Alexander v. Social Security Administration, Commissioner

Filing 19

MEMORANDUM OPINION. Signed by Magistrate Judge John H England, III on 09/16/2022. (AKD)

FILED
2022 Sep-16 AM 09:24
U.S. DISTRICT COURT
N.D. OF ALABAMA

UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
JASPER DIVISION
VIKKIE ALEXANDER,
Plaintiff,
v.
COMMISSIONER OF SOCIAL
SECURITY ADMINISTRATION,
Defendant.

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Case Number: 6:20-cv-01862-JHE

MEMORANDUM OPINION1
Plaintiff Vikkie Alexander (“Alexander”) seeks review, pursuant to 42 U.S.C. § 405(g), §
205(g) of the Social Security Act, of a final decision of the Commissioner of the Social Security
Administration (“Commissioner”), denying her application for disabled widow’s benefits. (Doc.
1). Alexander timely pursued and exhausted her administrative remedies. This case is therefore
ripe for review under 42 U.S.C. §§ 405(g), 1383(c)(3). The undersigned has carefully considered
the record, and, for the reasons stated below, the Commissioner’s decision is REVERSED AND
REMANDED.
I. Factual and Procedural History
On November 19, 2018, Alexander protectively filed an application for disabled widow’s
benefits, alleging a disability onset date of September 25, 2014. (Tr. 85, 147-53, 155-61, 171).
After the agency initially denied her application, Alexander requested and appeared at a hearing
before an Administrative Law Judge (“ALJ”) on September 10, 2019. (Tr. 41-69). The ALJ issued

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In accordance with the provisions of 28 U.S.C. § 636(c) and Federal Rule of Civil
Procedure 73, the parties have voluntarily consented to have a United States Magistrate Judge
conduct any and all proceedings, including trial and the entry of final judgment. (See doc. 13).

an unfavorable decision on January 29, 2020, finding Alexander not disabled. (Tr. 20-39).
Alexander requested review of the ALJ’s decision, but the Appeals Council denied her request on
September 23, 2020. (Tr. 1-6). On that date, the ALJ’s decision became the final decision of the
Commissioner. On November 20, 2020, Alexander initiated this action. (See doc. 1).
Alexander was 50 years old on her alleged onset date and at the time the ALJ rendered the
decision. (Tr. 34, 152, 171). Alexander has a high school education and no relevant past work
experience. (Tr. 177). She alleges disability due to anxiety, depression, chronic obstructive
pulmonary disease (“COPD”), chronic allergies, rheumatoid arthritis, hyponatremia, restless leg
syndrome, heartburn, a small blockage in the neck, and low blood pressure. (Tr. 176).
II. Standard of Review2
The court’s review of the Commissioner’s decision is narrowly circumscribed. The
function of this Court is to determine whether the decision of the Commissioner is supported by
substantial evidence and whether proper legal standards were applied. Richardson v. Perales, 402
U.S. 389, 390 (1971); Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002). This Court must
“scrutinize the record as a whole to determine if the decision reached is reasonable and supported
by substantial evidence.” Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983).
Substantial evidence is “such relevant evidence as a reasonable person would accept as adequate
to support a conclusion.” Id. It is “more than a scintilla, but less than a preponderance.” Id.
This Court must uphold factual findings supported by substantial evidence. “Substantial
evidence may even exist contrary to the findings of the ALJ, and [the reviewing court] may have

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In general, the legal standards applied are the same whether a claimant seeks DIB or SSI.
However, separate, parallel statutes and regulations exist for DIB and SSI claims. Therefore,
citations in this opinion should be considered to refer to the appropriate parallel provision as
context dictates. The same applies to citations for statutes or regulations found in quoted court
decisions.
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taken a different view of it as a factfinder. Yet, if there is substantially supportive evidence, the
findings cannot be overturned.” Barron v. Sullivan, 924 F.2d 227, 230 (11th Cir. 1991). However,
the Court reviews the ALJ’s legal conclusions de novo because no presumption of validity attaches
to the ALJ’s determination of the proper legal standards to be applied. Davis v. Shalala, 985 F.2d
528, 531 (11th Cir. 1993). If the court finds an error in the ALJ’s application of the law, or if the
ALJ fails to provide the court with sufficient reasoning for determining the proper legal analysis
has been conducted, it must reverse the ALJ’s decision. Cornelius v. Sullivan, 936 F.2d 1143,
1145-46 (11th Cir. 1991).
III. Statutory and Regulatory Framework
To qualify for disability benefits and establish his or her entitlement for a period of
disability, a claimant must be disabled as defined by the Social Security Act and the Regulations
promulgated thereunder.3 The Regulations define “disabled” as “the inability to do any substantial
gainful activity by reason of any medically determinable physical or mental impairment which can
be expected to result in death or which has lasted or can be expected to last for a continuous period
of not less than twelve (12) months.” 20 C.F.R. § 404.1505(a). To establish entitlement to disability
benefits, a claimant must provide evidence of a “physical or mental impairment” which “must
result from anatomical, physiological, or psychological abnormalities which can be shown by
medically acceptable clinical and laboratory diagnostic techniques.” 20 C.F.R. § 404.1508.
The Regulations provide a five-step process for determining whether a claimant is disabled.
20 C.F.R. § 404.1520(a)(4)(i-v). The Commissioner must determine in sequence:
(1)
(2)
(3)

whether the claimant is currently employed;
whether the claimant has a severe impairment;
whether the claimant’s impairment meets or equals an impairment listed

The “Regulations” promulgated under the Social Security Act are listed in 20 C.F.R. Parts
400 to 499.
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(4)
(5)

by the [Commissioner];
whether the claimant can perform his or her past work; and
whether the claimant is capable of performing any work in the national
economy.

Pope v. Shalala, 998 F.2d 473, 477 (7th Cir. 1993) (citing to the formerly applicable C.F.R.
section), overruled on other grounds by Johnson v. Apfel, 189 F.3d 561, 562-63 (7th Cir. 1999);
accord McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986). “Once the claimant has satisfied
steps One and Two, she will automatically be found disabled if she suffers from a listed
impairment. If the claimant does not have a listed impairment but cannot perform her work, the
burden shifts to the [Commissioner] to show that the claimant can perform some other job.” Pope,
998 F.2d at 477; accord Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir. 1995). The Commissioner
must further show such work exists in the national economy in significant numbers. Id.
IV. Findings of the Administrative Law Judge
After consideration of the entire record and application of the sequential evaluation
process, the ALJ made the following findings:
At Step One, the ALJ found Alexander was the unmarried widow of the deceased insured
worker who had attained the age of 50.4 (Tr. 26). At Step Two, the ALJ found Alexander had the
following severe impairments: degenerative disc disease/osteoarthritis of the cervical and lumbar
spine; degenerative joint disease of the right knee; rheumatoid arthritis, with joint flexion
contracture deformity of the right elbow and left knee; sensory axonal peripheral neuropathy;
obesity; mild, non-occlusive carotid artery disease; a major depressive disorder; an anxiety

A claimant may be eligible for widow’s insurance benefits if she is between fifty and
sixty years of age and is under a disability that began within a prescribed period. See 42 U.S.C. §
402(e)(1)(B)(ii); 20 C.F.R. § 404.335(c). As the ALJ noted, the prescribed period in Alexander’s
case began on September 14, 2018, and ends on February 29, 2024, the date she is last entitled to
survivor’s benefits. (Tr. 26). See 42 U.S.C. § 402(e)(4); 20 C.F.R. § 404.335(c)(1).
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disorder; and COPD/allergic rhinitis. (Id.). At Step Three, the ALJ found Alexander did not have
an impairment or combination of impairments that meets or medically equals one of the listed
impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 37).
Before proceeding to Step Four, the ALJ determined Alexander’s residual functioning
capacity (“RFC”), which is the most a claimant can do despite her impairments. See 20 C.F.R. §
404.1545(a)(1). The ALJ determined Alexander had the RFC to perform a reduced range of light
work as defined in 20 CFR 404.1567(b), 416.967(b).5 (Tr. 29-30). The ALJ further explained:
Specifically, the claimant can occasionally lift and/or carry up to twenty pounds
and frequently lift/and or carry up to ten pounds. She can stand and/or walk in
combination, with normal breaks, for at least six hours during an eight-hour
workday and sit, with normal breaks, for up to eight hours during an eight hour
workday. The claimant can occasionally climb ramps and stairs and should never
climb ladders, ropes, or scaffolds. She can occasionally balance, stoop, kneel, and
crouch, but she can never crawl. She should not be required to perform overhead
work activities bilaterally. She can frequently perform fine and gross manipulations
with her hands bilaterally. She should not be required to work in exposure to
extreme heat, extreme cold, wetness, humidity, or areas of vibration. She can
tolerate occasional (as the term “occasional” is defined in the Dictionary of
Occupational Titles (or DOT)) exposure to pulmonary irritants including fumes,
dusts, odors, gases, and areas of poor ventilation. The claimant should avoid
exposure to industrial hazards including working at unprotected heights, working
in close proximity to moving dangerous machinery, and the operation of motorized
vehicles and equipment. She can perform simple, routine tasks requiring no more
than short, simple instructions and simple work-related decisionmaking with few
workplace changes. She can have frequent interactions with co-workers and
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“Light work” is defined as follows:

Light work involves lifting no more than 20 pounds at a time with frequent lifting
or carrying of objects weighing up to 10 pounds. Even though the weight lifted may
be very little, a job is in this category when it requires a good deal of walking or
standing, or when it involves sitting most of the time with some pushing and pulling
of arm or leg controls. To be considered capable of performing a full or wide range
of light work, you must have the ability to do substantially all of these activities. If
someone can do light work, we determine that he or she can also do sedentary work,
unless there are additional limiting factors such as loss of fine dexterity or inability
to sit for long periods of time.
20 C.F.R. 404.1567(b).
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supervisors and occasional interactions with members of the general public. The
claimant can adapt and respond appropriately to routine changes in the workplace.
(Id.).
At Step Four, the ALJ determined Alexander had no past relevant work. (Tr. 33). At Step
Five, the ALJ considered Alexander’s RFC in conjunction with testimony from a vocational expert
(“VE”) and found Alexander could perform other work available in the national economy,
including representative occupations such as small parts assembler, electronics worker, and
inspector/hand packager (Tr. 33-34). Therefore, the ALJ determined Alexander had not been
under a disability from September 14, 2018, through the date of the decision and denied
Alexander’s claim. (Tr. 34).
V. Analysis
Although the court may only reverse a finding of the Commissioner if it is not supported
by substantial evidence or because improper legal standards were applied, “[t]his does not relieve
the court of its responsibility to scrutinize the record in its entirety to ascertain whether substantial
evidence supports each essential administrative finding.” Walden v. Schweiker, 672 F.2d 835, 838
(11th Cir. 1982) (citing Strickland v. Harris, 615 F.2d 1103, 1106 (5th Cir. 1980)). The court,
however, “abstains from reweighing the evidence or substituting its own judgment for that of the
[Commissioner].” Id. (citation omitted).
Alexander contends the ALJ erred when she improperly evaluated and discounted
Alexander’s complaints of pain and other disabling symptoms. (Doc. 16 at 14-18). Specifically,
Alexander contends the ALJ’s finding that Alexander can frequently perform fine and gross
manipulations with her hands bilaterally is not supported by substantial evidence. (Id. at 13-14).
Alexander also contends the ALJ did not properly apply the Eleventh Circuit’s pain standard when
discounting Alexander’s other complaints of pain. (Id. at 15-18). Here, there is not substantial
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evidence to support the ALJ’s determination that Alexander could frequently perform fine and
gross manipulations with her hands bilaterally.
A. There is Not Substantial Evidence to Support the Finding that Alexander Can
“Frequently Perform Fine and Gross Manipulations with her Hands Bilaterally”
In determining that Alexander could perform a reduced range of light work, the ALJ found
that “[s]he can frequently perform fine and gross manipulations with her hands bilaterally.” (Tr.
30). “Frequently means occurring from one-third to two-thirds of the time.” See SSR 83-10.
Alexander contends her testimony proves that she is not able to perform fine and gross
manipulations with her hands on a frequent daily basis. (Doc. 16 at 14). At her administrative
hearing, Alexander testified as follows: “My left thumb does not bend in. My right end won’t bend
out. I can’t hold anything for 10 minutes. I drop something twice a week if I don’t grip it right.”
(Tr. 50). She further testified that her hands are so numb she has scalded herself because she
cannot feel how hot the water is. (Tr. 53). During the hearing the ALJ noted Alexander’s
“significant curvature of [t]he thumb joint” and asked Alexander if she could flex it and bring it
into her palm. (Id.). Alexander answered no. (Id.). The ALJ then noted for the record that the
tip of Alexander’s thumb joint “is curved out at almost 90 degrees.” (Id.).
The ALJ asked Alexander whether she had any flexion of that joint at all and she said no.
(Tr. 53-54). Alexander stated: “I can’t grip with my left thumb. On my right hand, I can grip, but
that’s as far as it goes out.” (Tr. 54). Alexander testified that she can carry a gallon of milk to the
cash register with her right hand, but if she had to hold it with her left she would drop it. (Tr. 5455). If she tries to type, Alexander testified she can feel the keys with her right hand, but her left
hand would soon start tingling and go numb. (Tr. 55).
When asked how often her hand gets numb, Alexander testified: “My hand is anything I
do. I can’t load the dishwasher or clothes. It tingles and cramps. My arm I can’t hang wash out
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anymore. Lifting up and down with the left arm makes it go numb.” (Tr. 60).
Alexander also testified that Dr. Saag suggested she get a cane to walk or stand, “but my
hands, I can’t hold on to it.” (Tr. 61). She explained that, “[i]f my knee comes out from under
me, this hand is not going to hold it with the knots and all.” (Tr. 61-62). Alexander also testified
that the bump on her wrist swells, and she has knots on her left elbow from arthritis. (Tr. 62).
Although Alexander alleged that her symptoms and conditions were disabling, a claimant
cannot establish disability based solely on subjective descriptions of pain and other symptoms. See
42 U.S.C. § 423(d)(5)(A). The Commissioner’s regulations at 20 C.F.R. § 404.1529, identify how
the ALJ evaluates subjective complaints. According to the regulations, medical signs or laboratory
findings must show there is a medical impairment that could reasonably be expected to produce
the symptoms alleged. See 20 C.F.R. § 404.1529(a), (b). If medical signs or laboratory findings
demonstrate the existence of such a medical impairment, the ALJ then evaluates the intensity and
persistence of the symptoms to determine how the symptoms limit the claimant’s capacity for
work. See 20 C.F.R. § 404.1529(c)(1).
Similar to the Commissioner’s two-step process for evaluating subjective complaints, 20
C.F.R. § 404.1529, the Eleventh Circuit’s pain standard requires: (1) evidence of an underlying
medical condition: and, either (2) objective medical evidence that confirms the severity of the
alleged pain arising from that condition, or (3) that the objectively determined medical condition
is of such a severity that it can be reasonably expected to give rise to the alleged pain. See Wilson
v. Barnhart, 284 F.3d 1219, 1227 (11th Cir. 2002). If the claimant has met the pain standard, the
ALJ still considers the intensity, persistence, and limiting effects of a claimant’s pain. See Foote
v. Chater, 67 F.3d 1553, 1561 (11th Cir. 1995). The Eleventh Circuit has recognized the
Commissioner’s regulations at 20 C.F.R. § 404.1529 are consistent with the Eleventh Circuit’s

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pain standard, and the ALJ need not quote the pain standard verbatim as long as the ALJ applies
it. See Wilson, 284 F.3d at 1225-26. A court “will not disturb a clearly articulated” finding about
subjective complaints supported by substantial evidence. See Mitchell v. Comm’r, Soc. Sec.
Admin., 771 F.3d 780, 782 (11th Cir. 2014).
When evidence documents an impairment that could reasonably be expected to produce
the symptoms alleged by a claimant, the ALJ then evaluates the intensity and persistence of the
symptoms to determine how the symptoms limit the claimant’s capacity for work. See 20 C.F.R.
§ 404.1529(c)(1); Foote v. Chater, 67 F.3d 1553, 1561 (11th Cir. 1995). Subjective complaint
evaluations are the province of the ALJ. See Moore, 405 F.3d at 1212. In making findings related
to a claimant’s subjective statements of symptoms and limitations, the ALJ must articulate specific
reasons for discounting the claimant’s statements and these reasons must be supported by
substantial evidence. See Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005); see also Foote,
67 F.3d at 1562 (“A clearly articulated credibility finding with substantial supporting evidence in
the record will not be disturbed by a reviewing court.”).
In evaluating a claimant’s subjective complaints, the ALJ considers objective medical
evidence and information from the claimant and treating or examining physicians, as well as other
factors such as evidence of daily activities, the frequency and intensity of pain, any precipitating
and aggravating factors, medication taken and any resulting side effects, and any other measures
taken to alleviate the claimant’s pain or other symptoms. See 20 C.F.R. § 404.1529(c)(2), (3); SSR
16-3p, 2017 WL 1119029, at *4-6; see also Dyer, 395 F.3d at 1212 (finding the ALJ “adequately
explained his reasons” for discounting claimant’s pain testimony where “the ALJ considered
[claimant’s] activities of daily living, the frequency of his symptoms, and the types and dosages
of his medications, and concluded that [claimant’s] subjective complaints were inconsistent with

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his testimony and the medical record”). When evaluating symptom intensity and persistence, the
ALJ also considers an individual’s attempts to seek medical treatment for symptoms and to follow
treatment once it is prescribed. See SSR 16-3p, 2017 WL 1119029, at *9-10.
In evaluating the extent to which a claimant’s symptoms, such as pain, affect her capacity
to perform basic work activities, the ALJ appropriately considers all of the available evidence,
including inconsistencies in the evidence, and the extent to which there are conflicts between
claimant’s statements and the rest of the evidence, including the history, signs and laboratory
findings, and statements by treating and non-treating sources or other persons about how the
symptoms affect the claimant. See 20 C.F.R. § 404.1529(c)(4); see also SSR 16-3p, 2017 WL
1119029, at *5 (“We must consider whether an individual’s statements about the intensity,
persistence, and limiting effects of his or her symptoms are consistent with the medical signs and
laboratory findings of record.”). However, Eleventh Circuit case law does not require an ALJ to
enumerate every factor in every decision. See Dyer, 395 F. 3d. at 1210 (holding that an ALJ’s
decision need only be explicit enough to enable a reviewing court to determine the reasoning
behind findings); Foote, 67 F.3d at 1561 (concluding that the ALJ need not cite to particular
phrases or formulations, but must provide reasons that would enable a reviewing court to conclude
that the ALJ considered the claimant’s medical condition as a whole).
In her decision, the ALJ evaluated Alexander’s subjective complaints regarding the use of
her hands, and, as with other complaints of pain, the ALJ found Alexander’s “medically
determinable impairments could reasonably be expected to cause the alleged symptoms; however,
[Alexander]’s statements concerning the intensity, persistence and limiting effects of these
symptoms are not entirely consistent with the medical evidence and the other evidence in the
record, for the reasons explained in this decision.” (Tr. 31).

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As to the limitation regarding use of Alexander’s hands, the ALJ acknowledged Alexander
alleges she suffers from, among other things, rheumatoid arthritis. (Tr. 30). The ALJ reviewed
Alexander’s hearing testimony regarding the limited use of her hands and noted that there would
be some manipulative (and other) limitations. (Tr. 30-31). However, the ALJ determined that
Alexander’s allegations of severe functional limitations related to her hands were not supported
by objective evidence. (Tr. 31-33). Specifically, the ALJ noted that a rheumatologist had observed
“bogginess” (abnormal texture) and tenderness in several of Alexander’s finger joints as well as
synovitis (i.e., inflammation) in her finger joints. (Tr. 31). The ALJ further noted Alexander had
exhibited some clinical signs of peripheral neuropathy and electrodiagnostic testing has revealed
the presence of mild sensory axonal peripheral neuropathy, as well as chronic C7 cervical
radiculopathy, in her left upper extremity. (Id.).
The ALJ determined Alexander’s testimony that she was extremely limited in the use of
her hands was inconsistent with record evidence demonstrating minimal weakness in her
extremities as well as inconsistent with the conservative treatment she received. (Tr. 32).
Furthermore, the ALJ noted more recent treatment from the rheumatology specialist documented
improvement with Alexander’s rheumatoid arthritis symptoms with the use of appropriate
medication. (Id.; see tr. 651-55 (noting RA symptoms improved on Enbrel and prednisone)). The
ALJ purportedly accommodated these limitations by limiting Alexander to no overhead work and
no more than frequent fine and gross manipulations with her hands. (Tr. 30).
Although the ALJ notes that Alexander’s symptoms improved with Enbrel and prednisone,
she fails to account for the concurrent report that Alexander’s left hand and left arm pain and
heaviness persisted and became worse with activity. (Tr. 651). These records also include that
Alexander presented with left elbow with RA nodules and a positive MTP squeeze on the left. (Tr.

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654).
Although there appears to be some evidence in the record that Alexander’s condition may
not be as severe as she alleges,6 there is not substantial evidence to support the ALJ’s determination
that she can “frequently perform fine and gross manipulations with her hands bilaterally.” Even
when records note improvement with medication, those same records recognize persistent pain
that worsens with activity. (Tr. 651).
On remand, the ALJ should reevaluate Alexander’s RFC and consider whether the relevant
medical evidence supports further functional limitations - particularly related to Alexander’s use
of her hands.
VI. Conclusion
Based on the foregoing, and upon careful consideration of the administrative record and
memoranda of the parties, the Commissioner of Social Security’s decision denying Alexander’s
claim for disabled widow’s benefits is REVERSED, and this action is REMANDED with
instructions to reevaluate Alexander’s RFC and consider the frequency she can perform fine and
gross manipulations with her hands bilaterally. A separate order will be entered.
DONE this 16th day of September, 2022.

_______________________________
JOHN H. ENGLAND, III
UNITED STATES MAGISTRATE JUDGE

Many of the records the ALJ cites are for issues unrelated to Alexander’s rheumatoid
arthritis. For example, the ALJ points to a counseling visit in June 2019 for depression. While
this record indicates Alexander has normal movement of her extremities (tr. 745), it is highly
unlikely that a counseling visit for depression would involve a physical exam.
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