CHANDLER v. BERRYHILL

Filing 20

MEMORANDUM OPINION AND ORDER - Accordingly, pursuant to sentence four of 42 U.S.C § 405(g), the decision of the Commissioner to deny Plaintiff's application for a period of disability and disability benefits is REVERSED and REMANDED to the Commissioner for further proceedings consistent with this opinion and to consider referring Plaintiff for a consultative examination. The Clerk is DIRECTED to enter judgment for Plaintiff. Signed by MAGISTRATE JUDGE CHARLES A STAMPELOS on 4/12/2018. (tdl)

IN THE UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF FLORIDA
PANAMA CITYDIVISION
MELISSA E. CHANDLER,
Plaintiff,
vs.

Case No. 5:17cv175-CAS

NANCY A. BERRYHILL, Acting
Commissioner of Social
Security,
Defendant.
/
MEMORANDUM OPINION AND ORDER
This Social Security case was referred to the undersigned upon
consent of the parties, ECF No. 5 by Chief United States District Judge
M. Casey Rodgers. ECF No. 6. It is now before the Court pursuant to 42
U.S.C. § 405(g) for review of the final determination of the Acting
Commissioner (Commissioner) of the Social Security Administration
denying Plaintiff’s application for a period of disability and Disability
Insurance Benefits (DIB) pursuant to Title II of the Social Security Act. See
ECF No. 1. After careful consideration of the record, the decision of the
Commissioner is reversed and remanded for further proceedings.

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I. Procedural History and Facts
On November 20, 2013, Plaintiff filed an application with the Social
Security Administration for a period of disability and disability insurance
benefits under Title II, alleging disability beginning February 6, 2013.
Tr. 156-59.1 Plaintiff alleged disability citing rheumatoid arthritis, disc
disease, fibromyalgia, heart condition, and high cholesterol. Tr. 182.
The claim was denied initially on March 26, 2014, and upon
reconsideration on September 18, 2014. Tr. 97-99, 106-11. On March 14,
2016, a video hearing was held before Administrative Law Judge (ALJ)
Jim Beeby, who presided from Knoxville, Tennessee. Tr. 30-52. Plaintiff
appeared in Panama City, Florida, with counsel. Impartial vocational
expert Susan Thomas also testified.
On May 18, 2016, the ALJ issued a decision finding Plaintiff is not
disabled and denying the application for disability benefits. Tr. 17-29. The
Appeals Council denied Plaintiff’s request for review. Tr. 1-6. Thus, the
decision of the ALJ became the final decision of the Acting Commissioner
and is ripe for review. Accordingly, on July 3, 2017, Plaintiff, appearing
through counsel, filed a complaint for judicial review pursuant to 42 U.S.C.

1

Citations to the transcript/administrative record (ECF No. 13) shall be by the
symbol “Tr.” followed by a page number that appears in the lower right corner of each
page.
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§§ 1381, et seq., and 42 U.S.C. § 405(g). See ECF No. 1. Respondent
filed an answer on December 1, 2017, ECF No. 12, and both parties filed
memoranda in support of their positions. ECF Nos. 15, 16. On Plaintiff’s
motion, she was given leave to reply to the Commissioner’s memorandum,
ECF No. 18, and she filed a reply on March 23, 2018. ECF No. 19.
A. The Hearing
At the hearing held March 14, 2014, Plaintiff, age 46 at the time of the
hearing, testified that she lives with her husband and her father, who
recently came to stay. Tr. 33-34. She earned a GED in 2006 and last
worked in February 2013. Tr. 35. She testified that she quit her job due to
pain in her shoulder and knees and swelling in her feet and hands. Tr. 47.
Her previous employment was as a clerk or in food services at a grocery
store in both the deli and the seafood and meat department. Tr. 35-37.
She testified she smokes a half pack of cigarettes a day and is trying to
quit. Tr. 37.
Plaintiff described her typical day as one in which she wakes up and
takes a pain pill and waits about 20 minutes to get up. She then makes
and drinks coffee and takes her other medications. She lets the dogs out
and, if she is having a good day, she will help her husband with the
laundry. Other than that, she testified, she “just lay[s] around.” Tr. 38. She

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said her husband does the other household chores. Id. On a bad day, she
said, she cannot get out of bed at all due to the pain, even after taking a
pain pill. Tr. 44. When this happens, her back, knees, and hands hurt.
Tr. 45. She said this happens about three times a month. Id.
Plaintiff testified that her husband helps her into and out of the
shower, but she can still wash her hair and body. Sometimes he has to
help her dry off and put her clothes on if her shoulder is bothering her.
Tr. 39. She testified she can walk for about ten minutes and can stand for
about 30 minutes to one hour at a time, depending on how many pain pills
she has taken. Id. She said she cannot lift a five-pound bag of sugar and
when she drinks her coffee, she must use both hands. Id. She testified
that she drops things from her right hand “all the time” due to lack of hand
strength. Tr. 43-44.
Plaintiff testified the physical problem that most keeps her from
working is her right hand, which became worse about a year prior. Tr. 40.
She said her hand swells and her fingers cramp making it almost
impossible to move them. Id. Her next most problematic condition is both
knees, which frequently swell so badly she cannot walk. Tr. 40-41. The
last time she could not walk due to that condition was May 2013. Tr. 41.
Her left hand began to bother her in May 2013, and also swells but not as

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badly as in her right hand. She learned from a doctor that she had
rheumatoid arthritis. Tr. 41-42. She testified that she is in chronic pain all
the time due to fibromyalgia, which began “bothering her” in 2014 and for
which she takes Flexeril. Tr. 42.
When asked if there were other problems, Plaintiff said no, but on
questioning by her counsel, she explained that she had swelling in her left
ankle and foot which keeps her from walking when it flares up. She has
had five flare ups. Tr. 42-43. She also described memory problems that
began in 2013. Tr. 46.
The vocational expert testified that Plaintiff’s prior employment was
as gas station cashier, described as DOT § 211.462-010, light, unskilled,
SVP of 2; Deli counter worker, DOT § 317.664-010, medium, unskilled,
SVP of 2; and as a seafood counter worker, DOT § 222.684-010, medium,
unskilled, SVP of 2.2 The ALJ posed a hypothetical question describing an

2

DOT refers to the Dictionary of Occupational Titles (4th Ed., Rev. 1991), which
is one of the examples of sources that the ALJ may rely on for job information. See
SSR 00-4p; 20 C.F.R. § 404.1566(d). The ALJ may also rely on a vocational expert or
other specialist. See § 404.1566(e). An SVP (Specific Vocational Preparation) of 1
means “short demonstration only.” Dictionary of Occupational Titles (DOT) (4th ed.,
rev. 1991), Appendix C: Components of the Definition Trailer, § II, SVP. An SVP of 2
means “[a]nything beyond short demonstration up to and including 1 month.” Id. “[SVP]
is defined as the amount of lapsed time required by a typical worker to learn the
techniques, acquire the information, and develop the facility needed for average
performance in a specific job-worker situation.” Id. Unskilled work corresponds to an
SVP of 1 and 2. SSR 00-4p, 2000 SSR LEXIS 8, at *8 (Dec. 4, 2000). “Unskilled work
is work which needs little or no judgment to do simple duties that can be learned on the
job in a short period of time.” 20 C.F.R. § 404.1568(a). Further, unskilled work is work
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individual of the same age, education, and prior work experience as that of
Plaintiff, and who can lift and carry, push and pull twenty pounds
occasionally and ten pounds frequently with normal breaks in an eight-hour
day. The individual can sit for six hours and stand and/or walk for six
hours; can never climb ladders, ropes, or scaffolds; can occasionally climb
ramps and stairs; can occasionally balance, stoop, kneel, crouch, and
crawl; can tolerate occasional exposure to vibration; can tolerate
occasional right upper extremity handling and fingering and frequent left
upper extremity handling and fingering. When asked if such an individual
could perform Plaintiff’s past work as actually or generally performed in the
national economy, the vocational expert testified that the person could not
do so. Tr. 49.
The vocational expert testified there was other light, unskilled work
that this individual could perform, citing rental and counter clerk, DOT
§ 295.357-018, light, unskilled, with SVP of 2, with approximately 60,000
jobs in the national economy; usher and lobby attendant, DOT § 344.677014, light, unskilled, SVP of 2, with approximately 25,000 jobs in the

involving understanding, remembering, and carrying out simple instructions; making
simple work-related decision; dealing with changes in a routine work setting; and
responding appropriately to supervision, co-workers, and usual work situations. SSR
85-15, 1985 SSR LEXIS 20, at *10-11 (1985).
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national economy; and packing and machine filling machine tender, DOT
§ 520.667-066, light, unskilled work, SVP of 2, with approximately 85,000
jobs in the national economy. Tr. 49-50.
The ALJ posed a second hypothetical scenario with the same facts
as above, but with the addition that the individual would miss more than two
days of work a month due to impairments or treatment. The vocational
expert testified that there would be no work for that individual. Tr. 50. The
vocational expert testified that her testimony was consistent with the DOT.
Id.
B. The Decision of the Administrative Law Judge
In the decision issued on May 18, 2016, the ALJ made several
findings pertinent to this review. Tr. 17-24. The ALJ found that Plaintiff met
the insured status requirement on June 30, 2015. Tr. 19. She was 45
years old, defined as a younger individual, on the date last insured. Tr. 23.
She has at least a high school education and can communicate in English.
Id.
The ALJ found Plaintiff did not engage in substantial gainful activity
during the period from her alleged onset date of February 6, 2013, through
the date last insured of June 30, 2015. Tr. 19. The ALJ found that as of
the date last insured, Plaintiff had the following severe impairments:

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rheumatoid arthritis, bilateral knee osteoarthritis, fibromyalgia, and coronary
artery disease. Id.
The ALJ found that Plaintiff’s medically determinable impairments of
hypertension, hyperlipidemia, asthma by history, anxiety, and depression,
considered singly and in combination, did not cause more than minimal
limitation in the claimant’s ability to perform basic mental work and were
therefore nonsevere. Tr. 20.
The ALJ found that Plaintiff had “no to mild” limitation in the functional
areas of daily living, social functioning, and concentration, persistence or
pace. Id. The ALJ further found that Plaintiff experienced no episodes of
decompensation of extended duration. Id. The ALJ gave no weight to the
opinion of Dr. Julian Salinas, a consultative examiner who diagnosed
Plaintiff with major depressive disorder based on a single examination with
no functional analysis. Tr. 20 (citing records at Tr. 397-400). The ALJ
concluded that Plaintiff’s medically determinable mental impairments cause
no more than mild limitation in any of the first three functional areas, and no
episodes of decompensation of extended duration in the fourth area, and
thus were nonsevere. Tr. 20. The ALJ found that Plaintiff did not have any
impairment or combination of impairments that met or medically equaled

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the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart
P, Appendix 1.
In determining Plaintiff’s residual functional capacity (RFC), the ALJ
found that she could perform light work, lift and carry, push and pull twenty
pounds occasionally and ten pounds frequently, with normal breaks in an
eight-hour workday. She can sit for six hours and stand and/or walk for six
hours; can never climb ladders, ropes, or scaffold; can occasionally climb
ramps and stairs; can occasionally balance, stoop, kneel, crouch, and
crawl; and can tolerate occasional exposure to vibration; and can tolerate
right upper extremity handling and fingering and frequent left upper
extremity handling and fingering.3 Tr. 20-21.
In reaching this RFC, the ALJ concluded that although Plaintiff’s
medically determinable impairments could reasonably be expected to

3

Residual functional capacity is the most a claimant can still do despite
limitations. 20 C.F.R. § 404.1545(a)(1). It is an assessment based upon all of the
relevant evidence including the claimant’s description of his or her limitations,
observations by treating and examining physicians or other persons, and medical
records. Id. The responsibility for determining claimant’s RFC lies with the ALJ. 20
C.F.R. § 404.1546(c); see Social Security Ruling (SSR) 96-5p, 1996 SSR LEXIS 2, at
*12 (July 2, 1996) (rescinded eff. Mar. 27, 2017) (“The term ‘residual functional capacity
assessment’ describes an adjudicator’s finding about the ability of an individual to
perform work-related activities. The assessment is based upon consideration of all
relevant evidence in the case record, including medical evidence and relevant
nonmedical evidence, such as observations of lay witnesses of an individual’s apparent
symptomatology, an individual’s own statement of what he or she is able or unable to
do, and many other factors that could help the adjudicator determine the most
reasonable findings in light of all the evidence.”).
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cause the alleged symptoms, her statements concerning the intensity,
persistence, and limiting effects of these symptoms are not entirely
consistent with the medical evidence and other evidence in the record.
Tr. 21. The ALJ found that Plaintiff’s complaints exceed what is reasonably
expected in light of objective findings.
The ALJ cited radiological testing of Plaintiff’s right and left wrists,
right shoulder, left and right knees, left fibular, and ultrasound of the knees,
feet, and hands, concluding that they do show some degenerative changes
but not to the extent or severity alleged by Plaintiff. Id. (citing records at
Tr. 403-19, 448-49, 491). The ALJ cited Dr. Amir Agha’s reports that
Plaintiff had some limited range of motion in the hands, knees, and
shoulders, but not the kind of severe restriction expected in light of the
severity of Plaintiff’s claims in her testimony. Tr. 22 (citing records at
Tr. 434-55 and Tr. 458-83). The ALJ gave little weight to the opinion of
Dr. Krzysztof Lewandowski, a consultative examiner, who indicated that
Plaintiff had no significant impairment-related limitations, which ignored the
documented history of rheumatoid arthritis and fibromyalgia. Id.
The ALJ found that there were no contrary opinions to those of state
agency consulting physician Dr. Lionel Henry, who “essentially opined” that
Plaintiff has the following limitations: lifting a maximum of about twenty

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pounds occasionally and ten pounds frequently; and standing and/or
walking about six hours in an eight-hour workday. Id. (citing records at
Tr. 73-89). Based on the treatment histories of Dr. Hulon Crayton,
Dr. Agha, and Dr. Roger Gamad, the ALJ added the limitations relating to
Plaintiff’s difficulty with postural activities and wrist and hand motions. Id.
(citing records at Tr. 316-32, Tr. 403-19, Tr. 420-32 (Crayton); Tr. 434-55,
Tr. 458- 83 (Agha); and Tr. 484-500 (Gamad)).
Based on this RFC, and on the testimony of the vocational expert, the
ALJ found Plaintiff was unable to perform any past relevant work, but could
perform other work that exists in significant numbers in the national
economy. Tr. 22, 23. That representative work was found to be, as
testified by the vocational expert and set forth above, rental clerk, usher,
and packing and machine tender.
In conclusion, the ALJ found, based on the testimony of the
vocational expert and the record, that Plaintiff was capable of making a
successful adjustment to other work that existed in significant numbers in
the national economy and that Plaintiff was “not disabled” under section
216(i) and 223(d) of the Social Security Act through June 30, 2015, the
date last insured. Tr. 23-24.

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II. 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 F.3d 1219, 1221 (11th Cir. 2002)
(citations omitted).4 The Court may not decide the facts anew, reweigh the
evidence, or substitute its judgment for that of the Commissioner,
Bloodsworth, 703 F.2d at 1239, although the Court must scrutinize the

“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).
4

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entire record, consider evidence detracting from the evidence on which the
Commissioner relied, and determine the reasonableness of the factual
findings. Lowery v. Sullivan, 979 F.2d 835, 837 (11th Cir. 1992); Parker v.
Bowen, 793 F.2d 1177, 1180 (11th Cir. 1986). Review is deferential, but
the reviewing court conducts what has been referred to as “an independent
review of the record.” Flynn v. Heckler, 768 F.2d 1273, 1273 (11th Cir.
1985).
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. § 404.1509
(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). An individual is entitled to disability insurance benefits if he or she
is under a disability prior to the expiration of his insured status. See 42

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U.S.C. § 423(a)(1)(A); Moore, 405 F.3d at 1211; Torres v. Sec’y of Health
& Human Servs., 845 F.2d 1136, 1137-38 (1st Cir. 1988); Cruz Rivera v.
Sec’y of Health & Human Servs., 818 F.2d 96, 97 (1st Cir. 1986).
Pursuant to 20 C.F.R. § 404.1520(a)(4)(i)-(v), the Commissioner
analyzes a claim in five steps. Under the first step, the claimant has the
burden to show that she is not currently engaged in substantial gainful
activity. 20 C.F.R. § 404.1520(a)(4)(i). At the second step, the claimant
must show she has a severe impairment. 20 C.F.R. § 404.1520(a)(4)(ii).
Step two is a threshold inquiry, and the ALJ does not go on to step three if
the claimant fails to meet step two, but will find claimant is “not disabled.”
McDaniel v. Bowen, 800 F.2d 1026, 1032 (11th Cir. 1986); 20 C.F.R.
§ 404.1520(a)(4)(ii). At step three, the claimant must show that her severe
impairment or combination of impairments meets or equals the criteria in
the Listings of Impairments. 20 C.F.R. § 404.1520(a)(4)(iii). If the claimant
cannot meet or equal one of the listings, the ALJ considers at step four
whether the claimant has the residual functional capacity (“RFC”) to
perform her past relevant work. § 404.1520(a)(4)(iv). If the claimant
establishes she cannot perform her past relevant work, the burden shifts to
the Commissioner at step five to show that significant numbers of jobs exist
in the national economy that the claimant can perform in light of her RFC,

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age, education, and work experience. 20 C.F.R. §§ 404.1520(a)(4)(v),
404.1520(d), (g); Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir. 2004);
Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999); McMahon v. Comm’r,
Soc. Admin., 583 F. App’x 886, 887 (11th Cir. 2014) (unpublished). 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).
Plaintiff bears the burden of proving that she is disabled and,
consequently, is responsible for producing evidence in support of her claim.
See 20 C.F.R. § 404.1512(a); Moore, 405 F.3d at 1211. The responsibility
of weighing the medical evidence and resolving any conflicts in the record
rests with the ALJ. See Battle v. Astrue, 243 F. App’x 514, 523 (11th Cir.
2007) (unpublished). 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 [the
claimant’s] 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

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consultative examinations or brief hospitalizations.” 20 C.F.R.
§ 404.1527(c)(2).5 “This requires a relationship of both duration and
frequency.” Doyal v. Barnhart, 331 F.3d 758, 762 (10th Cir. 2003). “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 v. Bowen, 786 F.2d 1050, 1053. (11th Cir.
1986).
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 “supported a contrary finding,” the opinion is
“conclusory or inconsistent with [the treating physician’s] own 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
or is wholly conclusory.” Lewis, 125 F.3d at 1440; Edwards v. Sullivan, 937
F.2d 580, 583-84 (11th Cir. 1991) (citing Schnorr v. Bowen, 816 F.2d 578,

5

This provision applies to claims filed before March 27, 2017. See 20 C.F.R.
§ 404.1527, “Evaluating opinion evidence for claims filed before March 27, 2017.” For
claims filed after that date, the applicable provision is 20 C.F.R. § 404.1520c, titled
“How we consider and articulate medical opinions and prior administrative medical
findings for claims filed on or after March 27, 2017.”
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582 (11th Cir. 1987)). 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). 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.
Generally, more weight is given 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.” 20 C.F.R. § 404.1527(c)(2), (5)6; see also
Somogy v. Comm’r of Soc. Sec., 366 F. App’x 56, 65 n.13 (11th Cir. 2010)
(unpublished) (“ ‘Specialized knowledge may be particularly important with
respect to a disease such as fibromyalgia that is poorly understood within
much of the medical community,” and thus rheumatologists’ opinions were
entitled to greater weight than those of other physicians.” (quoting Benecke
v. Barnhart, 379 F.3d 587, 594 n.4 (9th Cir. 2004))). Although a claimant
may provide a statement containing a treating physician’s opinion of his
remaining capabilities, the ALJ must evaluate such a statement in light of

6

See note 5, supra.

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the other evidence presented and the ALJ must make the ultimate
determination of disability. 20 C.F.R. §§ 404.1512, 404.1513, 404.1527,
404.1545.
Opinions on issues such as whether the claimant is unable to work,
the claimant’s RFC, and the application of vocational factors, “are not
medical opinions, . . . but are, instead, opinions on issues reserved to the
Commissioner because they are administrative findings that are dispositive
of the case; i.e., that would direct the determination or decision of
disability.” 20 C.F.R. § 404.1527(d); see Bell v. Bowen, 796 F.2d 1350,
1353-54 (11th Cir. 1986). Although a claimant may provide a statement
containing a treating physician’s opinion of her remaining capabilities, the
ALJ must evaluate such a statement in light of the other evidence
presented and the ALJ must make the ultimate determination of disability.
See 20 C.F.R. §§ 404.1512, 404.1513, 404.1527, 404.1545.
III. Analysis
Plaintiff raises two challenges to the decision of the ALJ. Plaintiff first
claims that the ALJ reversibly erred by ignoring the pain standard when
evaluating Plaintiff’s testimony concerning the severity and limiting effects
of her impairments and by failing to properly consider the treating
physicians’ medical records documenting her impairments and symptoms.

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ECF No. 15 at 16. Next, Plaintiff contends that the ALJ reversibly erred by
failing to properly consider the effect of the combination of her impairments
in the step-five analysis and failing to include the combination of restrictions
in the hypothetical question posed to the vocational expert. ECF No. 15 at
26. Plaintiff also claimed that the ALJ reversibly erred in failing to
recognize Plaintiff’s obesity as a medically determinable severe
impairment, but that claim was abandoned in Plaintiff’s reply memorandum.
ECF No. 15 at 28; ECF No. 19 at 2.
A. Evaluation of Plaintiff’s subjective reports of pain in light of
the record.
Although Plaintiff frames this issue primarily as one of ALJ error in
ignoring the pain standard and failing to provide sufficient reasons for
rejecting Plaintiff’s testimony, the substance of the claim also goes to the
ALJ’s alleged failure to properly evaluate and give required weight to the
evidence of Plaintiff’s diagnoses and treatment by her medical specialists.
The ALJ recognized that Plaintiff asserts she is disabled and unable to
work primarily because of chronic pain and that her daily activities are
restricted. The ALJ cited Plaintiff’s testimony about pain and swelling in her
hands, knees, left foot, and ankle that prohibit her from walking more than
twenty minutes at a time or standing more than thirty to sixty minutes at a
time. Tr. 21. The ALJ found that Plaintiff had the severe impairments of
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rheumatoid arthritis, bilateral knee osteoarthritis, fibromyalgia, and coronary
artery disease, but concluded that her statements concerning the intensity,
persistence, and limiting effect of the symptoms caused by these
impairments are not entirely consistent with the medical evidence and other
evidence. Id.
The ALJ noted, generally, the radiological testing of Plaintiff’s wrists,
shoulder, knees and fibular, and ultrasound testing of her feet and hands,
concluding that the testing does not show degenerative changes sufficient
to support the severity of the pain and effects of the impairment testified to
by Plaintiff. Id. The specifics of those tests are not discussed in the
decision. In support of the finding that Plaintiff’s testimony concerning the
intensity, persistence, and limiting effects of her symptoms is not consistent
with the medical evidence and other evidence, the ALJ also cited records of
Dr. Amir Agha, Dr. Roger Gamad, and Dr. Hulon Crayton. Tr. 22. The
ALJ’s discussion of the treating, consultative, and non-examining
physicians’ records and opinions is, in toto, the following:
There was some limited range of motion in the hands, knees,
and shoulders in Dr. Agha’s reports, (Exhibits 14F and 16F),
but not the kind of severe restriction expected in light of the
severity of the claimant’s testimony. Dr. Lewandowski noted
full range of motion at his examination. (Exhibit 7F).
Dr. Lewandowski, a consultative examiner, essentially opined
that the claimant has no significant impairment-related

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limitations. (Exhibit 7F). This ignores the documented history
of rheumatoid arthritis and fibromyalgia, and is therefore given
little weight.
The reports of the state agency consulting physicians have [sic]
considered pursuant to 20 CFR 404.1512(b)(6), 20 CFR
404.1527(f) and Social Security Ruling 96-6p. Dr. Henry, a
state agency physician, essentially opined that the claimant has
the following limitations: lifting a maximum of about twenty
pounds occasionally and ten pounds frequently; standing
and/or walking about six hours in an eight-hour workday; and
sitting about six hours in an eight-hour workday. (Exhibit 3A).
There are no contrary opinions from any of the other treating or
examining sources. However, the treatment history from Dr.
Crayton (Exhibits 4F, 12F, and 13F), Dr. Agha (Exhibits 14F
and 16F), and Dr. Gamad (Exhibit 17F), all indicate the
claimant’s impairments cause difficulty with postural and wrist
and hand motions, thus supporting a finding that the claimant
has the following additional limitations:
can never climb ladders, ropes, or scaffolds; can
occasionally climb ramps and stairs; can
occasionally balance, stoop, crouch, and crawl; and
can tolerate occasional exposure to vibration; can
tolerate occasional right upper extremity handling
and fingering and frequent left upper extremity
handling and fingering.
Tr. 22. These additional limitations were added to the limitations proposed
by the non-examining agency physician to comprise the RFC determined
by the ALJ. Id.
Although the ALJ concluded that the notes of Amir Agha, M.D., a
rheumatologist with the Bay Arthritis Institute, showed “some limited range
of motion” in hands, knees, and shoulders, but not the kind of severe
restriction expected in light of Plaintiff’s testimony, the specifics of
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Dr. Agha’s examinations or treatment of Plaintiff were not discussed in any
detail. Nor were the examinations or treatment notes of Dr. Crayton or
Dr. Gamad.
Dr. Agha began seeing Plaintiff after her first rheumatologist,
Dr. Hulon Crayton, passed away. Plaintiff began seeing Dr. Crayton in
2013 (August, September, and December), then continued to see him in
2014 (February, April, August, and October), and 2015 (January). Tr. 31726, 383-425.
Plaintiff was initially referred to Dr. Crayton by Roger Gamad, M.D., of
the Family Clinic, who saw Plaintiff in 2013 for back pain, knee pain,
swelling, wrist pain, and foot pain. Tr. 345. An examination on May 15,
2013, disclosed tenderness in her left shoulder and some swelling of her
hands, left fingers, and elbow. Tr. 345. In a follow-up visit for Plaintiff’s
laboratory work on May 20, 2013, Dr. Gamad found her rheumatoid latex
agglutination test was very positive and noted that she would be referred to
rheumatologist Dr. Hulon Crayton. Tr. 342.
Plaintiff saw Dr. Crayton on August 9, 2013, and examination notes
show that Plaintiff, who was obese, was diagnosed with rheumatoid arthritis
(RA) based on a strongly positive rheumatoid factor. Tr. 317-18. Her
examination also revealed marked swelling and tenderness of the left wrist

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with 2+ synovitis and marked pain on motion and limitation of motion due to
pain. Tr. 317. Both knees had 1+ tenderness and swelling, and her right
wrist had 1+ synovitis. Tr. 317-18. She was referred for laboratory studies
and a treatment plan was formulated to include methotrexate and
prednisone for her RA. Tr. 318.
On August 28, 2013, Plaintiff saw Dr. Crayton and reported a
worsening of her pain. Her examination revealed marked swelling and
tenderness in both wrists and knees. Tr. 320. It was noted that she had “a
great deal of pain involving the left knee” and a 2+ effusion in the knee.
Tr. 321. Her diagnosis of “very active RA” was noted based on another
“strongly positive rheumatoid factor.” Tr. 320, 321. Further studies were
planned, as was future use of methotrexate, and she was kept on
prednisone. Tr. 320. In her visit on September 25, 2013, Dr. Crayton’s
notes indicate that Plaintiff’s weight had increased. Tr. 322. She had been
on both prednisone and methotrexate and was having a good response,
but relief was diminishing. She reported mouth ulcers and leg cramps after
being on methotrexate for a month. Dr. Crayton noted that if she continued
to have problems with the medication, more “aggressive treatment with a
biologic agent” is a consideration. Id. On that date, her joint exam was

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“surprisingly benign” without a great deal of synovitis and tenderness.
Tr. 323.
In her follow-up examination on November 6, 2013, Plaintiff reported
she was getting worse and complained of pain in her right shoulder, with
ongoing pain and stiffness in her large and small joints “that can be
incapacitating at times.” Tr. 324. Office notes indicate she has not
responded to appropriate treatment for RA. Id. An ultrasound of her
shoulder was ordered, and notes from December 4, 2013, indicate the
ultrasound showed three primary rotator cuff tendons with evidence of
tendonitis with inflammation. Tr. 326. At her December visit, Plaintiff
complained of pain in her knees and her left forearm, but her shoulder was
better. Id. Her joint examination was fairly benign, without a great deal of
swelling or tenderness. Tr. 327. The notes indicate that because she was
not responding to methotrexate, she had been taking an alternative that
caused nausea and vomiting. Tr. 326. Her fibromyalgia findings were also
noted. She was prescribed Flexeril to use at night and a trial of Lyrica was
a possible consideration. Id.
On February 24, 2014, Dr. Crayton’s office notes indicate that Plaintiff
complained of pain in her left wrist, hands, left knee, right ankle, and foot.
Tr. 380. She had marked synovitis of her left wrist, left knee and ankle

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tenderness. Id. Her RA was “not well controlled.” Id. Improvement was
shown in her April 9, 2014, visit, but she had left wrist tenderness on flexion
and extension. Tr. 383. She was continued on Plaquenil and prednisone
was to taper off as tolerated. Id.
After Plaintiff had been continued on prednisone, Methotrexate, and
Plaquenil, she complained of nausea and fatigue in a July 2014 visit to
Dr. Crayton, and cited mild pain and edema in her left wrist, worsening
swelling in he left knee, and new onset in her right knee. Tr. 386.
Moderate synovitis and tenderness on flexion and extension in her left wrist
were noted. Id. Her RA was assessed as “flaring uncontrolled.” Id. Notes
show Plaintiff continued to be obese. Id.
In August 2014, Plaintiff saw Dr. Crayton for a flare up of her RA.
She had been prescribed Enbrel and continued to take methotrexate and
Plaquenil. Tr. 393. Plaintiff complained of pain and edema in her right
wrist and both hands and knees. The notes indicate that ultrasounds
showed tendonitis in her right knee and a probable tear of her lateral
meniscus and spurs in her left knee. Id. Both knees were tender with
flexion and extension and had moderate crepitus. She was diagnosed with
synovitis in her proximal interphalangeal joints of both hands. Id.

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In October 2014, office notes show that Plaintiff continued to be
obese. Tr. 424. Plaintiff reported nausea and mild fatigue after taking her
methotrexate, and she reported feeling greater stress. Id. Plaintiff reported
pain in her left knee and left wrist. Examination revealed tenderness in her
left wrist on flexion and extension, and mild synovitis in her
metacarpophalangeal joints and her proximal interphalangeal joints. She
had tenderness in her left knee on flexion and extension, with crepitus
bilaterally, more moderate on the right. Id. She had completed therapy for
her left leg and reported that she continued to do the exercises at home.
Id. It was noted that her RA showed mild improvement with addition of
Enbrel. The notes also show her diagnosis of osteoarthritis. She was
continued on Enbrel, methotrexate and Plaquenil, and was prescribed
Flexeril. Id.
She last saw Dr. Crayton in January 2015, at which time she reported
some relief from steroid injections in October 2014. Tr. 421. She received
another injection on this date. Osteoarthritis was noted in her lower
extremities. Mild synovitis was noted in her wrist and proximal
interphalangeal joints. Id. Her medications were continued. Tr. 422.
Plaintiff began seeing Dr. Agha, rheumatology specialist at Bay
Arthritis, in July 2015. Plaintiff reported muscle aches, weakness, joint and

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back pain, morning stiffness, sleep disturbances and fatigue. Tr. 440.
Swelling in her extremities was not reported by Plaintiff, but was seen in
her right ankle. Tr. 440, 441. Her examination revealed limited range of
motion in her knees, but no swelling or tenderness. Tr. 441. Limited range
of motion was noted in her shoulders and her ankle. As for her
fibromyalgia diagnosis, twelve of eighteen tender points were positive in
her musculoskeletal examination, along with limited range of motion, but
motor strength was found to be normal. Id. Plaintiff had a limited range of
motion in both hands, with tenderness in her second and fourth
metacarpophalangeal joints and proximal interphalangeal joints. Synovitis
was found in her second and third metacarpophalangeal joints. Id. She
had bilateral carpometacarpal squaring in both hands. Her elbows were
tender to palpitation in her bilateral epicondyles. Plaintiff’s right wrist
showed tenosynovitis. Id. Her diagnoses included rheumatoid arthritis,
primary fibromyalgia syndrome, osteoarthritis of the knee with pain, hand
joint pain, ankle and foot pain, and acute pain. Tr. 445.
An August 2, 2015, ultrasound of Plaintiff’s knees showed
calcification of the meniscus in her right knee and a small pocket of
inflammation in the lateral aspect of her left knee. Some calcific tendonitis
was seen in the right patellar tendon. Tr. 448.

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At her visit on August 12, 2015, records show Plaintiff remained
obese and had a blood pressure of 157/98. Tr. 476. On December 2,
2015, her RA diagnosis was amended to Seropositive Rheumatoid Arthritis.
Tr. 471. On December 8, 2015, Plaintiff received a corticosteroid injection
in her right knee. Tr. 467. No improvement was shown over prior
examinations. In February 2016, Dr. Agha diagnosed Plaintiff with
seropositive rheumatoid arthritis, long-term drug therapy, and osteoarthritis
of the knee, and back spasms. Tr. 462. At that time, Plaintiff was taking
hydrocodone for pain, prednisone, methotrexate, Flexeril, and a number of
other prescribed medications. Tr. 460-61. At the December visit, Plaintiff
reported night sweats, vision changes, joint pain, back pain, swelling in
joints, morning stiffness, dactylitis, headaches, sleep disturbance, fatigue,
bruising, depression, and anxiety. Tr. 461. Plaintiff was taking
hydrocodone for pain management and had been receiving corticosteroid
injections in her knees and an intramuscular Toradol injection. Tr. 464-66,
471. Plaintiff was also prescribed Norco and Lortab for pain by Dr. Gamad
in 2015 and 2016. Tr. 486-89, 494, 496.
In finding that Plaintiff’s testimony concerning the intensity,
persistence, and limiting effects of her impairments is not “entirely
consistent” with the medical and other evidence, the ALJ relied in part on

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the report of Dr. Lionel Henry, a state agency non-examining physician who
opined on September 17, 2014, that Plaintiff could lift a maximum of about
twenty pounds occasionally and ten pounds frequently, and could sit and
stand and/or walk for about six hours in an eight-hour workday. Tr. 22
(citing records at Tr. 74-89). In reaching this RFC opinion, Dr. Henry had
before him, inter alia, the consultative examination rendered by
Dr. Lewandowski.7 See Tr. 81. In relying on Dr. Henry’s opinion of
Plaintiff’s RFC, the ALJ stated, “There are no contrary opinions from any of
the other treating or examining sources.” Tr. 22.
Plaintiff was given a consultative examination by Dr. Lewandowski on
February 26, 2014. Tr. 350-54. Dr. Lewandowski referred to Plaintiff’s
rheumatoid arthritis but not her fibromyalgia diagnosis. After a physical
examination, Dr. Lewandowski noted that she “does not show signs of
active inflammatory disease in her joints. All joints have full ROM and I do
not see any stiffness or swelling and her manual dexterity is normal. She
walks without a limp and does not need any assistive device for
ambulation. . . . Her functional ability does not seem to be impaired.”
Tr. 351. The ALJ considered Dr. Lewandowski’s findings in a somewhat

As discussed infra, the ALJ gave only little weight to Dr. Lewandowski’s
opinions because they ignored documented history of two of Plaintiff’s severe
impairments—rheumatoid arthritis and fibromyalgia. See Tr. 22.
7

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contrary manner, first citing the notation of full range of motion as indicating
that Plaintiff’s testimony of the severe restrictions caused by her
impairments is not supported—but contrarily giving only “little weight” to
Dr. Lewandowski’s opinion that Plaintiff has no significant impairmentrelated limitations because it “ignores the documented history of
rheumatoid arthritis and fibromyalgia.” Tr. 22.
Plaintiff contends that the severity of her fibromyalgia, rheumatoid
arthritis, and osteoarthritis of her knees has been described by her treating
physicians and that an examination of her longitudinal medical records
shows that her symptoms have waxed and waned with frequent flare-ups,
and are consistent with her testimony. ECF No. 15 at 24. Plaintiff
contends that the records support her testimony that she is unable to work
on a regular basis and that she is essentially incapacitated by her
impairments at least three days a month. See Tr. 45. And, the vocational
expert testified that if she misses on average more than two days a month,
there is no work for her in the national economy. See Tr. 50. Plaintiff
contends that the ALJ erred in failing to accord proper weight to the
medical evidence of her treating physicians when evaluating whether the
record supports Plaintiff’s claims of the severity and effect of her
impairments.

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The ALJ gave only a brief, and essentially superficial, discussion of
the medical records of Plaintiff’s treating physicians. The ALJ is correct
that no treating physician gave a contrary opinion concerning Petitioner’s
ability to lift twenty pounds occasionally and ten pounds frequently and to
sit, stand and/or walk for six hours each in a workday. However,
Petitioner’s treating physicians were rheumatologists and did not, nor were
they apparently requested to, provide an RFC evaluation. The only
examining physician who offered an opinion specifically relating to
Plaintiff’s ability to function was Dr. Lewandowski, which the ALJ
discounted due to his lack of familiarity with Plaintiff’s “documented history
of rheumatoid arthritis and fibromyalgia.” Tr. 22.
The treating physicians did not provide a functionality evaluation or
provide an RFC or functionality opinion concerning her ability to do the
things that the non-examining and consultative physicians believed she can
do. However, the treating physicians’ medical records provide a
longitudinal record of her symptoms, the waxing and waning of her joint
swelling and synovitis, her osteoarthritis, and fibromyalgia, and her
responses to a variety of medications and injections that have been tried in
an effort to return Plaintiff to her ability to function. The ALJ’s lack of an
explanation, in any meaningful and significant detail, concerning how these

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records do not support Plaintiff’s testimony concerning the restrictions on
her daily living caused by her severe impairments hampers this Court’s
effective and informed review of the decision.
By giving Dr. Lewandowski’s opinions “little weight” because he
ignored Plaintiff’s documented history of rheumatoid arthritis and her
properly diagnosed fibromyalgia, the ALJ has indicated that those severe
impairments deserve closer scrutiny and consideration. However, that
closer scrutiny and consideration were lacking in the ALJ’s decision despite
the volume of treatment records covering close to three years. Thus, while
the ALJ has given lip service to the finding of severe impairments of
rheumatoid arthritis and fibromyalgia, he has failed to analyze Plaintiff’s
fibromyalgia and rheumatoid arthritis-related symptoms in any meaningful
way in light of the unique symptoms relating to those impairments.
The ALJ supported his finding that Plaintiff’s complaints of intensity,
persistence, and limiting effects of her symptoms were not borne out by the
record primarily by stating:
There was some limited range of motion in the hands, knees,
and shoulders in Dr. Agha’s reports, but not the kind of severe
restriction expected in light of the severity of the claimant’s
testimony. Dr. Lewandowski noted full range of motion at his
examination.
Tr. 22. This ignores the fact that, as noted earlier, the ALJ proceeded to

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discount Dr. Lewandowski’s opinions and to ignore the fact that Plaintiff’s
documented rheumatoid arthritis and fibromyalgia are conditions in which
Plaintiff experiences flare-ups. As the Court in Benecke v Barnhart noted,
“One does not need to be ‘utterly incapacitated’ in order to be disabled.”
379 F.3d 587, 594 (9th Cir. 2004) (citing Vertigan v. Halter, 260 F.3d 1044,
1050 (9th Cir. 2001) (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir.
1989)). Full range of motion, lack of synovitis, or intact motor function in
any one examination does not provide substantial evidence that Plaintiff’s
severe systemic or other impairments do not cause the intensity,
persistence or limiting effects as testified by Plaintiff. See cf. Swindle v.
Sullivan, 914 F.2d 222, 226 (11th Cir. 1990) (“Nevertheless, full range of
motion, lack of synovitis, and intact motor function provide no evidence that
Ms. Swindle’s systemic lupus could not give rise to the pain in her lower
extremities and the dizziness she describes.”). These same considerations
would apply equally to the systemic symptoms of rheumatoid arthritis and
fibromyalgia.
Under Social Security Ruling SR 16-3p Titles II & XVI: Evaluation of
Symptoms in Disability Claims, SSR 16-3p, which applies to the decision in
this case, the ALJ must first determine if the claimant has a medically
determinable impairment that could reasonably be expected to produce the

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symptoms alleged by Plaintiff.8 SSR 16-3p, 2017 WL 5180304 (applicable
March 28, 2016), 82 Fed. Reg. 49462-03, 49468 & n.27, (republished Oct.
25, 2017). The ALJ in this case found that Plaintiff’s medically
determinable impairments could reasonably be expected to cause her
symptoms. Tr. 21. As for step two in evaluation of the intensity,
persistence, and limiting effects of a claimant’s symptoms, the Eleventh
Circuit has explained:
Step two is to evaluate the intensity and persistence of an
individual’s symptoms, such as pain, and determine the extent
to which an individual’s symptoms limit her ability to perform
work-related activities. [82 Fed. Reg.] 49,462 at 49,464-66. The
Commission stated:
Consistent with our regulations, we instruct our
adjudicators to consider all of the evidence in an
individual's record when they evaluate the intensity
and persistence of symptoms after they find that the
individual has a medically determinable
impairment(s) that could reasonably be expected to
produce those symptoms. We evaluate the
8

SSR 16-3p, applicable March 28, 2016, see 82 Fed. Reg. 49,462 (Oct. 25,
2017), supersedes SSR 96-7p and eliminates the use of the term “credibility,” and
clarifies that the subjective symptom evaluation is not an examination of the claimant’s
character. The ruling provides guidance as to how the Social Security Administration will
evaluate statements regarding the intensity, persistence, and limiting effects of
symptoms of disability. The revised and republished SSR 16-3p indicates that the
Social Security Administration’s adjudicators will apply this ruling when they make
decisions on or after March 28, 2016, and that when a decision is reviewed in federal
court, the court will review the decision using the rules that were in effect when the
decision under review was issued. See Arnold v. Soc. Sec. Admin., Comm’r, 2018 WL
833982, at *8 (Feb. 13, 2018). “Social Security Rulings are agency rulings ‘published
under the authority of the Commissioner of Social Security and are binding on all
components of the Administration.’ ” Sullivan v. Zebley, 493 U.S. 521, 530 n.9 (1990)
(quoting 20 C.F.R. § 422.408 (1989)). Although not binding on the court, they are
generally accorded deference. Fair v. Shalala, 37 F.3d 1466, 1469 (11th Cir. 1994).
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intensity and persistence of an individual’s
symptoms so we can determine how symptoms limit
ability to perform work-related activities for an adult
. . . with a title XVI disability claim.
Contreras-Zambrano v. Soc. Sec. Admin., Comm’r, No. 17-12447, 2018
WL 618420, at *3 (11th Cir. Jan. 30, 2018) (emphasis added). The ruling
states, “In considering the intensity, persistence, and limiting effects of an
individual’s symptoms, we examine the entire case record, including the
objective medical evidence; an individual’s statements about the intensity,
persistence, and limiting effects of symptoms; statements and other
information provided by medical sources and other persons; and any other
relevant evidence in the individual’s case record.” SSR 16-3p (Mar. 28,
2016). Social Security Ruling 16-3p further provides:
In evaluating an individual’s symptoms, it is not sufficient for our
adjudicators to make a single, conclusory statement that “the
individual’s statements about his or her symptoms have been
considered” or that “the statements about the individual’s
symptoms are (or are not) supported or consistent.” It is also
not enough for our adjudicators simply to recite the factors
described in the regulations for evaluating symptoms. The
determination or decision must contain specific reasons for the
weight given to the individual’s symptoms, be consistent with
and supported by the evidence, and be clearly articulated so
the individual and any subsequent reviewer can assess how the
adjudicator evaluated the individual’s symptoms.
SSR 16-3p (applicable Mar. 28, 2016) (emphasis added). SSR 16-3p
cautions that “we will not disregard an individual’s statements about the

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intensity, persistence, and limiting effects of symptoms solely because the
objective medical evidence does not substantiate the degree of
impairment-related symptoms. A report of minimal or negative findings or
inconsistencies in the objective medical evidence is one of many factors we
must consider in evaluating the intensity, persistence, and limiting effects of
an individual’s symptoms.”9 Id. at ¶ 1 (citing 20 C.F.R. 404.1529).
Thus, in providing the reasons required under SSR 16-3p for
discounting the Plaintiff’s statements concerning the intensity, persistence,
and limiting effects of her symptoms, the ALJ is directed to consider all the
evidence and clearly articulate the record-based reasons for the weight
given to the claimant’s symptoms to enable the reviewing body to assess
how the adjudicator evaluated the medical symptoms. In the present case,
the Court “cannot discern from the ALJ’s scant analysis in this case
whether [he] considered and dismissed, or completely failed to consider,”
the body of pertinent longitudinal treatment records documenting symptoms
and treatment for Plaintiff’s rheumatoid arthritis and fibromyalgia when
evaluating her statements about the intensity, persistence, and limiting

9

The ALJ relied primarily on his conclusion that the medical reports showed
Plaintiff had only “some limited range of motion” to support his finding that Plaintiff did
not have the “kind of severe restriction expected in light of the severity of Plaintiff’s
testimony.” Tr. 22. The focus on that consideration, which is only one of many factors,
does not meet the letter or the spirit of SSR 16-3p or 20 C.F.R. 404.1529, which call for
consideration of all the evidence in the record.
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effects of her symptoms. See Minnick v. Colvin, 775 F.3d 929, 936 (7th
Cir. 2015). Without more, the ALJ’s meager discussion of only a small
portion of the medical evidence fails to inform the Court in a meaningful,
reviewable way of the specific evidence the ALJ considered and relied on
in determining that the claimed intensity, persistence, and limiting effects of
Plaintiff’s symptoms were not supported by the body of evidence in the
record. See, e.g., id. at 937.
Plaintiff has consistently reported her symptoms both before and after
her diagnoses. She consistently saw her specialists and sought more
effective treatment modalities in order to alleviate her symptoms. She took
the many medications as prescribed and as those prescriptions were
changed over the course of her treatment, and she received other
treatments by way of injection—all over a lengthy period of time.
“Persistent attempts to obtain relief of symptoms, such as increasing
dosages and changing medications, trying a variety of treatments, referrals
to specialists, or changing treatment sources may be an indication that an
individual’s symptoms are a source of distress and may show that they are
intense and persistent.” SSR 16-3p, ¶ 7.
The evidence of specialists and treating physicians is to be given
greater weight than those of other physicians because specialized

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knowledge is particularly important with respect to a disease such as
fibromyalgia, which is often poorly understood. Benecke, 379 F.3d at 594
n.4. In this case, the Court cannot discern in any meaningful fashion if the
ALJ considered and gave weight to the longitudinal medical evidence of
Plaintiff’s treating physicians—specialists in rheumatology and
fibromyalgia—in evaluating Plaintiff’s statements of the intensity,
persistence, and limiting effect of her symptoms. For this reason, and
considering the record as a whole, the Court cannot conclude that the
ALJ’s decision to discount Plaintiff’s testimony, and the resulting finding
that she is not disabled, is based on substantial evidence. Thus, this
matter will be reversed and remanded for further proceedings.
B. The combination of Plaintiff’s impairments.
Plaintiff also alleged error in the ALJ’s step-four analysis of the effect
of her impairments when considered in combination. As discussed above,
on this record and in light of the ALJ’s findings, substantial evidence does
not support the ALJ’s Step 5 determination and he did not correctly follow
the law. In light of this conclusion, and because the decision is reversed
and remanded for further proceedings, it is not necessary to consider this
remaining issue raised by Plaintiff.

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IV. Conclusion
Considering the record as a whole, the decision of the Administrative
Law Judge is not supported by substantial evidence in the record and
application of the proper legal standards. Accordingly, pursuant to
sentence four of 42 U.S.C § 405(g), the decision of the Commissioner to
deny Plaintiff's application for a period of disability and disability benefits is
REVERSED and REMANDED to the Commissioner for further proceedings
consistent with this opinion and to consider referring Plaintiff for a
consultative examination. The Clerk is DIRECTED to enter judgment for
Plaintiff.
IN CHAMBERS at Tallahassee, Florida, on April 12, 2018.

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

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