used a walker to ambulate outside her house,
the objective medical evidence did not support the continued usage of the walker. The ALJ cited
the claimant’s prescription of a walker 8 by Dr. Holt on March 29, 2011 to be used after ankle
surgery, followed by Dr. Holt clearing the claimant for full activity on September 16, 2011 and
Dr. Lichtenstein questioning why the claimant needed a walker or had increased pain. (R. 22).
Although the ALJ noted that the claimant described limited daily activities, the ALJ cited
two factors that weighed against finding the claimant disabled. First, the ALJ noted that allegedly
limited daily activities are not objectively verifiable with a reasonable degree of certainty.
Second, the ALJ stated that even if the claimant’s activities were as limited as she claimed, the
8

However, the record shows that the prescription was not for a walker but a walking boot. (R. 573).

24

objective medical evidence did not support attributing the limitation of her activities to her
medical condition. (R. 22).
In reaching her findings, the ALJ gave little weight to the assessments of the claimant’s
treating physicians, Drs. Lichtenstein, Hexter, and Yazdani. The ALJ stated that Dr. Yazdani’s
opinion was based primarily on the claimant’s subjective complaints and was inconsistent with
the medical record as a whole. Next, the ALJ stated that the extent of the limitations proscribed
by Dr. Lichtenstein for the claimant was not supported by the objective evidence, including Dr.
Lichtenstein’s treatment record. The ALJ specifically noted that Dr. Lichtenstein stated in his
November 16, 2011 letter that the claimant used a walker because of her right ankle fracture, and
that Dr. Holt would presumably be the one to clear the claimant for more activity; however, the
ALJ noted that Dr. Holt had already cleared the claimant for more activity. The ALJ further
stated that Dr. Lichtenstein reported the claimant on October 9, 2012 as “feeling well except for
asthma” but also noted that the claimant’s breath sounds were normal. 9 (R. 23).
The ALJ stated that Dr. Hexter’s medical opinion lacked support from the objective
medical evidence. The ALJ cited Dr. Hexter’s lack of a longitudinal treatment relationship with
the claimant, stating that Dr. Hexter had only seen the claimant for two months. 10 The ALJ also
stated that Dr. Hexter’s medical opinion showed a conflict between computerized neurocognitive
testing, showing problems in the claimant’s concentration and executive functioning, and a
mental status examination that indicated normal results. Accordingly, the ALJ found that Dr.

9

The ALJ misstates the date of this visit, which was October 16, 2012. The record shows that the claimant was
admitted to the hospital on October 7, 2012, nine days before her visit with Dr. Lichtenstein, complaining of
shortness of breath and painful breathing. Further, the hospital notes indicate that the claimant had a previous asthma
diagnosis and prescription for an Albuterol inhaler, which is often used to treat asthma. (R. 761-62, 956-60).
10
The record shows that Dr. Hexter saw the patient for testing on July 8, 2011 and received a detailed update from
Dr. Lichtenstein on the claimant’s condition on November 16, 2011. (R. 536, 898).

25

Hexter’s opinion of the claimant’s limitations was based primarily on the claimant’s subjective
complaints. (R. 23).
The ALJ gave great weight to consultative examiner Dr. Sarah White’s August 3, 2012
opinion, stating that her findings were well-supported by the objective evidence from her exam.
However, the ALJ found the claimant to be more limited than Dr. White indicated because of the
claimant’s combination of impairments. The ALJ gave some weight to the state agency examiner
Dr. Singh, as his opinion was based on a review of the record through June 7, 2012, and greater
weight to state agency examiner Dr. Judy Kleppel, who on August 13, 2012, affirmed Dr.
Singh’s opinion and further limited the claimant to only occasional balancing and stooping. (R.
24). The ALJ gave great weight to state agency examiner Dr. Gregory Parker’s February 1, 2013
medical opinion based on a review of medical records; the ALJ stated that the opinion was
supported by the record as a whole, and adopted Dr. Parker’s opinion of the claimant’s
nonexertional impairments. Further, the ALJ considered the medical opinion of state agency
psychological consultant Linda Duke, Ph.D. and accorded her opinion some weight. (R. 24-25).
Next, the ALJ, relying on the testimony of the vocational expert, found that the claimant
was unable to perform any of her past relevant work. The ALJ determined that, based on the
claimant’s age, education, work experience, and residual functional capacity, the MedicalVocational Guidelines, 20 C.F.R. Part 404, Subpart P, Appendix 2, and the testimony of the
vocational expert, that jobs existed in significant numbers in the national economy that the
claimant can perform. Accordingly, the ALJ concluded that the claimant was not disabled as
defined under the Social Security Act. (R. 30-31).
VI. DISCUSSION
Weight given to treating sources by the ALJ

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The claimant argues that the ALJ erred in giving little weight to the claimant’s treating
physicians, Drs. Lichtenstein, Hexter, and Yazdani, because the ALJ’s findings are not supported
by substantial evidence. This court agrees and finds that substantial evidence does not support
the ALJ’s reasons for discrediting the opinions of the claimant’s treating physicians.
The ALJ must give “substantial or considerable weight” to the opinion of a treating
physician absent showing good cause to the contrary. Winschel v Comm’r of Soc. Sec., 631 F.3d
1176, 1179 (11th Cir. 2011); see also Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997).
Good cause exists when the evidence does not support a treating physician’s opinion; the
evidence supports a finding to the contrary; or when the treating physician’s opinion is
conclusory or inconsistent with the physician’s own records. Winschel, 631 F.3d at 1179 (citation
omitted). The ALJ must “clearly articulate” reasons for discounting the opinion of the treating
physician. Philips v. Barnhart, 357 F.3d 1232, 1240-41 (11th Cir. 2004).
If the ALJ expresses specific reasons for discounting the opinion of the treating
physician, but substantial evidence does not support those reasons, the ALJ commits reversible
error. Moore v. Barnhart, 405 F.3d 1208, 1212 (11th Cir. 2005). In reviewing the ALJ decision,
the district court must assess the record in its entirety, considering evidence both supporting and
undermining the ALJ’s decision; however, the court “must not reweigh the evidence.” Foote v.
Chater, 67 F.3d 1553, 1560 (11th Cir. 1995) (citation omitted). Further, the court should look to
the rationale actually offered by the ALJ, not “reasoning that ‘might have supported the ALJ’s
conclusion but was not offered by the ALJ himself.’” Hubbard v. Colvin, 643. F. App’x. 869,
873 (11th Cir. 2016) (per curiam) (quoting Owens v. Heckler, 748 F.2d 1511, 1516 (11th Cir.
1984) (per curiam)).
Dr. Lichtenstein

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The ALJ found that the extent of limitations expressed by Dr. Lichtenstein, the claimant’s
treating rheumatologist, lacked support from the objective evidence, including Dr. Lichtenstein’s
own treatment records. First, the ALJ noted that Dr. Lichtenstein stated on November 16, 2011,
in a letter to four of the claimant’s other doctors, including Dr. Holt, the claimant’s orthopedist,
that the claimant had only trace edema (swelling); that she continued to walk with a walker
“presumably” because of her fractured ankle; that Dr. Holt would be the one to clear her for
more activity; and that the claimant was otherwise “quite stable.” Second, the ALJ noted that Dr.
Holt had already indicated on September 6, 2011 that the claimant could “resume full activity.”
Third, the ALJ noted Dr. Lichtenstein’s October 16, 2012 assessment of the claimant as “feeling
well except for asthma” in contrast to the claimant’s normal, clear breathing sounds the same
day.
The examples that the ALJ cites fail to provide “such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion” to undermine the credibility of Dr.
Lichtenstein as a treating source. Dr. Lichtenstein’s November 2011 statements do not conflict
with his own records. Although Dr. Lichtenstein did say that the claimant was “quite stable,” he
noted on multiple later occasions that the claimant was in severe pain because of her sarcoidosis.
Similarly, Dr. Lichtenstein’s statement that Dr. Holt would be the one to clear the
claimant for more activity does not contradict the objective evidence. As the claimant’s
rheumatologist, Dr. Lichtenstein was not primarily responsible for evaluating the claimant’s
ankle fracture. On the other hand, as the claimant’s orthopedist and post-fracture surgeon, Dr.
Holt was responsible for evaluating the condition of her ankle at that time. Although the ALJ
notes that Dr. Holt cleared the claimant for full activity approximately two months prior to Dr.
Lichtenstein’s statements, the record is devoid of any communication from Dr. Holt to Dr.

28

Lichtenstein prior to Dr. Lichtenstein’s letter. Accordingly, Dr. Lichtenstein’s statement that Dr.
Holt would need to clear the claimant for more activity, presumably based on the status of her
ankle, reflects both of their distinct roles in the claimant’s medical care and the difficulty in
coordinating care for patients with complex conditions. It is not, however, a showing of
inconsistency with Dr. Lichtenstein’s own records or the objective evidence needed to serve as
substantial evidence to give little weight to Dr. Lichtenstein as a treating source.
Second, the ALJ’s finding of inconsistency in Dr. Lichtenstein’s October 16, 2012
assessment of the claimant ignores evidence directly supporting Dr. Lichtenstein’s findings of
that date. The record shows that the claimant was in the hospital on October 7, 2012, nine days
before her visit with Dr. Lichtenstein, complaining of shortness of breath and painful breathing.
Further, the hospital notes indicate that the claimant had a previous asthma diagnosis and
prescription for an Albuterol inhaler. Dr. Lichtenstein noting asthma as a new issue since the last
visit, regardless of the claimant exhibiting asthma symptoms on that date, is consistent with the
record. Furthermore, Dr. Lichtenstein’s statement that the claimant was “feeling well” is equally
insufficient to negate his medical opinion. Although Dr. Lichtenstein stated that the claimant was
“feeling well,” he still noted that the claimant was experiencing pain. Thus, this statement does
not show inconsistency with Dr. Lichtenstein’s own records or the objective evidence sufficient
to give Dr. Lichtenstein’s opinion little weight as a treating source.
Furthermore, the ALJ’s evaluation of Dr. Lichtenstein’s opinion falls short in other ways.
The statements of the ALJ about Dr. Lichtenstein’s reports regarding the claimant’s ankle and
asthma, even if supported by substantial evidence, fail to detract from the extent of limitations
asserted by Dr. Lichtenstein. In his medical opinion, Dr. Lichtenstein stated that the claimant’s
diagnosis of sarcoidosis and rheumatoid arthritis caused symptoms of joint pain, nerve pain, and

29

numbness in her arms and legs, causing her asserted physical limitations. Isolated excerpts from
the record discussing the status of the claimant’s ankle and asthma symptoms fail as evidence
adequate to support a conclusion that the extent of limitations stemming from joint pain, nerve
pain, and numbness in the arms and legs is worthy of little weight.
Dr. Hexter
The ALJ gave little weight to the medical opinion of Dr. Hexter, stating that it was both
unsupported by the objective evidence and in conflict with the record as a whole. In support of
this assertion, the ALJ stated that Dr. Hexter had only treated the claimant for two months at the
time he gave his medical opinion and, thus, lacked a longer view of the claimant’s impairments;
that Dr. Hexter’s results from computerized neurocognitive testing conflicted with the claimant’s
normal mental status examination results; and that Dr. Hexter’s opinion of the claimant’s
limitations appeared to be based on the claimant’s subjective complaints.
The ALJ’s statement that Dr. Hexter lacked a “longer longitudinal view” of the
claimant’s impairments lacks merit. The record shows that the claimant visited Dr. Hexter in July
2011 and that Dr. Hexter received a detailed update on the claimant’s condition from Dr.
Lichtenstein in November 2011. This previous treatment history shows a longer view of the
claimant’s condition than the ALJ asserted. Furthermore, the ALJ gave great weight to various
consulting physicians who either only saw the claimant personally once or did not see the
claimant at all. The conclusion that Dr. Hexter’s opinion lacks weight because of the shorter
length of the treatment relationship applies in equal or greater force to the conclusions of the
consulting physicians, and the court finds this rationale does not detract from the credibility of
Dr. Hexter. See Lewis, 125 F.3d at 1440-41 (concluding that a rationale that applies to one
medical source applies equally to other applicable medical sources).

30

The ALJ’s characterization of the discrepancy between the computerized neurocognitive
testing and the mental status examination also is not supported by substantial evidence. The
record indicates that although Dr. Hexter found the claimant’s normal mental status examination
“reassuring,” he also ordered the computerized neurocognitive testing specifically to evaluate the
claimant’s neurocognitive complaints. Furthermore, rather than showing inconsistency with the
objective evidence, Dr. Hexter’s showing normal results on the mental status examination
comports fully with the results of the mental status examination performed by Dr. Sara Phillips,
the state agency psychological examiner, and upon whose results Dr. Linda Duke’s medical
opinion, which received some weight, was based. The opinions of Drs. Phillips and Duke were
rendered prior to the claimant receiving computerized neurocognitive testing; therefore, rather
than conflicting with the record, Dr. Hexter’s opinion is more fully supported by having the
benefit of objective evidence not available to the consulting physicians.
Additionally, the ALJ’s assertion that Dr. Hexter’s opinion is based primarily on the
claimant’s subjective complaints ignores the fact that the opinion given in the Mental
Impairment Questionnaire comports with objective results from the computerized neurocognitive
testing that the claimant “scored very low in the complex attention and memory domains.” Thus,
for the above reasons, the evidence cited by the ALJ does not constitute substantial evidence to
support the ALJ’s giving little weight to Dr. Hexter’s opinion.
Dr. Yazdani
The ALJ discredited Dr. Yazdani’s medical source opinion as unsupported by the
objective evidence of record, based on subjective complaints, and in conflict with the record as a
whole. The ALJ’s opinion lacks any mention of Dr. Yazdani’s clinical findings or reference to
his treatment records. The ALJ did not “clearly articulate” reasons for discounting the source

31

opinion of Dr. Yazdani, and did not cite any “substantial evidence” to support her decision to
discredit Dr. Yazdani. Moreover, Dr. Yazdani’s independent medical source opinion is largely
consistent with that of Dr. Lichtenstein, lending weight to the credibility of both physicians.
Therefore, the court finds substantial evidence does not support the ALJ’s conclusion that Dr.
Yazdani’s opinion be given little weight as a treating source.
As the ALJ’s RFC determination gave little weight to the opinions of the claimant’s
treating physicians, this court finds it unsupported by substantial evidence and in need of
reevaluation, including in its evaluation of the claimant’s nonexertional impairments, on remand.
VII. CONCLUSION
For the reasons stated above, this court concludes that the decision of the Commissioner
is due to be REVERSED and REMANDED. The court will enter a separate Order in accordance
with the Memorandum Opinion.
DONE and ORDERED this 22nd day of August, 2017.

____________________________________
KARON OWEN BOWDRE
CHIEF UNITED STATES DISTRICT JUDGE

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