Hodge v. Social Security Administration, Commissioner
Filing
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MEMORANDUM OPINION AND ORDER AFFIRMING THE DECISION OF THE COMMISSIONER For the reasons stated above (and pursuant to 42 U.S.C. § 405(g)), the court AFFIRMS the Commissioner's decision. The court separately will enter final judgment. Signed by Magistrate Judge Nicholas A Danella on 3/26/2024. (SRD)
FILED
2024 Mar-26 PM 01:36
U.S. DISTRICT COURT
N.D. OF ALABAMA
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
NORTHEASTERN DIVISION
SHELBY HODGE,
)
)
)
)
)
)
)
)
)
)
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Plaintiff,
v.
SOCIAL SECURITY
ADMINISTRATION,
COMMISSIONER,
Defendant.
Case No. 5:23-cv-00155-NAD
MEMORANDUM OPINION AND ORDER
AFFIRMING THE DECISION OF THE COMMISSIONER
Pursuant to 42 U.S.C. § 405(g), Plaintiff Shelby Hodge appeals the decision
of the Commissioner of the Social Security Administration (“Commissioner”) on his
claim for disability benefits. Doc. 1. Plaintiff Hodge applied for supplemental
security income (SSI) benefits with an application date of December 7, 2020, and an
alleged onset date of June 1, 1998. Doc. 9-4 at 2; Doc. 9-7 at 2–13. The
Commissioner denied Hodge’s claim for benefits. Doc. 9-3 at 7–9, 23–45.
In this appeal, the parties consented to magistrate judge jurisdiction. Doc. 12;
28 U.S.C. § 636(c)(1); Fed. R. Civ. P. 73. After careful consideration of the parties’
submissions, the relevant law, and the record as a whole, the court AFFIRMS the
Commissioner’s decision.
1
ISSUES FOR REVIEW
In this appeal, Hodge argues that the court should reverse and remand because
the determination by the Administrative Law Judge (ALJ) of Hodge’s residual
functional capacity (RFC) is “inadequate and not supported by substantial
evidence,” as the ALJ “failed to properly evaluate the Plaintiff’s complaints
consistent with the Eleventh Circuit pain standard.” Doc. 15 at 5.
STATUTORY AND REGULATORY FRAMEWORK
A claimant applying for Social Security benefits bears the burden of proving
disability. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). To qualify for
disability benefits, a claimant must show the “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).
A physical or mental impairment is “an impairment that results from
anatomical, physiological, or psychological abnormalities which are demonstrable
by medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C.
§ 423(d)(3).
The Social Security Administration (SSA) reviews an application for
disability benefits in three stages:
(1) initial determination, including
2
reconsideration; (2) review by an ALJ; and (3) review by the SSA Appeals Council.
See 20 C.F.R. § 404.900(a)(1)–(4).
When a claim for disability benefits reaches an ALJ as part of the
administrative process, the ALJ follows a five-step sequential analysis to determine
whether the claimant is disabled. The ALJ must determine the following:
(1)
whether the claimant is engaged in substantial gainful activity;
(2)
if not, whether the claimant has a severe impairment or
combination of impairments;
(3)
if so, whether that impairment or combination of impairments
meets or equals any “Listing of Impairments” in the Social
Security regulations;
(4)
if not, whether the claimant can perform his past relevant work
in light of his “residual functional capacity” or “RFC”; and
(5)
if not, whether, based on the claimant’s age, education, and work
experience, he can perform other work found in the national
economy.
20 C.F.R. § 416.920(a)(4); see Winschel v. Commissioner of Soc. Sec. Admin., 631
F.3d 1176, 1178 (11th Cir. 2011).
The Social Security regulations “place a very heavy burden on the claimant to
demonstrate both a qualifying disability and an inability to perform past relevant
work.” Moore, 405 F.3d at 1211. At step five of the inquiry, the burden temporarily
shifts to the Commissioner “to show the existence of other jobs in the national
economy which, given the claimant’s impairments, the claimant can perform.”
Washington v. Commissioner of Soc. Sec., 906 F.3d 1353, 1359 (11th Cir. 2018)
3
(quoting Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987)).
If the
Commissioner makes that showing, the burden then shifts back to the claimant to
show that he cannot perform those jobs. Id. So, while the burden temporarily shifts
to the Commissioner at step five, the overall burden of proving disability always
remains on the claimant. Id.
STANDARD OF REVIEW
The federal courts have only a limited role in reviewing a plaintiff’s claim
under the Social Security Act. The court reviews the Commissioner’s decision to
determine whether “it is supported by substantial evidence and based upon proper
legal standards.” Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997).
A.
With respect to fact issues, pursuant to 42 U.S.C. § 405(g), the
Commissioner’s “factual findings are conclusive if supported by ‘substantial
evidence.’” Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990). “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. Commissioner of
Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004).
In evaluating whether substantial evidence supports the Commissioner’s
decision, a district court may not “decide the facts anew, reweigh the evidence,” or
substitute its own judgment for that of the Commissioner. Winschel, 631 F.3d at
1178 (citation and quotation marks omitted); see Walden v. Schweiker, 672 F.2d 835,
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838 (11th Cir. 1982) (similar). If the ALJ’s decision is supported by substantial
evidence, the court must affirm, “[e]ven if the evidence preponderates against the
Commissioner’s findings.” Crawford, 363 F.3d at 1158 (quoting Martin, 894 F.2d
at 1529).
But “[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, 672 F.2d at 838 (citing Strickland v.
Harris, 615 F.2d 1103, 1106 (5th Cir. 1980)); see Walker v. Bowen, 826 F.2d 996,
999 (11th Cir. 1987). “The ALJ must rely on the full range of evidence . . . , rather
than cherry picking records from single days or treatments to support a conclusion.”
Cabrera v. Commissioner of Soc. Sec., No. 22-13053, 2023 WL 5768387, at *8 (11th
Cir. Sept. 7, 2023).
B. With respect to legal issues, “[n]o . . . presumption of validity attaches to
the [Commissioner’s] legal conclusions, including determination of the proper
standards to be applied in evaluating claims.” Walker, 826 F.2d at 999.
BACKGROUND
A.
Hodge’s personal and medical history
Hodge was born on January 15, 1971. Doc. 9-3 at 58. In 2009, he was in a
car accident; Hodge’s wife died in the accident, and Hodge fractured his hip, pelvis,
and spine. Doc. 9-3 at 59; Doc. 9-10 at 58.
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Throughout 2015 and into January 2016, Hodge presented to Central North
Alabama Health Services with chronic hip and back pain, which he was directed to
treat with medication. Doc. 9-9 at 5–17.
On May 24, 2019, Hodge presented to the Huntsville Hospital emergency
department with head pain based on a head injury from 4 weeks prior that had
required stitches and staples; he wanted the stitches and staples removed. Doc. 9-9
at 75–76. Hodge was alert and oriented and walked without assistance. Doc. 9-9 at
76. Hodge was cooperative, not in any acute distress or discomfort, had clear speech
with normal affect and orientation, and was able to respond appropriately. Doc. 99 at 76.
On December 1, 2020, Hodge presented to the Huntsville Hospital emergency
department and was sent to the behavioral sciences department for a psychiatric
evaluation. Doc. 9-9 at 81. Hodge was noncompliant with his medication for bipolar
disorder and schizophrenia and was not able to stay focused in order to have a
conversation; he was having auditory and visual hallucinations but no suicidal
ideation. Doc. 9-9 at 87. Hodge had pressured speech amounting to “word salad”
and an agitated affect. Doc. 9-9 at 87. Hodge stated that he “never” engaged in
substance abuse. Doc. 9-9 at 87. His psychosis was noted to be worsening due to
noncompliance with medication. Doc. 9-9 at 88. Hodge was diagnosed with
psychosis and was voluntarily admitted. Doc. 9-9 at 93. He was discharged against
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medical advice on December 3, 2020. Doc. 9-9 at 83. Hodge was discharged with
prescriptions for Depakote, Olanzapine, and paliperidone (a monthly injection).
Doc. 9-9 at 95.
On December 11, 2020, Hodge reported to the Crestwood Medical Center
emergency department with back pain and requested a shot of Toradol for pain. Doc.
9-10 at 116. His behavior was appropriate, alert, cooperative, and oriented. Doc. 910 at 119. He said he had pain in his back and right hip at a level of 10 out of 10.
Doc. 9-10 at 120. Imaging showed mild degenerative changes in his lumbar spine.
Doc. 9-10 at 122.
On December 14, 2020, Hodge reported to the Huntsville Hospital emergency
department with “generalized achiness” and back and hip pain from his previous
injuries in 2009; he also stated that he was homeless and asked about laundry
services and food. Doc. 9-9 at 69–70. Hodge was well nourished, awake and alert,
cooperative, not in acute distress, and able to ambulate without difficulty. Doc. 9-9
at 71. His physical examination was normal. Doc. 9-9 at 71. He was diagnosed
with arthritis/chronic pain and homelessness. Doc. 9-9 at 71.
On December 15, 2020, Hodge reported to the Crestwood Medical Center
emergency department with chronic pain in his right hip that was worse because of
cold weather and because he was homeless. Doc. 9-10 at 108. He also had low back
pain, but his range of motion was normal. Doc. 9-10 at 108. He was diagnosed with
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arthritis, bursitis, and strain of his hip along with degenerative changes. Doc. 9-10
at 109, 114. Hodge requested a shot of Toradol for pain. Doc. 9-10 at 111.
On December 16, 2020, Hodge saw Dr. Berenice Serpas at the Huntsville
Family Health Center for his bipolar disorder. Doc. 9-9 at 111. He said he was
taking medication given to him by his sister, but he did not know what medication.
Doc. 9-9 at 111. The doctor could not complete a physical examination. Doc. 9-9
at 112. Hodge requested “pain pills” but was told he would need a chaperone in
order to receive pain medication. Doc. 9-9 at 112.
On December 17, 2020, Hodge presented at the Huntsville Hospital
emergency department for a psychiatric evaluation asking to be admitted to the
psychiatric floor based on homelessness and not having anywhere to go; he then
threatened to maybe “jump off a bridge or something.” Doc. 9-9 at 51–52. Hodge
was noncompliant with previous treatment recommendations and was not taking his
psychiatric medication. Doc. 9-9 at 52. Hodge complained of increased anxiety and
depression and reported auditory and visual hallucinations at night. Doc. 9-9 at 53.
His physical examination was normal. Doc. 9-9 at 53. Hodge stated that he wanted
to go back on his medication so that he could get off the streets, and said that he was
doing well otherwise. Doc. 9-9 at 58–59. He denied active hallucinations at the
time of examination and was “calm and appropriate” with “linear and organized”
thoughts. Doc. 9-9 at 59. A “psych screener disposition” from that same day noted
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that Hodge’s diagnosis was “malingering.” Doc. 9-9 at 64.
On December 22, 2020, Hodge presented at the Huntsville Hospital
emergency department complaining of chronic lower back and hip pain that had been
exacerbated by sleeping on the concrete floor at a homeless shelter. Doc. 9-9 at 45–
46. However, Hodge also reported that he had back and hip pain because he fell off
a bicycle. Doc. 9-9 at 46. Hodge was ambulatory but admitted that he was not taking
his bipolar medication; he had a bizarre affect and was “talking non-stop.” Doc. 99 at 46. The records show that Hodge appeared to be having a “flight of ideas” as
he was speaking rapidly and changing the subject. Doc. 9-9 at 46. Hodge appeared
well nourished, alert and oriented, cooperative, and was not in obvious discomfort;
he had rapid speech but was oriented and his responses were generally appropriate.
Doc. 9-9 at 47. Hodge had full range of motion but “mild discomfort” in his right
hip. Doc. 9-9 at 47.
On December 29, 2020, Hodge went to the Huntsville Hospital emergency
department complaining of issues with his teeth and pain in his right hip. Doc. 9-9
at 35–38. Hodge stated that he had suffered hip pain since his car accident in 2009.
Doc. 9-9 at 38. The record notes that it was “unclear if patient has had recent injury
or trauma to his hip as he is having flight of ideas on exam.” Doc. 9-9 at 38. A hip
x-ray showed “moderate to severe osteoarthritis of the right hip” and “postsurgical
changes within the pelvis.” Doc. 9-9 at 39. Hodge appeared well nourished, awake
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and alert, cooperative, ambulatory, and had clear but rapid speech and good
orientation.
Doc. 9-9 at 39.
Hodge was taking Depakote, Olanzapine, and
paliperidone psychiatric medications at the time. Doc. 9-9 at 42.
On December 31, 2020, Hodge presented to the Crestwood Medical Center
emergency department with bipolar disorder, hip pain, high blood pressure, and
diarrhea. Doc. 9-10 at 101. He was not taking his psychiatric medication. Doc. 910 at 101. He was concerned about getting COVID at “the mission.” Doc. 9-10 at
101. He was anxious but otherwise had normal mentation and memory. Doc. 9-10
at 102. He was diagnosed with arthritis pain and medication noncompliance. Doc.
9-10 at 102.
On January 17, 2021, Hodge reported to the Huntsville Hospital emergency
department complaining of right hip pain after he fell “while working at the mission”
and “hurt his hip again” after prior injuries in 2009. Doc. 9-9 at 26–27. The records
note that Hodge had a history of disability, bipolar, anxiety, schizophrenia, ADHD,
and homelessness, and had a car accident in 2009 that injured his pelvis. Doc. 9-9
at 27. Hodge reported that he accidentally slipped while working at the mission and
fell on his right hip. Doc. 9-9 at 27. Hodge was able to stand and walk at the scene
of the accident and at the hospital. Doc. 9-9 at 27. Hodge told the physician that he
needed to be admitted because he was suicidal, but could not “give a specific plan”
or explain why he was suicidal. Doc. 9-9 at 27. Hodge then asked to be admitted
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because he was homeless and it was cold outside. Doc. 9-9 at 27. Hodge was alert
and oriented upon three checks and walked without assistance. Doc. 9-9 at 27.
Hodge’s appearance was “[c]hronically ill appearing, disheveled, foul-smelling,
homeless, alert, awake, cooperative, no acute distress.” Doc. 9-9 at 28. He had clear
speech and orientation but a noted “bizarre affect,” though later notes showed
normal affect. Doc. 9-9 at 28. An x-ray of Hodge’s hip was “normal” and Hodge
“look[ed] just fine[,] he walks well.” Doc. 9-9 at 28. One diagnosis considered at
the visit was “malingering.” Doc. 9-9 at 29.
On January 28, 2021, Hodge filled out an adult disability report. Doc. 9-8 at
2. He stated that he could read and write more than just his name. Doc. 9-8 at 2.
He listed that he suffered from bipolar, schizophrenia, and delusions. Doc. 9-8 at 3.
He said that he stopped working on May 1, 1998, because of his conditions. Doc.
9-8 at 3. Hodge stated that he was a residential painter before then. Doc. 9-8 at 4.
He stated that he was taking Divalproex and Olanzapine for his mental health
conditions. Doc. 9-8 at 5.
On February 26, 2021, Hodge presented to the Crestwood Medical Center
emergency department requesting refills of his psychiatric medications and
medication for joint pain. Doc. 9-10 at 94. Hodge was negative for anxiety,
depression, and hallucinations. Doc. 9-10 at 94. He was pleasant and cooperative
with a calm affect and good orientation, but he had “flight of ideas” and could not
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concentrate. Doc. 9-10 at 95. He reported that he was out of his medication and that
he fell at the bicycle shop and hurt his hip. Doc. 9-10 at 97. He stated that his hip
pain was at a 6 or 8 out of 10. Doc. 9-10 at 97–98. His gait was not impaired and
was normal. Doc. 9-10 at 98.
On February 28, 2021, Hodge filled out an adult function report. Doc. 9-8 at
18–25. He stated that he has a plate in his head and problems with his spine and hip
from his car accident in 2009. Doc. 9-8 at 18. He stated that he lives in a house with
his sister. Doc. 9-8 at 18. He stated that his conditions affect his ability to do
“anything” and “all” his abilities to conduct personal care, without further specific
elaboration. Doc. 9-8 at 19. He stated that he needed reminders to cook and take
his medication, but also stated that he did not prepare his own meals. Doc. 9-8 at
20. He did not provide an explanation for why he could not prepare his own meals
beyond the word “wash.” Doc. 9-8 at 20.
Hodge did not address whether he did any chores, but checked a box that he
needed encouragement to do chores, and said that he went outside once per day “for
trash.” Doc. 9-8 at 20–21. He stated that he travelled by walking or riding a bicycle
because he did not know how to drive. Doc. 9-8 at 21. Hodge stated that he shopped
for food, but wrote “cant” in answer to how often and how long he shopped. Doc.
9-8 at 21. He stated that he was not able to handle money and that his sister helped
him. Doc. 9-8 at 21. Hodge listed “fishing” as a hobby. Doc. 9-8 at 22. Under
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questions about social activities, Hodge wrote that he could not read. Doc. 9-8 at
22. He also stated that he needed his sister to accompany him places and that he had
problems getting along with people. Doc. 9-8 at 22. In answer to whether there had
been any change in his social activities since his conditions began, Hodge wrote
“need education.” Doc. 9-8 at 22. Hodge checked every box in the list of abilities
that his conditions affected. Doc. 9-8 at 23. He stated that he cannot walk far, can
only pay attention “just a little,” and finds it very hard to follow written instructions.
Doc. 9-8 at 23. He stated that he had previously been fired for failing to interact
well with people and that he did not handle stress well. Doc. 9-8 at 24.
Also on February 28, 2021, Angie Westrope—Hodge’s sister—filled out a
third-party adult function report. Doc. 9-8 at 29. Westrope stated that Hodge lived
in her house with her. Doc. 9-8 at 29. She stated that Hodge cannot work because
he is “like a kid mentally” and has plates in his head and hip. Doc. 9-8 at 29. She
stated that Hodge did not “know much about caring for himself” and tended to spend
his days talking to himself and to people who were not there. Doc. 9-8 at 30. She
stated that Hodge does not sleep much without medication, but has no problem with
personal care. Doc. 9-8 at 30. However, she stated that he needs reminders to
change clothes after he showers, and that she has to give him his medication. Doc.
9-8 at 31. She stated that he can prepare his own meals but only sandwiches, whereas
he used to be able to make full meals. Doc. 9-8 at 31. She stated that he does not
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remember how to do chores and never finishes tasks, and that she has to tell him to
pick up his belongings “like a kid.” Doc. 9-8 at 31. She stated that he can shop in
stores for “junk food” when he goes with her to go shopping. Doc. 9-8 at 32.
Westrope said that Hodge cannot handle money except to count change, and will
“blow” money or give it away. Doc. 9-8 at 32. She stated that his hobbies included
fishing, watching television, and “playing with toys,” and that he did those things
daily. Doc. 9-8 at 33. She stated that Hodge “talks fast and makes no sense,” cannot
socialize without her, and cannot get along with people because he says “ugly”
things and “cusses people out.” Doc. 9-8 at 34. She stated that he “doesn’t know
how to do the things he used to do” and that his conditions affect all of his abilities
except for hearing, seeing, and using his hands. Doc. 9-8 at 34. Westrope stated
that Hodge’s back and hip hurt all the time, that he can only walk about a block, that
he can only pay attention for a “couple minutes,” that he does not finish what he
starts, and that he cannot read well. Doc. 9-8 at 34. She stated that he could follow
spoken instructions “okay sometimes.” Doc. 9-8 at 34. She stated that he did not
handle stress well and that his ability to handle changes in routine depended on his
mood. Doc. 9-8 at 35.
On March 22, 2021, Hodge reported to the Crestwood Medical Center
emergency department with hip pain and a request for a medication refill. Doc. 910 at 86, 89. He stated that his hip was hurting after helping his sister “move some
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plants around.” Doc. 9-10 at 89. He stated that his pain was at a 6 or 8 out of 10.
Doc. 9-10 at 86, 89. He had a normal gait but pain and decreased range of motion
in his right hip. Doc. 9-10 at 86. Hodge was “pleasant, cooperative” with a calm
affect, and had good orientation, and normal judgment/insight. Doc. 9-10 at 86.
Hodge denied using drugs. Doc. 9-10 at 89. No cognitive or functional deficits were
noted. Doc. 9-10 at 91. Hodge was diagnosed with arthritis, bursitis, and strain in
his hip, and his psychiatric medications were refilled. Doc. 9-10 at 87.
On April 1, 2021, Hodge had a telehealth visit with Jasmine Milloy at
Wellstone Medical for outpatient therapy. Doc. 9-10 at 2. Hodge had an appropriate
mood/affect, normal orientation, and was “alert, somewhat engaged and presented
with congruent thought process.” Doc. 9-10 at 3. Hodge’s sister was present at the
session and described Hodge as being “manic at times” and not getting good sleep.
Doc. 9-10 at 4. Hodge stated that his anxiety was “over the roof” and that he
generally watched television in his room until his sister got home. Doc. 9-10 at 4.
Hodge was experiencing auditory hallucinations but not delusions. Doc. 9-10 at 4.
Hodge stated that he was compliant with his medication. Doc. 9-10 at 4.
On April 5, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical, stating that he had “a lot of problems.” Doc. 9-10 at 45. Hodge could not
coherently describe his symptoms, and said that he was hearing voices “all the time”
and “seeing things” and they talked to him about “stealing people’s wallets and
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magic brooms.” Doc. 9-10 at 45. He was not compliant with his medication and
appeared delusional and disorganized. Doc. 9-10 at 45. Hodge reported anger issues
and a history of homelessness as well as bipolar disorder and schizophrenia. Doc.
9-10 at 45. Hodge was anxious and restless. Doc. 9-10 at 46. Hodge reported using
crystal meth in his twenties and most recently four months previously, though he
had previously denied a history of substance abuse. Doc. 9-10 at 45, 47. He was
diagnosed with uncontrolled schizophrenia. Doc. 9-10 at 48. Hodge was described
as unkempt but cooperative, alert, oriented, and appropriate with non-linear,
illogical, and tangential thought processes, anxious irritable mood, and poor
judgment and insight. Doc. 9-10 at 49. Hodge’s medication was changed and
increased. Doc. 9-10 at 49.
On May 17, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical, stating that he needed “something for [his] nerves.” Doc. 9-10 at 39.
Hodge reported hallucinations and paranoia, as well as high anxiety and depression.
Doc. 9-10 at 39. Hodge reported that he had taken a trip to Mobile and Pensacola to
try to find work, but came back after “getting ripped off” and deciding that the
homeless shelters there were not as nice. Doc. 9-10 at 39. Hodge’s sister reported
that Hodge walked around manically and had delusional thought content and
constant shaking.
Doc. 9-10 at 39.
However, Hodge’s erratic behavior was
somewhat improved. Doc. 9-10 at 39. Hodge’s schizoaffective disorder was listed
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as “not controlled”; he was cooperative and had appropriate behavior but had
pressured speech and illogical tangential thought processes. Doc. 9-10 at 42.
Seroquel was added to his medication regimen and he was directed to continue
taking Depakote. Doc. 9-10 at 43.
On May 25, 2021, Hodge saw Jasmine Milloy at Wellstone Medical. Doc. 910 at 5. He had appropriate affect/mood and normal orientation, he was “alert,
engaged and presented with a congruent thought process.” Doc. 9-10 at 6. Hodge
reported that he was “doing well” and that his mood was stable and his “only concern
is not sleeping.” Doc. 9-10 at 7. Hodge stated that he “helps his sister around the
house with chores to keep himself busy.” Doc. 9-10 at 7. He denied hallucinations
or delusions and reported that he was compliant with his medication. Doc. 9-10 at
7.
On May 29, 2021, Hodge underwent a consultative examination with nurse
practitioner James Van Hise. Doc. 9-10 at 58–64. Van Hise noted that Hodge was
taking multiple medications, including mental health injections every four weeks,
and that he suffered from bipolar disorder, schizophrenia, delusions, and lower back
pain. Doc. 9-10 at 58. Hodge reported that schizophrenia and delusions had the
greatest impact on his life, that he heard voices mostly while alone, and that he had
frequent anxiety and panic attacks around groups of people. Doc. 9-10 at 58. Hodge
stated that his medication helped reduce his anxiety and hallucinations but gave him
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dry mouth—which Van Hise stated did not limit his ability to take the medication.
Doc. 9-10 at 58. Hodge stated that he was in a car accident in 2009, in which his
wife had died and he had fractured his hip, pelvis, and spine, and that he still had
pain in his lower back and legs at a level of 8 out of 10. Doc. 9-10 at 58. Van Hise
reported that Hodge was rambling and off topic and needed to be refocused. Doc.
9-10.
Van Hise noted that Hodge had “no difficulty” with sitting, standing, or
walking, and was able to independently cook/meal prep, bathe and dress, and do
laundry and housekeeping, but he needed assistance with shopping, banking, and
driving. Doc. 9-10 at 59. Hodge appeared well groomed, alert, and oriented, and
was cooperative and appropriate. Doc. 9-10 at 59. He had no paraspinal tenderness
in his back and had negative straight leg raise. Doc. 9-10 at 60. He had normal
strength, dexterity, and sensation. Doc. 9-10 at 60. He had no difficulty getting on
and off an examination table, walking on his heels, walking on his toes, or squatting
and rising, and had normal gait and station. Doc. 9-10 at 61. He did not use any
assistance device. Doc. 9-10 at 61. Hodge had normal range of motion. Doc. 9-10
at 61–63.
Van Hise filled out a medical source statement opining that Hodge had no
limitations in sitting or standing and could perform those actions continuously, had
no limitations in walking, had no limitations in lifting and carrying and could carry
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around an estimated 10 to 15 pounds continuously on both sides, and had
psychological limitations due to auditory hallucinations and an inability to stay
focused on conversations. Doc. 9-10 at 63.
On June 21, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical, reporting that he was “antsy” and could not sit still. Doc. 9-10 at 33.
Otherwise, Hodge reported doing “okay” and having a fair mood, though he had
“frequent pacing” and “fidgeting” legs. Doc. 9-10 at 33. He had difficulty sleeping
and spent his time “hanging out at the house, watching tv, doing dishes, cutting the
grass.” Doc. 9-10 at 33. Hodge’s sister reported that Hodge was “doing much
better” but was “still like a toddler” with poor impulse control and a tendency to say
offensive things, and that she had to re-do the chores he did. Doc. 9-10 at 33. Hodge
had a history of chronic pain but “no mobility limitations.” Doc. 9-10 at 33–34.
Hodge was taking psychiatric medications including Depakote and Seroquel. Doc.
9-10 at 34. Hodge was diagnosed with stable schizophrenia. Doc. 9-10 at 35. He
was cooperative, alert, and coherent with appropriate behavior and linear, logical
thought but an anxious mood. Doc. 9-10 at 36.
On June 29, 2021, Hodge had a mental health consultative examination with
Jack Bentley, Ph.D. Doc. 9-10 at 66. Bentley stated that Hodge suffered from a
chronic pain syndrome after his car accident injuries in 2009. Doc. 9-10 at 66.
Bentley noted that Hodge had some arthritis in his right hip and degenerative disc
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disease in his back. Doc. 9-10 at 66. Bentley noted that Hodge had suffered a
traumatic brain injury in 2018 after being attacked with a piece of rebar. Doc. 9-10
at 66. Bentley noted that Hodge had PTSD from his 2009 car accident and had panic
attacks in public places. Doc. 9-10 at 66. Bentley stated that Hodge reported taking
Toradol for his physical pain, and psychiatric medications that “only slightly
improve his symptoms,” and that Hodge was hospitalized for psychiatric reasons in
2020 but left after 3 days against medical advice. Doc. 9-10 at 66. Bentley noted
that Hodge had a traumatic youth, and that Hodge described himself as a “slow
learner” and “barely literate.” Doc. 9-10 at 67. Bentley stated that Hodge was last
employed in 2009 as a residential painter. Doc. 9-10 at 67.
Bentley performed a mental status examination. Doc. 9-10 at 67. Hodge’s
appearance was disheveled and his grooming was poor; he also showed “numerous
pain related behaviors during the interview.” Doc. 9-10 at 67. Bentley stated that
Hodge appeared to be a low functioning adult, but that there were no limitations in
his receptive or expressive communication skills and that his memory was intact.
Doc. 9-10 at 67. His mood was dysphoric, as was his affect, and he showed anxiety
and agitation when discussing his 2009 car accident. Doc. 9-10 at 67. Hodge “did
not exhibit any unusual or peculiar behaviors” and showed “no evidence of bizarre
mentation.” Doc. 9-10 at 67. Bentley noted evidence of moderate to severe sleep
disturbance. Doc. 9-10 at 67. Bentley stated that Hodge “rarely attends church” and
20
that he is usually socially isolated because most of his friends are deceased, so he
mostly socialized with his sister. Doc. 9-10 at 67. Bentley stated that Hodge
completes activities of daily living with no assistance but denied specific hobbies.
Doc. 9-10 at 67.
Bentley diagnosed Hodge with PTSD, probable borderline intellectual
functioning, depressive disorder with anxiety, and orthopedic injuries sustained in
his car accident. Doc. 9-10 at 67. Bentley opined that Hodge was competent to
manage funds, that his prognosis for his current level of functioning was favorable,
and that there was no evidence of symptom exaggeration. Doc. 9-10 at 68. Bentley
stated that Hodge would have “marked limitations in his ability to perform complex
or repetitive work-related activities” and moderate limitation for simple tasks and in
his ability to communicate with coworkers and supervisors. Doc. 9-10 at 68.
Bentley stated that “most of [Hodge’s] work related restrictions would stem from
his numerous health problems rather [than] psychiatric symptoms” and those
limitations would need to be addressed by a physician. Doc. 9-10 at 68.
On August 2, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical, stating that he was doing “pretty good” but was having problems sleeping.
Doc. 9-10 at 26. He reported some mood swings but denied hallucinations or
paranoia. Doc. 9-10 at 26. He reported frequent anxiety and nervousness and
shaking in his hands. Doc. 9-10 at 26. Hodge’s sister reported that he was “doing
21
much better” and had “much more reality-based” conversations, and he was “even
preparing food for himself.” Doc. 9-10 at 27. Hodge reported pacing and leg
shaking, but said he experienced those things before starting his psychiatric
medication. Doc. 9-10 at 27. He stated that he slept a lot during the day. Doc. 910 at 27. Hodge was diagnosed with uncontrolled anxiety and stable schizophrenia.
Doc. 9-10 at 28–29. He was cooperative, alert, and coherent with appropriate
behavior and affect and logical, linear thought processes. Doc. 9-10 at 29–30.
On August 10, 2021, Hodge saw Dr. Berenice Serpas at the Huntsville Family
Health Center for chronic back pain from his car accident, nervousness, and chronic
shakes. Doc. 9-9 at 107. Hodge was taking psychiatric medication given to him by
his sister, apparently including Olanzapine and propranolol, though Hodge was not
sure what he was taking. Doc. 9-9 at 108. Hodge had joint pain, back pain, and
jerks in his left leg. Doc. 9-9 at 109. He reported depression and anxiety. Doc. 9-9
at 109. He had reduced range of motion and pain in his right hip and right knee.
Doc. 9-9 at 110. He had good insight and judgment but was anxious. Doc. 9-9 at
110.
On September 13, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical with a chief complaint that he had been “kinda sad since [his] brother
passed.” Doc. 9-10 at 20. Hodge’s sister reported that otherwise Hodge had been
“doing well,” though he was “skiddish” and his legs were shaky. Doc. 9-10 at 20.
22
Hodge reported frequently crying. Doc. 9-10 at 20. Hodge was diagnosed with
uncontrolled anxiety and stable schizophrenia. Doc. 9-10 at 22–23. He was
cooperative, oriented, alert, and coherent with appropriate behavior and affect and
linear, logical thought processes. Doc. 9-10 at 23–24.
On October 2, 2021, Hodge reported to the Crestwood Medical Center
emergency department with hip pain and toothache. Doc. 9-10 at 78. Hodge had
pain and decreased range of motion in his right leg. Doc. 9-10 at 78. He was alert,
oriented, and had clear and appropriate speech and behavior. Doc. 9-10 at 78, 81–
82. He was diagnosed with arthritis in his hip after imaging showed degenerative
changes and prescribed Toradol. Doc. 9-10 at 79, 84. Hodge was ambulatory. Doc.
9-10 at 82. No cognitive or functional defects were noted. Doc. 9-10 at 82–83.
On October 12, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical, reporting that he was “still depressed.” Doc. 9-10 at 14. Hodge reported
that he stayed in bed most of the time. Doc. 9-10 at 14. He was friendly and
conversed appropriately with “no overt psychosis or mania.” Doc. 9-10 at 14.
Hodge was taking multiple psychiatric medications including Depakote, Lexapro,
propranolol, and trazodone. Doc. 9-10 at 15. His depression was listed as “not
controlled” and his schizophrenia was listed as “stable.” Doc. 9-10 at 17. Hodge
was cooperative, alert, and coherent with appropriate behavior, linear logical thought
processes, and an appropriate affect. Doc. 9-10 at 17.
23
On November 12, 2021, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical, reporting that he was not sleeping well. Doc. 9-10 at 8. Hodge reported
that his mood had been “pretty good,” denied depression, stated he was not having
mood swings like in the past, denied hallucination, and denied paranoia. Doc. 9-10
at 8. Hodge was doing well but his sister reported that he lacked “motivation” and
was not very active. Doc. 9-10 at 8. She reported that Hodge would go outside to
smoke or take the dogs out, but otherwise spent most of the day “in his bed or on the
couch.” Doc. 9-10 at 8. His schizophrenia was “well-controlled” and he had not
had significant behavior problems. Doc. 9-10 at 8. Hodge reported “chronic pain.”
Doc. 9-10 at 9. Hodge was taking multiple psychiatric medications including
Depakote, Lexapro, propranolol, and trazodone. Doc. 9-10 at 9. Hodge’s depression
was listed as “controlled” and his schizophrenia was listed as “stable.” Doc. 9-10 at
10.
Hodge was cooperative with appropriate behavior, good orientation and
alertness, and was coherent with linear but illogical thought processes. Doc. 9-10 at
11. He had appropriate affect, good attention and concentration, and limited
judgment and insight. Doc. 9-10 at 12.
On November 16, 2021, Hodge saw Dr. Warren Everett at the Huntsville
Family Health Center for headaches and diarrhea. Doc. 9-9 at 102. He did not report
any pain. Doc. 9-9 at 102. Hodge was taking psychiatric medication given to him
by his sister, apparently including Olanzapine, propranolol, and trazodone, though
24
Hodge was not sure what he was taking. Doc. 9-9 at 103. Hodge had reduced range
of motion and pain in his right hip and right knee. Doc. 9-9 at 105. He had good
insight and judgment but was anxious. Doc. 9-9 at 105.
On March 18, 2022, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical. Doc. 9-10 at 128. Hodge reported that he was not sleeping well. Doc. 910 at 128. Hodge had depressed mood and low energy. Doc. 9-10 at 128. A
neighbor had called the police on him because he was stopping cars in the street to
ask for money. Doc. 9-10 at 128. His psychosis was classified as partially
controlled, with his depression not controlled. Doc. 9-10 at 130. His medication
was adjusted to add Wellbutrin to his regimen that already included Depakote,
propranolol, and trazodone. Doc. 9-10 at 133.
On May 25, 2022, Hodge saw nurse practitioner Ian Kinzer at Wellstone
Medical. Doc. 9-10 at 123. He reported that he spent most of the day in bed, was
having auditory hallucinations, and had bad mood swings; he had poor judgment and
impulse control and had a tendency to dig in the trash for food even though his sister
made sure he was fed. Doc. 9-10 at 123. Hodge had not been taking his Depakote
for two months. Doc. 9-10 at 123. His schizoaffective disorder was classified as
not controlled. Doc. 9-10 at 125. He had mild poverty of speech but was otherwise
oriented and appropriate. Doc. 9-10 at 125.
25
B.
Social Security proceedings
1.
Initial application and denial of benefits
On December 7, 2020, Hodge applied for SSI benefits under Title XVI of the
Social Security Act based on alleged disability due to bipolar disorder,
schizophrenia, and delusions. Doc. 9-4 at 2; Doc. 9-7 at 2–13. In his application,
Hodge alleged that he became disabled on June 1, 1998. Doc. 9-4 at 2. On August
11, 2021, Hodge’s application for benefits was denied at the initial level based in
part on a finding by agency consultant Gloria Roque, Ph.D. that Hodge had mild to
moderate limitations and no marked or severe mental impairments. Doc. 9-4 at 2–
15.
On September 15, 2021, Hodge filed a request for reconsideration of the initial
denial of benefits. Doc. 9-5 at 11, 14. On December 6, 2021, Hodge’s application
was again denied at the reconsideration level based in part on a finding by D.
Glanville that Hodge had only moderate mental limitations and no marked or severe
mental impairment, and a finding by Dr. Krishna Reddy that Hodge could perform
work with some exertional, postural, and environmental limitations. Doc. 9-4 at 16–
27.
Hodge requested a hearing before an ALJ (Doc. 9-5 at 22), and a telephonic
hearing was held on May 24, 2022 (Doc. 9-3 at 51–54).
On July 18, 2022, the ALJ issued an unfavorable decision, finding that Hodge
26
was not disabled under the Social Security Act. Doc. 9-3 at 23–45.
2.
ALJ hearing
On May 24, 2022, the ALJ held a telephonic hearing on Hodge’s application
for SSI benefits. Doc. 9-3 at 51–54. During the hearing, Hodge testified that he
lived with his sister, though she wanted him to move out because he drank her coffee.
Doc. 9-3 at 55–56. He testified that he was not working because he was “disabled,”
as he “broke [his] hip and pelvis in a car wreck, and [he] can’t walk.” Doc. 9-3 at
55. Hodge testified that he does not help his sister with chores, he just “l[ies] in bed
and look[s] at the wall.” Doc. 9-3 at 56. Hodge testified that he had no income and
previously had been “on the streets for a long time” because he was homeless. Doc.
9-3 at 56. Hodge testified that he could not work because he could not “climb ladders
no more and do stuff like that, yardwork, or anything like that . . . because [he] can’t
walk on [his] own,” and he could not sit in hard chairs because it caused pain due to
screws in his pelvis. Doc. 9-3 at 57. He testified that he can only sit for about 5
minutes before he has to get up and walk around. Doc. 9-3 at 57.
Hodge testified that he had not worked since 2009, and that he could not do a
job that allowed him to move between sitting and standing because he did not have
an education, had only gone through seventh grade in school, and did not know how
to read or write. Doc. 9-3 at 58. Hodge testified that he was schizophrenic and
bipolar, and that he had dropped out of school because he got married in seventh
27
grade and had nine children, all of whom are now adults. Doc. 9-3 at 58. Hodge
testified that he and his wife were in a car accident in 2009 in which his wife had
died and which had left him “handicapped.” Doc. 9-3 at 59. He stated that he had
not worked since the accident. Doc. 9-3 at 59. Hodge said he had not healed “much”
since the accident and still had “scars and everything all over [his] body.” Doc. 9-3
at 59.
The ALJ asked Hodge what he does all day and Hodge answered, “[n]othing,
just walk the streets . . . well I used to when I had a bicycle” but the bicycle “tore
up” so he traded it for a tent. Doc. 9-3 at 60. The ALJ asked if Hodge had been able
to ride a bicycle and Hodge said that he was “barely” able to do so because the gears
were “messed up” and it hurt his hip to ride. Doc. 9-3 at 60. Hodge testified that he
would previously ride his bicycle around the block, but it broke about a year prior to
the hearing and he could not ride it. Doc. 9-3 at 60. Hodge testified that previously
he had spent time sleeping outside in a tent and searching through garbage for food,
but that he would not be able to do that anymore because “[ly]ing on concrete hurts
[his] hip” and he cannot sleep at night. Doc. 9-3 at 61.
Hodge testified that he was hospitalized for schizophrenia in December 2020
after his sister had him admitted. Doc. 9-3 at 62. He testified that he had been
receiving treatment for schizophrenia over the past year and was still receiving
treatment that included appointments to “get a shot in [his] arm.” Doc. 9-3 at 62–
28
63. Hodge testified that he was having delusions, and that he saw and heard things
including his dead wife, and that he had bad dreams and got scared at night. Doc.
9-3 at 63. Hodge testified that he had “pretty severe arthritis” in his left hip and
degenerative disc disease in his lower back, and that his arms hurt all the time and
his “brain hurts, because [he] got hit in the head with a crowbar” when someone
tried to kill him three years prior. Doc. 9-3 at 63. Hodge testified that he could only
stand for about 10 minutes at a time before he had to sit down due to pain, and that
he could not walk around the block because he had breathing issues. Doc. 9-3 at 64.
Hodge testified that he could not bend at the waist, crawl, squat, kneel, or fully
extend his arms over his head due to pain. Doc. 9-3 at 64. He testified that he could
lift a gallon of milk, but not repetitively, and that the only thing he did all day was
lie in bed. Doc. 9-3 at 65. Hodge testified that he does not cook anything because
he does not know how to cook and that he does not help with any chores at his sister’s
house. Doc. 9-3 at 65. He testified that he does not do any grocery shopping and
does not do any socializing or go to church because all of his friends and family are
dead. Doc. 9-3 at 66.
Hodge testified that he is able to dress himself but sometimes falls down. Doc.
9-3 at 66. Hodge testified that he takes “a lot of medication” every night and every
morning but did not know what he takes. Upon questioning from the ALJ, Hodge
testified that he had not always taken his medication the year prior, but that he was
29
compliant at the time of the hearing. Doc. 9-3 at 67. The ALJ asked whether Hodge
“had any problems since [he] started taking his medicines again” and Hodge said,
“[n]o, not since I got out of the hospital.” Doc. 9-3 at 67. The ALJ asked what was
keeping Hodge from working and Hodge said it was “mostly” his “hip and stuff
hurting [him] all the time.” Doc. 9-3 at 67. He said he could not climb ladders
anymore because of his hip, which he used to do when he worked painting houses
and as a handyman at an apartment complex where he worked for his rent. Doc. 93 at 68.
Vocational Expert (VE) Debra Civils then testified that a hypothetical
individual with Hodge’s age and education and who could perform medium work
with the limitations posed by the ALJ would be able to perform jobs in the national
economy, including hand-packager, cleaner, and laundry worker. Doc. 9-3 at 69–
71. Counsel for Hodge then asked the VE if a hypothetical individual who was off
task 15% of the day and absent at least 2 days per month would be able to find
employment and the VE said that employers typically only tolerated 10% off-task
behavior and 1 absence per month. Doc. 9-3 at 72.
3.
ALJ decision
On July 18, 2022, the ALJ entered an unfavorable decision. Doc. 9-3 at 23.
In the decision, the ALJ found “[a]fter careful consideration of all the evidence,”
including “the complete medical history consistent with 20 C.F.R. 416.912,” that
30
Hodge “was not under a disability within the meaning of the Social Security Act
since December 7, 2020, the date the application was filed.” Doc. 9-3 at 27.
The ALJ applied the five-part sequential test for disability (see 20 C.F.R.
§ 416.920(a); Winschel, 631 F.3d at 1178). Doc. 9-3 at 27–28. The ALJ found that
Hodge had not engaged in substantial gainful activity since the application date of
December 7, 2020, and had the following severe impairments: “schizophrenia,
depression, anxiety, trauma, borderline intellectual functioning, and osteoarthrosis.”
Doc. 9-3 at 29. In determining Hodge’s severe impairments, the ALJ also considered
that Hodge was obese, but found that his obesity did not qualify as severe. Doc. 93 at 29. The ALJ found that Hodge did not have an impairment or combination of
impairments that met or medically equaled the severity of one of the impairments
listed in the applicable Social Security regulations.
Doc. 9-3 at 21–22.
In
determining that Hodge’s mental impairments did not meet or equal any listed
impairments, the ALJ considered the opinions of state agency consultants Roque and
Glanville, found them persuasive, and found that Hodge had only moderate
limitations in understanding, remembering, or applying information; interacting
with others; concentrating, persisting, or maintaining pace; and managing himself.
Doc. 9-3 at 32.
The ALJ determined Hodge’s RFC (or residual functional capacity), finding
that Hodge had the RFC to “perform medium work,” except that he could
31
occasionally lift and/or carry including upward pulling of 50 pounds; could
frequently lift and/or carry including upward pulling of 25 pounds; could sit for 6
hours in an 8-hour workday with normal breaks; could stand and/or walk with
normal breaks for 6 hours in an 8-hour workday; could push and/or pull including
operation of hand or foot controls without limitation; could lift and carry without
limitation; could occasionally climb ramps and stairs; could occasionally stoop;
could frequently kneel, crouch, and crawl; could not work on ladders, ropes,
scaffolds, unprotected heights, or around dangerous machinery; could not work with
heavy vibration; could learn, recall, and use information to perform uninvolved
instructions and work-related procedures with a reasoning development level of 1 or
2; could not perform detailed tasks; could focus and concentrate on uninvolved
instructions and tasks for 2-hour periods over an 8-hour workday and 40-hour
workweek with normal breaks and without interruption of psychological symptoms;
could relate to and work with supervisors, coworkers, and the general public on an
occasional basis; and could only have infrequent changes in his work environment.
Doc. 9-3 at 32–33.
The ALJ stated that the ALJ had considered all of Hodge’s symptoms and the
extent to which they reasonably could be accepted as consistent with the evidence.
Doc. 9-3 at 33. The ALJ also stated that the ALJ had considered any medical
opinions and prior administrative medical findings in accordance with 20 C.F.R.
32
§ 420.920c. Doc. 9-3 at 33.
In assessing Hodge’s RFC and the extent to which his symptoms limited his
function, the ALJ stated that the ALJ “must follow” the required “two-step process”:
(1) “determine[] whether there is an underlying medically determinable physical or
mental impairment[] . . . that could reasonably be expected to produce the claimant’s
pain or other symptoms”; and (2) “evaluate the intensity, persistence, and limiting
effects of the claimant’s symptoms to determine the extent to which they limit the
claimant’s work-related activities.” Doc. 9-3 at 33.
According to the ALJ, “whenever statements about the intensity, persistence,
or functionally limiting effects of pain or other symptoms are not substantiated by
objective medical evidence, the [ALJ] must consider other evidence in the record to
determine if the claimant’s symptoms limit the ability to do work-related activities.”
Doc. 9-3 at 33.
The ALJ stated that “after careful consideration of the evidence” the ALJ
found that Hodge’s “medically determinable impairments could reasonably be
expected to cause the alleged symptoms; however, [Hodge’s] statements concerning
the intensity, persistence, and limiting effects of these symptoms are not entirely
consistent with the medical evidence and other evidence in the record for the reasons
explained in this decision.” Doc. 9-3 at 33.
The ALJ then provided a detailed summary of Hodge’s medical records. Doc.
33
9-3 at 33. The ALJ found that Hodge attended the emergency room with complaints
of hip and low back pain after sleeping on the ground in December 2020 through
March 2021 and had a history of a broken hip in 2009. Doc. 9-3 at 33–34. The ALJ
found that Hodge was also seen for being noncompliant with his medication for his
psychological conditions, and signed forms for voluntary admission to the hospital
despite stating in his function report that he could not read. Doc. 9-9 at 34. The ALJ
found that noncompliance with his medications resulted in Hodge talking fast and
having a “bizarre affect.” Doc. 9-3 at 34. The ALJ found that examination and
imaging of Hodge’s hip were largely normal, that he was ambulatory, and that at one
point Hodge requested admission to the hospital because he was suicidal, but then
had no suicidal plan and said he wanted to be admitted because it was cold outside.
Doc. 9-3 at 34. The ALJ found that Hodge reported to the emergency room with hip
pain, but had been helping his sister move plants and—despite rating his pain at an
8 out of 10—was in no apparent distress and interacted normally. Doc. 9-3 at 34.
The ALJ also found that Hodge had gone to the doctor asking for pain pills at one
point. Doc. 9-3 at 34.
The ALJ then summarized Hodge’s records from Wellstone Medical, finding
that Hodge exhibited symptoms including delusions and disorganized presentation,
and that Hodge stated that he had no trouble with reading or writing. Doc. 9-3 at
34–35. The ALJ found multiple inconsistencies in Hodge’s records, including that
34
he denied substance abuse history but also reported previously using
methamphetamine.
Doc. 9-3 at 35.
The ALJ summarized Hodge’s visits to
Wellstone Medical with psychiatric symptoms and the attempts to regulate his
medication, then found that with medication Hodge was doing “okay” and then
doing well as his medication regimen was adjusted, until Hodge was “doing well”
and his schizophrenia was “well controlled” after he was “prescribed the right
medication regimen.” Doc. 9-3 at 35. The ALJ found that, while Hodge reported
not doing as well in May 2022, he had not been taking his Depakote and still had
good attention, concentration, and normal vocabulary and was well groomed,
oriented, and coherent. Doc. 9-3 at 35. The ALJ found that, even when he presented
for physical complaints, Hodge was alert, oriented, cooperative, appropriate, and in
no acute distress. Doc. 9-3 at 35.
The ALJ summarized Hodge’s consultative examination with Van Hise,
finding that Hodge’s functional status showed no difficulty sitting, standing, or
walking. Doc. 9-3 at 35. The ALJ found that Hodge’s ranges of motion and strength
were normal, he had no difficulty performing various physical motions, he had
normal gait and station, and he did not need an assistance device. Doc. 9-3 at 36.
The ALJ found that Van Hise opined that Hodge had no limitations in sitting,
standing, walking, lifting, or carrying, but could only lift 15 pounds continuously on
both sides. Doc. 9-3 at 36. The ALJ stated that the ALJ did not consider any
35
opinions from Van Hise regarding Hodge’s psychological limitations because
psychology was not Van Hise’s area of specialty. Doc. 9-3 at 36.
The ALJ then provided a comprehensive summary of Bentley’s psychological
consultative examination, finding that Bentley stated that Hodge had PTSD after his
2009 car accident. Doc. 9-3 at 36. The ALJ found that Bentley opined that Hodge’s
impairment level for simple tasks and communication would be moderate and that
most of Hodge’s work-based restrictions would stem from his physical health
problems rather than his psychiatric symptoms. Doc. 9-3 at 36.
The ALJ found that Hodge’s “allegations are not consistent with the evidence
based upon this inconsistency with the objective medical evidence.” Doc. 9-3 at 36.
The ALJ went on to find that, throughout the period at issue, “the medical evidence
shows that when the claimant is compliant with medication, his mental symptoms
improve,” but that Hodge had not been taking his medication as directed at his most
recent medical visit. Doc. 9-3 at 37. The ALJ found that, nonetheless, Hodge still
had good attention and concentration, was neatly groomed, and was oriented and
coherent. Doc. 9-3 at 37. The ALJ found that Hodge had only been hospitalized for
his mental impairments once and on that occasion he left against medical advice,
and that the record contained numerous inconsistencies including the following: that
Hodge said he was socially isolated but he went “to the mission,” that Hodge said
he spent all day in bed but the record showed that he engaged in activities such as
36
shopping for groceries, washing dishes, and going to the mission, that riding a bike
and mowing the lawn were inconsistent with his professed hip pain, and that he
purportedly went to Mobile and Pensacola looking for work but said he could not
work. Doc. 9-3 at 37.
The ALJ found that Hodge had low back pain and hip pain, but he routinely
had normal medical examinations and imaging showed no disorder that would
prevent medium work; the record also did not show a reason for surgery or a
recommendation for physical therapy or other treatment modalities. Doc. 9-3 at 37.
The ALJ found that Hodge routinely had normal gait and station and normal
examinations. Doc. 9-3 at 37. The ALJ found that, to the extent that Hodge sought
to argue that a lack of treatment was due to financial constraints, such an argument
was not persuasive. Doc. 9-3 at 37.
The ALJ considered the third-party function report submitted by Hodge’s
sister, finding that Westrope claimed that Hodge could not work because he was like
a child, but that she also reported that Hodge had no problems with personal care,
though he needed reminders to shower, change clothes, and take his medication, and
that he could make sandwiches but not cook. Doc. 9-3 at 37–38. The ALJ found
that Westrope reported that Hodge did not know how to do things, went outside
frequently, could shop for junk food, had hobbies including going fishing, tended to
make no sense, and interacted poorly with other people. Doc. 9-3 at 38.
37
The ALJ found Westrope’s statement “probative, but not entirely persuasive,”
finding that Westrope lacked medical training to make medical observations, and
that her statement was “largely inconsistent with the objective medical evidence and
medical opinions of record as discussed more fully above.” Doc. 9-3 at 38. The
ALJ also stated that the ALJ could not “be confident that [Westrope’s] statement
was free of bias” because of her relationship with her brother, and that her statement
could not “outweigh the accumulated medical evidence to find the claimant’s
impairments to be resulting in greater limitation than found in this decision.” Doc.
9-3 at 38.
The ALJ then assessed the medical opinions and prior administrative medical
findings. Doc. 9-3 at 38. The ALJ again provided a detailed summary of Bentley’s
consultative examination, finding that Bentley opined that Hodge would have
marked limitations in his ability to perform complex or repetitive work-related
activities. Doc. 9-3 at 39. The ALJ found Bentley’s opinion that Hodge would have
marked limitations to be “partially credible,” agreeing with the finding that Hodge
could not perform complex work activities, but finding that the opinion about
repetitive work was not persuasive because no part of the record supported that
limitation. Doc. 9-3 at 39. The ALJ found that Bentley’s opinion that Hodge would
have moderate impairment in completing simple tasks and communicating with
coworkers and supervisors was persuasive and consistent with the medical evidence
38
showing that, when Hodge was compliant with his medication, his symptoms
improved. Doc. 9-3 at 39.
The ALJ also considered the consultative examination of Van Hise. Doc. 93 at 39. The ALJ provided a detailed summary of Van Hise’s examination and
opinions and found them “probative but not entirely persuasive,” finding that the
opinion about the limitation that Hodge could only lift and carry an estimated 10 to
15 pounds was speculative and conclusory based on his normal examination, and
that the opinion about Hodge’s psychological limitations was likewise conclusory
and speculative as it was not consistent with the record or Van Hise’s examination.
Doc. 9-3 at 40.
The ALJ considered the opinions of the state agency consultants and found
the opinions of moderate physical limitations persuasive. Doc. 9-3 at 41. The ALJ
found that the opinions of state agency psychological consultants Roque and
Glanville were not entirely consistent with the ALJ’s findings because they lacked
clarity, were vague, were not well explained or specific, and lacked sufficient
information to usefully define Hodge’s limitations. Doc. 9-3 at 41. The ALJ then
more specifically examined and addressed the opinions. Doc. 9-3 at 41–42. The
ALJ found that the opinions were “persuasive or not persuasive insofar as they are
consistent with the evidence of record as a whole and support a finding that the
claimant is ‘not disabled.’” Doc. 9-3 at 42.
39
The ALJ found that Hodge’s “impairments are not incapacitating to the extent
alleged,” finding that Hodge testified and “understandably may honestly believe that
his impairments are totally disabling,” but the ALJ considered “the totality of all of
the other evidence in the record” and found Hodge’s allegations not entirely
consistent with the evidence of record. Doc. 9-3 at 43.
The ALJ then found that Hodge had no past relevant work and that,
considering Hodge’s RFC, age, education, work experience, and the testimony of
the VE, Hodge was capable of performing jobs existing in significant numbers in the
national economy. Doc. 9-3 at 43–44. Therefore, the ALJ found that Hodge had
not been disabled under the Social Security Act since the December 7, 2020
application date through the date of the decision. Doc. 9-3 at 44.
4.
Appeals Council decision
On July 26, 2022, Hodge appealed the ALJ’s decision to the Appeals Council.
Doc. 9-6 at 38–40. On December 9, 2022, the Appeals Council denied Hodge’s
request for review of the ALJ’s July 18, 2022 decision, finding no reason to review
the ALJ’s decision. Doc. 9-3 at 7–11. Because the Appeals Council found no reason
to review the ALJ’s decision, the ALJ’s decision became the final decision of the
Commissioner. See 42 U.S.C. § 405(g).
DISCUSSION
Having carefully considered the record and briefing, the court concludes that
40
the ALJ’s decision was supported by substantial evidence and based on proper legal
standards.
I.
The ALJ’s decision properly was based on the multi-part “pain
standard.”
As an initial matter, the ALJ’s decision properly was based on the multi-part
“pain standard.” While Hodge argues in his brief that the ALJ failed to properly
evaluate his complaints consistent with the Eleventh Circuit pain standard (Doc. 15
at 5–7), the ALJ’s decision properly tracks the controlling law.
When a claimant attempts to establish disability through his own testimony
concerning pain or other subjective symptoms, the multi-step “pain standard”
applies. That “pain standard” requires (1) “evidence of an underlying medical
condition,” and (2) either “objective medical evidence confirming the severity of the
alleged pain” resulting from the condition, or that “the objectively determined
medical condition can reasonably be expected to give rise to” the alleged symptoms.
Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002); see Raper v.
Commissioner of Soc. Sec., 89 F.4th 1261, 1277 (11th Cir. 2024); 20 C.F.R.
§ 416.929 (standard for evaluating pain and other symptoms).
Then, according to both caselaw and the applicable regulations, an ALJ “will
consider [a claimant’s] statements about the intensity, persistence, and limiting
effects of [his] symptoms,” and “evaluate [those] statements in relation to the
objective medical evidence and other evidence, in reaching a conclusion as to
41
whether [the claimant is] disabled.” 20 C.F.R. § 416.929(c)(4); see Hargress v.
Social Sec. Admin., Comm’r, 883 F.3d 1302, 1307 (11th Cir. 2018).
Here, the ALJ’s decision articulated and tracked that controlling legal
standard. In analyzing Hodge’s RFC, and the extent to which Hodge’s symptoms
limited his functioning, the ALJ’s decision reasoned that the ALJ “must follow” the
required “two-step process”:
(1) “determine[] whether there is an underlying
medically determinable physical or mental impairment[] . . . that could reasonably
be expected to produce the claimant’s pain or other symptoms”; and (2) “evaluate
the intensity, persistence, and limiting effects of the claimant’s symptoms to
determine the extent to which they limit the claimant’s work-related activities.”
Doc. 9-3 at 33. The ALJ found at the first step of the pain standard that Hodge’s
“medically determinable impairments could reasonably be expected to cause [his]
alleged symptoms.” Doc. 9-3 at 33. The ALJ then proceeded to the second step of
the pain standard and found that Hodge’s “statements concerning the intensity,
persistence, and limiting effects of these symptoms are not entirely consistent with
the medical evidence and other evidence in the record for the reasons explained in
this decision.” Doc. 9-3 at 33. Thus, the ALJ’s decision properly applied the multipart pain standard, and properly provided sufficient reasoning to demonstrate that
the ALJ had conducted the correct legal analysis. See Doc. 15 at 3.
42
II.
Substantial evidence supported the ALJ’s decision to discredit Hodge’s
subjective testimony regarding his impairments and associated
symptoms.
Furthermore, substantial evidence supported the ALJ’s decision not to credit
Hodge’s subjective testimony regarding his impairments and symptoms.
A.
The Eleventh Circuit requires that an ALJ must articulate explicit
and adequate reasons for discrediting a claimant’s subjective
testimony.
Under controlling Eleventh Circuit law, an ALJ must articulate explicit and
adequate reasons for discrediting a claimant’s subjective testimony. Wilson, 284
F.3d at 1225. A claimant can establish that he is disabled through his “own
testimony of pain or other subjective symptoms.” Dyer v. Barnhart, 395 F.3d 1206,
1210 (11th Cir. 2005).
An ALJ “will not reject [the claimant’s] statements about the intensity and
persistence of [his] pain or other symptoms or about the effect [those] symptoms
have” on the claimant’s ability to work “solely because the available objective
medical evidence does not substantiate [those] statements.”
20 C.F.R.
§ 416.929(c)(2).
So, when an ALJ evaluates a claimant’s subjective testimony regarding the
intensity, persistence, or limiting effects of his symptoms, the ALJ must consider all
of the evidence, objective and subjective. 20 C.F.R. § 416.929. Among other things,
the ALJ considers the nature of the claimant’s pain and other symptoms, his
43
precipitating and aggravating factors, his daily activities, the type, dosage, and
effects of his medications, and treatments or measures that he has to relieve the
symptoms. See 20 C.F.R. § 416.929(c)(3).
Moreover, the Eleventh Circuit has been clear about what an ALJ must do, if
the ALJ decides to discredit a claimant’s subjective testimony “about the intensity,
persistence, and limiting effects of [his] symptoms.” 20 C.F.R. § 416.929(c)(4). If
the ALJ decides not to credit a claimant’s subjective testimony, the ALJ “must
articulate explicit and adequate reasons for doing so.” Holt v. Sullivan, 921 F.2d
1221, 1223 (11th Cir. 1991).
“A clearly articulated credibility finding with substantial supporting evidence
in the record will not be disturbed by a reviewing court.” Foote v. Chater, 67 F.3d
1553, 1562 (11th Cir. 1995); see Mitchell v. Commissioner of Soc. Sec., 771 F.3d
780, 792 (11th Cir. 2014) (similar). “The credibility determination does not need to
cite particular phrases or formulations but it cannot merely be a broad rejection
which is not enough to enable . . . [a reviewing court] to conclude that the ALJ
considered [the claimant’s] medical condition as a whole.” Dyer, 395 F.3d at 1210
(quotation marks and alterations omitted). 1 “The question is not . . . whether [the]
1
The Social Security regulations no longer use the term “credibility,” and have
shifted the focus away from assessing an individual’s “overall character and
truthfulness”; instead, the regulations now focus on “whether the evidence
establishes a medically determinable impairment that could reasonably be expected
to produce the individual’s symptoms and[,] given the adjudicator’s evaluation of
44
ALJ could have reasonably credited [the claimant’s] testimony, but whether the ALJ
was clearly wrong to discredit it.” Werner v. Commissioner of Soc. Sec., 421 F.
App’x 935, 939 (11th Cir. 2011).
B.
The ALJ properly explained the decision not to credit Hodge’s
subjective testimony regarding his impairments and symptoms,
and substantial evidence supported that decision.
The ALJ properly explained the decision to discredit Hodge’s subjective
testimony regarding his symptoms of his physical and mental impairments, and
substantial evidence supported the ALJ’s decision.
In his brief, Hodge argues that the ALJ improperly assessed Hodge’s physical
capability to perform medium work because objective records showed moderate to
severe osteoarthritis and degenerative changes in Hodge’s hip and back and Hodge
frequently sought medical attention for pain in his hip and back. Doc. 15 at 8–10.
Hodge also argues that the ALJ did not properly consider his mental impairments
because the record was replete with symptoms of debilitating mental illness and
because the ALJ mischaracterized and over-relied upon Hodge’s daily activities,
when the activities were actually very limited. Doc. 15 at 11–17. However, the
the individual’s symptoms, whether the intensity and persistence of the symptoms
limit the individual’s ability to perform work-related activities.” Hargress, 883 F.3d
at 1308 (quoting SSR 16-3p, 81 Fed. Reg. 14166, 14167, 14171 (March 9, 2016)).
But, generally speaking, a broad assessment of “credibility” still can apply where
the ALJ assesses a claimant’s subjective complaints about symptoms and
consistency with the record. Id. at 1308 n.3.
45
ALJ’s decision shows that the ALJ properly took the entire record into account
without cherry-picking, and that the ALJ articulated explicit and adequate reasons
for discrediting Hodge’s testimony. See Cabrera, 2023 WL 5768387, at *8 (“The
ALJ must rely on the full range of evidence . . . , rather than cherry picking records
from single days or treatments to support a conclusion.”). Moreover, review of the
record shows that substantial evidence supported the decision.
The ALJ explicitly articulated the basis for finding Hodge’s testimony not
entirely credible. The ALJ found that, while Hodge’s underlying impairments could
reasonably be expected to cause Hodge’s alleged symptoms, Hodge’s “statements
concerning the intensity, persistence, and limiting effects of these symptoms are not
entirely consistent with the medical evidence and other evidence in the record”—for
reasons that the ALJ explained in the decision. Doc. 9-3 at 33; see supra Background
B.3 (ALJ decision). The ALJ went on to find that Hodge’s “allegations are not
consistent with the evidence based upon their inconsistency with the objective
medical evidence.” Doc. 9-3 at 36. The ALJ also found that Hodge’s “impairments
are not incapacitating to the extent alleged” because, although Hodge testified and
“understandably may honestly believe that his impairments are totally disabling,”
the ALJ considered “the totality of all of the other evidence in the record” and found
Hodge’s allegations not entirely consistent with the evidence of record. Doc. 9-3 at
43.
Accordingly, the ALJ provided an explicit statement of the reasons for
46
discrediting Hodge’s subjective testimony. Wilson, 284 F.3d at 1225.
Moreover, the ALJ provided detailed bases in the record evidence for that
articulation of the reasons not to fully credit Hodge’s subjective testimony. In
determining Hodge’s RFC (and citing 20 C.F.R. § 416.920c and SSR 16-3p), the
ALJ stated that the ALJ considered “all symptoms and the extent to which these
symptoms can reasonably be accepted as consistent with the objective medical
evidence and other evidence” and considered any medical opinions and prior
administrative medical findings. Doc. 9-3 at 33. The ALJ included information
based on both objective and subjective evidence (see 20 C.F.R. § 416.929),
providing detailed and lengthy summaries of Hodge’s medical records, consultative
examinations, and third-party function report, as well as Hodge’s own allegations
and testimony. Doc. 9-3 at 33–43.
When providing that summary and considering the record, the ALJ did not
shy away from finding elements of the record that could support Hodge’s claim for
disability; the ALJ found that Hodge had reported to the hospital multiple times
reporting pain in his hip and back, that he presented to Wellstone Medical with
delusions and disorganized presentation, and that his sister reported that he acted
like a child. Doc. 9-3 at 33–38. However, the ALJ also found numerous facts in the
record that undermined or were inconsistent with Hodge’s allegations. The ALJ
found that Hodge had symptomatic psychosis on multiple occasions, but that those
47
occasions tended to occur when he was not compliant with his medication, and he
reported doing “okay” or doing well when he was compliant with his medication.
Doc. 9-3 at 34–35. The ALJ further found that imaging did not tend to show severe
injury to Hodge’s hip or back, and that Hodge routinely had normal physical
examinations, was ambulatory, presented relatively normally, and appeared in no
acute distress despite reporting severe pain. Doc. 9-3 at 34–37. The ALJ found
multiple instances of outright contradiction in the record, including conflicting
evidence regarding Hodge’s ability to read and write, conflicting evidence regarding
past drug abuse, and conflicting evidence regarding Hodge’s daily activities. Doc.
9-3 at 34–37. The ALJ also considered several instances in which Hodge reported
to the hospital with alleged pain or suicidal tendencies, but upon follow-up
questioning simply sought admission due to homelessness or sought pain pills. Doc.
9-3 at 34.
The ALJ considered that Van Hise opined that Hodge had no difficulty sitting,
standing, or walking, had no difficulty performing physical activities such as
squatting, and had normal gait and station. Doc. 9-3 at 36. Additionally, the ALJ
considered Bentley’s opinion that Hodge’s restrictions would stem more from his
physical health issues than his psychological issues. Doc. 9-3 at 36.
Not only did the ALJ engage in a lengthy and detailed recitation of the
evidence of Hodge’s condition and make an explicit finding of inconsistency, the
48
ALJ also did not entirely discredit Hodge’s testimony about his symptoms. Instead,
the ALJ incorporated parts of Hodge’s testimony in the RFC determination by
limiting Hodge to medium work and providing additional restrictions including
disallowing climbing of ladders—consistent with Hodge’s testimony about his
physical pain—and limiting him to uninvolved instructions and no detailed tasks,
only occasional interaction with others, and infrequent changes in environment.
Doc. 9-3 at 33. Accordingly, the ALJ did not entirely discredit or discount Hodge’s
testimony.
In short, the ALJ’s decision and RFC determination accounted for Hodge’s
credible subjective testimony regarding his impairments, related pain, and other
symptoms, and included the necessary “explicit and adequate reasons” for
discrediting Hodge’s subjective testimony that he could not work on account of his
alleged impairments. Wilson, 284 F.3d at 1225. The breadth of the ALJ’s review
shows that the ALJ “considered [Hodge’s] medical condition as a whole,” and the
decision was not just a “broad rejection” of Hodge’s subjective testimony. Dyer,
395 F.3d at 1210.
Further, substantial evidence supports the ALJ’s decision not to credit
Hodge’s subjective testimony.
While the court cannot “decide the facts anew, reweigh the evidence,” or
substitute its own judgment for that of the Commissioner (Winschel, 631 F.3d at
49
1178), the record in this case is rife with information calling into question Hodge’s
subjective testimony. As an initial matter, Hodge’s medical records show at least
two incidents in which physicians considered whether Hodge was simply
malingering. Doc. 9-9 at 29, 64. The record also shows multiple instances in which
Hodge reported to doctors or hospitals with complaints of pain, but was seeking pain
pills, admission to get off the street, or other services. Doc. 9-9 at 27, 51–52, 69–
70, 112.
The record contains numerous instances of clear contradiction between
Hodge’s testimony regarding his condition and his condition as evidenced by
objective and subjective evidence in the record. Hodge testified that he could not
walk (Doc. 9-3 at 55), but medical records show that he routinely was able to walk
normally without assistance when he reported for medical care (see, e.g., Doc. 9-9
at 27, 46, 71, 76; Doc. 9-10 at 82, 86, 98); Hodge also reported to Ian Kinzer that he
had chronic pain but no mobility limitations (Doc. 9-10 at 33–34). Hodge reported
at least once that he never engaged in substance abuse (Doc. 9-9 at 87; Doc. 9-10 at
45), but also reported that he had a history of using crystal meth (Doc. 9-10 at 47).
Hodge stated multiple times that he did not go anywhere or socialize, but the records
reflect that he spent time at “the mission” (Doc. 9-9 at 26–27; Doc. 9-10 at 101).
Hodge stated that he could read or write more than his name in his disability report
(Doc. 9-8 at 2), and filled out a function report (Doc. 9-8 at 15–25), but also testified
50
that he could not read or write (Doc. 9-3 at 58). Hodge testified that he did not do
any shopping (Doc. 9-3 at 66), but Hodge’s sister reported in her third-party function
report that Hodge could shop for junk food (Doc. 9-8 at 32). Hodge testified that he
could not help his sister with chores (Doc. 9-3 at 56, 65), but medical records show
that Hodge reported that he helped his sister with chores to stay busy (Doc. 9-10 at
7). Despite stating that he was unable to work (Doc. 9-3 at 56–57), Hodge also
reported that at one point he went to Mobile and Pensacola to look for work, though
he returned in part because he did not like the homeless shelters there (Doc. 9-10 at
39).
Contrary to the argument in Hodge’s brief that the ALJ’s “determination that
[Hodge’s] symptoms improved to the point that he would be able to sustain the
mental demands of employment are not supported by substantial evidence” (Doc. 15
at 12; see Doc. 15 at 14 (similar)), the record also contains information, including
Hodge’s own testimony, indicating that his psychological impairments were greatly
improved by medication. When he was not compliant with his mediation, Hodge
suffered from evident psychosis, could not stay focused or have a conversation, and
had hallucinations. Doc. 9-9 at 28, 38, 46, 53, 87, 93; Doc. 9-10 at 45, 49, 101–02.
However, when he was compliant with his medication, Hodge presented much more
normally and was alert and engaged with congruent thought process and no
hallucinations or delusions. Doc. 9-10 at 7–10, 14–17, 20–24, 26–30, 33–35, 58, 67.
51
Between May and November 2021, Hodge regularly attended Wellstone Medical
with relatively normal presentation and stabilized schizophrenia. See Doc. 9-10 at
6–39. Hodge frequently presented to hospitals and doctors’ offices with clear
speech, appropriate responses, and normal affect and orientation. See, e.g., Doc. 99 at 71, 76; Doc. 9-10 at 59, 82–83, 86, 105, 110, 119. When Hodge began to have
severe symptoms again, he also reported that he had not been taking his Depakote
for two months. Doc. 9-10 at 123. Even then, Hodge was oriented and appropriate.
Doc. 9-10 at 125. Hodge also testified at his hearing that, since he started taking his
medicines again, he had not had any mental problems, and that it was mostly his hip
pain that kept him from working. Doc. 9-3 at 67. When Hodge underwent a mental
consultative examination with Bentley while compliant with his medication, Bentley
did note some mental-impairment-related limitations, but went so far as to opine that
Hodge’s work restrictions would stem more from his physical impairments—which
would need to be addressed by a physician—than from his psychiatric symptoms.
Doc. 9-10 at 68. All of these facts offer support for a finding that, when he was
compliant with his medication, Hodge’s mental impairments were not as disabling
as he alleged. See Werner, 421 F. App’x at 939 (“The question is not . . . whether
[the] ALJ could have reasonably credited [the claimant’s] testimony, but whether
the ALJ was clearly wrong to discredit it.”).
In addition, the record contains evidence suggesting that, while Hodge clearly
52
experienced pain in his hip and back, his physical condition was not so extreme as
to prevent him from performing medium level work with additional limitations.
Imaging of Hodge’s hip and back showed only mild degenerative changes or, at
worst, moderate to severe arthritis. Doc. 9-9 at 28; Doc. 9-10 at 66, 79, 84, 122. He
stated on multiple occasions that he could ride a bicycle and had only stopped
because the bicycle broke (Doc. 9-9 at 46; Doc. 9-10 at 97; Doc. 9-3 at 60), and at
one point he reported to the hospital that he had been helping his sister move plants
(Doc. 9-10 at 89). Upon examination of Hodge, consultative examiner Van Hise
found that Hodge had no difficulty with sitting, standing, or walking, had no
paraspinal tenderness and negative leg raise, had normal strength, dexterity, and
sensation, and had no difficulty with gait and station or various physical tasks. Doc.
9-10 at 61–63. Van Hise opined that Hodge had no physical limitations beyond a
limitation in continuously carrying more than 10 to 15 pounds per side. Doc. 9-10
at 63. Thus, the record contains evidence that Hodge’s physical limitations were not
disabling to the extent that he alleged.
While the record does also contain evidence supporting Hodge’s alleged
limitations, “[u]nder a substantial evidence standard of review, [a plaintiff] must do
more than point to evidence in the record that supports [his] position; [he] must show
the absence of substantial evidence supporting the ALJ’s conclusion.” Sims v.
Commissioner of Soc. Sec., 706 F. App’x 595, 604 (11th Cir. 2017) (citing Barnes
53
v. Sullivan, 932 F.2d 1356, 1358 (11th Cir. 1991)). Here, the record—including the
combination of the consultative evaluations, each of which found that Hodge’s
limitations would be primarily in the areas outside of the examiner’s expertise, see
Doc. 9-10 at 63, 68—includes sufficient facts to support the ALJ’s RFC finding of
medium work with additional restrictions and ultimate finding that Hodge was not
disabled. As explained above, substantial evidence requires “such relevant evidence
as a reasonable person would accept as adequate to support a conclusion.”
Crawford, 363 F.3d at 1158. In short, the record contains sufficient evidence of
inconsistencies and weaknesses in Hodge’s testimony about his symptoms and
limitations that the ALJ was not “clearly wrong” to discredit Hodge’s subjective
testimony (see Werner, 421 F. App’x at 939), and that a reasonable person would
accept as adequate to support the ALJ’s finding (see Crawford, 363 F.3d at 1158).
As a final note, Hodge also includes—without development—an argument
that the ALJ failed “to fully and fairly develop the record” (Doc. 15 at 18). But that
is not the case. An ALJ “has a basic duty to develop a full and fair record.” Henry
v. Commissioner of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir. 2015). However, the
claimant ultimately “bears the burden of proving that he is disabled, and,
consequently, he is responsible for producing evidence in support of his claim.”
Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003); see also 20 C.F.R.
§ 416.912(a) (“[I]n general, you have to prove to us that you are . . . disabled. You
54
must inform us about or submit all evidence known to you that relates to whether or
not you are . . . disabled.”). And, notwithstanding the ALJ’s responsibility to
develop a “full and fair” record, “there must be a showing of prejudice before it is
found that the claimant’s right to due process has been violated to such a degree that
the case must be remanded.” Graham v. Apfel, 129 F.3d 1420, 1422–23 (11th Cir.
1997). The Eleventh Circuit has instructed that “[t]he court should be guided by
whether the record reveals evidentiary gaps which result in unfairness or clear
prejudice.” Graham, 129 F.3d at 1423 (quotation marks omitted). Here, Hodge has
provided no basis for the court to find prejudice and the record contains no clear
evidentiary gaps; therefore, Hodge has not shown that the ALJ failed to fully and
fairly develop the record.
Thus, substantial evidence supported the ALJ’s decision in this case. And the
court must affirm an ALJ’s factual findings if they are supported by substantial
evidence, “[e]ven if the evidence preponderates against the Commissioner’s
findings.” Crawford, 363 F.3d at 1158 (quoting Martin, 894 F.2d at 1529).
CONCLUSION
For the reasons stated above (and pursuant to 42 U.S.C. § 405(g)), the court
AFFIRMS the Commissioner’s decision. The court separately will enter final
55
judgment.
DONE and ORDERED this March 26, 2024.
_________________________________
NICHOLAS A. DANELLA
UNITED STATES MAGISTRATE JUDGE
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