White v. Social Security Administration

Filing 16

MEMORANDUM RULING. IT IS ORDERED that this matter is REVERSED and REMANDED to the Commissioner pursuant to the fourth sentence of 42 U.S.C. § 405(g) for further administrative proceedings with instructions to properly weigh Dr. Sullivan's o pinions, to reevaluate the claimant's residual functional capacity, and to reevaluate whether there are jobs in the economy that the claimant can perform. Inasmuch as the reversal and remand recommended herein falls under sentence four of Section 405(g), any judgment entered in connection herewith will be a "final judgment" for purposes of the Equal Access to Justice Act (EAJA). Signed by Magistrate Judge Patrick J Hanna on 4/22/2016. (crt,Alexander, E)

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF LOUISIANA
LAFAYETTE DIVISION
CHRISTA NOEL WHITE

CIVIL ACTION NO. 6:15-cv-01492

VERSUS

JUDGE HANNA

U.S. COMMISSIONER, SOCIAL
SECURITY ADMINISTRATION

BY CONSENT OF THE PARTIES

MEMORANDUM RULING
Before the Court is an appeal of the Commissioner’s finding of non-disability.
In accordance with the provisions of 28 U.S.C. § 636(c) and Fed. R. Civ. P. 73, the
parties consented to have this matter resolved by the undersigned Magistrate Judge.
(Rec. Doc. 15). Considering the administrative record, the briefs of the parties, and
the applicable law, it is ordered that the Commissioner’s decision be reversed and
remanded for further administrative action.
ADMINISTRATIVE PROCEEDINGS
The claimant, Christa Noel White, fully exhausted her administrative remedies
prior to filing this action in federal court. The claimant filed an application for
disability insurance benefits (“DIB”), alleging disability beginning on June 30, 20111
due to fibromyalgia, psoriatic arthritis, degenerative disc disease, hypoglycemia, and

1

Rec. Doc. 7-1 at 192, 95.

depression.2 Her application was denied.3 She requested a hearing, which was held
on July 9, 2013 before Administrative Law Judge Kim McClain-Leazure.4 The ALJ
issued a decision on October 17, 2013,5 concluding that the claimant was not disabled
within the meaning of the Social Security Act from June 30, 2011 through the date
of the decision. The claimant requested review of the decision, but the Appeals
Council concluded that there was no basis for review of the ALJ’s decision.6
Therefore, the ALJ’s decision became the final decision of the Commissioner for the
purpose of the Court’s review pursuant to 42 U.S.C. § 405(g). The claimant then
filed this action seeking review of the Commissioner’s decision.
FACTUAL BACKGROUND
The claimant was born on December 23, 1972.7 At the time of the ALJ’s
decision, she was forty years old. She has a degree in business management8 and past

2

Rec. Doc. 7-1 at 95.

3

Rec. Doc. 7-1 at 106.

4

The hearing transcript is found at Rec. Doc. 7-1 at 38-94.

5

Rec. Doc. 7-1 at 17-31.

6

Rec. Doc. 7-1 at 5.

7

Rec. Doc. 7-1 at 192.

8

Rec. Doc. 7-1 at 71.

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relevant work experience as a bookkeeper, paralegal, and retail manager.9 She alleges
that she has been disabled since June 30, 201110 due to fibromyalgia, psoriatic
arthritis, degenerative disc disease, hypoglycemia, and depression.11
Ms. White began treating with Dr. Laura K. Hollensworth at the Daphne
Family Practice in Daphne, Alabama on May 11, 2011.12 She was diagnosed with
hyperlipidemia, psoriasis, hip joint pain, scoliosis, cervicalgia, rotator cuff tear,
lumbago, degenerative disc disease, menopausal hot flashes, weight gain, sleep
disturbance, and diarrhea. Several diagnostic tests were ordered. On that same date,
Dr. David L. Fore of the Thomas Medical Center in Daphne, Alabama, took a series
of lumbar, cervical, and hip x-rays.13 The cervical x-rays showed degenerative
changes while the other x-rays were normal.
On May 16, 2011,14 Ms. White complained to Dr. Hollensworth of numbness
and tingling in her left arm and hand as well as swelling and a rash on her arm and
face. The doctor’s assessment included weight gain, degenerative disc disease,
9

Rec. Doc. 7-1 at 41, 43-45, 223, 235.

10

Rec. Doc. 7-1 at 95, 192.

11

Rec. Doc. 7-1 at 95.

12

Rec. Doc. 7-1 at 318-324, 297-305.

13

Rec. Doc. 7-1 at 277-279.

14

Rec. Doc. 7-1 at 314-317.

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psoriasis, cervical radiculopathy, hyperglyceridemia, and peripheral edema. MRIs
of the cervical and lumbar spine were ordered.
On June 1, 2011,15 Ms. White saw Dr. William F. Sullivan, a rheumatologist.
He noted that she had a long history of chronic pain. His examination showed that
she had a good range of movement in her shoulders, elbows, wrists, hips, knees, and
ankles, no significant synovitis, no edema, but tenderness in the trapezius, lumbar
paraspinous, and trochanteric bursa region. He diagnosed her with anxiety, arthritis,
depression, headache, acute upper respiratory infection, and urinary tract infection.
He prescribed an array of medications.
An MRI of the cervical spine, obtained on June 2, 2011, showed degenerative
disc disease at C5-6 and C6-7 with moderate central canal stenosis at C5-6.16 A
lumbar MRI, obtained on the same date, showed minimal degenerative changes.17
On June 9, 2011,18 Ms. White saw Dr. Patricia A. Boltz. Her chief complaint
was chronic neck pain, right shoulder pain, and bilateral arm pain. A neurologic
examination showed that Ms. White’s gait and station were mildly antalgic, she had

15

Rec. Doc. 7-1 at 365-367.

16

Rec. Doc. 7-1 at 275.

17

Rec. Doc. 7-1 at 276.

18

Rec. Doc. 7-1 at 284-286.

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difficulty getting up out of a chair, and she had mild decreased grip strength in her
right hand.19 On June 23, 2011,20 Dr. Boltz administered a cervical epidural steroid
injection at C6-7.
The claimant saw Dr. Hollensworth again on June 27, 2011,21 complaining of
right leg numbness and tingling, bilateral neck pain, and lower back pain. It was
noted that her hands were swelling, and she had moderate pain in her hands and hip.
Ms. White saw Dr. Sullivan again on June 30, 2011.22 His assessment included
generalized osteoarthrosis involving multiple sites, fibromyalgia, other malaise and
fatigue, and psoriatic arthropathy. He prescribed Methotrexate for her psoriatic
arthritis.
The claimant saw Dr. Hollensworth again on July 8, 2011.23 She was
experiencing a cough after having started taking Methotrexate. Moderate pain in her
hands was again noted.

19

Ms. White is right handed. Rec. Doc. 7-1 at 55.

20

Rec. Doc. 7-1 at 282.

21

Rec. Doc. 7-1 at 310-312.

22

Rec. Doc. 7-1 at 410-413.

23

Rec. Doc. 7-1 at 307-309.

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Ms. White underwent an additional cervical epidural steroid injection at C6-7
on July 14, 2011.24
On August 31, 2011,25 Ms. White again saw Dr. Sullivan. She described
increasing severe right hip pain that interfered with walking. Trochanteric bursitis
was added to her diagnoses. Dr. Sullivan again noted that she had a good range of
movement in her shoulders, elbows, wrists, hips, knees, and ankles, no significant
synovitis, no edema, but tenderness in the trapezius, lumbar paraspinous, and
trochanteric bursa region.
On September 13, 2011, Ms. White was seen in the emergency department of
Thomas Hospital,26 complaining of a grinding in her posterior neck along with
burning pain in the same location. A CT scan of her cervical spine showed posterior
disc spurs at C5-6 and C6-7. She was diagnosed with degenerative disc disease,
given pain medication, prescribed Flexeril, and discharged with instructions to see
Dr. Hollensworth.

24

Rec. Doc. 7-1 at 281.

25

Rec. Doc. 7-1 at 368-376.

26

Rec. Doc. 7-1 at 288-294.

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Ms. White saw Dr. Sullivan again on October 13, 2011.27 He noted swelling
and synovitis in her wrists and hands as well as swelling in her ankles and joints. He
diagnosed psoriatic arthropathy, psoriasis, neck pain, and back pain.
Ms. White returned to Dr. Sullivan on November 2, 2011.28 Her primary
complaint was an acute skin infection. Swelling and synovitis in her wrists and
swelling in her hands was again noted.
Ms. White was again seen by Dr. Sullivan on December 20, 2011.29 Her skin
condition had improved. Swelling and synovitis in her wrists was again noted as was
synovitis in her elbows, knees, and ankles, and swelling in her hands, swelling of her
joints, and joint pain.
On January 19, 2012, Dr. Sullivan completed a “Physical Capacities
Evaluation.”30 In his opinion, Ms. White was capable of sitting for two hours per
work day, walking for one hour, and standing for less than one hour. Further, he
noted that she can occasionally lift or carry six to ten pounds, but can never lift or
carry more than that. He stated that she cannot use her hands for repetitive action

27

Rec. Doc. 7-1 at 362-364.

28

Rec. Doc. 7-1 at 359-361.

29

Rec. Doc. 7-1 at 355-358.

30

Rec. Doc. 7-1 at 390-392.

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such as simple grasping, pushing and pulling, or fine manipulation. He also noted
that she cannot use her feet for repetitive movements such as pushing and pulling.
On March 14, 2012, Ms. White was examined by psychologist Kendra
LaConsay31 at the request of the Disability Determination Service. Although Dr.
LaConsay found Ms. White to be independent in her activities of daily living, she
diagnosed Major Depressive Disorder, Recurrent, Moderate and Anxiety Disorder,
NOS. She stated that “[i]t is questionable as to whether Ms. White will be able to
return to work within the next 6 to 12 months. This is highly dependant upon the
stabilization of her medical and psychiatric conditions.”32
Ms. White again saw Dr. Sullivan on May 2, 2012.33 Her skin condition had
improved but her arthritis had worsened significantly. It was again noted that she had
swelling and synovitis in her wrists, swelling of her hands, ankles, and joints as well
as neck pain, back pain, and joint pain.
On October 31, 2012, Ms. White began treating with Dr. Herbert Kinsey. She
saw him again on November 27, 2012, December 11, 2012, January 8, 2013, January

31

Rec. Doc. 7-1 at 382-386.

32

Rec. Doc. 7-1 at 385.

33

Rec. Doc. 7-1 at 414-416.

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22, 2013, February 5, 2013, February 20, 2013, and March 5, 2013.34 Among her
many complaints to Dr. Kinsey were pain in multiple joints and swollen fingers. Dr.
Kinsey ordered an ANA test, which was negative.35 An ANA test detects antinuclear
antibodies (ANA) in the blood, which are usually present in the event of an
autoimmune reaction, and is used to help diagnose autoimmune diseases such as
lupus, rheumatoid arthritis, or scleroderma.36
On March 12, 2013, Ms. White saw Nurse Practitioner Selisa Helvacioglu in
Dr. Sullivan’s office.37 The treatment note indicates that Ms. White had been treating
with Dr. Kinsey through his free clinic, that she had stopped taking Enbrel due to
increasing migraine-type headaches and a butterfly rash on her face, that the
headaches were responsive to Imitrex, that stopping the Enbrel did not improve the
headaches but resulted in increased arthritis activity, and that Humira was to be
avoided because it caused an exacerbation of skin problems. The plan was to restart
the Enbrel. Swelling and synovitis in the wrists was noted as well as swelling of the

34

Rec. Doc. 7-1 at 397-409.

35

Rec. Doc. 7-1 at 404-407.

36

Mayo Clinic, http://www.mayoclinic.org/tests-procedures/ana-test/basics/definition/
prc-20014566 (last visited Apr. 21, 2016).
37

Rec. Doc. 7-1 at 417-419.

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MTP joints (where the foot joins the toes), swelling of the hands, neck pain, back
pain, and joint pain.
Dr. Sullivan completed a second “Physical Capacities Evaluation” on April 18,
2013.38 He again opined that Ms. White was capable of sitting for two hours per
work day, walking for one hour, and standing for less than one hour. Further, he
noted that she can occasionally lift or carry six to ten pounds, but can never lift or
carry more than that. He stated that she cannot use her hands for repetitive action
such as simple grasping, pushing and pulling, or fine manipulation. or use her feet for
repetitive movements such as pushing and pulling.
Between February and April 2013, the claimant attended physical therapy at
Bishop Physical Therapy, LLC in Daphne, Alabama.39
Ms. White was seen at University Hospital and Clinic in Lafayette, Louisiana,
on February 25, 2014.40 It was noted that she had recently moved from Alabama,
needed to get established with a primary care physician, and needed to refill her
prescriptions. She complained of pain and requested medication management. She
was diagnosed with psoriasis, psoriatic arthritis, right shoulder pain secondary to an

38

Rec. Doc. 7-1 at 433-435.

39

Rec. Doc. 7-1 at 408, 420-432.

40

Rec. Doc. 7-1 at 435-436.

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injury, left foot pain described as likely to be a calcaneal spur or plantar fasciitis,
fibromyalgia, depression, and neck pain. Various medications were prescribed,
including Enbrel and Methotrexate, and diagnostic testing was performed.
At the time of the hearing, the claimant was taking twelve prescription
medications:

Mobic, Methotrexate, Folic Acid, Cymbalta, Flexeril, Percocet,

Tramadol, Enbrel, Neurontin, Soma, Thoradone, and Celexa.41
At the hearing, Ms. White identified Dr. Hollensworth as her primary care
physician and Dr. Sullivan as her treating rheumatologist.42 She testified that she has
arthritis in her hands, that her hands swell “pretty bad,” that holding a computer
mouse causes her hand to cramp, and that she can no longer type. She also stated that
she has trouble lifting things. To lift a gallon of milk, she has to use both hands. She
also stated that she cannot lift “over and over again” because such activity creates “an
issue with my shoulder into my neck.” She described pain in both arms and hands,
numbness in her arms and hands, and swelling in her hands that prevents her from
making a fist. She explained that the swelling “is a constant condition” and gets so
severe that “I won’t have any wrinkles left in my fingers.”

41

Rec. Doc. 7-1 at 264-266.

42

Rec. Doc. 7-1 at 52.

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The claimant now challenges the ALJ’s ruling, particularly with regard to the
finding that Ms. White retains the functional capacity to use her hands in performing
sedentary work that requires repetitive reaching, pushing, pulling, and fine
manipulation.
ANALYSIS
A.

STANDARD

OF

REVIEW

Judicial review of the Commissioner's denial of disability benefits is limited
to determining whether substantial evidence supports the decision and whether the
proper legal standards were used in evaluating the evidence.43 “Substantial evidence
is more than a scintilla, less than a preponderance, and is such relevant evidence as
a reasonable mind might accept as adequate to support a conclusion.”44 Substantial
evidence “must do more than create a suspicion of the existence of the fact to be
established, but ‘no substantial evidence’ will only be found when there is a
‘conspicuous absence of credible choices' or ‘no contrary medical evidence.’”45

43

Villa v. Sullivan, 895 F.2d 1019, 1021 (5th Cir. 1990); Martinez v. Chater, 64 F.3d
172, 173 (5 Cir. 1995).
th

44

Villa v. Sullivan, 895 F.2d at 1021-22 (quoting Hames v. Heckler, 707 F.2d 162, 164
(5 Cir. 1983)).
th

45

Hames v. Heckler, 707 F.2d at 164 (quoting Hemphill v. Weinberger, 483 F.2d 1137.
1139 (5 Cir. 1973), and Payne v. Weinberger, 480 F.2d 1006, 1007 (5th Cir. 1973)).
th

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If the Commissioner's findings are supported by substantial evidence, then they
are conclusive and must be affirmed.46 In reviewing the Commissioner's findings, a
court must carefully examine the entire record, but refrain from re-weighing the
evidence or substituting its judgment for that of the Commissioner.47 Conflicts in the
evidence and credibility assessments are for the Commissioner to resolve, not the
courts.48 Four elements of proof are weighed by the courts in determining if
substantial evidence supports the Commissioner's determination: (1) objective
medical facts, (2) diagnoses and opinions of treating and examining physicians, (3)
the claimant's subjective evidence of pain and disability, and (4) the claimant's age,
education and work experience.49
B.

Entitlement to Benefits
The Disability Insurance Benefit (“DIB”) program provides income to

individuals who are forced into involuntary, premature retirement, provided they are

46

42 U.S.C. § 405(g); Martinez v. Chater, 64 F.3d at 173; Carey v. Apfel, 230 F.3d 131,
135 (5 Cir. 2000).
th

47

Hollis v. Bowen, 837 F.2d 1378, 1383 (5th Cir. 1988); Villa v. Sullivan, 895 F.2d at
1021; Ripley v. Chater, 67 F.3d 552, 555 (5th Cir. 1995); Carey v. Apfel, 230 F.3d at 135; Boyd v.
Apfel, 239 F.3d 698, 704 (5th Cir. 2001).
48

Martinez v. Chater, 64 F.3d at 174.

49

Wren v. Sullivan, 925 F.2d 123, 126 (5th Cir. 1991); Martinez v. Chater, 64 F.3d at

174.

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both insured and disabled, regardless of indigence.50 The term “disabled” or
“disability” means the 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 twelve months.”51 A claimant is disabled only if
his physical or mental impairment or impairments are so severe that he is unable to
not only do his previous work, but cannot, considering his age, education, and work
experience, participate in any other kind of substantial gainful work which exists in
significant numbers in the national economy, regardless of whether such work exists
in the area in which the claimant lives, whether a specific job vacancy exists, or
whether the claimant would be hired if he applied for work.52
C.

Evaluation Process and Burden of Proof
The Commissioner uses a sequential five-step inquiry to determine whether a

claimant is disabled. At step one, an individual who is working and engaging in
substantial gainful activity will not be found disabled regardless of medical findings.
At step two, an individual who does not have a severe impairment will not be found

50

See 42 U.S.C. § 423(a).

51

42 U.S.C. § 1382c(a)(3)(A).

52

42 U.S.C. § 1382c(a)(3)(B).

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disabled. At step three, an individual who meets or equals an impairment listed in the
regulations at 20 C.F.R. Part 404, Subpart P, Appendix 1 will be considered disabled
without consideration of vocational factors. If an individual is capable of performing
the work he has done in the past, a finding of not disabled will be made at step four.
At step five, if an individual's impairment precludes him from performing his past
work, other factors including age, education, past work experience, and residual
functional capacity will be considered to determine if the claimant can perform any
other work.53
Before going from step three to step four, the Commissioner assesses the
claimant's residual functional capacity54 by determining the most the claimant can still
do despite his physical and mental limitations based on all relevant evidence in the
record.55 The claimant's residual functional capacity is used at the fourth step to
determine if he can still do his past relevant work and at the fifth step to determine
whether he can adjust to any other type of work.56

53

20 C.F.R. § 404.1520; see, e.g., Wren v. Sullivan, 925 F.2d at 125; Perez v. Barnhart,
415 F.3d 457, 461 (5th Cir. 2005); Masterson v. Barnhart, 309 F.3d 267, 271-72 (5th Cir. 2002);
Newton v. Apfel, 209 F.3d 448, 453 (5th Cir. 2000).
54

20 C.F.R. § 404.1520(a)(4).

55

20 C.F.R. § 404.1545(a)(1).

56

20 C.F.R. § 404.1520(e).

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The claimant bears the burden of proof on the first four steps.57 At the fifth
step, however, the Commissioner bears the burden of showing that the claimant can
perform other substantial work in the national economy.58 This burden may be
satisfied by reference to the Medical-Vocational Guidelines of the regulations, by
expert vocational testimony, or by other similar evidence.59 If the Commissioner
makes the necessary showing at step five, the burden shifts back to the claimant to
rebut this finding.60 If the Commissioner determines that the claimant is disabled or
not disabled at any step, the analysis ends.61
D.

THE ALJ’S FINDINGS AND CONCLUSIONS
In this case, the ALJ determined, at step one, that the claimant has not engaged

in substantial gainful activity since June 30, 2011, the claimant’s alleged onset date.62
This finding is supported by evidence in the record.

57

Perez v. Barnhart, 415 F.3d at 461; Masterson v. Barnhart, 309 F.3d at 272; Newton
v. Apfel, 209 F.3d at 453.
58

Perez v. Barnhart, 415 F.3d at 461; Masterson v. Barnhart, 309 F.3d at 272; Newton
v. Apfel, 209 F.3d at 453.
59

Fraga v. Bowen, 810 F.2d 1296, 1304 (5th Cir. 1987).

60

Perez v. Barnhart, 415 F.3d at 461; Masterson v. Barnhart, 309 F.3d at 272; Newton
v. Apfel, 209 F.3d at 453.
61

Anthony v. Sullivan, 954 F.2d 289, 293 (5th Cir. 1992), citing Johnson v. Bowen, 851
F.2d 748, 751 (5th Cir. 1988). See, also, 20 C.F.R. § 404.1520(a)(4).
62

Rec. Doc. 7-1 at 19.

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At step two, the ALJ found that the claimant has the following severe
impairments: disorders of the back, obesity, fibromyalgia, psoriatic arthritis, and
affective disorders.63 This finding is supported by evidence in the record.
At step three, the ALJ found that the claimant has no impairment or
combination of impairments that meets or medically equals the severity of a listed
impairment.64 The claimant does not challenge this finding.
The ALJ found that the claimant has the residual functional capacity to perform
work at the sedentary level – but with a long list of limitations, including a need to
stand and stretch for one to two minutes after sitting for thirty minutes, doing no
overhead reaching with either arm or doing any pushing or pulling with her hands or
arms, never climbing ladders or scaffolds, never working around unprotected heights
or dangerous equipment, never operating a commercial vehicle, never being exposed
to temperature extremes, witness, or vibration, and only performing positions
requiring specific vocational preparation levels no greater than three.65 The claimant
challenges this finding.

63

Rec. Doc. 7-1 at 19.

64

Rec. Doc. 7-1 at 20.

65

Rec. Doc. 7-1 at 21.

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At step four, the ALJ found that the claimant is not capable of performing her
past relevant work.66 This finding is supported by evidence in the record.
At step five, the ALJ found that the claimant was not disabled from June 30,
2011 through October 17, 2013 (the date of the decision) because there are jobs in the
national economy that she can perform.67 The claimant challenges this finding.
E.

THE ALLEGATIONS

OF

ERROR

The claimant contends that the ALJ erred by improperly applying controlling
law in evaluating Dr. Sullivan’s medical opinions and by reaching conclusions
concerning the claimant’s limitations that are not supported by substantial evidence.
F.

THE ALJ ERRED

IN

WEIGHING DR. SULLIVAN’S OPINIONS

The ALJ has sole responsibility for determining the claimant's disability
status.68 Although a treating physician’s opinions are not determinative, the opinion
of a treating physician who is familiar with the claimant's impairments, treatments,
and responses should be accorded great weight by the ALJ in determining disability.69
In fact, when a treating physician's opinion regarding the nature and severity of an

66

Rec. Doc. 7-1 at 29.

67

Rec. Doc. 7-1 at 31.

68

Newton v. Apfel, 209 F.3d at 455.

69

Pineda v. Astrue, 289 Fed. App’x 710, 712-13 (5th Cir. 2008), citing Newton v. Apfel,
209 F.3d at 455.

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impairment is well-supported by medically acceptable clinical and laboratory
diagnostic techniques and is not inconsistent with the other substantial evidence in
the record, the ALJ must give that opinion controlling weight.70 As the Fifth Circuit
stated, “[t]he expert opinion[ ] of a treating physician as to the existence of a
disability [is] binding on the fact-finder unless contradicted by substantial evidence
to the contrary.”71
The Social Security regulations and rulings explain how medical opinions are
to be weighed.72 Generally, the ALJ must evaluate all of the evidence in the case and
determine the extent to which medical source opinions are supported by the record.
If an ALJ declines to give controlling weight to a treating doctor’s opinion, she may
give the opinion little or no weight – but only after showing good cause for doing
so.73 Good cause may be shown if the treating physician’s opinion is conclusory,
unsupported by medically acceptable clinical laboratory diagnostic techniques, or is
otherwise unsupported by the evidence.74
70

20 C.F.R. § 404.1527(c)(2). See, also, Loza v. Apfel, 219 F.3d 378, 393 (5th Cir.

71

Loza v. Apfel, 219 F.3d at 393 (quoting Bastien v. Califano, 572 F.2d 908, 912 (2nd

2000).
Cir. 1978)).
72

20 C.F.R. § 404.1527(c), § 416.927(c), SSR 96-2p, SSR 96-5p.

73

Thibodeaux v. Astrue, 324 Fed. App’x 440, 443-44 (5th Cir. 2009).

74

Thibodeaux v. Astrue, 324 Fed. App’x at 443-444.

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In this case, the ALJ gave “little weight” to Dr. Sullivan’s opinions concerning
the claimant’s functional capabilities,75 gave “partial weight” to Dr. Sullivan’s
opinions concerning the claimant’s ability to perform repetitive movements with her
hands,76 and concluded that Ms White is able to perform a modified range of
sedentary work that is not consistent with Dr. Sullivan’s opinions. In particular, Dr.
Sullivan opined in January 2012 and again in April 2013 that Ms. White cannot use
her hands for repetitive actions such as simple grasping, pushing and pulling arm
controls, and fine manipulation, and he also opined that she cannot use her feet for
repetitive movements such as pushing and pulling leg controls. At the hearing, a
vocational expert testified that the jobs he suggested for the claimant all require
frequent manual dexterity and stated that if a person was unable to engage in simple
grasping, pushing and pulling of arm controls, or fine manipulation, she would be
unable perform these jobs.77 The ALJ found that Ms. White is able to reach
frequently – other than overhead – handle, finger, and feel but is not capable of doing
any pushing or pulling with her hands and arms.78 Thus, she accepted part – but not

75

Rec. Doc. 7-1 at 26.

76

Rec. Doc. 7-1 at 27.

77

Rec. Doc. 7-1 at 75.

78

Rec. Doc. 7-1 at 21.

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all – of Dr. Sullivan’s assessment of the functional capabilities of Ms. White’s hands
and arms. It is not clear from the record whether the ALJ’s acknowledgment that Ms.
White is incapable of pushing or pulling arm controls disqualifies her from doing the
jobs suggested by the vocational expert, especially since he testified that “all jobs in
our economy require some repetitive action.”79 Still, the ALJ found that Ms. White
is capable of performing the jobs identified by the vocational expert.
The ALJ discounted Dr. Sullivan’s opinions on the basis that they are “not
supported by the objective evidence and [are] inconsistent with the treatment notes
. . . indicating the claimant has good range of motion in her wrists, elbows and hands,
and the claimant’s own statements that she is able to go shopping, drive her daughter
to her practices, and prepare meals.”80 Although the ALJ acknowledged the evidence
in the record establishing swelling in Ms. White’s hands and wrists and numbness and
tingling in her hands and arms, she downplayed the claimant’s pain complaints, failed
to appreciate the significance of the consistent mention of synovitis in the medical
records, and apparently decided that the evidence concerning the claimant’s range of
motion outweighed the other medical evidence.

79

Rec. Doc. 7-1 at 90.

80

Rec. Doc. 7-1 at 26-27.

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Synovitis is “inflammation of a synovial membrane usually with pain and
swelling of the joint.”81 Frequent findings of synovitis are found in the record. Such
findings are consistent with the claimant’s psoriatic arthritis diagnosis. Rather than
focusing on the frequent and consistent treatment notes concerning pain, swelling,
and synovitis, however, the ALJ found it persuasive that the records fail to expressly
state that the claimant experienced a restriction of movement of her hands. The ALJ
also stated that the claimant never complained to Dr. Kinsey about her hands. That
conclusion is not supported by the record since “fingers swelled up” is one of the
items listed in the treatment note of March 5, 2013.82 Thus, the ALJ’s conclusion that
Dr. Sullivan’s opinions concerning the claimant’s hands are not supported by
objective evidence lacks a sound evidentiary basis.
The ALJ also focused on the claimant’s allegedly being non-compliant with her
medications, stating “[s]welling of the hands is a symptom and here, it is more likely
than not, related at least in a small part, to not taking medication as prescribed each
and every day.”83 Evidence in the record documents that the claimant was required
to stop taking her medications before doing blood work for certain diagnostic testing
81

Merriam-Webster Dictionary, http://www.merriam-webster.com/dictionary/synovitis
(last visited Apr. 22, 2016).
82

Rec. Doc. 7-1 at 409.

83

Rec. Doc. 7-1 at 28.

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and while taking antibiotics.84 She also stopped taking certain medications in an
effort to control side effects.85 There is no medical opinion evidence in the record
linking an increase in her hand swelling with a failure to take all prescribed
medications exactly as prescribed or suggesting that her medication should not ever
have been stopped. Instead, the ALJ’s conclusion that the swelling of the claimant’s
hands is causally linked to her failure to take all of her medication every day appears
to be the result of the ALJ substituting her own opinion for that of the medical
professionals.
The ALJ’s conclusions were also influenced by the fact that the claimant had
a negative ANA test. There is no evidence in the record explaining the purpose of
this test or the significance of a negative result. Finally, the ALJ found that the
claimant had only occasional hand swelling, and she assumed that this swelling
resulted in mild restriction of movement.86 Again, these findings are the result of the
ALJ interpreting the medical evidence on her own rather than adopting the findings
of a physician.

84

Rec. Doc. 7-1 at 67.

85

Rec. Doc. 7-1 at 417-447.

86

Rec. Doc. 7-1 at 27.

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An ALJ “must be careful not to succumb to the temptation to play doctor” or
make their own independent medical assessments.87 In this case, however, the ALJ
concluded, on her own, that range of motion tests outweigh evidence concerning the
existence of synovitis, pain complaints, and swelling when determining the functional
capacity of a person’s hands. She also concluded, on her own, that the claimant’s
swollen hands resulted from a failure to take certain medication exactly as prescribed
rather than from an ongoing disease process. She concluded, on her own, that the
claimant’s hands are swollen only occasionally and that the swelling results in only
a mild restriction of movement. The ALJ’s tendency to play doctor was also evident
at the hearing, when she advised the claimant that soaking in epsom salt would pull
the swelling out88 and suggested that the claimant should look into taking B vitamins
to combat the Methotrexate and Enbrel causing her hair to fall out.89
“Although the ALJ may weigh competing medical opinions about. . .
limitations and use objective medical evidence to support its determination that one
opinion is better founded than another, neither the ALJ nor the court is free to

87

Frank v. Barnhart, 326 F.3d 618, 622 (5th Cir. 2003).

88

Rec. Doc. 7-1 at 64.

89

Rec. Doc. 7-1 at 50.

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substitute its own opinion.”90 Thus, the ALJ erred when she substituted her own
opinion for that of the claimant’s physicians.
The ALJ also erred when she gave Dr. Sullivan’s opinions only “little” or
“partial” weight. Dr. Sullivan is a specialist in the field of rheumatology, and he is
the claimant’s treating physician. As such, his opinions are entitled to deference.
That is particularly so in this case, in which the record contains no analysis of the
functional capacity of the claimant’s hands and arms by any doctor other than Dr.
Sullivan. There is no medical opinion in the record that disputes or refutes his
evaluation. There is, however, confirmation of the diagnosis of psoriatic arthritis and
confirmation of the symptoms of pain, numbness, tingling, swelling, and loss of grip
strength. Furthermore, as noted above, Dr. Sullivan’s evaluation is based on the
objective evidence he gathered in his eight examinations of the claimant over a two
year period and set forth in his treatment notes. There is no evidence in the record
disputing his evaluation. Accordingly, the ALJ’s assignment of “little” or “partial”
weight to his opinions does not result from a weighing of his opinions against those
of another doctor and is not supported by substantial evidence in the record. For

90

Fabre v. Astrue, No. 13-00076-BAJ-RLB, 2014 WL 4386424, at *6, n. 6 (M.D. La.

Sept. 4, 2014).

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those reasons, this matter will be remanded for a proper weighing of medical opinions
and a reevaluation of the claimant’s application for benefits.
CONCLUSION
This Court concludes that the ALJ’s finding regarding the claimant’s residual
functional capacity and the ALJ’s finding that the claimant is not disabled were
reached by applying an inappropriate legal standard and are not based on substantial
evidence in the record. Accordingly,
IT IS ORDERED that this matter is REVERSED and REMANDED to the
Commissioner pursuant to the fourth sentence of 42 U.S.C. § 405(g) for further
administrative proceedings with instructions to properly weigh Dr. Sullivan’s
opinions, to reevaluate the claimant’s residual functional capacity, and to reevaluate
whether there are jobs in the economy that the claimant can perform.
Inasmuch as the reversal and remand recommended herein falls under sentence
four of Section 405(g), any judgment entered in connection herewith will be a “final
judgment” for purposes of the Equal Access to Justice Act (EAJA).91

91

See, Richard v. Sullivan, 955 F.2d 354 (5th Cir. 1992), and Shalala v. Schaefer, 509
U.S. 292 (1993).

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Signed in Lafayette, Louisiana, this 22nd day of April 2016.

____________________________________
PATRICK J. HANNA
UNITED STATES MAGISTRATE JUDGE

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