Howell v. Social Security Administration, Commissioner
MEMORANDUM OPINION and ORDER DISMISSING CASE that the decision of the Commissioner is AFFIRMED costs are taxed against claimant as more fully set out in order. Signed by Judge C Lynwood Smith, Jr on 7/28/2017. (AHI)
2017 Jul-28 PM 12:09
U.S. DISTRICT COURT
N.D. OF ALABAMA
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
TAMMY W. HOWELL,
NANCY A. BERRYHILL, Acting
Commissioner, Social Security
Case No. 7:16-CV-1769-CLS
MEMORANDUM OPINION AND ORDER
Claimant, Tammy Howell, commenced this action on October 30, 2016,
pursuant to 42 U.S.C. § 405(g), seeking judicial review of a final adverse decision of
the Commissioner, affirming the decision of the Administrative Law Judge (“ALJ”),
and thereby denying her claim for a period of disability, disability insurance, and
supplemental security income benefits.
The court’s role in reviewing claims brought under the Social Security Act is
a narrow one. The scope of review is limited to determining whether there is
substantial evidence in the record as a whole to support the findings of the
Commissioner, and whether correct legal standards were applied. See Lamb v.
Bowen, 847 F.2d 698, 701 (11th Cir. 1988); Tieniber v. Heckler, 720 F.2d 1251, 1253
(11th Cir. 1983).
Claimant contends that the Commissioner’s decision is neither supported by
substantial evidence nor in accordance with applicable legal standards. Specifically,
claimant asserts that the ALJ improperly considered the medical opinions in the
record and improperly evaluated her fibromyalgia.1 Upon review of the record, the
court concludes that these contentions lack merit, and that the Commissioner’s ruling
is due to be affirmed.
The opinion of a treating physician “must be given substantial or considerable
weight unless ‘good cause’ is shown to the contrary.” Phillips v. Barnhart, 357 F.3d
1232, 1240-41 (11th Cir. 2004) (internal citations omitted). Good cause exists when
“(1) [the] treating physician’s opinion was not bolstered by the evidence; (2) [the]
evidence supported a contrary finding; or (3) [the] treating physician’s opinion was
conclusory or inconsistent with the doctor’s own medical records.” Id. (alterations
supplied). Additionally, the ALJ is not required to accept a conclusory statement
from a medical source, even a treating source, that a claimant is unable to work,
because a determination on the question of whether a claimant is disabled is not a
Claimant also stated in her opening brief that she was challenging the ALJ’s consideration
of her subjective reports of pain, and the ALJ’s development of the administrative record. See doc.
no. 8 (claimant’s brief), at ECF 4. Even so, she did not make any substantive argument about either
of those issues, and she has therefore waived the right to argue them. See Morrison v. Commissioner
of Social Security, 660 F. App’x 829, 832 (11th Cir. 2016) (“To preserve an issue for appeal, the
party must raise the ‘specific issue to the district court’ so that the district court has ‘an opportunity
to consider the issue and rule on it. . . . Generally, this means that the issue must be plainly and
prominently raised, with supporting arguments and citations to the evidence and to relevant
authority.”) (citations omitted).
medical opinion, but is, instead, a decision “reserved to the Commissioner.” 20
C.F.R. §§ 404.1527(d), 416.927(d).
Social Security regulations also provide that, in considering what weight to
give any medical opinion (regardless of whether it is from a treating or non-treating
physician), the Commissioner should evaluate: the extent of the examining or
treating relationship between the doctor and patient; whether the doctor’s opinion can
be supported by medical signs and laboratory findings; whether the opinion is
consistent with the record as a whole; the doctor’s specialization; and other evidence
of record. See 20 C.F.R. §§ 404.1527(c), 416.927(c). See also Wheeler v. Heckler,
784 F.2d 1073, 1075 (11th Cir. 1986) (“The weight afforded a physician’s conclusory
statements depends upon the extent to which they are supported by clinical or
laboratory findings and are consistent with other evidence as to claimant’s
Claimant asserts that the ALJ improperly considered the opinions of treating
physician Dr. Keisha Lowther and consultative physician Dr. Larry O. Skelton. Dr.
Lowther provided a Medical Source Statement dated October 25, 2011. She indicated
that claimant experienced symptoms of muscular pain, fatigue, joint pain, leg cramps,
and depression, all of which have been identified by the American College of
Rheumatology as being associated with fibromyalgia. She also indicated that
claimant experienced pain in the following areas: occiput; low cervical; trapezius;
lateral epicondyle; gluteal; and greater trochanter, all of which are relevant to a
fibromyalgia diagnosis. She rated claimant’s pain as falling within the “moderate to
moderately severe” range, with “moderate” being defined as “can do most activities
of daily living, self-care and work activity, but patient requires brief breaks to
complete activities,” and “moderately severe” defined as “symptoms and
abnormalities substantially interfere with the patient’s ability to do activities of daily
living, some activities of self-care, and work activity; the patient may start tasks, but
symptoms and abnormalities cause patient to abandon tasks.”2 More than three days
a month, claimant would experience pain so severe that she would be unable to
perform activities of daily living and some activities of self-care, might be confined
to a chair or bed, and would require continuing medications to effectuate her pain
management. Factors such as changing weather, fatigue, and stress would exacerbate
claimant’s pain. Claimant also experienced fatigue that was sufficiently severe to
decrease her ability to participate in ordinary activities by 50%. Her fatigue would
cause her to feel “unrefreshed” even after sleeping for an adequate amount of time.3
In a sustained work setting, claimant would be able to lift and carry a maximum of
five pounds occasionally and one pound frequently. She could stand and/or walk less
Tr. 598 (emphasis in original).
than two hours, and sit for less than six hours, during an eight-hour work day. She
could occasionally use her fingers, hands, and arms for grasping, manipulating
objects, and reaching. Dr. Lowther did not comment on claimant’s need for
additional work breaks, her cognitive functioning, or the overall effect of claimant’s
limitations on her ability to do work activities. She did indicate that claimant would
be absent from work about three times a month as a result of her impairments and
treatment, and that claimant had experienced the noted limitations since July 16,
The ALJ afforded Dr. Lowther’s Medical Source Statement only “some
weight” because Dr. Lowther’s opinion that claimant could perform less than a full
range of sedentary work “is just not supported by her own physical examination
findings on the claimant, which show little abnormalities.”5 That decision is
supported by the record. Despite claimant’s diagnosis of fibromyaliga and the
corresponding notations of back and other joint pain, Dr. Lowther consistently
reported that claimant demonstrated full range of motion, normal gait, and no motor
Dr. Skelton conducted a “disability physical” examination on September 10,
Tr. 535-39, 546-48, 666-78, 698-703.
2012. He stated that claimant complained of “fibromyalgia, with severe pain and
fatigue. Neuropoathy of all didgets [sic], lower back pain. States can not sit or stand
for any length of time. Not able to drive due to back and leg pain.”7 The clinical
examination that claimant’s gait was very slow, and she shuffled her feet, but she did
not use a cane or assistive device to ambulate. She could not squat and rise, or stand
on her toes or heels. She had normal range of motion in her fingers, wrists, elbows,
ankles, and knees, but abnormal range of motion in her cervical and lumbar spine,
both shoulders, and both hips.8 Dr. Skelton’s neurological examination findings
included intact cranial nerves, equal deep tendon reflexes, normal sensation in all
extremities, positive trigger points for fibromyalgia, and full grip strength, upper arm
strength, and lower leg strength. Claimant’s mood and affect were appropriate, and
her decision-making was normal. Dr. Skelton assessed fibromyalgia, peripheral
neuropathy, lower back pain, depression, and anxiety. His summary findings were
that claimant is “very vocal and complains of severe pain to any ROM of her body,”
and that “[a]ll trigger points for fibromyalgia are positive.”9 Dr. Skelton did not
comment on what functional limitations claimant might experience as a result of her
Tr. 685 (alteration supplied).
The ALJ afforded Dr. Skelton’s assessment “some weight” because, “while the
claimant certainly may have some fibromyalgia pain, the physical findings during
[Dr. Skelton’s] examination show some contrast with the claimant’s treatment
The ALJ pointed to Dr. Lowther’s consistent findings of muscle
tenderness but normal gait and range of motion. She also pointed to an assessment
by a nurse practitioner in Dr. Lowther’s office from September 26, 2012, only
approximately two weeks after Dr. Skelton’s assessment, which stated that claimant
exhibited normal range of motion, muscle strength, and stability in all her extremities,
with no pain upon inspection.11
The ALJ also considered the consistency of Dr. Lowther’s and Dr. Skelton’s
assessments with evidence from other medical providers.12 Dr. Drake Lavender, who
treated claimant from April to July 2014, and from October 2014 to January 2015,
noted claimant’s diagnosis of fibromyalgia but did not document any related
functional limitations.13 Neurological findings by Dr. Mohammed Alsharabati during
August and September of 2012 were normal.14 Finally, Cr. Chima Ukachi noted in
an October 9, 2010 consultative examination report that claimant that had been
Tr. 782-91, 813-22.
diagnosed with fibromyalgia, but he described claimant’s functional status as follows:
She has independent activities of daily living such as shower,
feeding and going to bathroom. She works as a medical biller as
mentioned earlier. She can dress herself and feed herself. She can stand
at one time for 10-15 minutes and walk on level ground for less than 200
feet. She can sit for 10-15 minutes. She can lift 15-20 pounds. She can
drive a car independently and she is able to do the household chores.
She is able to do vacuuming.
Tr. 520. During the clinical examination, claimant was able to get on and off the
exam table, get up and out of a chair, and undress herself. The spine and extremity
findings were as follows:
Revealed palpable peripheral pulses in the pedal and radial area.
No edema, cyanosis or clubbing. Gait is normal. She does not require
any assistive device. Her grip strength is 5/5 bilaterally. She is righthand dominant. Range of motion is normal in the elbow, forearm, wrist,
shoulder, knee and ankle. She has slightly decreased range of motion in
the cervical spine at 40 degrees on flexion and 60 degrees on extension.
Lumbar spine flexion is 60 degrees on anterior flexion and lateral
flexion 10 degrees. Straight leg raising test was positive at 60 degrees.
She lays straight back on the table with difficulty. She can walk on her
heels and walk on her toes without difficulty. She can squat better than
halfway. Heel-to-toe coordination was good. No ulcerations on her
skin. No varicosities.
Tr. 521. Claimant’s neurological findings — including muscle strength, coordination,
and reflexes — were normal. In summary, Dr. Ukachi observed that, although
claimant experienced limited range of motion in the cervical and lumbar areas, no
limitations were observed in functional areas such as sitting, walking, hearing, or
speaking.15 Even though Dr. Ukachi’s assessment was dated more than three years
before the ALJ’s decision, while claimant still was working, his findings, and the
findings in the other medical records described above, are consistent with the ALJ’s
findings. In summary, the court finds that the ALJ adequately articulated her reasons
for failing to fully credit the opinions of Drs. Lowther and Skelton, and that the ALJ’s
findings were supported by substantial evidence.
Claimant also asserts that the ALJ failed to properly consider her fibromyalgia
in accordance with Social Security Ruling 12-2p. But all of her arguments are based
upon the portions of the Ruling which provide instructions for evaluating whether
fibromyalgia is a medically determinable impairment. Those arguments miss the
point, because the ALJ not only considered claimant’s fibromyalgia to be a medically
determinable impairment, she found that it was a severe impairment.16 The remaining
consideration is whether claimant’s fibromyalgia, considered in combination with her
other severe and non-severe impairments, resulted in disabling functional limitations.
Social Security Ruling 12-2p provides that, once fibromyalgia has been established
as a medically determinable impairment,
we then evaluate the intensity and persistence of the person’s pain or
any other symptoms and determine the extent to which the symptoms
limit the person’s capacity for work. If objective medical evidence does
not substantiate the person’s statements about the intensity, persistence,
and functionally limiting effects of symptoms, we consider all of the
evidence in the case record, including the person’s daily activities,
medications or other treatments the person uses, or has used, to alleviate
symptoms; the nature and frequency of the person’s attempts to obtain
medical treatment for symptoms; and statements by other people about
the person’s symptoms.
SSR 12-2p, 2012 WL 3104869, at *5. In assessing the claimant’s residual functional
capacity, the ALJ should “consider a longitudinal record whenever possible because
the symptoms of [fibromyaliga] can wax and wane so that a person may have ‘bad
days and good days.’” Id. at *6 (alteration supplied). ALJ’s are also cautioned that
pain, fatigue, and other symptoms associated with fibromyalgia may result in
exertional and non-exertional limitations that would erode the claimant’s
occupational base, preclude use of the medical-vocational guidelines (“Grids”), and
require vocational expert testimony. Id.
The ALJ in this case did not explicitly mention SSR 12-2p, but her analysis
nonetheless was consistent with the requirements of that Rule. She stated:
After careful consideration of the evidence, the undersigned finds
that the claimant’s medically determinable impairments could
reasonably be expected to cause the alleged symptoms; however, the
claimant’s statements concerning the intensity, persistence and limiting
effects of these symptoms are not entirely credible for the reasons
explained in this decision. While it is reasonable that the claimant may
experience some swelling and pain that would cause some exertional
and non-exertional limitations, the objective medical evidence does not
support a complete inability to work.
Tr. 23. The ALJ considered claimant’s treatment history, the reports from treating
and consultative physicians, the effect of claimant’s obesity on her overall abilities,
and claimant’s reported daily activities. The ALJ did not consider only a snapshot
of claimant’s symptoms at a given time, but instead evaluated the totality of her
medical condition and its evolving effects on her functional abilities over the several
years that had passed since her alleged onset date. Finally, the ALJ adequately
considered both exertional and non-exertional limitations, found claimant to be
capable of performing less than a full range of sedentary work, and obtained
vocational expert testimony to determine claimant’s ability to perform work existing
in significant numbers in the national economy despite her limitations.
In summary, the court concludes the ALJ’s decision was based upon substantial
evidence and in accordance with applicable legal standards. Accordingly, the
decision of the Commissioner is AFFIRMED. Costs are taxed against claimant. The
Clerk is directed to close this file.
DONE this 28th day of July, 2017.
United States District Judge
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