Sandlin v. Social Security Administration, Commissioner

Filing 12

MEMORANDUM OPINION. Signed by Judge Madeline Hughes Haikala on 9/14/2016. (KEK)

FILED
2016 Sep-14 AM 10:30
U.S. DISTRICT COURT
N.D. OF ALABAMA

UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
NORTHEASTERN DIVISION

SHARON ANN SANDLIN,
Plaintiff,
v.
CAROLYN W. COLVIN,
Commissioner of the
Social Security Administration,
Defendant.

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Case No.: 5:14-CV-1885-MHH

MEMORANDUM OPINION
Pursuant to 42 U.S.C. §§ 405(g) and 1383(c), plaintiff Sharon Ann Sandlin
seeks judicial review of a final adverse decision of the Commissioner of Social
Security. The Commissioner denied Ms. Sandlin’s claims for a period of disability
and disability insurance benefits and supplemental security income. After careful
review, the Court remands so that the Commissioner may fully consider Ms.
Sandlin’s request for a closed period of disability covering the months during
which Ms. Sandlin was treated for breast cancer.
I.

PROCEDURAL HISTORY
Ms. Sandlin applied for a period of disability and disability insurance

benefits and supplemental security income on September 22, 2011. (Doc. 5-3, pp.

88, 96). Ms. Sandlin alleges that her disability began on March 16, 2011.

(Id.

88). Initially, Ms. Sandlin sought an indeterminate finding of disability. The
Commissioner denied Ms. Sandlin’s claims on November 3, 2011. (Doc. 5-4, p.
2).1
Ms. Sandlin requested a hearing before an Administrative Law Judge (ALJ).
(Id. at 7). During the administrative hearing, Ms. Sandlin’s attorney suggested to
the ALJ that Ms. Sandlin might qualify for a “closed period of disability from
March 16, [2011] through at least November the 7th, 2012.” (Doc. 5-3, p. 59).
The ALJ issued an unfavorable decision on March 28, 2013. (Doc. 5-3, p. 32).
The ALJ’s opinion does not mention Ms. Sandlin’s request for a closed period of
disability.
Ms. Sandlin sought relief from the Appeals Council. In the proceedings
before the Appeals Council, Ms. Sandlin’s attorney argued that the ALJ:

1

Ms. Sandlin would not have been eligible for a closed period of disability at this stage of the
proceedings because she had not yet been absent from her job for more than 12 months.
Disability is defined as “an inability to engage in any substantial gainful activity by reason of any
medically determinable physical or mental impairment which can be expected to result in death
or which has lasted or can be expected to last for a continuous period of not less than 12
months.” 42 U.S.C. § 423(d)(1)(A); see also Barnhart v. Walton, 535 U.S. 212, 217 (2002) (A
claimant’s impairments and inability to work must last for a continuous period of at least twelve
months); Harvey v. Astrue, 2009 WL 2634399, at *8 (M.D. Fla. Aug. 24, 2009) (“A closed
period of disability may be considered when a claimant had an impairment that: 1) prevented
substantial gainful activity for at least twelve (12) months, 2) continued to or through the month
of filing, and 3) ceased in or after the month of filing but prior to the date of adjudication.
POMS § DI 25510.01(A). Thus, a claimant who is unable to point to a period of twelve (12)
consecutive months in which she was unable to engage in substantial gainful activity[] is not
entitled to a closed period of social security benefits. Phillips v. Barnhart, 91 Fed. Appx. 775,
782 (3rd Cir. 2004); Kennedy v. Comm'r of Soc. Sec., 87 Fed. Appx. 464 (6th Cir. 2003).”).
2

did not consider a closed period of disability from March 16, 2011 to
January 1, 2013. That closed period of disability reflects the period of
time that Ms. Sandlin was unable to work because of her cancer and
treatment for her cancer. Therefore, we believe that the decision of
the Administrative Law Judge for the closed period is not supported
by substantial evidence. . . .
(Doc. 5-3, p. 9). On September 16, 2014, the Appeals Council declined Ms.
Sandlin’s request for review (Id. at 2), making the Commissioner’s decision final
and a proper candidate for this Court’s judicial review. See 42 U.S.C. §§ 405(g)
and 1383(c).
II.

STANDARD OF REVIEW
The scope of review in this matter is limited. “When, as in this case, the

ALJ denies benefits and the Appeals Council denies review,” the Court “review[s]
the ALJ’s ‘factual findings with deference’ and [his] ‘legal conclusions with close
scrutiny.’” Riggs v. Comm’r of Soc. Sec., 522 Fed. Appx. 509, 510-11 (11th Cir.
2013) (quoting Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001)).
The Court must determine whether there is substantial evidence in the record
to support the ALJ’s factual findings.

“Substantial evidence is more than a

scintilla and is such relevant evidence as a reasonable person would accept as
adequate to support a conclusion.” Crawford v. Comm’r of Soc. Sec., 363 F.3d
1155, 1158 (11th Cir. 2004). In making this evaluation, the Court may not “decide
the facts anew, reweigh the evidence,” or substitute its judgment for that of the
ALJ. Winschel v. Comm’r of Soc. Sec. Admin., 631 F.3d 1176, 1178 (11th Cir.
3

2011) (internal quotations and citation omitted). If the ALJ’s factual findings are
supported by substantial evidence, then the Court “must affirm even if the evidence
preponderates against the Commissioner’s findings.” Costigan v. Comm’r, Soc.
Sec. Admin., 603 Fed. Appx. 783, 786 (11th Cir. 2015) (citing Crawford, 363 F.3d
at 1158).
With respect to the ALJ’s legal conclusions, the Court must determine
whether the ALJ applied the correct legal standards. If the Court finds an error in
the ALJ’s application of the law, or if the Court finds that the ALJ failed to provide
sufficient reasoning to demonstrate that the ALJ conducted a proper legal analysis,
then the Court must reverse the ALJ’s decision. Cornelius v. Sullivan, 936 F.2d
1143, 1145-46 (11th Cir. 1991).
III.

SUMMARY OF THE ALJ’S DECISION
To determine whether a claimant has proven that she is disabled, an ALJ

follows a five-step sequential evaluation process. The ALJ considers:
(1) whether the claimant is currently engaged in substantial gainful
activity; (2) whether the claimant has a severe impairment or
combination of impairments; (3) whether the impairment meets or
equals the severity of the specified impairments in the Listing of
Impairments; (4) based on a residual functional capacity (“RFC”)
assessment, whether the claimant can perform any of his or her past
relevant work despite the impairment; and (5) whether there are
significant numbers of jobs in the national economy that the claimant
can perform given the claimant’s RFC, age, education, and work
experience.
Winschel, 631 F.3d at 1178.
4

In this case, the ALJ found that Ms. Sandlin has not engaged in substantial
gainful activity since March 16, 2011, the alleged onset date. (Doc. 5-3, p. 26).
The ALJ determined that Ms. Sandlin’s “breast cancer stage III status post double
mastectomy and reconstructive surgery with residual effects of chemotherapy” are
non-severe impairments. (Doc. 5-3, p. 27).2 However, the ALJ concluded that
“these medically determinable impairments may create functional deficits in
combination with other symptoms that are severe.” (Doc. 5-3, p. 27; see also Doc.
5-3, p. 30 (“[Considering the totality of the evidence in the light most favorable to
the claimant, the undersigned finds the combination of the claimant’s impairments
to be severe. . . .”)).

Based on a review of the medical evidence in the

administrative record, the ALJ concluded that Ms. Sandlin did not have an
impairment or a combination of impairments that met or medically equaled the
severity of any of the listed impairments in 20 C.F.R. Part 404, Subpart P,
Appendix 1. (Id. at 27-28).
In light of Ms. Sandlin’s impairments, the ALJ evaluated her residual
functional capacity (RFC). The ALJ determined that Ms. Sandlin has the RFC to
“perform the full range of light work as defined in 20 C.F.R. 404.1567(b) and
416.967(b).” (Doc. 5-3, p. 28). Based on this RFC, the ALJ concluded Ms.

2

The residual effects of Ms. Sandlin’s chemotherapy include diarrhea, cramping, nausea,
migraine headaches, fatigue, and neuropathy. (Doc. 5-3, p. 29).
5

Sandlin is able to perform her past relevant work as an assembly operator and a
general clerk. (Id. at 31). Accordingly, the ALJ determined that Ms. Sandlin has
not been under a disability within the meaning of the Social Security Act. (Id. at
32).
IV.

ANALYSIS
Ms. Sandlin argues the ALJ’s decision is subject to remand or reversal

because the ALJ did not:
address the issue of a closed period of disability for the Plaintiff, but
instead determined that the Plaintiff was not disabled under the Social
Security Act. The Plaintiff contends that she was disabled for a
closed period from March 16, 2011 to January 10, 2013 and that
benefits should have been granted for that period and that the ALJ
improperly applied 42 U.S.C.A. § 423(d)(5)(A) during that period and
that the reasons given for rejecting the Plaintiff’s testimony during
that period are not supported by substantial evidence.
(Doc. 9, pp. 24-25) (citations omitted).3 The Court agrees that it is appropriate to
ask the ALJ to address Ms. Sandlin’s claim for a closed period of disability.
“A claimant may request benefits for a finite period of disability, even if she
is later able to work. In such ‘closed period’ cases, ‘the decision maker determines
that a new applicant for disability benefits was disabled for a finite period of time
3

Ms. Sandlin also argues that the ALJ’s reliance on the opinion of Dr. Robert Estock to help
determine the severity of her (Ms. Sandlin’s) physical impairments is not supported by
substantial evidence and that the ALJ’s decision that the “general clerk” position was past
relevant work is not supported by substantial evidence. Because the Court finds that Ms.
Sandlin’s argument concerning the ALJ’s failure to consider a closed period of disability is
meritorious, the Court will not address Ms. Sandlin’s alternative arguments.
6

which started and stopped prior to the date of his decision.’” Mitchell v. Comm’r
of Soc. Sec., 393 Fed. Appx. 651, 652 (11th Cir. 2010) (quoting Pickett v. Bowen,
833 F.2d 288, 289 n.1 (11th Cir. 1987)). A claimant may raise the issue of a
closed period of disability on appeal if the claimant has specified the dates that
define the closed period for which benefits are sought. Jones v. Comm’r of Soc.
Sec., 181 Fed. Appx. 767, 772-73 (11th Cir. 2006). As noted above, counsel for
Ms. Sandlin identified the closed period for which she seeks benefits both during
the administrative hearing in this case and in the proceedings before the Appeals
Council, and she has presented the time frame clearly to this Court. (Doc. 5-3, pp.
9, 59).4
The administrative record contains sufficient evidence of pain during the
closed period to warrant remand for further proceedings. “To establish a disability
based on testimony of pain and other symptoms, the claimant must satisfy two
parts of a three-part test by showing ‘(1) evidence of an underlying medical
condition; and (2) either (a) objective medical evidence confirming the severity of
the alleged pain; or (b) that the objectively determined medical condition can
In Jones, the claimant argued that “the ALJ should have considered [her] eligibility for a closed
period of disability because [her] debilitating symptoms exceeded a 12-month duration.” 181
Fed. Appx. at 772. The Eleventh Circuit concluded that the ALJ did not err in failing to consider
the claimant’s eligibility for a closed period of disability because “Jones’s argument on appeal
does not sufficiently provide us with the specific 12–month time period for which she believes
she is entitled to a closed period of disability” and because substantial evidence supported the
ALJ’s finding “that Jones was not disabled for any time during that entire period.” Id. at 773.
Here, Ms. Sandlin requested that the ALJ consider a closed period of disability and provided the
ALJ, the Appeals Council, and this Court with the specific time period.
4

7

reasonably be expected to give rise to the claimed pain.’” Zuba-Ingram v.
Commissioner of Social Sec., 600 Fed. Appx. 650, 656 (11th Cir. 2015) (quoting
Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002) (per curiam)).

A

claimant’s testimony coupled with evidence that meets this standard “is itself
sufficient to support a finding of disability.” Holt v. Sullivan, 921 F.2d 1221, 1223
(11th Cir. 1991) (citation omitted).
If the ALJ discredits a claimant’s subjective testimony, then the ALJ “must
articulate explicit and adequate reasons for doing so.” Wilson, 284 F.3d at 1225.
“While an adequate credibility finding need not cite particular phrases or
formulations[,] broad findings that a claimant lacked credibility . . . are not enough.
. . .” Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir. 1995) (per curiam); see SSR
16-3P, 2016 WL 1119029 at *9 (“The determination or decision must contain
specific reasons for the weight given to the individual’s symptoms, be consistent
with and supported by the evidence, and be clearly articulated so the individual and
any subsequent reviewer can assess how the adjudicator evaluated the individual’s
symptoms.”).
During her administrative hearing, Ms. Sandlin testified that while she was
undergoing treatment for breast cancer, “I was throwing up. I had cramps. I had
diarrhea. I had migraines. I stayed in the bed. . . Pretty much 24 hours a day.”
(Doc. 5-3, p. 49). She stated: “I wasn’t sleeping. I had neuropathy in my hands
8

and my feet. And I was numb halfway down both arms and across my back and
chest from the surgery.” (Id. at 53). She explained that her chemotherapy lasted
from May 2011 until May 2012. (Id. at 49).
Ms. Sandlin acknowledged that she worked for short periods during her
cancer treatment to avoid losing her insurance and to keep her job, but she could
not do her previous work as a press operator. (Id. at 51-53). Ms. Sandlin testified
that she received accommodations from a supervisor who “had a family member
that was also going through cancer and chemo.” Ms. Sandlin explained that her
supervisor:
put a chair in the bathroom where I could stay because he knew I was
just trying to get my 30 days in and that I wasn’t able to work. . . . I
spent all my time sitting…. I had to keep a garbage can with me all
the time. I was throwing up, or I would spend the time in the
bathroom because I had diarrhea so bad.”
(Id. at 54).
Ms. Sandlin underwent reconstructive surgery on both breasts in August
2012 and again in January 2013. She then returned to work. (Doc. 5-3, p. 29; Doc.
5-10, pp. 103-105).5 Ms. Sandlin testified that as of January 2013, she was “trying
to work an eight hour day.” (Doc. 5-3, pp. 43-44). When she returned to work in
January 2013, Ms. Sandlin handled paperwork rather than operating machinery.

5

The ALJ noted that there are no medical records for the January 2013 procedure in the
administrative record. (Doc. 5-3, p. 30). That is accurate, but there is a pre-op record from
December 11, 2012. (Doc. 5-10, pp. 108-109).
9

(Id. at 44). She worked seven to eight hours a day, five days a week and made
$17.00 an hour. (Id. at 45). She testified that Dr. Rayburn placed restrictions on
lifting more than “5 pounds.” (Id. at 48).
The ALJ accurately summarized Ms. Sandlin’s subjective testimony. (Doc.
5-3, p. 29). The ALJ correctly applied the first part of the pain standard, finding
“that the claimant’s medically determinable impairments could reasonably be
expected to cause the alleged symptoms.” (Id.). The ALJ then found that Ms.
Sandlin’s testimony concerning the “intensity, persistence and limiting effects” of
her symptoms was not entirely credible. (Id.).
The ALJ explained that Ms. Sandlin’s medical records and treatment history
are not consistent with her allegations of disabling pain. The ALJ stated:
Notably, the claimant alleges that during the period of chemotherapy
treatment, she was unable to get out of bed most days and experienced
nausea, vomiting, headaches and pain related to neuropathy; however
complaints to this degree are not seen in the medical record.
(Doc. 5-3, p. 30). Although some medical records in the administrative record
indicate that Ms. Sandlin managed the side effects of chemotherapy well for
periods of time, other records reflect that Ms. Sandlin suffered with severe side
effects at other times during the treatment.
The medical records that were before the ALJ indicate that Ms. Sandlin was
diagnosed with breast cancer on March 16, 2011. (Doc. 5-8, pp. 13-14). Two
weeks later she underwent a double mastectomy. (Doc. 5-9, pp. 4-6). Ms. Sandlin
10

had a post-surgical check up with Dr. Seth Rayburn on April 4, 2011. (Id. at 7).
Ms. Sandlin reported that “she [had] pain and nausea with movement of either
arm,” but Dr. Rayburn found that Ms. Sandlin was “able to move her arms with
good motion,” and her drains were intact. (Id.). Dr. Rayburn noted that Ms.
Sandlin was doing well and instructed her to continue wearing compressive
garments to aid her recovery. (Id. at 8). Three days later, Dr. Rayburn saw Ms.
Sandlin again. She had less pain, but she had developed a burning sensation on her
right side. (Id. at 9). Dr. Rayburn prescribed Neurotin for the burning sensation
and told Ms. Sandlin that she could begin to ease the compressive garments. (Id. at
10).
By April 14, 2011, Ms. Sandlin reported that her pain had subsided, and her
range of motion was good. (Doc. 5-9, p. 11). On April 21, 2011, Ms. Sandlin
stated that “she [was] doing well.” (Doc. 5-9, p. 13). Ms. Sandlin received ports
for chemotherapy on May 4, 2011, and she began her chemotherapy regime eight
days later. (Id. at 15). When she began chemotherapy, Ms. Sandlin was still sore
from her surgical procedure, but otherwise, she was relatively healthy. (Id. at 1516).
On May 5, 2011, Ms. Sandlin saw Dr. Brian Mathews. Dr. Mathews started
Ms. Sandlin on the “standard protocol” medications for chemotherapy:
“[C]arboplatin, Taxotere, and Herceptin.” (Doc. 5-9, p. 83). To address nausea,
11

Dr. Mathews prescribed Alovi, Decadron, and Emend. (Id.). Dr. Mathews also
noted that Ms. Sandlin could take Zofran and Decafrom to treat her nausea. (Id.).
Dr. Mathews evaluated Ms. Sandlin after her first round of chemotherapy.
(Doc. 5-9, p. 78). Overall, Ms. Sandlin was “stable.” (Id.). Dr. Mathews noted
that Ms. Sandlin “did have quite a bit of diarrhea after her first cycle. It is not clear
if this was chemo related or if she could have a coincidental virus.” (Id.). Dr.
Mathews prescribed Bentyl to treat the diarrhea, and he maintained Ms. Sandlin’s
other medications. (Id.).
Less than a week later on June 21, 2011, Ms. Sandlin returned to Clearview
Cancer Institute “due to an urgent complaint of severe abdominal pain with
cramping. The pain was so severe that [] a STAT CT of the abdomen and pelvis”
was ordered. (Doc. 5-9, p. 72). CT results showed a possible “benign bone
island.”

(Id.).

Although the CT was negative with regard to diarrhea and

cramping, Ms. Sandlin was prescribed “Librax three times a day” to alleviate both
conditions. (Id. at 73). Ms. Sandlin also continued to suffer gastroesophageal
reflux, and she was instructed to continue taking Prilosec. (Id.). The record from
Ms. Sandlin’s June 21, 2011 visit to the Cancer Institute does not make clear
whether Ms. Sandlin saw a doctor or a physician’s assistant or a nurse. The record
indicates that Ms. Sandlin did not have an appointment and that she was a “work-

12

in” because of her urgent condition. The record states that Ms. Sandlin was
scheduled to see Dr. Mathews again on June 23, 2011. (Doc. 5-9, pp. 72-73).
Records ranging from July 14, 2011 to September 15, 2011 indicate that Ms.
Sandlin’s severe symptoms subsided. Dr. Mathews noted that Ms. Sandlin had
“[n]o major problems to report,” (Doc. 5-9, p. 67); she “overall is doing well,” (Id.
at 62) and had “no complaints,” (Id. at 57). In fact, based on his examination of
Ms. Sandlin on July 14, 2011, Dr. Mathews wrote that Ms. Sandlin “had fantastic
tolerance of her chemotherapy last time,” and she was preparing for her last two
rounds of treatment. (Doc. 5-9, p. 67). Between July and September 2011, nausea
was a reoccurring problem, but Ms. Sandlin received medication to treat the
nausea. (Id. at 58, 67). A July 12, 2011 note from Ms. Sandlin’s plastic surgeon
stated that Ms. Sandlin “has a history of migraines, which are frequent with her
chemotherapy.” (Doc. 5-10, p. 116).
When Ms. Sandlin visited the Cancer Institute on October 6, 2011, she had
completed six cycles of TCH chemotherapy, and she was taking a weekly regimen
of Herceptin and Taxol. Ms. Sandlin reported “that she [had] noticed she has been
having more migraine like headaches lately, not relieved by her regular pain
medications.” (Doc. 5-10, p. 96). Dr. Mathews prescribed Fiorinal to treat the
migraine headaches. (Id. at 95-97).

13

One week later, Ms. Sandlin reported that the Fiorinal “did not help a great
deal” and that she was “still having some joint pain,” though her Lortab seemed “to
help more.” (Doc. 5-10, p. 94). Her nausea continued, but it was “better than last
time.”

(Id.).

To address the nausea, Dr. Mathews moved Ms. Sandlin to a

“Sancuso patch.” (Id. at 94-95). Ms. Sandlin planned to take Excedrin migraine
and Lortab “as needed” to treat her headaches. (Id. at 95).
On October 20, 2011, Dr. Mathews noted that, “[o]verall, [Ms. Sandlin] is
much better. Counts are stable. Nausea has been eliminated for now. Headaches
have been better. Pain has been controlled. She still has fatigue, but otherwise is
doing well.” (Doc. 5-10, p. 92). Dr. Mathews reported that the Sancuso patch
helped Ms. Sandlin’s nausea “a good bit.” (Doc. 5-10, p. 93). Dr. Mathews gave
Ms. Sandlin a work note limiting her to “light duty” because her employer
instructed her to return to work for 30 days to qualify for additional short term
disability. (Id.). Ms. Sandlin was concerned “that she simply [would not] have
enough energy to do her previous full time work, but she is in a hard situation
needing to keep her financial and insurance status stable.” (Id.).
On October 27, 2011, Dr. Mathews noted “no issues to report aside” from
Ms. Sandlin continuing on her plan to switch chemotherapy drugs. (Doc. 5-10, p.
90). On November 21, 2011, the physician’s assistant reported that Ms. Sandlin
was “feeling well” with some fatigue issues after returning to work “but is
14

otherwise stable.” (Id. at 88). Ms. Sandlin’s nausea was no longer an issue, and
she was “doing better with Lortab” treatment for her migraines. (Id. at 89). Ms.
Sandlin received “notes for work to return to work but to remain at the light duty
post” she was filling. (Id.).
By December 15, 2011, Ms. Sandlin’s condition had worsened.

Dr.

Mathews noted that Ms. Sandlin “had nausea, vomiting, and headaches over the
past week.” (Doc. 5-10, p. 86). Dr. Mathews attributed the symptoms to a virus.
(Doc. 5-10, pp. 86-87). He prescribed “fluids and Aloxi” for nausea and “a Z-pak
and Medrol-Dosepak” for sinusitis. (Id.).
On January 3, 2012, Dr. Mathews noted that while Ms. Sandlin was “stable,”
she “continues to have a number of problems.” (Doc. 5-10, p. 84). She suffered
“nausea with occasional episodes of vomiting” and “headaches… not clearly sinus
in nature.” She also complained of “decreased energy and appetite,” and “hot
flashes.” (Id.). Dr. Mathews decided to adjust Ms. Sandlin’s medication, and he
ordered a CT scan to explore the cause of her sinusitis and headaches. (Id. at 8485).
Treatment notes from January 12, 2012 state that Ms. Sandlin suffered from
“numerous and frequent headaches which have not been alleviated by NSAIDS or
prescription butabital.” (Id. at 82). The headaches occasionally caused nausea.
(Id.). Ms. Sandlin’s hot flashes and decreased energy continued, but Ms. Sandlin
15

was “feeling much better,” and her hot flashes had improved in response to Celexa.
(Id. at 83).
When Dr. Mathews examined Ms. Sandlin on January 26, 2012, he noted
that Ms. Sandlin was “stable,” though she “continues to have lots of headaches”
and required an “urgent” appointment with a neurologist. (Doc. 5-10, p. 80). Dr.
Mathews stated that he hoped to see improvement because Ms. Sandlin was “off
chemotherapy.” (Id.). On February 16, 2012, a physician’s assistant indicated that
Ms. Sandlin was still “on maintenance Herceptin.” (Doc. 5-10, p. 78). Ms.
Sandlin “continue[d] to have persistent headaches although Imitrex has helped
quite a bit. She is having to take Imitrex on a daily basis so we certainly have not
lessened her headaches.” (Id.). The physician’s assistant noted that Ms. Sandlin
suffered from “[c]hronic pain issues.” (Id. at 79).
On March 5, 2012, Dr. Mathews reported that Ms. Sandlin’s “[h]eadaches
[had] almost completely resolved within several days of starting amitriptyline,”
and he remarked that “except for grade I or II peripheral neuropathy she is doing
very well.” (Doc. 5-10, p. 76). With respect to the neuropathy, Dr. Mathews
stated “unfortunately I have little to offer,” and he suggested increasing Ms.
Sandlin’s dosage of amitriptyline. (Id.).

16

Ms. Sandlin saw Dr. Scott Hitchcock, a neurologist, on March 3, 2012. Dr.
Hitchcock noted that Ms. Sandlin’s chief complaint was headaches. With respect
to those headaches, Dr. Hitchcock reported:
She has a history of previous headaches. Typically, when she had a
headache it would be around her menstrual cycle. Her headaches
were not really much of a problem until after the chemo. She then
developed a daily headache. It was usually left-sided and throbbing,
as well as quite severe. It was associated with photophobia,
phonophobia, as well as osmophobia. Sometimes the headaches
would be triggered by smells. She would have to hibernate in a dark
quite [sic] room. Imitrex 50 mg was of some help. The headaches
would go on for hours at a time. They were worse with activity and
better with sleep. Since she started a small dose of amitriptyline, her
headaches have completely resolved. She tells me that she has not
had a headache for about two to three weeks now.
(Doc. 5-11, p. 36).

Dr. Hitchcock also noted that Ms. Sandlin developed

neuropathy following her chemotherapy treatments. He explained:
She has a burning and stinging pain in her fingers, toes and feet. She
has difficulty telling the temperature of water with her hands and feet.
She does have a significant amount of spontaneous pain, as well as
allodynia. She has noticed that this may have improved just a bit with
amitriptyline, but is still a significant problem.
(Doc. 5-11, p. 36).
Dr. Hitchcock diagnosed Ms. Sandlin with peripheral neuropathy which Dr.
Hitchcock suspected was “fairly mild.” (Doc. 5-11, p. 37). Dr. Hitchcock stated:
Her reflexes are generally intact except for being slightly decreased at
the ankles. Vibratory sensation was only minimally decreased at the
toes. Therefore, I suspect the neuropathy is likely not that severe.
Hopefully over time, she will make a spontaneous recovery.
17

(Doc. 5-11, p. 37). Dr. Hitchcock described Ms. Sandlin’s migraine headaches as
“typical,” explained the steps that Ms. Sandlin had to take to address the
photophobia that accompanied the headaches, and prescribed an increased dose of
amitriptyline to which Ms. Sandlin had had “an excellent response” and advised
Ms. Sandlin that she could take two Imitrex “to help better abort the headache.”
(Id.).
On April 16, 2012, Dr. Mathews noted that “overall” Ms. Sandlin was
“relatively stable,” but her “headaches have recurred,” along with “pretty
substantial bone and muscular pain, which has worsened as well.” (Doc. 5-10, p.
74). Dr. Mathews began to suspect Herceptin might be the cause of Ms. Sandlin’s
problems. (Id.). Dr. Mathews decided to maintain the course of her treatment
because Ms. Sandlin was almost done with her Herceptin treatment. (Id. at 74-75).
On May 7, 2012, Dr. Mathews noted that Ms. Sandlin returned to “complete
her Herceptin,” “had a lot of issues with Tamoxifen,” and had injured her back
after her last visit. (Doc. 5-10, p. 72). Dr. Mathews indicated that Ms. Sandlin’s
headaches were “much better,” and he hoped she would continue to improve. (Id.).
During a July 18, 2012 examination, Dr. Mathews reported that Ms. Sandlin “had
quite a bit of intolerance” of Tamoxifen. (Id. at 70). Dr. Mathews stated that Ms.
Sandlin’s neuropathy and headaches were “stable to improving.” (Id.).

18

On November 7, 2012, Dr. Mathews examined Ms. Sandlin, noting “[s]he
has had quite a bit of arthritic type pain, largely associated with getting back to
work and has also had an occasional migraine but has had good control on
amitriptyline.” (Doc. 5-10, p. 68). Dr. Mathews wanted to start Ms. Sandlin “back
on half a dose of tamoxifen every other day” to deal with her “substantial pain and
other symptoms.” (Id.). Ms. Sandlin’s neuropathy was “stable to improved,”
though Dr. Mathews found that her condition “seems to be aggravated more by
getting up.” (Id.). He noted that Ms. Sandlin “is not attempting to go back to a
very physical job.” (Id.). At Ms. Sandlin’s request, Dr. Mathews ordered her to
begin taking only amitriptyline for her headaches so that she could “drop her
medications.” (Id.). Dr. Mathews stated, “I think once she is up and about a good
bit more, I think she will feel a lot better.” (Id. at 69).
During a December 19, 2012 visit, Dr. Mathews noted that Ms. Sandlin’s
arthritic pain and headaches had improved and that she had returned to work.
(Doc. 5-10, p. 66).

He explained that her previous hot flashes were due to

menopause. (Id.). Dr. Mathews restarted Ms. Sandlin on Tamoxifen and planned
to review her progress in two months. (Id. at 67).
Based on these medical records, there is some evidence that supports the
ALJ’s decision to discount Ms. Sandlin’s testimony about the severity of her pain.
For example, Ms. Sandlin’s medical records suggest that she was not constantly in
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pain, and her testimony that she was bedridden is inconsistent with evidence of
periods of controlled nausea and reduced abdominal cramping. (Doc. 5-9, pp. 42,
57-58, 67; Doc. 5-10, p. 92). But there also is a good deal of evidence that the ALJ
did not discuss in her opinion that supports Ms. Sandlin’s testimony. The ALJ
properly noted that to evaluate Ms. Sandlin’s pain, she (the ALJ) would have to
examine a variety of factors such as Ms. Sandlin’s daily activities, the types of
medication prescribed to alleviate pain, and “[a]ny measures other than treatment
the claimant uses or has used to relieve pain or other symptoms (e.g., lying flat on
his or her back . . .).” (Doc. 5-3, pp. 28-29). Yet, the ALJ’s opinion contains no
indication that the ALJ considered, for example, the amount of time that Ms.
Sandlin reportedly had to stay in the bathroom or the cocktail of medications that
Ms. Sandlin used to treat her nausea, diarrhea, neuropathy, and migraine
headaches. Similarly, the ALJ’s opinion does not acknowledge the steps that Ms.
Sandlin used to try to manage her migraine headaches such as “hibernating” in a
darkened room.
An ALJ does not have to mention every piece of evidence in an opinion, but
an ALJ must acknowledge the evidence that is favorable to a claimant and explain
how that evidence factored into her analysis of the administrative record. See
McCruter v. Bowen, 791 F.2d 1544, 1548 (11th Cir. 1986) (If the record viewed in
its entirety indicates that the ALJ “focus[ed] upon one aspect of the evidence and
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ignor[ed] other parts of the record,” then the reviewing court “cannot properly find
that the administrative decision is supported by substantial evidence. It is not
enough to discover a piece of evidence which supports that decision, but to
disregard other contrary evidence. The review must take into account and evaluate
the record as a whole.”).6 On remand, the ALJ should consider the administrative
record as it pertains to the closed period of disability that ranges from the date of
Ms. Sandlin’s mastectomy through her return to work in January 2013.7
V.

CONCLUSION
For the reasons discussed above, the Court remands the decision of the

Commissioner for reevaluation of Ms. Sandlin’s request for benefits for the closed
period of time ranging from March 16, 2011 through January 1, 2013. The Court
will enter a separate order consistent with this memorandum opinion.
6

The ALJ found that Ms. Sandlin had not been under a disability from March 16, 2011 through
the date of the ALJ’s decision in part because Ms. Sandlin “completed her Associate’s degree in
April 2011, less than a month after undergoing a double mastectomy.” (Doc. 5-3, p. 30). Ms.
Sandlin explained “[t]hat was the year the tornados hit. So school ended early.” (Id. at 50).
Given the evidence that Ms. Sandlin had a double mastectomy on March 30, 2011, it is unlikely
that Ms. Sandlin had school work that she had to complete after her surgery because her classes
were cancelled.
The ALJ did not discuss whether Ms. Sandlin’s intermittent work during the closed period of
disability constituted substantial gainful activity. (Doc. 5-3, pp. 26-27). If the ALJ decides on
remand that this employment constitutes substantial gainful activity, then the ALJ must
determine how long Ms. Sandlin was disabled during the relevant period. The Eleventh Circuit
has held that “[s]ubstantial gainful activity clearly does bar benefits under the statute regardless
of any actual disability of the claimant. But it bars such benefits only for such periods of
activity.” Powell o/b/o Powell v. Heckler, 773 F.2d 1572, 1576 (11th Cir. 1985) (emphasis in
original).
7

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DONE and ORDERED this September 14, 2016.

_________________________________
MADELINE HUGHES HAIKALA
UNITED STATES DISTRICT JUDGE

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