RAMSEY v. COLVIN

Filing 19

MEMORANDUM OPINION AND ORDER: The decision of the Commissioner to deny Plaintiff's application for Social Security benefits is AFFIRMED and the Clerk is DIRECTED to enter judgment for Defendant. Signed by MAGISTRATE JUDGE CHARLES A STAMPELOS on 6/25/14. (amm)

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IN THE UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF FLORIDA
PANAMA CITY DIVISION
BARBARA P. RAMSEY,
Plaintiff,
vs.

Case No. 5:13cv401-CAS

CAROLYN W. COLVIN,
Acting Commissioner of the
Social Security Administration,
Defendant.
______________________________/
MEMORANDUM OPINION AND ORDER
This is a Social Security case referred to the undersigned U.S. Magistrate Judge
upon consent of the parties and reference by District Judge Richard Smoak. Doc. 12.
See Fed. R. Civ. P. 73; 28 U.S.C. § 636(c). After careful consideration of the entire
record, the decision of the Commissioner is affirmed.
I. Procedural History
On or about May 5, 2010, Plaintiff, Barbara P. Ramsey, filed an application for
supplemental security income (SSI) pursuant to Title XVI of the Social Security Act,
alleging disability beginning the date of filing. R. 24, 42, 157, 170. (Citations to the
record shall be by the symbol “R” followed by a page number that appears in the lower
right corner.) Plaintiff’s application was denied initially on August 6, 2010, and upon
reconsideration on September 18, 2010. R. 24, 83, 92, 97, 100. On November 12,
2010, Plaintiff requested a hearing. R. 24, 106.

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On December 22, 2011, Administrative Law Judge (ALJ) Charles Wm. Dorman
held a hearing in Tallahassee, Florida. R. 24, 38-82. Plaintiff was represented by
Forrest E. Jackson, an attorney. R. 17-18, 20, 24, 38, 40, 103-05, 148-56. Plaintiff and
Robert N. Strader, an impartial vocational expert, testified. R. 24, 44-82, 141 (Resume
of vocational expert). At the conclusion of the hearing, the ALJ stated that he would
arrange for Plaintiff to attend a consultative physical examination (CE). R. 80-81, 690.
After the hearing, the ALJ advised that he secured additional evidence including a
neurological CE dated February 1, 2012, from E. Jacob, M.D., R. 684-92, and an x-ray
of the lumbar spine dated January 31, 2012, from James M. Strohmenger, M.D., R. 681.
Plaintiff’s counsel (Quinn E. Brock) was also advised that a supplemental hearing could
be requested. R. 240-41. On April 23, 2012, Plaintiff’s counsel advised ALJ Dorman of
Dr. Jacob’s physical examination results and requested the ALJ to find Plaintiff disabled.
R. 244. In his decision, the ALJ stated that he “fully considered [counsel’s] response”
and that his
ruling to include these post-hearing materials is explained in detail within the
rationale of this decision. I note that the claimant has not requested an
opportunity to question the author of her post-hearing consultative exam, nor has
she requested a supplemental hearing. Even if the claimant had requested an
opportunity to question the consultative examiner, I find such questioning
unnecessary to inquire fully into the matters at issue.
R. 24.
On May 29, 2012, the ALJ entered a decision denying Plaintiff’s application for
benefits, concluding that Plaintiff was not disabled since May 5, 2010, the date the
application was filed, R. 170. R. 32. At the outset of the hearing, Plaintiff’s counsel

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agreed with the ALJ that the onset date would be the date of the filing of the application.
R. 42.
Plaintiff requested the Appeals Council to review the ALJ’s decision and counsel
submitted a brief. R. 4, 16, 246-49. On October 23, 2013, the Appeals Council denied
Plaintiff’s request for review making the ALJ’s decision the final decision of the
Commissioner. R. 1-5; see 20 C.F.R. § 404.981. On December 5, 2013, Plaintiff filed a
Complaint in this Court seeking judicial review. Doc. 1. The parties filed memoranda of
law, docs. 17 and 18, which have been considered.
II. Findings of the ALJ
The ALJ made several findings relative to the issues raised in this appeal:
1. “The claimant has not engaged in substantial gainful activity since May 5,
2010, the application date.” R. 26.
2. “The claimant has the following severe impairments: hypertension, obesity,
hepatitis C, asthma, degenerative disc disease and spondylosis,
radiculopathy, history of cardiac catheterization and dyspnea.” Id.
3. “The claimant does not have an impairment or combination of impairments
that meets or medically equals the severity of one of the listed impairments in
20 CFR Part 404, Subpart P, Appendix 1.” R. 27.
4. “[T]he claimant has the residual functional capacity [RFC] to perform light
work as defined in 20 C.F.R. § 416.967(b), except she can never climb
ladders, ropes and scaffolds; she can occasionally balance, stoop, kneel,
crouch, crawl, and climb ramps and stairs; she can tolerate only occasional
exposure to extreme heat, extreme cold, wetness, humidity, excessive
vibration and lung irritants; and she can tolerate no exposure to moving
machinery and unprotected heights.” Id.
5. “The claimant is capable of performing past relevant work as a childcare
worker (Dictionary of Occupational Titles # 359.677-018, specific vocational
preparation level 4, light exertional level). This work did not require the

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performance of work-related activities precluded by the claimant’s [RFC].”
R. 32.
6. “The claimant has not been under a disability, as defined in the Social
Security Act, since May 5, 2010, the date the application was filed.” Id.
III. Medical and Other Evidence
A. The ALJ’s Findings
At step four, the ALJ assessed Plaintiff’s RFC and ultimately determined that
Plaintiff was able to perform her past relevant work as a childcare worker. R. 27-32.
Plaintiff does not argue that the ALJ overlooked material evidence when making his
RFC assessment. Rather, Plaintiff argues that the ALJ erred when he did not give
proper weight to the entire opinion of Dr. Jacob and erred because the ALJ did not
perform an assessment of the effect of Plaintiff’s obesity on her ability to work. Doc. 17
at 6-15. The ALJ’s material RFC findings are set forth below.
Born January 31, 1958, the claimant was approaching advanced age on the date
her supplemental security income application was filed. The claimant has
obtained a general equivalency diploma and she is able to communicate in
English. The claimant has alleged disability due to hypertension, obesity,
hepatitis C, asthma, degenerative disc disease, spondylosis, radiculopathy,
cardiac catheterization, multinodulargoiter, headaches, gastroesophageal reflux
disease, thyromegaly, hyperlipidemia and dyspnea (2E; 3E; 7E; 8E; 11E;
testimony).
The claimant testified that she experiences fatigue and shortness of breath,
which requires that she rest frequently at least 1 to 2 days per week. The
claimant said that she usually lies down to rest for at least 30 minutes to 1 hour
every day. The claimant reported occasional chest pains that occur about 2 to 3
days per month. The claimant also said that she gets dizzy when her blood
pressure is elevated. The claimant testified that she has some difficulty bending
due to back pain. Rather than bend over, the claimant said that she is able to
kneel or squat down to the floor in order to pick up dropped items.

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According to her testimony, the claimant has the ability to perform hygiene and
self-care tasks independently, perform household chores, prepare meals, shop
for groceries and operate a motor vehicle.
The claimant alleged no medication side effects in August 2010 (7E), although
she reported urination frequency with Lasix in November 2010 (11E). The
claimant’s current medication list at exhibit 16E was considered. When
questioned during the hearing, the claimant reported medication side effects of
drowsiness, dry mouth and fatigue resulting from current hepatitis C injections.
During the hearing, the claimant said that although her treating physician
returned her to light duty work in October 2010, she has not attempted to return
to work since that time.
After careful consideration of the evidence, I find 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 credible to the extent
they are inconsistent with the above residual functional capacity assessment.
Since filing her supplemental security income application in 2010, the claimant
has reported intermittent chest pain and shortness of breath (2F; 11F; 15F).
The claimant was hospitalized for two days in April 2010 for chest pain and
elevated blood pressure. Cardiac enzyme tests were negative, and the claimant
was treated with nitroglycerine, which decreased her blood pressure and
significantly improved her chest pains. She was discharged following significant
clinical improvement (14F).
X-rays from April 2010 showed clear, well-expanded Iungs, with no vascular
congestive changes, infiltrates or effusions appreciated (2F/55).
The claimant was admitted for treatment again in May 2010 due to chest pain
with shortness of breath. Her cardiac enzyme testing was negative. The
claimant was assessed with “mild” reactive airway disease/asthma and she was
treated with nebulizer treatments during her hospitalization. The claimant was
discharged in stable condition with a prescription for Ventolin for her asthmarelated symptoms (14F).
A cardiac catheterization showed no obstructive coronary artery disease and
normal left ventricular systolic function in May 2010 (3F; 4F).

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The claimant reported dyspnea on exertion in June 2010, and the resulting
examination showed normal breath sounds, no rales, rhonchi, wheezes, rubs or
crackles (6F/11-12).
A CT scan conducted in July 2010 identified no evidence of pulmonary
thromboembolic disease (5F/2; 6F; 9F).
The claimant was admitted for an overnight hospital stay for abdominal pain,
chest pain and shortness of breath in August 2010 (10F; 15F). A chest x-ray
showed a slight increase in interstitial vascular markings with no evidence of
effusions or consolidations. An echocardiogram showed septal and posterior left
ventricular hypertrophy, no evidence of cardiac enlargement, ejection fraction
range of 50-55%, trace pulmonic and trace mitral regurgitation, mild aortic
regurgitation and moderate tricuspid regurgitation. Cardiac enzyme tests were
negative, and a CT scan of the claimant’s abdomen was negative. The
claimant’s pain resolved with administration of the pain reliever Ultram, and she
was discharged in “very stable” condition (10F).
The claimant has reported lower back pain that radiates to her buttocks and both
legs, which began in early 2011 after she reportedly fell out of a chair in her
home. The claimant alleged some difficulty bending over due to back pain;
however, she testified that she is able to kneel or squat down to the floor in order
to pick dropped items.
Objectively, x-rays obtained in May 2011 showed mild degenerative changes
throughout the claimant’s lumbar spine; her disc heights were appropriate; no
subluxation or listhesis was present; no obvious acute abnormalities were
observed; and the claimant’s hips and S1 joints were benign (20F). An electro
diagnostic study of the claimant’s lower extremities from December 2011 showed
S1 radiculopathy on the left (19F). Three views of the claimant’s lumbar spine
taken in January 2012 showed minimal degenerative change with no acute
abnormality (21F).
Providers from the Tallahassee Orthopedic Clinic evaluated the claimant’s low
back pain in May 2011, and she was referred for physical therapy services. The
claimant reported some improvement; however, it was noted in June 2011 that
the claimant had not been compliant in attending some of her scheduled
appointments (20F/27). In July 2011, the claimant decided to continue with
conservative treatment, but by September 2011, physical therapy was deemed
unsuccessful and an MRI was ordered. The resulting imagining studies
performed in October 2011 showed evidence of multilevel degenerative
spondylosis with no disc protrusion or definitive impingement. No definitive
diagnosis was offered to explain the claimant’s continued back pain, and she was

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referred to vocational rehabilitation for possible pain management control and
further testing. The claimant was released to return only on an as-needed basis
by the Tallahassee Orthopedic clinic in October 2011 (20F) [see R. 642-43].
The claimant is currently treated for chronic Hepatitis C, and progress notes
show that she was doing well with treatment in May 2011 (16F). During the
hearing, the claimant reported some drowsiness, dry mouth and fatigue resulting
from her hepatitis C injections.
E. Jacob, M. D., consultatively examined the claimant in February 2012 at the
request of the Social Security Administration. Upon examination, the claimant
was alert and oriented, and there was no evidence of anemia, cyanosis,
jaundice, clubbing or generalized lymphadenopathy. No abnormalities were
observed in the claimant’s thoracic or cervical spine. The lumbar spine had
normal curvature, no tenderness and no paravertebral muscle spasms. Straight
leg raise testing was negative bilaterally, and the sciatic notch and sciatic joint
areas were non-tender. The claimant’s jugular venous pressure was not
elevated, her heart sounds were normal, there was no gallop or murmur, was no
evidence of cardiomegaly, and the claimant’s peripheral sensations were normal.
The claimant’s lungs were clear, and the base of the lungs were also clear
without adventitious sounds. The claimant’s higher intellectual functions, speech,
memory and affect were normal. The claimant’s cranial nerve examination
produced the following results: normal funduscopic examination; Nerves II
showed early cataracts bilaterally; Nerves III, IV, VI showed full movements with
no nystagmus; the pupils were equal and reactive to light; the corneal reflexes
were normal; Nerves V, VII showed no sensory loss or muscle weakness; Nerve
VIII hearing was normal for both bone and air conduction; Nerves IX, X gag was
normal and uvula was midline; Nerve XI trapezius and sternocleidomastoid
muscles were normal with no atrophy noted; Nerve XII tongue was midline and
normal in appearance with no fasciculation noted. The claimant’s tone, power
and coordination in the upper and lower extremities were normal; finger-to-nose
and toe-to-heel tests were negative; toe walk, heel walk and tandem walk were
performed; ankle jerks were absent; and plantar reflexes were down-going; the
claimant reported reduced pinprick sensation in the S1 dermatome distribution on
the right, she had lymphedema on the left foot, and Romberg’s test was negative
(22F).
As for the opinion evidence, pursuant to 20 CFR 416.927, and Social Security
Rulings 96-6p, 96-2p, my finding above is supported by reports from treating and
examining physicians, as documented in the medical evidence of record. I have
considered these medical source reports, along with opinions from State agency
consultants, in my evaluation of the claimant’s functional limitations and weighed
them accordingly.

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Disability Determination Service medical consultant, Olga M. Garcia, M.D.,
determined the claimant [is] capable of work at the light exertional level with the
following environmental limitations in September 2010: avoid concentrated
exposure to fumes, odors, gases, dusts, and poor ventilation due to asthmarelated symptoms (12F). I have considered and assigned significant weight to
this assessment, as it is consistent with the overall evidence of record in this
case. Dr. Garcia’s status as a licensed physician was also considered in
evaluating tins opinion.
An unsigned medical excuse letter dated August 16, 2010, was produced by the
T.J. Roulhac Clinic, which medically excused the claimant from work beginning
on April 19, 2010 (15F/13). In October 2010, the claimant's treating physician,
Val-Dee Harmon Sheffield, M.D., of the T.J. Roulhac Clinic, returned the claimant
to light duty work (15F/97). Dr. Sheffield’s opinion in returning the claimant to
light duty work is assigned significant weight based upon its consistency with the
overall evidence of record in this case. Dr. Sheffield’s status as a licensed,
treating physician was also considered in evaluating this opinion.
Based upon his February 2012 consultative examination findings, Dr. Jacob
asserted that the claimant is able to lift up to 20 pounds frequently and up to 50
pounds occasionally, and carry up to 10 pounds frequently and up to 50 pounds
occasionally due to back pain with radicular symptoms. Dr. Jacob determined
the claimant able to sit for 1 to 2 hours at once; stand for 30 minutes at once;
walk for 20 minutes at once; sit for a total of 6 hours in an 8-hour workday; stand
for a total of 2 hours in an 8-hour workday; and walk for a total of 1 hour in an 8hour workday with breaks. Dr. Jacob limited the claimant to only frequent
operation of foot controls; however, I note that the claimant’s past work as a
childcare provider does not require the operation of foot controls. Dr. Jacob
limited the claimant’s climbing, balancing, stooping, kneeling, crouching and
crawling to only occasional. Dr. Jacob[’]s added environmental limitations of only
occasional exposure to moving machinery and unprotected heights (22F).
I have considered and assigned significant weight to the portion of Dr. Jacob’s
assessment regarding the claimant’s ability to lift, as the other evidence of record
supports this finding; however, little weight is given to the portion his assessment
concerning the claimant's ability to sit and stand because Dr. Jacob based this
finding on the claimant's “deconditioning,” and not too [sic] a medically
determinable impairment. The overall evidence of record generally supports
Dr. Jacob’s limitations on climbing, balancing, stooping, kneeling, crouching and
crawling; however, in considering the record as a whole, I have added additional
environmental limitations to my above-stated residual functional capacity
assessment.

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In sum, the above residual functional capacity assessment above is well
supported by the weight of the evidence of record, as I have considered the
objective medical evidence of record, the treatment required by the claimant, the
claimant’s testimony and subjective complaints, and my assessment of the
claimant’s credibility.
R. 28-32.
The ALJ then determined that Plaintiff is capable of performing past relevant
work as a childcare worker. R. 32. The ALJ relied, in part, on the testimony of the
vocational expert. Id.; see R. 78-79. The ALJ expressly rejected the limitations
suggested by Plaintiff’s counsel in another hypothetical question posed to the vocational
expert. R. 32 (“I find that the medical evidence of record does not support the limitations
posed by the representative in this hypothetical, and accordingly, I have given no weight
to the vocational expert’s responsive testimony to the hypothetical.”); see R. 79-80.
IV. Legal Standards Guiding Judicial Review
This Court must determine whether the Commissioner’s decision is supported by
substantial evidence in the record and premised upon correct legal principles.
42 U.S.C. § 405(g); Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). “Substantial
evidence is more than a scintilla, but less than a preponderance. It is such relevant
evidence as a reasonable person would accept as adequate to support a conclusion.”
Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983) (citations omitted); accord
Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). “The Commissioner’s factual
findings are conclusive if supported by substantial evidence.” Wilson v. Barnhart, 284

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F.3d 1219, 1221 (11th Cir. 2002) (citations omitted).1
“In making an initial determination of disability, the examiner must consider four
factors: ‘(1) objective medical facts or clinical findings; (2) diagnosis of examining
physicians; (3) subjective evidence of pain and disability as testified to by the claimant
and corroborated by [other observers, including family members], and (4) the claimant’s
age, education, and work history.’” Bloodsworth, 703 F.2d at 1240 (citations omitted).
The Commissioner analyzes a claim in five steps. 20 C.F.R. § 416.920(a)(4)(i)(v):
1. Is the individual currently engaged in substantial gainful activity?
2. Does the individual have any severe impairments?
3. Does the individual have any severe impairments that meet or equal
those listed in Appendix 1 of 20 C.F.R. Part 404, Subpart P?
4. Does the individual have the RFC to perform work despite limitations
and are there any impairments which prevent past relevant work?2
1

“If the Commissioner’s decision is supported by substantial evidence we must
affirm, even if the proof preponderates against it.” Phillips v. Barnhart, 357 F.3d 1232,
1240, n.8 (11th Cir. 2004) (citations omitted). “A ‘substantial evidence’ standard,
however, does not permit a court to uphold the Secretary’s decision by referring only to
those parts of the record which support the ALJ. A reviewing court must view the entire
record and take account of evidence in the record which detracts from the evidence
relied on by the ALJ.” Tieniber v. Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983).
“Unless the Secretary has analyzed all evidence and has sufficiently explained the
weight he has given to obviously probative exhibits, to say that his decision is supported
by substantial evidence approaches an abdication of the court's ‘duty to scrutinize the
record as a whole to determine whether the conclusions reached are rational.’” Cowart
v. Schweiker, 662 F.2d 731, 735 (11th Cir. 1981) (citations omitted).
2

A residual functional capacity (RFC) is the most a claimant can still do despite
limitations. 20 C.F.R. § 416.945(a)(1). It is an assessment based upon all of the
relevant evidence including the claimant’s description of her limitations, observations by
treating and examining physicians or other persons, and medical records. Id. The
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5. Do the individual’s impairments prevent other work?
A positive finding at step one or a negative finding at step two results in disapproval of
the application for benefits. A positive finding at step three results in approval of the
application for benefits. At step four, the claimant bears the burden of establishing a
severe impairment that precludes the performance of past relevant work. Consideration
is given to the assessment of the claimant’s RFC and the claimant’s past relevant work.
If the claimant can still do past relevant work, there will be a finding that the claimant is
not disabled. If the claimant carries this burden, however, the burden shifts to the
Commissioner at step five to establish that despite the claimant’s impairments, the
claimant is able to perform other work in the national economy in light of the claimant’s
RFC, age, education, and work experience. Phillips, 357 F.3d at 1237; Jones v. Apfel,
190 F.3d 1224, 1229 (11th Cir. 1999); Chester, 792 F.2d at 131; MacGregor v. Bowen,
786 F.2d 1050, 1052 (11th Cir. 1986); 20 C.F.R. § 416.920(a)(4)(v). If the
Commissioner carries this burden, the claimant must prove that he or she cannot
perform the work suggested by the Commissioner. Hale v. Bowen, 831 F.2d 1007,
1011 (11th Cir. 1987).

V. Legal Analysis
responsibility for determining claimant’s RFC lies with the ALJ. 20 C.F.R.
§ 416.946(c).
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A. The ALJ Properly Considered and Gave Appropriate Weight to the
Opinion of Dr. Jacob.
Plaintiff argues that the Commissioner’s decision should be reversed because
the ALJ failed to give great weight to a portion of Dr. Jacob’s opinion regarding Plaintiff’s
ability to sit and stand. Doc. 17 at 6-12.
Dr. Jacob is Board Certified in Neurology and Clinical Neurophysiology. R. 33536. On December 2, 2011, Plaintiff first appeared before Dr. Jacob based on a referral
by M. Gaston, P.A., for an electrodiagnostic evaluation. R. 635. Dr. Jacob noted:
The patient presents with low back pain and radiation of symptoms to the left leg.
The patient showed weakness of the dorsiflexion and eversion of the left foot and
ankle. The ankle reflexes are absent bilaterally in the patient reported reduced
pinprick sensation in the S1 dermatome distribution on the left. Please note that
patient has chronic lymphedema of the left leg. Tinel’s sign is negative over the
tarsal tunnel.
The patient underwent NCV and EMG evaluation.
R. 636. Dr. Jacob noted that the results of the NCV study of the lower extremities were
technically suboptimal because of the lymphedema of the left leg. The peroneal
motor study showed a normal latency, drop in amplitude and a normal velocity.
The tibial motor response could not be obtained because of the lymphedema.
The sural sensory response could not be elicited on the left side. The peroneal
F. wave latency is normal on the left. The H flex latency is normal on the left.
R. 636. Dr. Jacob’s impression was “suboptimal NCV study.” Id. Dr. Jacob reported
the results of the EMG of Plaintiff’s lower extremities:
The paravertebral muscles in the lower lumbar area showed increased
insertional activity, fibrillation, potentials, positive sharp waves and excess
polyphasics. The S1 innervated muscles on the left side showed increased
insertional activity, fibrillation potentials excess polyphasics with reduced
recruitment.

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R. 535. Dr. Jacob’s electrodiagnostic impression was: “S1 radiculopathy on the left.”
Id. There is no indication from these two pages of notes that Dr. Jacob treated Plaintiff.
R. 635-36.
The administrative hearing was held on December 22, 2011. R. 24. At the
conclusion of the hearing, the ALJ stated that he would arrange for Plaintiff to attend a
consultative physical examination. R. 80-81, 690. After the hearing, the ALJ advised
that he secured additional evidence including a neurological CE dated February 2,
2012, from Dr. Jacob, R. 684-92, and an x-ray of the lumbar spine dated January 31,
2012, from James M. Strohmenger, M.D., R. 681.3 Plaintiff’s counsel (Quinn E. Brock)
was also advised that a supplemental hearing could be requested. R. 240-41.
In the decision, the ALJ summarized the results of Dr. Jacob’s consultative
examination. R. 30.4 (Dr. Jacob’s report does not indicate that treatment was provided.
3

Dr. Strohmenger reviewed x-rays of the Plaintiff’s lumbar spine (with three
views). R. 681. His findings are that Plaintiff “is leaning to the left. The lumbar
vertebral bodies are intact on the lateral view. The alignment and disc spaces on the
lateral maintained normally. There is some minimal anterior scurrying at L2 and L3.” Id.
His impressions are: minimal degenerative change and no acute abnormality. Id.
4

Based solely on Plaintiff’s impairments, Dr. Jacob opined, by check marks on
the form, that Plaintiff could perform activities like shopping; travel without a companion
for assistance; ambulate without using a wheelchair, walker, or 2 canes or 2 crutches;
walk a block at a reasonable pace on rough or uneven surfaces; use standard public
transportation; climb a few steps at a reasonable pace with the use of a single hand rail’
prepare a simple meal and feed herself; provide for her personal hygiene; and sort,
handle, or use paper and files. R. 689. Dr. Jacob also opined that Plaintiff did not
require a cane to ambulate, that a cane was not medically necessary, and that with a
cane, Plaintiff can use her free hand to carry small objects. R. 685. In his type-written
physical evaluation, Dr. Jacob’s impressions were: history of chest pain and
palpitations; workup negative for coronary artery disease and heart disease; history of
hypertension; and history of low back pain with radicular symptoms. R. 692.
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Id.) Dr. Jacob also provided a medical source statement of Plaintiff’s ability to do workrelated activities (physical). R. 684-89. The ALJ summarized Dr. Jacob’s evaluation
and concluded:
I have considered and assigned significant weight to the portion of Dr. Jacob’s
assessment regarding the claimant’s ability to lift, as the other evidence of record
supports this finding; however, little weight is given to the portion [of] his
assessment concerning the claimant’s ability to sit and stand because Dr. Jacob
based this finding on the claimant’s “deconditioning,” and not too [sic] a medically
determinable impairment. The overall evidence of record generally supports
Dr. Jacob’s limitations on climbing, balancing, stooping, kneeling, crouching and
crawling; however, assuming the record as a whole, I have added additional
environmental limitations to my above-stated residual functional capacity
assessment.
R. 31 (emphasis added). Plaintiff takes issue with the ALJ giving “little weight” to the
emphasized portion of Dr. Jacob’s assessment. Doc. 17 at 9.
On April 23, 2012, Plaintiff’s counsel (Mr. Jackson) advised ALJ Dorman of
Dr. Jacob’s physical examination results and requested the ALJ to find Plaintiff disabled
pursuant to Medical-Vocational Guideline 201.14. R. 244. In part, Mr. Jackson
concluded that “Dr. Jacob’s opinion supports a finding that Ms. Ramsey is limited to
sedentary exertional level work due to the limitation to standing a total of 2 hours during
an eight hour workday with breaks and only occasional stooping.” Id. In his decision,
the ALJ stated that he “fully considered [counsel’s] response” and that his
ruling to include these post-hearing materials is explained in detail within the
rationale of this decision. I note that the claimant has not requested an
opportunity to question the author of her post-hearing consultative exam, nor has
she requested a supplemental hearing. Even if the claimant had requested an
opportunity to question the consultative examiner, I find such questioning
unnecessary to inquire fully into the matters at issue.
R. 24.

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The burden is on the claimant to prove she is disabled. Bell v. Bowen, 796 F.2d
1350, 1352 (11th Cir. 1986) (citing 20 C.F.R. §§ 404.1525, 404.1526); Wilkinson v.
Bowen, 847 F.2d 660, 663 (11th Cir. 1987). A disability is defined as a physical or
mental impairment of such severity that the claimant is not only unable to do past
relevant work, “but cannot, considering his age, education, and work experience,
engage in any other kind of substantial gainful work which exists in the national
economy.” 42 U.S.C. § 423(d)(2)(A). A disability is an “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); see 20 C.F.R. § 416.909 (duration requirement). Both the “impairment”
and the “inability” must be expected to last not less than 12 months. Barnhart v.
Walton, 535 U.S. 212 (2002).
Acceptable medical sources provide evidence in order to establish whether a
claimant has a medically determinable impairment. These medical sources include
licensed physicians (medical or osteopathic doctors), licensed or certified psychologists,
and others. 20 C.F.R. § 416.913(a). In addition to evidence from the acceptable
medical sources, evidence from other sources may be considered to show the severity
of the claimant’s impairment and how it affects their ability to work. 20 C.F.R.
§ 416.913(d)(1).
As the finder of fact, the ALJ is charged with the duty to evaluate all of the
medical opinions of the record, resolving conflicts that might appear. 20 C.F.R.

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§ 416.927. When considering medical opinions, the following factors apply for
determining the weight to give to any medical opinion: (1) the frequency of examination
and the length, nature, extent of the treatment relationship; (2) the evidence in support
of the opinion, i.e., “[t]he more a medical source presents relevant evidence to support
an opinion, particularly medical signs and laboratory findings, the more weight” that
opinion is given; (3) the opinion’s consistency with the record as a whole; (4) whether
the opinion is from a specialist and, if it is, it will be accorded greater weight; and (5)
other relevant but unspecified factors. 20 C.F.R. § 416.927(b) & (c).
The opinion of the claimant’s treating physician must be accorded considerable
weight by the Commissioner unless good cause is shown to the contrary. Lewis v.
Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997). This is so because treating physicians
“are likely to be the medical professionals most able to provide a detailed, longitudinal
picture of your medical impairment(s) and may bring a unique perspective to the
medical evidence that cannot be obtained from the objective medical findings alone or
from reports of individual examinations, such as consultative examinations or brief
hospitalizations.” 20 C.F.R. § 416.927(c)(2). “This requires a relationship of both
duration and frequency.” Doyal v. Barnhart, 331 F.3d 758, 762 (10th Cir. 2003). “‘The
treating physician doctrine is based on the assumption that a medical professional who
has dealt with a claimant and his maladies over a long period of time will have a deeper
insight into the medical condition of the claimant than will a person who has examined a
claimant but once, or who has only seen the claimant’s medical records.’ Barker v.
Shalala, 40 F.3d 789, 794 (6th Cir. 1994) (emphasis added).” Id.

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As the Supreme Court recently observed, “the assumption that the opinions of a
treating physician warrant greater credit that [sic] the opinions of [other experts]
may make scant sense when, for example, the relationship between the claimant
and the treating physician has been of short duration.” Black & Decker Disability
Plan v. Nord, [538 U.S. 822, 832 (2003)]. Moreover, a longstanding treatment
relationship provides some assurance that the opinion has been formed for
purposes of treatment and not simply to facilitate the obtaining of benefits.
A physician’s opinion is therefore not entitled to controlling weight on the basis of
a fleeting relationship, or merely because the claimant designates the physician
as her treating source. Absent an indication that an examining physician
presented “the only medical evidence submitted pertaining to the relevant time
period,” the opinion of an examining physician who only saw the claimant once is
not entitled to the sort of deferential treatment accorded to a treating physician’s
opinion. Reid v. Chater, 71 F.3d 373, 374 (10th Cir. 1995) (emphasis added).
Doyal, 331 F.3d at 762-63.
The reasons for giving little weight to the opinion of the treating physician must
be supported by substantial evidence, Marbury v. Sullivan, 957 F.2d 837, 841 (11th Cir.
1992), and must be clearly articulated. Phillips, 357 F.3d at 1241. “The Secretary must
specify what weight is given to a treating physician’s opinion and any reason for giving it
no weight, and failure to do so is reversible error.” MacGregor, 786 F.2d at 1053.
The ALJ may discount a treating physician’s opinion report regarding an inability
to work if it is unsupported by objective medical evidence and is wholly conclusory.
Edwards v. Sullivan, 937 F.2d 580, 583-84 (11th Cir. 1991). Stated somewhat
differently, the ALJ may discount the treating physician’s opinion if good cause exists to
do so. Hillsman v. Bowen, 804 F. 2d 1179, 1181 (11th Cir. 1986). Good cause may be
found when the opinion is “not bolstered by the evidence,” the evidence “supports a
contrary finding,” the opinion is “conclusory” or “so brief and conclusory that it lacks
persuasive weight,” the opinion is “inconsistent with [the treating physician’s own

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medical records,” the statement “contains no [supporting] clinical data or information,”
the opinion “is unsubstantiated by any clinical or laboratory findings,” or the opinion “is
not accompanied by objective medical evidence.” Lewis, 125 F.3d at 1440; Edward,
937 F.2d at 583 (citing Schnorr v. Bowen, 816 F.2d 578, 582 (11th Cir. 1987)). Further,
where a treating physician has merely made conclusory statements, the ALJ may afford
them such weight to the extent they are supported by clinical or laboratory findings and
are consistent with other evidence as to a claimant’s impairments. Wheeler v. Heckler,
784 F.2d 1073, 1075 (11th Cir. 1986).
Plaintiff refers to Dr. Jacob as a treating physician. See, e.g., Doc. 17 at 6, 8-9.
Plaintiff also refers to Dr. Jacob’s December 2011 evaluation, R. 635, and February
2012 assessment, R. 690-91, as “treatment notes” that “support his opinions.” Doc. 17
at 10. Here, Dr. Jacob had one evaluation and one assessment of Plaintiff and
Dr. Jacob’s provided a “medical opinion” as a “medical source.” 20 C.F.R.
§ 416.927(a)(2). (“Medical opinions are statements from physicians and psychologists
. . . [that] reflect judgment about the nature and severity of [the claimant’s] impairments.”
20 C.F.R. § 416.927(a)(2).) There is no substantial evidence that Dr. Jacob provided
actual treatment to Plaintiff in that Dr. Jacob did not record that he provided any plan of
treatment to Plaintiff, including prescribing any medication.
Assuming that Dr. Jacob is a treating physician, agency regulations are clear that
the “longer a treating source has treated [the claimant] and the more times [the
claimant] have been seen by the treating source, the more weight we will give to the
source’s medical opinion.” 20 C.F.R. § 416.927(c)(2)(i). “When the treating source has

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seen [the claimant] a number of times and long enough to have obtained a longitudinal
picture of your impairment, we will give the source’s opinion more weight than we would
give it if it were from a nontreating source.” Id. Dr. Jacob did not provide the ALJ with
“a detailed longitudinal picture of [Plaintiff’s] medical impairment(s)” such that it brought
“a unique perspective to the medical evidence that cannot be obtained from reports of
individualized examinations, such as consultative examinations or brief
hospitalizations.” 20 C.F.R. § 416.927(c)(2). Dr. Jacob’s rather brief relationship with
Plaintiff was that of a consultant, rather than a true treating physician.
Nevertheless, the ALJ accepted significant portions of Dr. Jacob’s opinions that
included Plaintiff’s abilities comporting at least with the definition of light work. 20
C.F.R. § 416.967(b). The ALJ accepted Dr. Jacob’s lifting assessment as consistent
with the record and consistent with the RFC that he fashioned. R. 31. The ALJ also
accepted Dr. Jacob’s assessment of the postural maneuvers that Plaintiff could perform.
R. 31, 687.
The ALJ deviated from Dr. Jacob’s statement to the extent he suggested Plaintiff
would experience certain limitations in sitting, standing, and walking--limitations that
Dr. Jacob confirmed were caused not by Plaintiff’s physical impairments, but by
“deconditioning.” R. 31, 685. When he assessed the lifting restrictions that appeared in
his statement, Dr. Jacob explicitly confirmed that those, which the ALJ accepted, were
the result of Plaintiff’s back pain and radicular symptoms. R. 684. By contrast, when he
set forth various sitting, standing, and walking limitations, Dr. Jacob explained that those
particular limitations were “due to deconditioning,” but did not define what he meant by

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the phrase “due to deconditioning.” R. 685.
The ALJ explained that “little weight is given to the portion [of] his assessment
concerning the claimant’s ability to sit and stand because Dr. Jacob based this finding
on the claimant’s ‘deconditioning,’ and not too [sic] a medically determinable
impairment.” R. 31. The ALJ appropriately explained that “deconditioning” is not a
medically determinable physical impairment within the meaning of the Social Security
Act. R. 31; see, e.g., Cooper v. Comm’r of Soc. Sec., 521 F. App’x 803, 806-7 (11th
Cir. June 3, 2013) (unpublished); Pinkins v. Astrue, Civil Action No: 09-6920 Section:
“D” (5), 2010 U.S. Dist. LEXIS 102119, at *27 (E.D. La. Sept. 8, 2010), approved and
adopted by, 2010 U.S. Dist. LEXIS 102693 (E.D. La. Sept. 24, 2010); Sturgill v. Astrue,
Case No. 1:08-CV-687, 2010 U.S. Dist. LEXIS 15933, at *11-12 (S.D. Ohio Feb. 23,
2010).5
The ALJ’s decision is further supported by the opinion rendered by nonexamining state agency physician consultant Dr. Garcia, who reviewed the record in
5

The term “deconditioning” has been defined by several courts. See, e.g., King
v. Colvin, No. 12 C 9280, U.S. Dist. LEXIS 59463, at *12 n.7 (N.D. Ill. Apr. 29, 2014)
(“’Deconditioning’ means ‘a state of prolonged underuse of muscles.’” (citation omitted));
Ramsey v. Colvin, Case No. 4:12-CV-1003-NAB, 2013 U.S. Dist. LEXIS 137291, at *13
n.3 (E.D. Mo. Sept. 25, 2013) (“Deconditioning means to cause or lose fitness or muscle
tone, especially through lack of exercise.” (citation omitted)); Furtado v. Astrue, C.A. No.
07-387ML, 2008 U.S. Dist. LEXIS 56499, at *31 n.3 (D. R.I. July 25, 2008) (“Although
the ALJ does not define the term ‘deconditioning,’ the Court assumes that she means
that Plaintiff’s lack of activity resulted in him becoming ‘out of shape’”). “Deconditioning”
has also been defined as “a change in cardiovascular function after prolonged periods
of weightlessness, probably related to a shift of a quantity of blood from the lower limbs
to the thorax, resulting in reflex diuresis and a reduction of blood volume.” Dorland’s
Illustrated Medical Dictionary 475 (32nd ed. 2012); see 20 C.F.R. Pt. 404, Subpt. P.,
App. 1, § 4.00D.3.d. (referencing deconditioning regarding evaluating chronic heart
failure).
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September 2010, and opined that Plaintiff’s physical limitations were compatible with a
range of light work. R. 31, 461-66.6 The ALJ’s decision is otherwise supported by the
medical evidence, including but not limited to the patient records of Dr. Sheffield, one of
Plaintiff’s treating physicians, who, on October 18, 2010, stated that Plaintiff “may return
back to work light duty,” R. 603, as noted by the ALJ. R. 31. (In August 2010, Plaintiff
had an unsigned medical excuse letter from the T. J. Roulhac Clinic that she was
medically excused from work beginning on April 19, 2010, until further notice. R. 31,
519.) The ALJ assigned “significant weight” to Dr. Sheffield’s opinion “based upon its
consistency with the overall evidence of record in this case. Dr. Sheffield’s status as a
licensed, treating physician was also considered in evaluating this opinion.” R. 31.
The ALJ’s RFC assessment is consistent with the medical evidence. Substantial
evidence supports the ALJ’s consideration and weight that was given to Dr. Jacob’s
opinions. No error has been shown.
B. Substantial Evidence Supports the ALJ’s Consideration of Plaintiff’s
Obesity
Plaintiff argues that the ALJ erred because he did not perform an assessment of
the effect of Plaintiff’s severe impairment of obesity on her ability to work. Doc. 17 at
13-15. In support, Plaintiff notes in part that she has other severe impairments including
hypertension, hepatitis C, asthma, degenerative disc disease and spondylosis,

6

State agency medical consultants are “highly qualified physicians who are
experts in the evaluation of the medical issues in disability claims under the Act.” See
Social Security Ruling 96-6p. Their opinions regarding an individual’s RFC are entitled
to consideration and weight. 20 C.F.R. § 416.927(e)(2).
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radiculopathy, history of catheterization and dyspnea, identified by the ALJ, R. 26. Doc.
17 at 14. Plaintiff suggests that “it is reasonable to believe that [Plaintiff’s] obesity would
exacerbate” these severe impairments “and cause more significant limitations in her
functional abilities.” Id.
As noted, the ALJ found Plaintiff’s obesity to be a severe impairment and
addressed the issue at step two:
At each step of the sequential evaluation process, I have specifically considered
the effects of the claimant’s obesity Social Security Ruling [SSR] 02-1p in
formulating the claimant’s residual functional capacity. The claimant’s medical
records document “morbid obesity” in May 2011 (20F/41). At hearing in
December 2011, the claimant testified to a height of 5’ 5” and a weight of 260
pounds, which corresponds to a Body Mass Index (BMI) of 43.3, classified at
Level III under the clinical guidelines specified in [SSR] 02-01p. Because the
claimant’s obesity has more than a minimal impact on her ability to perform basic
work activities, it is severe.
R. 27.
Plaintiff criticizes the ALJ for allegedly failing to consider her obesity in later steps
in the sequential disability analysis. The ALJ referred to Plaintiff’s claims of disability
due to obesity among other impairments. R. 28. The ALJ expressly referred to SSR
02-01p and noted that he had “specifically considered the effects of the claimant’s
obesity” in “formulating the claimant’s [RFC].” Id. In fashioning the Plaintiff’s RFC, the
ALJ relied on the opinion of state agency physician Dr. Garcia who made a careful note
of Plaintiff’s height, weight, and BMI in assessing limitations from Plaintiff’s impairmentslimitations with which the ALJ generally concurred. R. 31, 461-62. The ALJ also relied
on the statement from Dr. Sheffield, who was acquainted with Plaintiff’s severe obesity,
R. 445, 521, 525, 527, 529, that Plaintiff was approved for light duty in October 2010.

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R. 31, 603.
Substantial evidence supports the ALJs consideration of Plaintiff’s obesity when
he determined her RFC. See generally Solomon v. Comm’r of Soc. Sec., 532 F. App’x
837, 840-41 (11th Cir. 2013) (unpublished). No error has been shown.
VI. Conclusion
Plaintiff has the burden to prove she is disabled. Moore, 405 F.3d at 1211. The
record does not support Plaintiff’s assertion that she was disabled since the date her
application was filed, that is, she was unable to engage in any substantial gainful activity
due to a medically determinable impairment that can be expected to last for a
continuous period of not less than 12 months. See 42 U.S.C. §§ 416(i) and
423(d)(1)(A). Considering the record as a whole, the findings of the ALJ are based
upon substantial evidence and the ALJ correctly followed the law. Accordingly,
pursuant to the fourth sentence in 42 U.S.C § 405(g), the decision of the Commissioner
to deny Plaintiff's application for Social Security benefits is AFFIRMED and the Clerk is
DIRECTED to enter judgment for Defendant.
DONE AND ORDERED at Tallahassee, Florida, on June 25, 2014.

s/ Charles A. Stampelos__________
CHARLES A. STAMPELOS
UNITED STATES MAGISTRATE JUDGE

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