Gage v. Social Security Administration
MEMORANDUM OPINION AND ORDER affirming the decision of the Commissioner. Gage's complaint is dismissed, all requested relief is denied, and judgment will be entered for the Commissioner. Signed by Magistrate Judge Patricia S. Harris on 6/27/2017. (jak)
IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
LINDA S. GAGE
NO. 3:16-cv-00344 PSH
NANCY A. BERRYHILL, Acting Commissioner
of the Social Security Administration
MEMORANDUM OPINION AND ORDER
Plaintiff Linda S. Gage (“Gage”) began the case at bar by filing a complaint
pursuant to 42 U.S.C. 405(g). In the complaint, she challenged the final decision of the
Acting Commissioner of the Social Security Administration (“Commissioner”), a decision
based upon findings made by an Administrative Law Judge (“ALJ”).
Gage maintains that the ALJ’s findings are not supported by substantial evidence
on the record as a whole and offers two reasons why.1 Gage first maintains that her
impairments meet or equal Listing 1.02, and the ALJ erred at step three of the
sequential evaluation process when she failed to so find.2
The question for the Court is whether the ALJ’s findings are supported by substantial evidence
on the record as a whole. “Substantial evidence means less than a preponderance but enough that a
reasonable person would find it adequate to support the decision.” See Boettcher v. Astrue, 652 F.3d
860, 863 (8th Cir. 2011).
Gage maintains that her impairments meet or equal Listings 1.00B2b and 1.00B2c. 1.00B2b and
1.00B2c, though, are not listings in the conventional sense. 1.00B2b defines, and provides examples of,
what is meant by the phrase “inability to ambulate effectively.” 1.00B2c defines, and provides examples
of, what is meant by the phrase “inability to perform fine and gross movements effectively.” Like the
Commissioner, the Court believes Gage intends to allege that her impairments meet or equal Listing
1.02. The Court will therefore analyze her first assertion of error pursuant to Listing 1.02.
At step three, the ALJ is required to determine whether a claimant’s
impairments meet or equal a listed impairment. See Raney v. Barnhart, 396 F.3d 1007
(8th Cir. 2005). The determination is solely a medical determination, see Cockerham v.
Sullivan, 895 F.2d 492 (8th Cir. 1990), and the claimant bears the burden of showing
that her impairments meet or equal a listed impairment, see Pyland v. Apfel, 149 F.3d
873 (8th Cir. 1998).
Listing 1.02 encompasses a major dysfunction of a joint and is characterized by
“gross anatomical deformity ... and chronic joint pain and stiffness with signs of
limitation of motion or other abnormal motion of the affected joint(s) and findings on
appropriate medically acceptable imaging of joint space narrowing, bony destruction,
or ankylosis of the affected joint(s).” See Listing 1.02. The listing additionally requires
the involvement of one major peripheral weight-bearing joint resulting in an inability
to ambulate effectively as defined in 1.00B2b or the involvement of one peripheral
joint in each upper extremity resulting in an inability to perform fine and gross
movements effectively as defined in 1.00B2c.
The inability to ambulate effectively means “an extreme limitation of the ability
to walk.” See Listing 1.00B2b. It includes, but is not limited to, such things as the
inability to walk without the use of a walker or the inability to walk without the use of
two crutches or two canes.
The inability to perform fine and gross movements effectively means “an
extreme loss of function of both upper extremities.” See Listing 1.00B2c. It includes,
but is not limited to, such things as the inability to prepare a simple meal and feed
oneself and the inability to take care of personal hygiene.
Gage alleges that she became disabled on December 1, 2013, as a result of
impairments that include back problems, diabetes, left arm pain, and feet problems.
In her brief, she represents that her ambulatory limitation is caused by “chronic back
and heel pain.” See Docket Entry 11 at CM/ECF 13. She also represents in her brief that
her upper extremity limitation is caused by “an impingement of her left shoulder” and
the pain the impingement causes in her neck, back, and shoulder. See Docket Entry 11
at CM/ECF 7, 13.
The medical evidence relevant to Gage’s ambulatory and upper extremity
impairments reflects that she has sought medical attention for her back pain at
irregular intervals. She underwent testing in January of 2010, and the results revealed,
in part, the following: “[t]he bony structures in the T-spine show a little bit of mild
osteoarthritic type changes.” See Transcript at 321. In March of 2013, she presented to
a medical clinic complaining of back pain. See Transcript at 275-278. She represented
that the pain radiated along her right side. Her vital signs were taken and reflected,
inter alia, that she was sixty-four inches tall and weighed 174 pounds, or had a Body
Mass Index (“BMI”) of 29.71. No joint swelling or tenderness was noted, and no spinal
tenderness was noted. A backache was assessed. In June of 2014, Gage was seen again
for back pain. See Transcript at 494/507-509. She denied numbness and tingling but
reported that the pain was exacerbated by standing and bending. She reported pain
upon lumbar flexion, extension, and rotation, and her lumbar spine was tender to
palpation. Physical therapy was recommended, as was a home exercise program that
included stretching. She never completed the therapy program, though, because she
was discharged from it because of her non-attendance.
Gage has occasionally sought medical attention for leg pain and restless leg
syndrome. The record indicates that she did so on at least three occasions prior to June
of 2014. See Transcript at 334, 332-333, 315-316. No significant findings were recorded.
In June of 2014, she presented to a medical clinic complaining of leg pain. See
Transcript at 510-513. Her vital signs were taken and reflected, inter alia, that she was
sixty-four inches tall and weighed 177 pounds, or had BMI of 30.38. A musculoskeletal
examination was abnormal. The assessment included a backache and diabetes mellitus.
Medication was prescribed. Gage was seen for depression in August of 2014. See
Transcript at 452-453. The report from that examination is noteworthy because the
nurse practitioner noted that Gage had pain in her calves when walking any distance.
Gage has on occasion sought medical attention for heel pain. In October of 2007,
she presented to a medical clinic complaining of a burning sensation in her feet. See
Transcript at 323-324. It was attributed to diabetic neuropathy, and she was prescribed
medication. She did not seek medical attention for her heel pain again until February
of 2013. See Transcript at 282-284. No significant findings were recorded, but diabetes
mellitus was again diagnosed.
Gage has on occasion sought medical attention for pain and swelling in her right
shoulder. In September of 2006, she presented to a medical clinic complaining of right
shoulder pain. See Transcript at 339. A strain/spasm in her rhomboid muscles was
assessed, and medication was prescribed. She did not seek medical attention for her
right shoulder again until September of 2014. See Transcript at 498-499. At that time,
she exhibited a decreased range of motion in her shoulder and some tenderness but had
no effusion or swelling. Joint pain was diagnosed.
Gage has also sought medical attention for pain in her left shoulder, and a left
shoulder impingement has been noted. See Transcript at 253. In October of 2012, she
presented to a medical clinic complaining of pain in her left shoulder. See Transcript
at 291-294. She reported that a recent “steroid shot” had helped, as did over-thecounter ibuprofen. See Transcript at 291. A musculoskeletal examination revealed joint
pain and stiffness but no joint swelling. Joint pain and diabetes mellitus were assessed.
Gage declined an x-ray and attributed the pain to “just arthritis and working.” See
Transcript at 294. Mobic was prescribed.
In February of 2013 and again in March of 2013, Gage presented to a medical
clinic complaining of left shoulder pain. See Transcript at 282-284, 390-392. No joint
swelling or tenderness was noted in February of 2013, but joint pain localized in her
left shoulder was assessed. In March of 2013, the attending physician recorded Gage’s
report that “[h]er pain radiates down to the elbow at times” and her pain “increased
with overhead activity, behind the back activities, and when she sleeps on her left
side.” See Transcript at 391. Gage was observed to have a decreased range of motion
in her left shoulder. A treatment plan included therapy and a home exercise program
that included stretching and strengthening exercises.
In February and March of 2014, Dr. James Ameika, M.D., (“Ameika”) saw Gage
in connection with medical imaging testing and to discuss the occulsion, or blockage,
he found in her right and left internal carotid arteries. See Transcript at 356-359, 363367. The findings contained in his reports are relevant to her ambulatory and upper
extremity impairments in the following four respects. First, he observed that she had
“no weakness involving either of her upper or lower extremities.” See Transcript at
356. Second, a musculoskeletal examination revealed no evidence of arthralgia, joint
pain, joint swelling, limb pain, or limb swelling. Third, an examination of her
extremities revealed the following: “pedal pulses are within normal limits, ... no
clubbing, edema was not present, showed no cyanosis, cellulitis was not present, ...”
See Transcript at 359. Fourth, a neurological examination revealed, inter alia, that she
had no difficulty walking but had a normal gait.
At step three, the ALJ considered whether Gage’s impairments meet or equal
several of the listings. The ALJ specifically considered whether Gage’s impairments
meet or equal Listing 1.02. The ALJ found that they do not meet the listing because
“the available medical evidence did not demonstrate the specified criteria required of
the listing.” See Transcript at 15. In so finding, the ALJ observed that “the evidence
does not demonstrate that the claimant has the degree of difficulty in performing fine
and gross movements as defined in 1.00B2c.” See Transcript at 15. The ALJ made no
observation with regard to whether Gage’s impairments give rise to an inability to
ambulate effectively as required by 1.00B2b. In considering whether Gage’s
impairments meet or equal Listing 1.04, though, the ALJ observed that “there is no
evidence ... [his] back disorder result[s] in an inability to ambulate effectively ...” See
Transcript at 15.3
Substantial evidence on the record as a whole supports the ALJ’s finding at step
three because Gage has failed to produce medical evidence that her impairments meet
or equal Listing 1.02. The Court so finds for two reasons.
Listing 1.04 encompasses disorders of the spine and requires evidence of “nerve root compression, spinal
arachnoiditis or lumbar spinal stenosis.” See Transcript at 15. The ALJ found that Gage’s impairments did not meet
or equal Listing 1.04.
First, there is no medical evidence that Gage’s impairments result in an inability
to ambulate effectively, i.e., she has “an extreme limitation of the ability to walk.” It
is true that she has a history of back, leg, and heel problems, and testing has revealed
“mild osteoarthritic type changes” in her thoracic spine. See Transcript at 321. Her
back problems, though, were characterized as a backache, and there is no medical
evidence her problems impair her ability to walk or otherwise require the use of an
assistive device. Ameika observed that Gage had no weakness in either of her lower
extremities and observed that she had no difficulty walking but had a normal gait. On
more than one occasion, home exercises were recommended. Gage testified during the
administrative hearing that she falls at least three times a week, see Transcript at 43,
but she has offered no medical evidence to substantiate her testimony.
Second, there is no medical evidence that Gage’s impairments result in an
inability to perform fine and gross movements effectively. Admittedly, she has a history
of shoulder pain and has a history of a left shoulder impingement. She also has, at
times, exhibited a reduced range of motion in her left shoulder. Nevertheless, her
shoulder impairment does not give rise to “an extreme loss of function of both upper
extremities.” Ameika observed that Gage had no weakness in either of her upper
extremities, and he could find no evidence of joint swelling or limb swelling. On more
than one occasion, home exercises were recommended, part of which involved
stretching and strengthening exercises. Gage also represented in a series of disability
documents that she can attend to her personal care, see Transcript at 220, and she
testified during the administrative hearing that she is able to clean her house, do
laundry, and cook, see Transcript at 39.
Gage offers a second reason why the ALJ’s findings are not supported by
substantial evidence on the record as a whole. Gage maintains that her residual
functional capacity was not properly assessed because she is unable to perform light
work as the ALJ found.
The ALJ is required to assess the claimant’s residual functional capacity, which
is a determination of “the most a person can do despite that person’s limitations.” See
Brown v. Barnhart, 390 F.3d 535, 538-39 (8th Cir. 2004). The assessment is made using
all of the relevant evidence in the record, but the assessment must be supported by
some medical evidence. See Wildman v. Astrue, 596 F.3d 959 (8th Cir. 2010). As a part
of making the assessment, the ALJ is required to evaluate the claimant’s subjective
complaints. See Pearsall v. Massanari, 274 F.3d 1211 (8th Cir. 2001). The ALJ does so by
considering the medical evidence and evidence of the claimant's daily activities; the
duration, frequency, and intensity of her pain; the dosage and effectiveness of
medication; any precipitating and aggravating factors; and any functional restrictions.
The medical evidence relevant to Gage’s impairments reflects that she has a
history of depressive symptoms and has taken medication for them.4 In June of 2014,
she was seen by Dr. Catherine Hubbard Adams, Ph.D., (“Adams”) for a mental
diagnostic evaluation. See Transcript at 427-432. Gage reported that she wanted to
sleep all the time and was having nightmares every other night. Gage was dressed
appropriately, her predominant mood was nervous, and her affect was appropriate.
Adams diagnosed a generalized anxiety disorder and made the following findings with
respect to Gage’s adaptive functioning:
The Court will not repeat the summary of Gage’s shoulder, back, leg, and heel problems.
How do mental impairments interfere with this person’s day to day
adaptive functioning? ... Claimant’s difficulties do not seem to interfere
with age-appropriate ADLs [i.e., activities of daily living]. Some of her
ADLs, such as driving, are limited, but this seems due to physical ailments
and not cognitive or mental challenges.
Capacity to communicate and interact in a socially adequate
manner? ... Claimant’s interactions during interview were appropriate.
Capacity to communicate in an intelligible and effective manner?
Claimant communicated in a manner that was effective and intelligible.
Capacity to cope with the typical mental/cognitive demands of
basic work-like tasks? Claimant seems to have difficulty coping with worktype demands. [She] seems to struggle with turning in assignments and
maintaining focus to stay on tasks.
Ability to attend and sustain concentration on basic tasks? The
claimant seems to have difficulty attending and sustaining concentration
on basic tasks. Her performance today indicates limited working memory.
This limitation does not seem due to anxiety, but is potentially related to
diabetes or previous seizure history.
Capacity to sustain persistence in completing tasks? It seems
claimant has little difficulty sustaining persistence in completing work
Capacity to complete work-like tasks within an acceptable
timeframe? Claimant seems to have little difficulty completing tasks
within an acceptable timeframe.
See Transcript at 430-431. Adams opined that Gage was capable of managing her
finances without assistance. Adams found no evidence of malingering.
Gage was seen for her depressive symptoms on at least two subsequent
occasions. See Transcript at 493/504-506, 452-453. On each occasion, she was awake,
alert, and oriented to person, place, and time. No remarkable findings were noted, but
she was diagnosed with depression and anxiety. Medication was prescribed for her
Gage has a history of small vessel ischemic disease. See Transcript at 356-359,
363-367. Testing revealed that she has one hundred percent “occulusions of both the
right and left internal carotid arteries,” but Ameika opined that there was “nothing
surgical to be done ..., see Transcript at 356. He noted no evidence of stroke or strokelike symptoms. See Transcript at 366. He encouraged her to work “very hard on her risk
factors including the need to stop smoking and maintain well controlled blood pressure
and cholesterol levels.” See Transcript at 356.
Gage has a history of obesity and diabetes mellitus. Her BMI has routinely been
in the twenty-nine to thirty range, which places her in the obese range. She takes
insulin for her diabetes mellitus and checks her blood sugar regularly.
Gage also has a history of right eye problems apparently associated with diabetes
mellitus and has sought frequent treatment for her eye problems. See Transcript at
264-267 (10/29/2013), 257-259 (01/22/2014), 253-256/447 (01/28/2014), 444-446
(02/04/2014), 349-351 (02/18/2014), 347-348 (02/25/2014), 443 (03/05/2014), 345
(03/18/2014), 344 (04/18/2014), 442 (04/16/2014), 411 (07/14/2014). The problem
caused, inter alia, blurred vision, pain, redness, and light sensitivity. She was
prescribed medication, an ointment, and given an injection to treat her symptoms, but
the treatment provided only temporary relief. She was eventually diagnosed with
rubeosis of the right eye.5
The record reflects that Gage also has a history of seizures, epilepsy and hearing problems. The Court will
not devote much attention to those impairments, save to note the following. The medical evidence pertaining to her
seizure disorder is minimal. Although she takes seizure medication, she testified during the administrative hearing
that she has not had a seizure in three or four years. See Transcript at 43. The medical evidence pertaining to her
epilepsy is equally minimal. It is included as a diagnosis on some of the progress notes, see Transcript at 478, but the
impact of the impairment on her residual functional capacity is not clear. Gage has been diagnosed with otitis media,
or an inflammation of the middle ear, see Transcript at 478, and has been prescribed medication. She subsequently
reported that the medication provided little relief, and her hearing problems persisted.
Gage’s medical records were reviewed by state agency medical professionals.
See Transcript at 63-77, 80-96. They opined that Gage is capable of performing a
reduced range of light work.
A summary of the non-medical evidence indicates that Gage worked between
the years 1993 and 2012. A summary of her FICA earnings reflects that although her
earnings during that period were modest, her work was mostly regular. See Transcript
Gage completed a series of documents in connection with her application for
disability insurance benefits. See Transcript at 217-218, 219-226. In the documents, she
represented that she experiences pain in her back and legs on a daily basis. She cannot
stand or walk for long periods of time and begins to experience pain after only about
ten minutes. She also has problems with her right eye. Her impairments affect her
ability to lift, stand, walk, climb stairs, kneel, squat, reach, see, bend, remember, and
complete tasks. She helps take care of her spouse and is capable of attending to her
own personal care, preparing meals, cleaning, doing laundry, and driving an
automobile, although she does not do so because of her poor vision. She shops and can
pay her bills. She can follow written instructions “semi-well” and follow spoken
instructions “well.” See Transcript at 224.
Gage testified during the administrative hearing. See Transcript at 34-54. She
was born on March 19, 1962, and was fifty-three years old at the time of the hearing.
She completed the eleventh grade in school but did not graduate. She smokes a pack
of cigarettes a day. She spends her day cleaning her house and doing laundry but must
take frequent breaks. She is unable to perform any outdoor activities. Gage must spend
two hours a day resting. Her inability to stand and her anxiety prevent her from working.
She takes five shot a day for her diabetes mellitus. She has had seizures in the past,
but she has not had one in three or four years. She can be around people but does not
enjoy it. She falls at least three times a week but does not know why she falls. She has
trouble seeing out of her right eye, and eyeglasses do not help her vision.
The ALJ found at step two that Gage has severe impairments in the form of
“diabetes mellitus, small vessel ischemic disease, history of epilepsy, right shoulder
joint pain, lower back pain, 100 percent occlusion of both the right and left carotid
arteries, right eye vision loss, bilateral hearing loss with otitis media, obesity,
depression, and generalized anxiety disorder.” See Transcript at 14. The ALJ assessed
Gage’s residual functional capacity and found that she can perform light work with the
following limitations: “the claimant must avoid moderate exposure to hazards, is
limited to work where monocular vision is permitted, can occasionally reach overhead,
and is limited to simple and routine work with simple instructions.” See Transcript at
17. The ALJ found at step four that Gage cannot return to her past relevant work but
found at step five that there is other work she can perform. The ALJ therefore
concluded that Gage was not disabled for purposes of the Social Security Act.
Gage has limitations caused by various impairments. The question for the ALJ
was the extent to which they impact the most Gage can do. The ALJ incorporated
limitations for the impairments into the assessment of Gage’s residual functional
capacity but found she was not disabled. The ALJ could find as he did as substantial
evidence on the record as a whole supports his consideration of the evidence and his
assessment of her residual functional capacity. The Court so finds for several reasons.
First, the ALJ adequately considered the medical evidence relevant to Gage’s
mental impairments. The ALJ could and did credit Adams’ opinions that Gage can
perform most activities of daily living; can communicate and interact in a socially
adequate, effective, and intelligible manner; has little difficulty sustaining persistence
in completing work tasks; and seems to have little difficulty completing tasks within an
acceptable timeframe. Adams also opined, though, that Gage “seems to have difficulty
coping with work-type demands,” “seems to struggle with turning in assignments and
maintaining focus to stay on tasks,” and “seems to have difficulty attending and
sustaining concentration on basic tasks.” See Transcript at 430. The ALJ could and did
also credit the state agency medical professionals who opined that Gage is limited to
unskilled work. The ALJ accounted for the abovementioned limitations in crafting
Gage’s residual functional capacity because he limited her to “simple and routine work
with simple instructions.” See Transcript at 17.
Second, the ALJ adequately considered the non-medical evidence relevant to
Gage’s mental impairments. Gage represented in her disability documents that she can
follow written instructions “semi-well” and follow spoken instructions “well.” See
Transcript at 224. It is true that Gage prefers to be alone, but, as the ALJ could and did
note, “[Gage] testified she visits with friends and family on a weekly basis.” See
Transcript at 21. The ALJ noted during the administrative hearing that Gage had worked
around people for approximately fifteen years but was now maintaining she could not
be around people. When asked what brought about the change, Gage testified as
follows: “I’m not saying I’m not able to be around people. I, I just—it—it’s not the same
as it was like five years ago.” See Transcript at 41.
Third, the ALJ adequately considered the medical evidence relevant to Gage’s
physical impairments. The ALJ could and did find that Gage has limitations caused by
eye problems and shoulder pain and incorporated those limitations into the assessment
of her residual functional capacity. Specifically, the ALJ found, inter alia, that Gage is
limited to work where monocular vision is permitted and can only occasionally reach
overhead.6 Although Gage’s diabetes mellitus and obesity give rise to work-related
limitations, they do not give rise to such severe limitations that she is prevented from
performing light work. She was repeatedly found to have no joint swelling, no
tenderness, no spinal tenderness, a normal gait, normal neurological and motor
examinations, and normal strength. At times, she exhibited a reduced range of motion.
When Ameika saw Gage in February of 2014 and again in March of 2014, though, he
observed that she had no weakness in either of her upper or lower extremities and had
no difficulty walking.
Fourth, the ALJ adequately considered the non-medical evidence relevant to
Gage’s physical impairments. Specifically, the ALJ considered and credited that Gage
is capable of performing most of her daily activities, activities that include attending
to her own personal care, preparing meals, and cooking. The ALJ repeatedly noted
Gage’s use of medication and the fact that it provided only temporary relief for her
symptoms. The ALJ could and did also note that Gage has ignored the repeated advice
of her medical professionals to stop smoking. The ALJ noted that smoking “negatively
affect[s] [Gage’s] carotid arteries” and her “eye condition.” See Transcript at 21.
It appears that the ALJ also accounted for Gage’s history of seizures when he found that she must avoid
moderate exposure to hazards.
Gage appears to challenge the finding that she can perform light work, noting
that light work requires the ability to stand and walk for up to six hours in an eight hour
workday. The ALJ could, though, find as she did. The findings with respect to Gage’s
ability to stand and walk are unremarkable as she was repeatedly observed to have no
joint swelling, no tenderness, no spinal tenderness, a normal gait, normal neurological
and motor examinations, and normal strength.7
The governing standard in this case, i.e., substantial evidence on the record as
a whole, allows for the possibility of drawing two inconsistent conclusions. See
Culbertson v. Shalala, 30 F.3d 934 (8th Cir. 1994). In this instance, the ALJ’s assessment
of Gage’s residual functional capacity was not improper, and the ALJ could find as she
On the basis of the foregoing, the Court finds that there is substantial evidence
on the record as a whole to support the ALJ’s findings. Gage’s complaint is dismissed,
all requested relief is denied, and judgment will be entered for the Commissioner.
IT IS SO ORDERED this 27th day of June, 2017.
UNITED STATES MAGISTRATE JUDGE
Gage also appears to challenge a hypothetical question posed to the vocational expert. See Docket Entry
11 at CM/ECF 14‐15. There is no merit to Gage’s assertion.
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