Dubois v. Social Security Administration

Filing 14

MEMORANDUM RULING re 12 Order Referring Case to Magistrate Judge. Signed by Magistrate Judge Patrick J Hanna on 8/8/16. (crt,Jordan, P)

UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF LOUISIANA
LAFAYETTE DIVISION
RHONDA SUE DUBOIS

CIVIL ACTION NO. 6:15-cv-02184

VERSUS

MAGISTRATE 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. 12). Considering the administrative record, the parties’ briefs, and the
applicable law, the Commissioner’s decision is reversed, and benefits are awarded.
ADMINISTRATIVE PROCEEDINGS
The claimant, Rhonda Sue Dubois, fully exhausted her administrative remedies
prior to filing this action. The claimant filed applications for disability insurance
benefits (“DIB”) and for supplemental security income benefits (“SSI”), alleging
disability beginning on May 1, 2009.1 Her applications were initially granted2 but

1

Rec. Doc. 7-1 at 237, 239.

2

Rec. Doc. 7-1 at 80, 99.

then denied.3 The claimant requested a hearing, which was held on June 5, 2012
before Administrative Law Judge Lawrence T. Ragona.4 The ALJ issued a decision
on June 26, 2012,5 concluding that the claimant was not disabled within the meaning
of the Social Security Act through the date of the decision. The Appeals Council
vacated the ruling and remanded the case to the ALJ for further consideration.6 More
particularly, the Appeals Council ordered an evaluation of new evidence from the
claimant’s treating psychiatrist, Dr. Lindsay Legnon, a more comprehensive
discussion of the impact of the claimant’s mental limitations on her residual
functional capacity, and an evaluation of the opinions of the state agency medical
consultant, Dr. Cathy Castille. A second hearing was held on February 19, 2014
before the same ALJ.7 The ALJ issued his second decision on May 13, 2014, again
concluding that the claimant was not disabled from May 1, 2009 through the date of
the decision.8 Therefore, the ALJ’s decision became the final decision of the

3

Rec. Doc. 7-1 at 59, 69.

4

The hearing transcript is found at Rec. Doc. 7-1 at 5-19.

5

Rec. Doc. 7-1 at 103.

6

Rec. Doc. 7-1 at 116-118.

7

The hearing transcript is found at Rec. Doc. 7-1 at 37-58.

8

Rec. Doc. 7-1 at 18-29.

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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.
SUMMARY

OF

PERTINENT FACTS

The claimant, Rhonda Sue Dubois, was born on October 29, 1969.9 At the time
of the ALJ’s decision, she was forty-four years old. She graduated from high school
but had no vocational training or formal education thereafter.10 She has past relevant
work experience as a parts technician for an air conditioning and heating business,
as a waitress in a pizza restaurant, and as a receptionist and file clerk.11 She alleges
that she has been disabled since May 1, 2009 due to mental illness.12
The claimant has treated at the Tyler Mental Health Center since December 28,
2009. On that date, she was diagnosed by psychiatrist Dr. Lindsay Legnon with
Major Depressive Disorder, Single Episode, Moderate, and Generalized Anxiety
Disorder.13

That diagnosis was later changed to Bipolar Disorder, NOS, and

Generalized Anxiety Disorder.14 The claimant has seen Dr. Legnon approximately
9

Rec. Doc. 7-1 at 6, 38, 237, 239.

10

Rec. Doc. 7-1 at 8, 40.

11

Rec. Doc. 7-1 at 8-9, 40-41, 292.

12

Rec. Doc. 7-1 at 70, 239.

13

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

14

Rec. Doc. 7-1 at 385.

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once each month since that initial visit. She has also seen a mental health therapist
or counselor at the Tyler Center approximately once a month.
During the initial evaluation, the claimant was described as nervous, stressed,
and crying. She explained feelings of helplessness, worthlessness, and hopelessness,
and complained of worrying that had worsened since the birth of her handicapped
child. At that time, she had a three-year-old son with autism who required constant
attention, as well as older children aged twenty-two and eleven. She indicated that
she had had no friends since the birth of her youngest child. She described frequent
crying spells, poor sleep, weight gain, fatigue, and recent suicidal ideation. She also
told Dr. Legnon that she needs to keep things in order and very clean. Dr. Legnon
assigned a GAF score of 55, indicating moderate symptoms.15 Following the initial
evaluation, counseling and medication were started. Dr. Legnon prescribed Sertraline
for depression and anxiety and Vistaril for anxiety and insomnia.16
On March 24, 2010,17 the claimant again saw Dr. Legnon. She reported only
minimal improvement in her symptoms although her suicidal ideation had resolved
and she had experienced a decrease in obsessional cleaning behavior. She was not
15

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (“DSM–IV”)

16

Rec. Doc. 7-1 at 447.

17

Rec. Doc. 7-1 at 432.

at 32.

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taking three showers per day any more and was only mopping her house three times
per week rather than three times per day. Her medication was adjusted.
Dr. Legnon saw the claimant again on April 14, 2010.18 The claimant reported
an increase in agitation, depression, racing thoughts, distractibility, and anxiety with
the recent increase in her Zoloft prescription. Dr. Legnon decided to taper off the
Zoloft and prescribe Depakote in its place.
The claimant next saw Dr. Legnon on May 5, 2010.19 She described racing
thoughts, increased speech, irritability, and mood swings. Her mood was not good,
and her affect was labile or emotionally unstable. Her Depakote dosage was
increased. Dr. Legnon noted that her diagnosis was now Bipolar Disorder, NOS and
Generalized Anxiety Disorder.
On May 19, 2010,20 the claimant told Dr. Legnon that her depression was better
but she was continuing to have trouble sleeping, she felt as though her mind and body
were racing, and she continued to have symptoms of obsessive-compulsive disorder
centered on obsessive cleanliness such as showering three times each day.

18

Rec. Doc. 7-1 at 431.

19

Rec. Doc. 7-1 at 427.

20

Rec. Doc. 7-1 at 425.

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On June 18, 2010,21 the claimant told Dr. Legnon she had been doing “fairly
well” until about two weeks earlier when she became irritable, angry, and easily
overwhelmed with crying spells. She stated that she took only one dose of Geodon
because it made her feel “terrible.” She was continuing to take Depakote, and Abilify
was added for mood symptoms.
On July 21, 2010,22 Dr. Legnon noted that the claimant was unable to take
Abilify because it made her dizzy. The claimant had also reduced the dosage of
Depakote because she felt it was making her symptoms worse. She reported
irritability, crying spells, and racing thoughts. Her mood was dysphoric, and her
affect was labile. Dr. Legnon prescribed Tegretol.
On August 4, 2010,23 the claimant denied any improvement with Tegretol, and
she reported that she was feeling more depressed. However, her racing thoughts had
decreased and she was sleeping slightly better.

She also described feeling

overwhelmed easily. Her Tegretol prescription was increased, and a short term trial
of Clonazepam was prescribed.

21

Rec. Doc. 7-1 at 423.

22

Rec. Doc. 7-1 at 421.

23

Rec. Doc. 7-1 at 420.

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The claimant next saw Dr. Legnon on September 16, 2010.24 She noted some
improvement in her mood since starting Tegretol but was unable to tolerate its
sedating effects. Her crying spells had also started again. Dr. Legnon decided to
discontinue the Tegretol due to oversedation and prescribed Trileptal instead.
The claimant’s next appointment with Dr. Legnon was on November 9, 2010.25
The claimant reported that she was doing much better with the Trileptal and denied
feeling excessively up or down. However, she also described panic attacks and
reported that she was avoiding certain places during busy hours because she did not
want to be around people due to her anxiety.
On December 8, 2010,26 the claimant was reevaluated by a therapist at the Tyler
Mental Health Center, social worker Cristy James. She was again diagnosed with
Major Depressive Disorder, Single Episode, Moderate and Generalized Anxiety
Disorder. The claimant reported to the counselor that she had been doing well despite
having several stressors including financial concerns and being the sole caregiver for
her two minor children, one of whom has autism. The claimant also reported that she
is a caretaker for her parents. At that time, the claimant was taking both Trileptal and

24

Rec. Doc. 7-1 at 419.

25

Rec. Doc. 7-1 at 418.

26

Rec. Doc. 7-1 at 370, 408-409, 417.

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Paxil. She reported that the Paxil helps her with being in crowds. But she was still
taking three showers per day.
Dr. Legnon saw the claimant again on January 21, 2011.27 The claimant
reported that she was doing well and that the Paxil had helped significantly with
reducing social anxiety and obsessional cleaning. Her worry had decreased, and she
was functioning at a higher level.
Dr. Legnon’s handwritten notes from January 24, 2011 and February 25, 2011
are largely illegible; however, it appears that Seroquel was prescribed and the Paxil
dosage was adjusted.28
The claimant again saw Dr. Legnon on July 12, 2011.29 The claimant described
mood lability, racing thoughts, irritability, and anger. Although she initially reported
her mood as good, she later acknowledged that she was feeling depressed and
anxious. Her affect was labile, and her thought processes were tangential at times.
Dr. Legnon decided to titrate up the Seroquel dosage. On that same date, Dr. Legnon

27

Rec. Doc. 7-1 at 416.

28

Rec. Doc. 7-1 at 415, 414, respectively.

29

Rec. Doc. 7-1 at 385.

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changed the claimant’s diagnosis to Bipolar Disorder, NOS, and Generalized Anxiety
Disorder, and she assigned a GAF score of 50,30 which indicates serious symptoms.31
On August 9, 2011, the claimant was seen again by Dr. Legnon.32 The claimant
reported very poor sleep, slightly improved depression with fewer crying spells, but
increased energy, irritability, some impulsivity, and racing thoughts. She stated that
she avoids people because she does not want to be ugly to them. She identified
chronic joint pain, hernia pain, and her autistic son as stressors. Dr. Legnon noted
that the claimant’s excessive worry continues. Her mood was irritable, her affect was
labile, and she was tearful. Her medication dosages were adjusted, Trileptal was
discontinued, and Lamictal was started.
On September 7, 2011,33 the claimant told social worker James that she is
unable to control her impulsive verbal expressions to others and explained that when
she has a thought, she expresses it, regardless of how harmful or hurtful it may be to
another person, admitting that “I have no filter.”

30

Rec. Doc. 7-1 at 386.

31

DSM–IV at 32.

32

Rec. Doc. 7-1 at 465.

33

Rec. Doc. 7-1 at 464.

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Dr. Legnon saw the claimant again on September 21, 2011.34 The claimant
reported panic attacks, an inability to tolerate Lamictal, and side effects of
oversedation from Seroquel. She reported that she was still very irritable with racing
thoughts and saying things that she later regrets. Her medications were again
adjusted, by discontinuing Paxil and starting Clonazepam, and changing the dosage
of Lamictal.
The claimant returned to Dr. Legnon on October 18, 2011,35 reporting that she
felt like she was “back to square one.” She described increased irritability, not
sleeping well, and saying things that she feels bad about later. Her mood was
aggravated, her affect was congruent with her mood, and she was tearful. Dr. Legnon
decided to restart Paxil, discontinue Clonazepam, add a low dose of Seroquel, and
increase the dosage of Lamictal.
On November 11, 2011, the claimant returned to Dr. Legnon.36 She reported
that she was unable to tolerate the increased dosage of Seroquel due to sedation. The
Paxil made no difference in her anxiety or panic attacks. Her mood was not good, her

34

Rec. Doc. 7-1 at 463.

35

Rec. Doc. 7-1 at 462.

36

Rec. Doc. 7-1 at 461.

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affect was tearful, she reported being very irritable and wanting to strangle people
other than her children. Her medications were again adjusted.
On February 2, 2012, the claimant was again seen by Dr. Legnon.37 The
claimant reported some reduction in irritability and mood but also reported the onset
of visual and auditory hallucinations. Her mood was not too good, her affect was
anxious. Her medications were adjusted again.
On March 1, 2012,38 Dr. Legnon noted that the Seroquel would be discontinued
because it may have been causing psychosis and because it was ineffective for the
claimant’s mood disorder. Risperdal was to be tried instead. The patient reported
irritability such that she avoids people in order to prevent herself from saying
something mean to them.
On April 4, 2012,39 Dr. Legnon again saw the claimant. The claimant reported
that the change from Seroquel to Risperdal did not result in any improvement, that her
sleep had worsened, and that her appetite had increased. She reported continued
mood swings, especially sadness as well as problematic irritability. She was tearful,
her mood was labile, her affect was dysphoric, and her thought processes were

37

Rec. Doc. 7-1 at 460.

38

Rec. Doc. 7-1 at 452.

39

Rec. Doc. 7-1 at 451.

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organized but occasionally tangential. Dr. Legnon discontinued the Risperdal due to
the claimant’s rapid weight gain, prescribed Abilify for mood stabilization, adjusted
the Trileptal dose, and continued the Paxil.
On May 4, 2012,40 Dr. Legnon noted that the claimant had broken out into a
rash after taking Abilify and also felt hung over after taking it. However, she was
feeling more calm. The Abilify was discontinued, and Saphris was started. On May
9, 2012, however, Dr. Legnon noted that the Saphris induced vomiting, so the
medications were again adjusted.41
On June 5, 2012, the claimant testified at a hearing before ALJ Lawrence T.
Ragona. She explained that she has a bipolar disorder, anxiety, and a sleep disorder,
which results in her crying a lot.42 She stated that caring for her autistic child is a
challenge.43 She testified that she assists her disabled parents.44 She stated that her
moods change frequently.45 She explained that the main reason she stopped working

40

Rec. Doc. 7-1 at 459.

41

Rec. Doc. 7-1 at 459.

42

Rec. Doc. 7-2 at 9.

43

Rec. Doc. 7-2 at 10.

44

Rec. Doc. 7-2 at 10.

45

Rec. Doc. 7-2 at 12.

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was because of stress.46 She also stated that she has frequent panic attacks as often
as three times per day,47 sleeps only about four hours per night,48 and engages in no
social activities.49
The claimant saw Dr. Legnon again on June 26, 2012.50 She reported that she
had been sleeping poorly, had high anxiety, experienced several panic attacks each
day, and was agitated and irritable. She was unable to begin Zyprexa because it was
not available.
The claimant saw Dr. Legnon again on July 23, 2012.51 After consulting with
another doctor, Dr. Legnon decided to discontinue the Trileptal and return to
Depakote.
On July 27, 2012,52 the claimant was tearful from the beginning of the
appointment, stated that she was sleeping very little, and reported agitation and

46

Rec. Doc. 7-2 at 13.

47

Rec. Doc. 7-2 at 14.

48

Rec. Doc. 7-2 at 15.

49

Rec. Doc. 7-2 at 14

50

Rec. Doc. 7-1 at 526.

51

Rec. Doc. 7-1 at 525.

52

Rec. Doc. 7-1 at 523-524.

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irritability. Dr. Legnon noted that her symptoms were marked and, with regard to
global improvement, noted that the claimant was “minimally worse.”
Dr. Legnon saw the claimant again on August 21, 201253 and again noted that
her symptoms were marked and had not improved. At this appointment, the claimant
was feeling very irritable and said she had difficulty waiting in the waiting room. Her
moods were described as up and down, her sleep was reported to be poor, and she had
lost her Klonopin prescription while moving. The rash from the Zyprexa was still
resolving. She exhibited a dysphoric, irritable mood, her affect was tearful and labile,
and her pace was faster than usual.
On that same date, August 21, 2012, Dr. Legnon wrote a letter54 in which she
noted that she had been the claimant’s treating psychiatrist since December 28, 2009.
She stated that the claimant has been diagnosed with Bipolar Disorder Not Otherwise
Specified and Generalized Anxiety Disorder and, although the claimant was
compliant with prescribed medications and counseling sessions, she had not reached
stability. Dr. Legnon noted that the claimant is easily overwhelmed by small matters
and has a low stress tolerance in general. She has difficulty being around others and
has had trouble waiting in the waiting area at Dr. Legnon’s office. The claimant is

53

Rec. Doc. 7-1 at 519-520.

54

Rec. Doc. 7-1 at 479.

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often embarrassed by her impulsive verbal remarks. Dr. Legnon opined that, because
of the severity and persistence of her psychiatric symptoms, the claimant will not be
able to maintain employment.
On September 25, 2012, the claimant again saw Dr. Legnon.55 The claimant
reported that she was angry and irritable the day before the appointment, happy the
day before that, but depressed the day of the appointment. Dr. Legnon described her
mood as depressed, her affect as tearful, and the severity of her symptoms as marked.
Her Depakote dosage was adjusted.
The claimant returned to see Dr. Legnon on October 23, 2012.56 Dr. Legnon
noted that the claimant continued to describe mood instability. Dr. Legnon described
the claimant’s affect as labile and tearful and described her mood as anxious. She
rated the severity of her symptoms as moderate but noted no change in global
improvement.
At the appointment on December 4, 2012,57 Dr. Legnon described the claimant
as hyperactive, with a labile and tearful affect, and an anxious, irritable, depressed
mood. Dr. Legnon described the severity of her symptoms as marked. The claimant

55

Rec. Doc. 7-1 at 516-517.

56

Rec. Doc. 7-1 at 513-514.

57

Rec. Doc. 7-1 at 511-512.

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had difficulty staying in the waiting room, and described irritability, racing thoughts,
low motivation, sadness, crying spells, and anger. Dr. Legnon prescribed Ativan.
The claimant returned to see Dr. Legnon on February 27, 2013.58 Dr. Legnon
again described the severity of her symptoms as marked. The claimant reported that
she was feeling very irritable. She was unable to sit in the waiting room and reported
that she isolates herself from others when she is irritable. However, she stated that
she is patient with her children. She reported that the Ativan had helped her sleeping
but she was forgetful and distracted.
The claimant’s next visit with Dr. Legnon was on April 29, 2013.59 Dr. Legnon
indicated that the severity of her symptoms was marked but minimally improved. The
claimant stated that the increased dose of Depakote helped to calm her down a little,
but she reportedly remained very irritable and anxious but with fewer crying spells.
On May 10, 2013, the claimant reported to social worker Michelle Maloney
that the symptoms of her obsessive-compulsive disorder were very active and she was
cleaning and recleaning often.60

58

Rec. Doc. 7-1 at 509-510.

59

Rec. Doc. 7-1 at 504-505.

60

Rec. Doc. 7-1 at 501.

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On June 7, 2013, the claimant again met with Ms. Maloney.61 The claimant
rated her obsessive-compulsive disorder symptoms as a five on a scale of one to ten,
and rated her depression with irritability, yelling, and crying also as a five.
On July 15, 2013,62 Ms. Maloney noted that the claimant’s mood was
depressive but she “functions well.”
On July 29, 2013, the claimant again saw Dr. Legnon.63 The claimant reported
feeling very irritable and avoiding places where there are more than a few people.
She reported difficulty tolerating the waiting area at Dr. Legnon’s office. Dr. Legnon
noted that her affect was labile and tearful, her mood was irritable, the severity of her
symptoms was marked, and her symptoms were minimally worse.
The claimant next saw Dr. Legnon on August 15, 2013.64 The claimant
reported that, since discontinuing Depakote, her mood has worsened and she had
experienced increased irritability, mood swings, and general impatience. She
reported that she avoids being around others. Dr. Legnon described her mood as
anxious, dysphoric, and irritable, and described her affect as labile. Dr. Legnon noted

61

Rec. Doc. 7-1 at 499.

62

Rec. Doc. 7-1 at 498.

63

Rec. Doc. 7-1 at 496-497.

64

Rec. Doc. 7-1 at 492-493.

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that the claimant’s symptoms were markedly severe and minimally worse. Dr.
Legnon again adjusted the medication regimen.
On September 11, 2013, Dr. Legnon completed a mental functional capacity
assessment.65 In five categories, Dr. Legnon found that the claimant had limitations
that were likely to occur more than fifty percent of the work week, including the
following: perform activities within a schedule, and be punctual within customary
tolerances; work in coordination with or in proximity to others without being
distracted by them; complete a normal work-day and work week without interruptions
from psychologically-based symptoms and to perform at a consistent pace without an
unreasonable number and length of rest periods; accept instructions and respond
appropriately to criticism from supervisors; and get along with coworkers or peers
without distracting them. She also found that the claimant had limitations in two
additional areas that would likely occur from 25% to 50% of the work week, i.e.,
maintain attention and concentration for two hour blocks of time and maintain
socially appropriate behavior and to adhere to basic standards of neatness and
cleanliness. Dr. Legnon assigned a GAF score of 45, indicating serious symptoms.66
Dr. Legnon also added handwritten comments to the assessment form, stating that the

65

Rec. Doc. 7-1 at 481-482.

66

DSM–IV at 32.

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claimant “has been compliant with medications and psychotherapy appointments,
however, neither have been very effective for her symptoms. She is unable to handle
even the smallest stressor and has difficulty being around people other than her
immediate family. She is easily overwhelmed and emotional. I do not believe she
would be able to maintain any form of employment.”
On September 12, 2013,67 the claimant told social worker Michelle Maloney
that she was feeling overwhelmed and she cried through much of the session. Her
anxiety was high and she could not wait in the waiting area at the mental health center
due to her great discomfort being around people. Still, the claimaint reported that,
with regard to daily functioning, she was managing “fairly well” due to her special
needs son having returned to school, giving the claimant a couple of hours per day
respite from his constant needs. The claimant stated that she had not told anyone off
in quite some time and, although tempted, she had not sprayed anyone with Clorox
cleanser in public for a while. She noted an increased tolerance for body odors and
she noted an improvement characterized as leaving situations rather than
overstepping personal boundaries or confronting people.

67

Rec. Doc. 7-1 at 490.

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On October 8, 2013, the claimant again saw Dr. Legnon.68 Dr. Legnon
described her affect as labile and tearful, described her mood as irritable and
depressed, and noted that the claimant continued to have difficulty tolerating other
people. Her medication was again adjusted.
On October 9, 2013,69 the claimant again reported to Ms. Maloney that she was
leaving stores when other people’s hygiene bothered her rather than spraying them
with Clorox bleach.
On December 12, 2013,70 the claimant reported to Dr. Legnon that her moods
were up and down, that she cried easily, that she remained easily agitated, and that
she avoided people as much as possible because they aggravate her. Dr. Legnon
described her as hyperactive, labile, irritable, and depressed.
On January 8, 2014, the claimant met with Ms. Maloney.71 She reported having
had three panic attacks in the previous month. Discussion centered on her lack of
tolerance, anxiety, and constant worry.

68

Rec. Doc. 7-1 at 536-637.

69

Rec. Doc. 7-1 at 538.

70

Rec. Doc. 7-1 at 533-534.

71

Rec. Doc. 7-1 at 530.

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At the second hearing, on February 19, 2014, the claimant testified that her
constant worrying and lack of the ability to focus prevent her from working.72 She
described her panic attacks, and explained that she cannot stand how people smell,
so she sprays them with Clorox.73 She stated that she worries constantly and cleans
constantly, taking as many as four showers per day.74 She testified that, despite three
mental health appointments per month, she does not think her symptoms are
improving.75 She stated that she carries soap, hand sanitizer, bath powder, Clorox,
and Febreeze in her purse, and washes her hands approximately twenty times per
day.76 She explained that the Tyler Mental Health Center tries to get her in and out
of her appointments quickly because she has trouble tolerating the waiting room.77
ANALYSIS
A.

THE 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
72

Rec. Doc. 7-1 at 41.

73

Rec. Doc. 7-1 at 42.

74

Rec. Doc. 7-1 at 46.

75

Rec. Doc. 7-1 at 49.

76

Rec. Doc. 7-1 at 50.

77

Rec. Doc. 7-1 at 51-52.

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proper legal standards were used in evaluating the evidence.78 “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.”79 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.’”80
If the Commissioner's findings are supported by substantial evidence, then they
are conclusive and must be affirmed.81 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.82 Conflicts in the
evidence and credibility assessments are for the Commissioner to resolve, not the

78

Villa v. Sullivan, 895 F.2d 1019, 1021 (5th Cir. 1990); Martinez v. Chater, 64 F.3d
172, 173 (5th Cir. 1995).
79

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

80

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

81

42 U.S.C. § 405(g); Martinez v. Chater, 64 F.3d at 173; Carey v. Apfel, 230 F.3d 131,
135 (5th Cir. 2000).
82

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).

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courts.83 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.84
B.

ENTITLEMENT

TO

BENEFITS

The Disability Insurance Benefit (“DIB”) program provides income to
individuals who are forced into involuntary, premature retirement, provided they are
both insured and disabled, regardless of indigence.85 Every individual who meets
certain income and resource requirements, has filed an application for benefits, and
is determined to be disabled is eligible to receive Supplemental Security Income
(“SSI”) benefits.86
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

83

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

84

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

85

See 42 U.S.C. § 423(a).

86

42 U.S.C. § 1382(a)(1) & (2).

174.

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be expected to last for a continuous period of not less than twelve months.”87 A
claimant shall be determined to be 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.88
C.

THE EVALUATION PROCESS

AND THE

BURDEN

OF

PROOF

The Commissioner uses a sequential five-step inquiry to determine whether a
claimant is disabled. This process requires the ALJ to determine whether a claimant
(1) is currently working; (2) has a severe impairment; (3) has an impairment listed in
or medically equivalent to those in 20 C.F.R. Part 404, Subpart P, Appendix 1; (4) is
able to do the kind of work he did in the past; and (5) can perform any other work at

87

42 U.S.C. § 1382c(a)(3)(A).

88

42 U.S.C. § 1382c(a)(3)(B).

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step five.89 “A finding that a claimant is disabled or is not disabled at any point in the
five-step review is conclusive and terminates the analysis.”90
Before going from step three to step four, the Commissioner assesses the
claimant's residual functional capacity91 by determining the most the claimant can still
do despite his physical and mental limitations based on all relevant evidence in the
record.92 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.93
The claimant bears the burden of proof on the first four steps.94 At the fifth
step, however, the Commissioner bears the burden of showing that the claimant can
perform other substantial work in the national economy.95 This burden may be
89

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).
90

Greenspan v. Shalala, 38 F.3d 232, 236 (5th Cir. 1994), cert. den. 914 U.S. 1120
(1995) (quoting Lovelace v. Bowen, 813 F.2d 55, 58 (5th Cir. 1987)).
91

20 C.F.R. § 404.1520(a)(4).

92

20 C.F.R. § 404.1545(a)(1).

93

20 C.F.R. § 404.1520(e).

94

Perez v. Barnhart, 415 F.3d at 461; Masterson v. Barnhart, 309 F.3d at 272; Newton
v. Apfel, 209 F.3d at 453.
95

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

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satisfied by reference to the Medical-Vocational Guidelines of the regulations, by
expert vocational testimony, or by other similar evidence.96 If the Commissioner
makes the necessary showing at step five, the burden shifts back to the claimant to
rebut this finding.97 If the Commissioner determines that the claimant is disabled or
not disabled at any step, the analysis ends.98
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 May 1, 2009.99 This finding is supported by the
evidence in the record.
At step two, the ALJ found that the claimant has the following severe
impairments: a bipolar disorder and an anxiety disorder.100 This finding is supported
by evidence in the record.

96

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

97

Perez v. Barnhart, 415 F.3d at 461; Masterson v. Barnhart, 309 F.3d at 272; Newton
v. Apfel, 209 F.3d at 453.
98

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).
99

Rec. Doc. 7-1 at 20.

100

Rec. Doc. 7-1 at 20.

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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.101 The claimant does not challenge this finding.
The ALJ found that the claimant has the residual functional capacity to perform
a full range of work at all exertional levels but with the following nonexertional
limitations: work requiring one, two, and three-step instructions and work requiring
only occasional interaction with others.102 The claimant challenges this finding.
At step four, the ALJ found that the claimant is not capable of performing her
past relevant work.103 The claimant does not challenge this finding.
At step five, the ALJ found that the claimant was not disabled from May 1,
2009 (the alleged disability onset date) through May 13, 2014 (the date of the
decision) because there are jobs in the national economy that she can perform.104 The
claimant challenges this finding.

101

Rec. Doc. 7-1 at 20.

102

Rec. Doc. 7-1 at 26.

103

Rec. Doc. 7-1 at 27.

104

Rec. Doc. 7-1 at 28-29.

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E.

THE CLAIMANT’S ALLEGATIONS

OF

ERROR

The claimant argues that the ALJ erred (1) because he did not properly evaluate
the opinions of the claimant’s treating psychiatrist, Dr. Lindsey Legnon; (2) because
he failed to apply controlling law in evaluating the April 2011 medical opinions of
Dr. Cathy Castille; and (3) because he improperly evaluated the claimant’s residual
functional capacity.
F.

THE ALJ FAILED TO PROPERLY EVALUATE DR. LEGNON’S OPINIONS
The ALJ has the sole responsibility for determining the claimant's disability

status;105 therefore, a treating physician’s opinions concerning a claimant’s
employability are not determinative. However, 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.106 In fact, when a treating
physician's opinion regarding the nature and severity of an 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

105

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

106

Pineda v. Astrue, 289 Fed. App’x 710, 712-713 (5th Cir. 2008), citing Newton v.
Apfel, 209 F.3d at 455.

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give that opinion controlling weight.107 If an ALJ declines to give controlling weight
to a treating doctor’s opinion, he may give the opinion little or no weight – but only
after showing good cause for doing so.108 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.109
Before declining to give any weight to the opinions of a treating doctor, an ALJ must
also consider the length of treatment by the physician, the frequency of his
examination of the claimant, the nature and extent of the doctor-patient relationship,
the support provided by other evidence, the consistency of the treating physician’s
opinion with the record, and the treating doctor’s area of specialization, if any.110
In this case, Dr. Legnon is a psychiatrist who saw the claimant almost every
month for four years. The length and frequency of the doctor-patient relationship as
well as Dr. Legnon’s status as a specialist are factors that favor giving great weight
to her opinions.

107

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

108

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

109

Thibodeaux v. Astrue, 324 Fed. App’x at 443-44.

110

Myers v. Apfel, 238 F.3d 617, 621 (5th Cir. 2001); Newton v. Apfel, 209 F.3d at 456.

2000).

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The Social Security regulations and rulings explain how medical opinions are
to be weighed.111 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.
Therefore, if Dr. Legnon’s opinions are supported by substantial evidence in the
record, they should also be accorded great weight – or even controlling weight.
In this case, however, the ALJ rejected Dr. Legnon’s mental functional capacity
assessment of September 11, 2013 and gave it no weight at all on the basis that Dr.
Legnon’s findings conflict with her treatment notes.112 The ALJ did not identify any
of Dr. Legnon’s treatment notes that conflict with the opinions set forth in the
September 11, 2013 assessment. The ALJ also failed to evaluate Dr. Legnon’s letter
of August 21, 2012. The opinions set forth in that letter are consistent with those
reached in the September 11, 2013 assessment, and the ALJ did not expressly reject
the opinions set forth in that letter. Most importantly, a review of the treatment notes
spanning the entirety of Dr. Legnon’s course of treatment from December 2009
through December 2013 shows that, despite numerous counseling sessions and the
prescription of myriad medications, the claimant’s symptoms did not vary much over
the four-year treatment span. The claimant remained easily overwhelmed, anxious,

111

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

112

Rec. Doc. 7-1 at 27.

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depressed, obsessive-compulsive about cleanliness, and overly emotional, with a low
stress tolerance and an inability to be comfortable around others. In sum, despite the
ALJ’s contrary finding, Dr. Legnon’s treatment notes actually are consistent with the
opinions she expressed in the August 2012 letter and in the September 2013 mental
functional capacity assessment.
Although the ALJ did not identify any treatment notes that conflict with Dr.
Legnon’s opinions, the Commissioner identified four in his brief.

First, the

Commissioner directed attention to the treatment note from January 12, 2011, noting
that the claimant was “doing well,” that she was taking Trileptal that was “effective
and without side effects,” that Paxil had helped significantly with reducing social
anxiety and obsessional cleaning, that her worry was reduced, that she was
functioning at a higher level, and that she had begun exercising. Focusing on this one
positive treatment note out of the context of the overall four years of treatment
ignores the fact that, just twelve days later, the claimant reported increased crying
spells and increased feelings of being overwhelmed. A month after that, the claimant
reported an increase in anxiety. A few months later, in July 2011, Dr. Legnon
changed the diagnosis, and in August 2011 Dr. Legnon replaced Trileptal with
Lamictol in an effort to control the claimant’s symptoms.

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The second example cited by the Commissioner of a treatment note that
conflicts with Dr. Legnon’s opinion is a continuity of care data form dated December
8, 2010.113 The Commissioner correctly noted that this form says the claimant was
doing well despite several stressors. However, the Commissioner did not cite to
social worker Christy James’s treatment note for that same day,114 which indicates that
Trileptal made the claimant dizzy, and that although her medications were helping
with the symptoms of her obsessive-compulsive disorder she was still obsessively
taking three showers per day.
The third example cited by the Commissioner of a conflicting treatment note
is that of social worker Michelle Maloney regarding a counseling session on
September 12, 2013.115 The Commissioner cited this treatment note because it
indicates that the claimant was functioning “fairly well.” What the Commissioner
failed to acknowledge is that this same treatment note also indicates that the claimant
told the social worker that her anxiety was high and she could not wait in the mental
health center’s waiting area because of her great discomfort around people. The
Commissioner did not note that the claimant wept through much of the session, told

113

The Commissioner erroneously provided the date of December 6, 2010 for this form.

114

Rec. Doc. 7-1 at 417.

115

Rec. Doc. 7-1 at 490.

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the social worker that she was feeling overwhelmed, told the social worker that she
was still often tempted to spray people with Clorox although she was doing better
with leaving situations before stepping over personal boundaries or confronting
people, told the social worker that she continued to get depressed and cry, told the
social worker that she had a difficult time not perserverating on the past and fears of
the future, and told the social worker that she did not drive at night due to the
combination of a vision problem and her fears.
The final treatment note cited by the Commissioner as inconsistent with Dr.
Legnon’s opinions is that of October 9, 2013,116 in which the social worker noted that
the claimant’s generalized anxiety and obsessive-compulsive disorder were fairly well
managed and her activities of daily living were ok as long as she could control her
home environment. The Commissioner failed to note that the claimant was also
looking forward to a new dose of medication and was “feeling bad. . . like I could
jump through the window.” The Commissioner also failed to mention Dr. Legnon’s
treatment note of the previous day,117 in which she reported that the claimant
presented with an irritable and depressed mood and a labile, tearful affect. On that

116

Rec. Doc. 7-1 at 538.

117

Rec. Doc. 7-1 at 536.

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day, the claimant told Dr. Legnon that her “mood changes like the wind,” she
continues to have difficulty tolerating other people, and she was still irritable.
On eight separate occasions in 2012 and 2013, Dr. Legnon expressly noted that
the claimant’s symptoms were marked in their severity. Although her treatment notes
do indicate short periods of some improvement in the claimant’s symptoms, as
illustrated by the treatment noted from January 2011 that the Commissioner primarily
relied upon, the treatment notes also indicate that Dr. Legnon struggled to find an
appropriate medication that would alleviate the claimant’s depression, anxiety, and
obsessive-compulsive behavior without causing intolerable side effects.

The

treatment notes also demonstrate that, over the four-year span of treatment, little
improvement was reached in helping the claimant to become comfortable with people
other than her immediate family. At the time of the second hearing, which was after
the date of the last treatment note in the record, the claimant was still washing her
hands twenty times per day and carrying Clorox in her purse.
Considering the evidence in the record as a whole, this Court concludes that
the ALJ’s conclusion that Dr. Legnon’s opinions are inconsistent with her treatment
notes is not supported by substantial evidence in the record. The opinions set forth
in Dr. Legnon’s letter dated August 21, 2012 and those set forth in her mental
functional capacity assessment dated September 11, 2013 are consistent with Dr.
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Legnon’s treatment notes. In August 2012 and again in September 2013, Dr. Legnon
described the claimant as unable to handle even small stressors, emotional, easily
overwhelmed, and uncomfortable around people other than her immediate family. Dr.
Legnon explained on both occasions that neither medication nor counseling had been
effective in improving the claimant’s symptoms, which is evident from the record.
In Dr. Legnon’s opinion, the severity and persistence of the claimant’s psychiatric
symptoms impair her ability to maintain employment. This Court finds that, because
these opinions are supported by substantial evidence in the record, the ALJ erred in
rejecting Dr. Legnon’s opinions and in failing to give them either great weight or
controlling weight.
G.

THE ALJ FAILED TO PROPERLY EVALUATE DR. CASTILLE’S OPINIONS
The claimant’s second alleged error centers on the ALJ’s evaluation of the

opinions of Dr. Cathy Castille, a non-examining state agency psychological
consultant. Shortly after the claimant applied for benefits, Dr. Castille opined that the
claimant was markedly limited in her ability to complete a normal workday and
workweek without interruptions from psychologically-based symptoms and to
perform at a consistent pace without an unreasonable number and length of rest

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periods.118 Dr. Castille found the claimant to be disabled.119 That decision was
reviewed by Paula Kresser, Ph.D., who concluded that additional evidence was
necessary to determine the claimant’s functional limitations.120 Thereafter, Dr.
Castille reevaluated the claimant – again without meeting or examining her – and
opined that the claimant was moderately limited in the ability to complete a normal
workday and workweek.
The Social Security regulations state that “[r]egardless of its source, we will
evaluate every medical opinion we receive.”121 Thus, the ALJ was required to
consider both of Dr. Castille’s opinions. Additionally, when the Appeals Council
remanded this matter for reconsideration, the Appeals Council expressly directed the
ALJ to consider both of Dr. Castille’s opinions. The Appeals Council noted that the
ALJ was not bound by Dr. Castille’s opinions but stated that “the opinions provided
by Dr. Castille. . . must be fully evaluated and the weight assessed those opinions
must be noted.”122

118

Rec. Doc. 7-1 at 95.

119

Rec. Doc. 7-1 at 80, 99.

120

Rec. Doc. 7-1 at 369.

121

20 C.F.R. § 404.1527.

122

Rec. Doc. 7-1 at 117.

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In the second ruling, however, the ALJ expressly gave significant weight to Dr.
Castille’s July 2011 opinions but failed to even mention her earlier opinions. This is
significant because Dr. Castille’s April 2011 opinions are similar to those of Dr.
Legnon, which as noted above are consistent with substantial evidence in the record.
The ALJ, however, failed to even mention Dr. Castille’s earlier opinions and
expressly rejected Dr. Legnon’s opinions while giving significant weight to Dr.
Castille’s July 2011 opinions, which are flanked chronologically by the medical
opinions that were not accorded any weight.
An ALJ is required to consider all of the evidence in the record and cannot
“pick and choose” only the evidence that supports his position.123 Dr. Castille may
have had valid reasons for changing her opinion between April and July of 2011, but
it was error for the ALJ to rely upon one of her opinions without even mentioning the
other, especially since there were other medical opinions in the record that were
consistent with the opinions of Dr. Castille that the ALJ expressly rejected. The ALJ
erred in failing to consider all of the medical opinions in the record, particularly
including Dr. Castille’s opinions of April 2011, and this error mandates reversal of
the ALJ’s decision.

123

Loza v. Apfel, 219 F.3d at 393.

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H.

THE ALJ FAILED TO PROPERLY EVALUATE THE CLAIMANT’S RESIDUAL
FUNCTIONAL CAPACITY
The claimant’s final argument is that the ALJ’s residual functional capacity

assessment does not account for all of her functional limitations. More specifically,
the claimant argues that the ALJ’s finding regarding her residual functional capacity
fails to account for her limitations in maintaining concentration, persistence, or pace
as well as her limitations in social functioning, which were recognized by Dr.
Legnon124 and by Dr. Castille in her earlier evaluation.125
The responsibility for determining a claimant's residual functional capacity
belongs to the ALJ.126 In making a finding in that regard, the ALJ must consider all
of the evidence in the record, evaluate the medical opinions in light of other
information contained in the record, and determine the plaintiff's ability despite any
physical and mental limitations.127
In crafting his finding concerning the claimant’s residual functional capacity,
the ALJ rejected Dr. Legnon’s September 11, 2012 opinions, gave significant weight
to Dr. Castille’s July 2011 opinions, and gave significant weight to the claimant’s

124

Rec. Doc. 479, 481-482.

125

Rec. Doc. 93-95.

126

Ripley v. Chater, 67 F.3d at 557.

127

Martinez v. Chater, 64 F.3d at 176.

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records from the Tyler Mental Health Center, particularly those from September
2013, which indicated that the claimant was functioning fairly well despite her mental
health symptoms. In a prior section of this ruling, it was demonstrated that the ALJ
erred in rejecting Dr. Legnon’s opinions, in failing to consider Dr. Castille’s April
2011 opinions, and in relying heavily on the medical records from September 2013.
In evaluating the claimant’s residual functional capacity, the ALJ gave
significant weight to Dr. Castille’s July 2011 opinions, citing in particular her opinion
that the claimant was capable of getting along with others. Dr. Castille’s July 2011
opinion also noted that the claimant had no social interaction limitations.128 That
conclusion is contrary to the evidence in the record.
In her initial work-up at Tyler Mental Health, the claimant denied social
interaction, reporting that since the birth of her youngest child she had had no
friends.129 On March 24, 2010, the claimant told her counselor that she did not want
to be around people.130 On May 19, 2010, she reported snapping at people and
worrying about people knowing her business or coming into her home to take her

128

Rec. Doc. 7-1 at 65.

129

Rec. Doc. 7-1 at 437.

130

Rec. Doc. 7-1 at 433.

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medicine.131 On November 9, 2010, the claimant told Dr. Legnon that she did not
want to be around people because of her anxiety. In December 2010, the claimant
was reluctant to seek certain services for her autistic son because it would require
another person to come into her home.132 At the first hearing, she denied having any
hobbies other than occasionally watching a House Hunters episode on television and
denied doing anything socially through a church or any other organization.133 At the
second hearing, the claimant discussed her lack of tolerance of other people, stating
that she dislikes being around a lot of people and has such a dislike of smells that she
sprays people with Clorox and sits by herself.134 She testified that when she takes her
son to McDonald’s, she sits off in the corner.135 She occasionally lets one or two of
her neighbors into her house but has no friends or hobbies.136 This behavior was
corroborated in the medical records, along with impulsive verbal outbursts regardless

131

Rec. Doc. 7-1 at 425.

132

Rec. Doc. 7-1 at 417.

133

Rec. Doc. 7-2 at 13-14.

134

Rec. Doc. 7-1 at 42, 52.

135

Rec. Doc. 7-1 at 47.

136

Rec. Doc. 7-1 at 48.

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of how hurtful they might be to others.137 The record as a whole does not support a
conclusion that the claimant has no limitations in the category of social interactions.
Accordingly, this Court finds that the ALJ’s evaluation of the claimant’s
residual functional capacity failed to incorporate the claimant’s limitations in social
interactions that are documented in the record. This was the result of the ALJ’s errors
in applying an improper legal standard and reaching a conclusion that was not
supported by substantial evidence in the record. These errors in evaluating the
claimant’s residual functional capacity mandate reversal of the Commissioner’s
ruling.
Having found that the ALJ failed to properly evaluate the claimant’s residual
functional capacity by failing to properly address her limitations in social interactions,
this Court pretermits discussion of whether the ALJ also failed to properly evaluate
how her limitations in maintaining concentration, persistence, or pace affect her
residual functional capacity.
CONCLUSION
This Court finds that the ALJ failed to properly weigh the medical opinions in
the record, particularly that of Dr. Legnon; failed to properly evaluate Dr. Castille’s
medical opinions, particularly those of April 2011; and failed to properly evaluate the
137

Rec. Doc. 7-1 at 452, 462, 464.

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claimant’s residual functional capacity. When Dr. Legnon’s opinions are given
controlling weight, as they must be since they are supported by substantial evidence
in the record, this Court concludes that the claimant is disabled.
Accordingly, IT IS ORDERED that the Commissioner’s decision is
REVERSED and remanded to the Commissioner pursuant to the fourth sentence of
42 U.S.C. § 405(g) with instructions that the claimant’s applications for Disability
Insurance Benefits and Supplemental Security Income be granted and for computation
and payment of an award of benefits beginning on the alleged disability onset date,
May 1, 2009. Inasmuch as the reversal ordered 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).138
Signed in Lafayette, Louisiana, this 8th day of August 2016.

____________________________________
PATRICK J. HANNA
UNITED STATES MAGISTRATE JUDGE

138

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

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