Ackles v. Social Security Administration, Commissioner
MEMORANDUM OPINION. Signed by Magistrate Judge John H England, III on 3/30/2016. (KEK)
2016 Mar-30 PM 02:14
U.S. DISTRICT COURT
N.D. OF ALABAMA
UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
TERRY LEE ACKLES,
CAROLYN W. COLVIN, ACTING
COMMISSIONER OF SOCIAL
Case Number: 4:14-cv-02457-JHE
MEMORANDUM OPINION 1
Plaintiff Terry Lee Ackles (“Ackles”) seeks review, pursuant to 42 U.S.C. § 405(g), §
205(g) of the Social Security Act, of a final decision of the Commissioner of the Social Security
Administration (“Commissioner”), denying his application for period of disability, Disability
Insurance Benefits (“DIB”), and Supplemental Security Income (“SSI”). Ackles timely pursued
and exhausted his administrative remedies.
This case is therefore ripe for review under 42
U.S.C. §§ 405(g), 1383(c)(3). The undersigned has carefully considered the record and, for the
reasons stated below, the Commissioner’s decision is AFFIRMED.
I. Factual and Procedural History
Ackles was a fifty-four-year-old male at the time of the Administrative Law Judge’s
(“ALJ”) decision. (Tr. 96-97). He completed high school, (tr. 96 & 213), and worked as a
grinder, hand packer, overhead crane operator, saw operator, tongue and groove machine
operator, and as a poultry hanger, (tr. 95).
In accordance with the provisions of 28 U.S.C. § 636(c) and Federal Rule of Civil
Procedure 73, the parties have voluntarily consented to have a United States Magistrate Judge
conduct any and all proceedings, including trial and the entry of final judgment. (Doc. 9).
Ackles filed his application for a period of disability, DIB, and SSI on July 20, 2011. (Tr.
The Commissioner initially denied his application, (tr. 123-24), and Ackles requested a
hearing before an ALJ on November 8, 2011, (tr. 125-26). After a hearing, the ALJ denied his
claim on June 21, 2013. (Tr. 97). Ackles sought review by the Appeals Council, (tr. 80-82), but
it declined his request on October 20, 2014, (tr. 1-6). On that date, the ALJ’s decision became
the final decision of the Commissioner.
On December 22, 2014, Ackles initiated this action.
(See doc. 1).
II. Standard of Review2
The court’s review of the Commissioner’s decision is narrowly circumscribed.
function of this Court is to determine whether the decision of the Commissioner is supported by
substantial evidence and whether proper legal standards were applied. Richardson v. Perales,
402 U.S. 389, 390 (1971); Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002). This Court
must “scrutinize the record as a whole to determine if the decision reached is reasonable and
supported by substantial evidence.” Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir.
1983). Substantial evidence is “such relevant evidence as a reasonable person would accept as
adequate to support a conclusion.”
It is “more than a scintilla, but less than a
This Court must uphold factual findings supported by substantial evidence. However, it
reviews the ALJ’s legal conclusions de novo because no presumption of validity attaches to the
ALJ’s determination of the proper legal standards to be applied. Davis v. Shalala, 985 F.2d 528,
In general, the legal standards applied are the same whether a claimant seeks DIB or
SSI. However, separate, parallel statutes and regulations exist for DIB and SSI claims. Therefore,
citations in this opinion should be considered to refer to the appropriate parallel provision as
context dictates. The same applies to citations for statutes or regulations found in quoted court
531 (11th Cir. 1993). If the court finds an error in the ALJ’s application of the law, or if the ALJ
fails to provide the court with sufficient reasoning for determining the proper legal analysis has
been conducted, it must reverse the ALJ’s decision. Cornelius v. Sullivan, 936 F.2d 1143, 114546 (11th Cir. 1991).
III. Statutory and Regulatory Framework
To qualify for disability benefits and establish his or her entitlement for a period of
disability, a claimant must be disabled as defined by the Social Security Act and the Regulations
promulgated thereunder. 3 The Regulations define “disabled” as “the inability to do 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 twelve (12) months.” 20 C.F.R. § 404.1505(a). To
establish entitlement to disability benefits, a claimant must provide evidence of a “physical or
mental impairment” which “must result from anatomical, physiological, or psychological
abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic
techniques.” 20 C.F.R. § 404.1508.
The Regulations provide a five-step process for determining whether a claimant is
disabled. 20 C.F.R. § 404.1520(a)(4)(i-v). The Commissioner must determine in sequence:
whether the claimant is currently employed;
whether the claimant has a severe impairment;
whether the claimant’s impairment meets or equals an impairment listed
by the [Commissioner];
whether the claimant can perform his or her past work; and
whether the claimant is capable of performing any work in the national
Pope v. Shalala, 998 F.2d 473, 477 (7th Cir. 1993) (citing to the formerly applicable C.F.R.
The “Regulations” promulgated under the Social Security Act are listed in 20 C.F.R.
Parts 400 to 499.
section), overruled on other grounds by Johnson v. Apfel, 189 F.3d 561, 562-63 (7th Cir. 1999);
accord McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986). “Once the claimant has
satisfied steps One and Two, she will automatically be found disabled if she suffers from a listed
impairment. If the claimant does not have a listed impairment but cannot perform her work, the
burden shifts to the [Commissioner] to show that the claimant can perform some other job.”
Pope, 998 F.2d at 477; accord Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir. 1995). The
Commissioner must further show such work exists in the national economy in significant
IV. Findings of the Administrative Law Judge
After consideration of the entire record and application of the sequential evaluation
process, the ALJ made the following findings:
At Step One, the ALJ found Ackles met the insured status requirements of the Social
Security Act through December 31, 2015, and did not engage in substantial gainful activity from
the alleged onset date of May 1, 2011. (Tr. 88). At Step Two, the ALJ found Ackles has the
following severe impairments: chronic obstructive pulmonary disease (“COPD”), lumbar strain,
At Step Three, the ALJ found Ackles does not have an impairment or
combination of impairments that meets or medically equals one of the listed impairments in 20
C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 89).
Before proceeding to Step Four, the ALJ determined Ackles’s residual functioning
capacity (“RFC”), which is the most a claimant can do despite his impairments. See 20 C.F.R. §
404.1545(a)(1). The ALJ determined Ackles has the RFC to perform light work as defined in 20
C.F.R. 404.1567(b) and 416.967(b), with specified limitations. (Tr. 91). Specifically, he can
lift and carry 20 pounds occasionally and 10 pounds frequently, stand or walk in
combination for up to six hours in an eight-hour day, sit for up to six hours in an
eight-hour day, and push and pull with the upper and lower extremities. He can
occasionally climb ladders, ropes, or scaffolds, balance, stoop, kneel, crouch, and
crawl. He can frequently climb ramps or stairs. The claimant has no
manipulative, visual, or communicative limitations but should avoid all exposure
to work hazards and should avoid concentrated exposure to temparture extremes
and fumes, odors, dusts, gases, poor ventilation, etc. The claimant would need to
use an inhaler for several minutes intermittently during the workday but would
not need to leave the work facility for this purpose.
At Step Four, the ALJ determined Ackles is unable to perform any past relevant work.
(Tr. 95). At Step Five, the ALJ determined, based on his age, education, work experience, and
RFC, jobs exist in significant numbers in the national economy Ackles could perform. (Tr. 96).
Therefore, the ALJ determined Ackles has not been under a disability, as defined by the Social
Security Act, from May 1, 2011, through the date of the ALJ’s decision, and denied his claim.
Although the court may only reverse a finding of the Commissioner if it is not supported
by substantial evidence or if improper legal standards were applied, “[t]his does not relieve the
court of its responsibility to scrutinize the record in its entirety to ascertain whether substantial
evidence supports each essential administrative finding.” Walden v. Schweiker, 672 F.2d 835,
838 (11th Cir. 1982) (citing Strickland v. Harris, 615 F.2d 1103, 1106 (5th Cir. 1980)). The
court, however, “abstains from reweighing the evidence or substituting its own judgment for that
of the [Commissioner].” Id. (citation omitted).
Ackles contends generally the ALJ’s decision should be reversed and remanded because
the ALJ improperly evaluated the credibility of his testimony of disabling symptoms under the
Eleventh Circuit Pain Standard.
The Eleventh Circuit “has established a three part ‘pain
standard’ that applies when a claimant attempts to establish disability through his or her own
testimony of pain or other subjective symptoms. The pain standard requires (1) evidence of an
underlying medical condition and either (2) objective medical evidence that confirms the severity
of the alleged pain arising from that condition or (3) that the objectively determined medical
condition is of such a severity that it can be reasonably expected to give rise to the alleged pain.”
Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991).
Subjective testimony supported by
medical evidence satisfying the standard is sufficient to support a finding of disability.
However, the ALJ may still make a credibility determination on the claimant’s statements about
the intensity and effect of that pain. See Foote v. Chater, 67 F.3d 1553, 1561-62 (11th Cir.
1995); Hogard v. Sullivan, 733 F.Supp. 1465, 1469 (M.D. Fla. 1990). The ALJ’s adverse
credibility determination must be supported by “explicit and adequate reasons,” Holt, 921 F.2d at
1223, and substantial evidence, see Foote, 67 F.3d at 1561-62. An ALJ’s clearly articulated
credibility determination will not be disturbed if supported by substantial evidence. Petteway v.
Comm’r of Soc. Sec., 353 Fed. App’x. 287, 288 (11th Cir. 2009).
When evaluating the credibility of a plaintiff’s statements regarding the intensity,
persistence, or limiting effects of his symptoms, the ALJ considers all available subjective and
objective evidence. 20 C.F.R. §§ 404.1529(c)(1), 416.929(c)(1); S.S.R. 96-7p. This may include
the nature of a plaintiff’s symptoms, the effectiveness of medication, his method of treatment, his
activities, and any conflicts between a plaintiff’s statements and the rest of the evidence.
20 C.F.R. §§ 404.1529(c)(3) & (4), 416.929(c)(3) & (4). In articulating reasons for discrediting
subjective testimony, an ALJ need not refer to every piece of evidence in the record as long as
the decision is not a broad rejection which leaves a district or appellate court unable to conclude
that the medical condition was considered as a whole. Petteway, 353 Fed. App’x. at 288.
Here, the ALJ concluded Ackles’s medically determinable impairments could reasonably
be expected to cause some of the alleged symptoms, but “[Ackles]’s statements concerning the
intensity, persistence, and limiting effects of these symptoms are not entirely credible . . . .” (Tr.
93). Ackles alleges three errors in assessing his credibility. First, he asserts the ALJ failed to
properly consider the longitudinal history of pain in the record.
(Doc. 12 at 4-6).
Ackles argues the ALJ improperly drew inferences from Ackles’s failure to seek medical
treatment without considering the evidence he could not afford specialized care. (Id. at 6-7).
Third, Ackles contends the ALJ did not properly consider the combined effects of his multiple
impairments. (Id. at 7-8).
A. Longitudinal History
Ackles’s first argument is the ALJ “failed to properly consider the medical records which
reveal [Ackles]’s longitudinal history for back pain and shortness of breath and treatment for the
same.” (Doc. 12 at 4). In support of this argument, he notes the medical evidence documenting
the presence of severe impairments, including a chest x-ray from April 2010 showing COPD,
another from June 2010 showing bilateral interstitial fibrosis, a lumbar spine x-ray showing mild
multi-level degenerative changes, and medical records showing continuous treatment for COPD
and lower back pain. (Doc. 12 at 5) (citing tr. 290, 313-47, & 380-92). He also points to a
consultative examination by Dr. Shabrez Tariq from September 24, 2011, which documents
Ackles’s reports of pain and Dr. Tariq’s observations of mild paravertebral muscle spasms with a
potential diagnosis of lumbodorsal spondylosis with bilateral L4-L5 moderate tenderness along
the facet line. (Id.) (citing tr. 300-303). Lastly, Ackles states “[t]here is no indication that any of
[Ackles]’s treating physicians did not believe he suffered from back pain and shortness of
breath” but, “[t]o the contrary, [they] continually prescribed medication to help alleviate those
symptoms.” (Id. at 5-6) (citing tr. 314, 319, 323, 327, 332, & 336).
First, the arguments there is evidence to support the existence of medical impairments
and that Ackles’s treating physicians acknowledged his pain and treated him for it misses the
The ALJ explicitly considers all of the evidence to which Ackles cites, (tr. 93-94);
acknowledges the existence of COPD and lower back strain, (tr. 88); and attempts to account for
the COPD and lower back pain in his RFC, (tr. 95).
The question is not whether these
impairments exist but whether they are as bad as Ackles claims they are (i.e., disabling). The
problem for Ackles is none of the evidence to which he points is descriptive of the level of pain
or its effect on his ability to work. While the presence of a longitudinal history of treatment
“lends support” to his allegations for credibility purposes, it is just part of the ALJ’s review of
the entire record and is not conclusive proof of the truth of Ackles’s allegations. See Titles II &
XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual’s
Statements, S.S.R. 96-7P (S.S.A. July 2, 1996).
Although the medical records show Ackles was consistently prescribed a muscle relaxer
and a narcotic-like pain medication, (tr. 313-32), the medication was not changed or increased
from the time Ackles first complained of back pain in the records through the most recent
records (February 2012 to May 2013), (id.); during that time, Ackles often claimed pain of zero
out of ten, (tr. 322, 326, 341, 345, & 391); his physicians did not suggest to him any other modes
of treatment, (tr. 107); and there is evidence from September 2011 that medication had
previously been effective at controlling his pain, (tr. 300). The ALJ concluded this evidence
showed routine and conservative treatment of intermittent symptoms. (Tr. 95). In his opinion,
the ALJ also considered Ackles’s “vague and unpersuasive” testimony at the hearing, that Ackles
had not originally asserted his back pain as disabling in his Disability Report, and that there were
no medical opinions indicating disability or limitations greater than the ALJ had determined.
(Tr. 92 & 95). (There was, however, a functional capacity assessment completed in October 3,
2011, upon which the ALJ’s RFC was based.
(Tr. 95 & 304-11).) Based on this lack of
“medical treatment one would expect for a totally disabled individual,” Ackles’s “unpersuasive”
testimony, and the consultative medical opinion finding no disability, the ALJ found the
evidence did not support the inference of disabling pain. (Tr. 95). There is substantial evidence
to support the ALJ’s finding Ackles’s description of his pain as disabling is not credible.
B. Inferences from Lack of Treatment
Because of the ALJ’s conclusion regarding the lack of expected medical treatment,
Ackles’s second argument is the ALJ erred by making that inference without first considering
other explanations for it, specifically, evidence in the record indicating Ackles could not afford
other care. (Doc. 12 at 6). Ackles cites evidence he lives in low-income housing, receives food
stamps, was supposed to have an additional exam but did not have the insurance for it, and a
medical record showing he was referred to a doctor but did not have the resources to go. (Doc.
12 at 6) (citing tr. 105-07 & 385). 4
Under S.S.R. 96-7P, the credibility of an individual’s statements may be undermined “if
the level or frequency of treatment is inconsistent with the level of complaints”; however,
“[w]hen the ALJ ‘primarily if not exclusively’ relies on a claimant’s failure to seek treatment,
but does not consider any good cause explanation for this failure, [the] court will remand for
further consideration.” Henry v. Comm’r of Soc. Sec., 802 F.3d 1264, 1268 (11th Cir. 2015). In
Henry, the Eleventh Circuit acknowledged the claimant’s statement he was unable to pay for
Both the unpursued specialist referral and the exam for which Ackles did not have
insurance appear to have been for conditions unrelated to his back pain. (See tr. 107 (“[T]hey’re
supposed to stuck a light up in me, but I didn’t have the insurance to do it with.”) & 385
(discussing, under a section titled “abdominal pain,” Ackles’s lack of resources to follow up with
continued medical treatment and reversed, finding “the ALJ failed to consider any good cause
explanations for failure to seek medical treatment” because “the ALJ neither developed the
record nor addressed Henry’s financial ability to pursue a more rigorous course of treatment.”
In the instant case, however, the ALJ not only explicitly noted Ackles’s statements in
September 2011 that his medications relieved his pain, (tr. 94) (citing tr. 300), but he also
expanded the record at the hearing by asking Ackles whether his doctors had recommended any
additional treatments beyond medication, (tr. 107). It is unknown whether the ALJ would have
gone on to ask if Ackles did not pursue further treatments due to his poverty, because Ackles’s
answer to the first question was negative, (tr. 107) (“No, sir.
They just give me the
medication.”). With positive evidence the medications relieved Ackles’s pain, direct testimony
from Ackles his doctors had not recommended further treatment, and consultative medical
opinions showing no disability, the ALJ was not primarily relying on a negative inference from
Ackles’s medical history. However, even if he were, he cannot be faulted for doing so because,
while there was evidence of Ackles’s poverty, there was also substantial evidence in the record
poverty was not the reason greater measures were not taken for his pain.
C. Combined Effects
Lastly, Ackles contends the ALJ did not consider all of his multiple impairments
together. (Doc. 12 at 7). He points to the evidence showing lumbar degeneration, shortness of
breath, and back pain and the subsequent treatment of those conditions as evidence he could only
do sedentary work.
(Id. at 7-8).
Other than these contrary conclusions from the evidence,
Ackles points to nothing to indicate the ALJ did not consider the impairments in combination.
Not only does the ALJ state he considered the impairments in combination, (tr. 89), specifically
regarding the compounding effects of obesity, which he found to be negligible, (tr. 91 & 94), but
he addressed the other impairments together and relied on a consultative physician’s overall
conclusions when crafting limitations for the RFC, (tr. 95). The fact the ALJ came to a different
conclusion about the combined severity of the impairments does not mean he did not consider
them in combination.
For the reasons set forth herein, and upon careful consideration of the administrative
record and memoranda of the parties, the decision of the Commissioner of Social Security
denying Ackles’s claim for a period of disability, DIB, and SSI is AFFIRMED and this action is
DISMISSED WITH PREJUDICE.
DONE this 30th day of March 2016.
JOHN H. ENGLAND, III
UNITED STATES MAGISTRATE JUDGE
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