Nestlehut v. Social Security Administration
OPINION affirming the Commissioner's decision and denying Nestlehut's request for relief. Signed by Judge J. Leon Holmes on 7/11/2014. (ks)
IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
JEANIE LINN NESTLEHUT
No. 1:13CV00033 JLH-JTK
CAROLYN W. COLVIN, Acting Commissioner,
SOCIAL SECURITY ADMINISTRATION
Jeanie Linn Nestlehut seeks judicial review of the denial of her application for disability
insurance benefits. The magistrate judge recommended that the decision of the Commissioner be
affirmed. After conducting a de novo review, the Court agrees with the magistrate judge’s
recommendation that the decision of the Commissioner should be affirmed but not with all of the
magistrate judge’s reasoning. The following opinion incorporates much but not all of the magistrate
Nestlehut has worked for her husband’s insurance business since 2003.1 Initially, she
worked as a full-time office manager, but the business grew, the husband hired additional
employees, and Nestlehut cut back her hours. She now works part-time as the bookkeeper,2 but
claims that she cannot work full-time due to fibromyalgia and pain in her neck, back, and right
SSA Record at pp. 130 and 137.
Id. at p. 44.
Id. at pp. 129, 145 and 164.
THE COMMISSIONER’S DECISION
After considering the application, the Commissioner’s ALJ determined that Nestlehut has
severe impairments – degenerative disc disease and fibromyalgia4 – but that she can perform
sedentary work with restrictions on driving, working at heights, and working near dangerous
machinery.5 Because a vocational expert classified Nestlehut’s current job as sedentary work,6 the
ALJ determined that Nestlehut is not disabled and denied the application.7
After the Commissioner’s Appeals Council denied a request for review,8 the decision became
a final decision for judicial review.9 Nestlehut commenced this action to appeal the decision.10 In
reviewing the decision, the court must determine whether substantial evidence supports the decision
and whether the ALJ made a legal error.11
Id. at p. 15.
Id. at p. 16.
Id. at p. 57.
Id. at pp. 20-21.
Id. at p. 1.
See Anderson v. Sullivan, 959 F.2d 690, 692 (8th Cir. 1992) (stating, “the Social Security
Act precludes general federal subject matter jurisdiction until administrative remedies have been
exhausted” and explaining that claimants may appeal only final decisions).
See 42 U.S.C. § 405(g) (requiring the district court to determine whether the
Commissioner’s findings are supported by substantial evidence and whether the Commissioner
conformed with applicable regulations); Long v. Chater, 108 F.3d 185, 187 (8th Cir. 1997) (“We
will uphold the Commissioner’s decision to deny an applicant disability benefits if the decision is
not based on legal error and if there is substantial evidence in the record as a whole to support the
conclusion that the claimant was not disabled.”).
Nestlehut complains because her case was not reviewed by a psychiatrist or psychologist.
She contends that the ALJ should have developed the record by ordering a consultative mental
evaluation and completing a psychiatric review technique (PRT). She challenges the ALJ’s reliance
on the agency medical consultant’s opinion because the medical consultant did not review
subsequent medical records and because the consultant’s specialty does not relate to Nestlehut’s
impairments. She challenges the ALJ’s reliance on her part-time work, arguing that she should not
be penalized for working because her husband allows her to work at her convenience. She insists
that she cannot do sedentary work on a full-time basis. For these reasons, she maintains that
substantial evidence does not support the ALJ’s decision.12
APPLICABLE LEGAL PRINCIPLES
Substantial evidence is evidence sufficient to show a reasonable mind that the findings of
the ALJ are correct.13 The ALJ found that Nestlehut can perform sedentary work with restrictions
to avoid danger due to drowsiness. “Sedentary work involves lifting no more than 10 pounds at a
time and occasionally lifting or carrying articles like docket files, ledgers, and small tools.”14
Sedentary work “represents a significantly restricted range of work. Individuals who are limited to
no more than sedentary work by their medical impairments have very serious functional
Slusser v. Astrue, 557 F.3d 923, 925 (8th Cir. 2009); Britton v. Sullivan, 908 F.2d 328, 330
(8th Cir. 1990).
20 C.F.R. § 404.1567(a).
limitations.”15 In determining Nestlehut’s residual functional capacity, the ALJ imposed additional
limitations beyond the definition of “sedentary work” by eliminating work at unprotected heights,
work near moving or dangerous machinery, and driving a vehicle.16 The question before the court
is whether a reasonable mind would accept the evidence as adequate to show that Nestlehut can
work within these parameters.
Nestlehut claims that she experiences constant, disabling pain such that she cannot work fulltime. Her claim turns on her credibility because no medical professional has opined that she has
such serious functional limitations. The ALJ evaluated Nestlehut’s credibility using the required
two-step process and the required factors,17 so the dispositive question is whether substantial
evidence shows that Nestlehut can work within the defined parameters.
Nestlehut claims that she has been disabled since August 2010. At that time, Nestlehut
complained about neck and back pain, but diagnostic imaging showed a normal neck and some
degenerative changes in the lumbar spine, though nothing sufficiently acute to account for her pain.18
Nestlehut’s doctor referred her to an orthopedic surgeon who ordered more diagnostic imaging.19
SSR 96-9p, Pol’y Interpretation Ruling Titles II & XVI: Determining Capability to Do
Other Work—Implications of a Residual Functional Capacity for Less Than a Full Range of
SSA Record at p. 16.
See SSR 96-7p, Pol’y Interpretation Ruling Titles II & XVI: Evaluation of Symptoms in
Disability Claims: Assessing the Credibility of an Individual’s Statements.
SSA Record at p. 318.
Id. at p. 331.
The imaging showed degenerative changes in the neck at multiple levels, and in the low back at
L5/S1, but nothing requiring surgery.20 Nestlehut was referred to another orthopedic physician.21
According to the second orthopedist, the diagnostic imaging did not explain the reported
symptoms.22 The orthopedist suspected fibromyalgia but diagnosed myofascial pain syndrome.23
He treated Nestlehut with trigger point injections and oral medications. After a few months of
treatment, he diagnosed fibromyalgia.24 During her last visit, the orthopedist reported that Nestlehut
was doing well.25
The following day, Nestlehut saw a rheumatologist. Although she had been doing well the
day before, the rheumatologist reported that all 18 fibromyalgia trigger points were positive.26
Medical standards provide for a diagnosis of fibromyalgia if a patient has “widespread pain in
combination with tenderness in at least 11 of the 18 sites known as trigger points,” after ruling out
other reasons for complaints of pain.27 The rheumatologist reported that Nestlehut has “classic
Id. at pp. 330 and 332-34.
Id. at p. 330.
Id. at p. 339.
Id. at p. 476.
Id. at p. 525.
Id. at p. 529.
Paula Ford-Martin, Michele R. Webb & Laura Jean Cataldo, Fibromyalgia, 3 The Gale
Encyclopedia of Med. 1729 (4th ed.).
fibromyalgia symptoms of lower back and neck stiffness along with shoulder and hip stiffness and
According to the agency medical consultants, the medical evidence of degenerative changes
and fibromyalgia supports sedentary work.29 Nestlehut complains that the ALJ gave “great weight”
to the opinions of one of these medical consultants. She points out that the number “24” next to the
first medical consultant’s name30 indicates that his medical specialty is in nephrology, which is not
relevant to her diagnoses. Nestlehut does not challenge the expertise of the second medical
consultant.31 The second medical consultant independently received Nestlehut’s medical records
and then affirmed the first consultant’s conclusions.32
In support of her argument, Nestlehut relies on 20 C.F.R. § 404.1527(c)(5), which provides,
“We generally give more weight to the opinion of a specialist about medical issues related to his or
her area of specialty than to the opinion of a source who is not a specialist.” One problem with
Nestlehut’s argument is that the opinions offered by the agency medical consultants regarding
Nestlehut’s residual functional capacity are not contrary to any opinions stated in the record by any
physician with greater expertise in orthopedics or rheumatology than the agency consultants.
Furthermore, the decision as to a claimant’s residual functional capacity is reserved to the
SSA Record at p. 528.
Id. at pp. 488 and 540.
The first medical consultant was James Wellons, M.D. Code number 24 appears next to
Dr. Wellons’ name. See POMS DI 28086.31 B.2.
Jim Takach, M.D.
SSA Record at pp. 536-40.
Commissioner.33 The regulation also provides: “State agency medical and psychological consultants
and other program specialists are highly qualified physicians, psychologists, and other medical
specialists who are also experts in Social Security disability evaluation. Therefore, administrative
law judges must consider findings and other opinions of state agency medical consultants . . . .”34
That the ALJ gave “great weight” to the opinion of a state agency medical consultant in assessing
Nestlehut’s residual functional capacity is not error.
The medical consultants did not review the rheumatologist’s records, but nothing in those
records support a further reduction. The rheumatologist confirmed what the record already showed:
a diagnosis of fibromyalgia.
Nestlehut also complains because the medical consultants did not review her nerve
conduction study.35 The nerve conduction study was performed the month after the ALJ issued his
decision. Nestlehut submitted the report for review by the Appeals Council, which accepted the
study as new evidence but found that it did not provide a basis for changing the ALJ’s decision.36
Although the nerve conduction study was performed after the ALJ’s decision, Nestlehut correctly
argues that it relates to her condition on or before the ALJ’s decision.37 There is no reasonable
likelihood, however, that the nerve conduction study would have changed the ALJ’s opinion.38
20 C.F.R. § 404.1527(d)(2) and (3).
20 C.F.R. § 404.1527(e)(2)(i).
The nerve conduction study is found in the SSA Record at pp. 573-74.
Id. at pp. 1-5.
Williams v. Sullivan, 905 F.2d 214, 216 (8th Cir. 1990).
Cf. Jones v. Callahan, 122 F.3d 1148, 1154 (8th Cir. 1997).
Although the nerve conduction study found “evidence of moderate right carpal tunnel syndrome,”39
the examination found that Nestlehut had full strength and normal motor sensory reflexes.40 Nothing
in the record suggests that Nestlehut’s carpal tunnel syndrome cannot be managed by conservative
treatment or healed by surgery.
A reasonable mind would accept the evidence as adequate to show Nestlehut can do
sedentary work because fibromyalgia’s primary symptom is pain “with aches, tenderness, and
stiffness of multiple muscles, joints, and soft tissues . . . most common in the neck, shoulders, chest,
arms, legs, hips, and back.”41 Symptoms fluctuate. No medical evidence shows that these symptoms
prevent Nestlehut from lifting 10 pounds at a time or occasionally lifting or carrying articles like
docket files, ledgers, and small tools, albeit with some degree of fluctuating pain.
Because fibromyalgia has no cure, treatment consists of symptom management.42 Nestlehut
sees a chiropractor regularly;43 the chiropractor prescribed regular stretching exercises.44 The
rheumatologist prescribed oral medications.45 These recommendations indicate that Nestlehut’s
condition can be controlled with treatment. “An impairment which can be controlled by treatment
SSA Record at p. 574.
Id. at p. 573.
Paula Ford-Martin , Michele R. Webb & Laura Jean Cataldo, Fibromyalgia, 3 The Gale
Encyclopedia of Med. 1728 (4th ed.).
Id. at p. 1729.
SSA Record at pp. 222-316, 342-444, 491-506 and 543-68.
Id. at pp. 224-25, 505-06, 547-48, and 556.
Id. at 570-71.
or medication is not considered disabling.”46
Nestlehut reported some improvement from
medication, but she does no regular exercise. She testified that her medications make her sleepy;
one medication was prescribed for sleep. To the extent that medication causes daytime sleepiness,
the elimination of work at unprotected heights, moving or dangerous machinery, and driving,
responds to that side effect.
The ALJ determined Nestlehut has no severe mental impairment. After applying for
disability benefits, Nestlehut underwent computer testing that indicates she has attention deficits,47
but this report is unsigned,48 so the record does not show who administered the test and wrote the
report, nor whether the person or persons who did so were qualified to administer the test or render
opinions based upon it. A report that contains expert opinions but which is unsigned and is not
shown to be the work of an expert is not substantial evidence.49 Nestlehut’s doctor prescribed
Adderall to control her symptoms but imposed no limitations on her activities.50 This scant evidence
Estes v. Barnhart, 275 F.3d 722, 725 (8th Cir. 2002).
SSA record at p. 512. Nestlehut was tested using the IVA+Plus Integrated Visual &
Auditory Continuous Performance Test. “Continuous Performance Tests, which involve tasks
performed on a computer, may support a diagnosis of attention-deficit . . . but by themselves are not
diagnostic.” Tish Davidson, Laura Jean Cataldo & William A. Atkins, Attention Deficit
Hyperactivity Disorder (ADHD), 1 The Gale Encyclopedia of Mental Health 152 (3d ed.).
The report was sent to SSA by Nestlehut’s lawyer via facsimile.
Cf. Roach v. Colvin, No. 6:12CV06092, 2013 WL 2151550, at *4 (W.D. Ark. May 16,
SSA record at p. 519.
does not implicate the need for a consultative mental evaluation. Even if a PRT was required,51
Nestlehut can show no error because “there is no credible evidence of a severe mental
CONCLUSION AND RECOMMENDATION
A vocational expert classified Nestlehut’s bookkeeping as sedentary work. Substantial
evidence shows that Nestlehut can perform sedentary work with the additional limitations imposed
by the ALJ. The ALJ properly performed the five-step sequential evaluation and made no legal
For these reasons, Nestlehut’s request for relief is denied.
Commissioner’s decision is affirmed.
IT IS SO ORDERED this 11th day of July, 2014.
J. LEON HOLMES
UNITED STATES DISTRICT JUDGE
One purpose of the PRT is to identify the need for consultative mental examination. 20
C.F.R. § 404.1520a(a)(1).
Cuthrell v. Astrue, 702 F.3d, 1114, 1118 (8th Cir. 2013).
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