DeGroot v. Colvin

Filing 26

MEMORANDUM AND ORDER re: 25 SOCIAL SECURITY CROSS BRIEF re 18 SOCIAL SECURITY BRIEF filed by Defendant Carolyn W. Colvin, 18 SOCIAL SECURITY BRIEF filed by Plaintiff Cynthia DeGroot. IT IS HEREBY ORDERED that the decision of the Commissioner is REVERSED, and this cause is REMANDED for further proceedings. A separate Judgment in accordance with this Memorandum and Order is entered this same date. Signed by Magistrate Judge Abbie Crites-Leoni on 9/28/15. (CSG)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
SOUTHEASTERN DIVISION
CYNTHIA DeGROOT,
Plaintiff,
vs.
CAROLYN W. COLVIN,
Acting Commissioner of Social Security,
Defendant.

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) Case No. 1:14CV00045 ACL
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MEMORANDUM AND ORDER
Plaintiff Cynthia DeGroot requested supplemental security income based on a number of
physical and mental conditions. An examination of DeGroot’s medical and mental health records
support that she has received treatment for fibromyalgia, degenerative disc disease of the cervical
spine, bilateral carpal tunnel syndrome, hepatitis C, stage II liver disease, thyroid issues, social
anxiety, and depression. DeGroot brings this action pursuant to 42 U.S.C. ' 405(g), seeking
judicial review of the Social Security Administration Commissioner’s denial of her application for
Disability Insurance Benefits under Title II of the Social Security Act and Supplemental Security
Income under Title XVI of the Act.
An Administrative Law Judge (ALJ) found that, despite DeGroot’s multiple severe
impairments, she was not disabled as she had the residual functional capacity (“RFC”) to perform
light work with additional standing and walking limitations. A vocational expert testified that the
job numbers would be somewhat eroded due to said limitations, however, De Groot would be able
to perform the requirements of occupations such as hand packer and production worker assembler,
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which exist in significant numbers in the national economy.
This matter is pending before the undersigned United States Magistrate Judge, with
consent of the parties, pursuant to 28 U.S.C. § 636(c). A summary of the entire record is
presented in the parties’ briefs and is repeated here only to the extent necessary.
I. Procedural History
On August 10, 2011, DeGroot filed applications for Disability Insurance Benefits (DIB)
and Supplemental Security Income (SSI), claiming that she became unable to work due to her
disabling condition on October 1, 2008.1 (Tr. 126-32, 133-39). DeGroot’s claims were denied
initially. (Tr. 64-65, 73-77.) Following an administrative hearing, DeGroot’s claims were
denied in a written opinion by an ALJ, dated April 18, 2013. (Tr. 9-24.) DeGroot then filed a
request for review of the ALJ=s decision with the Appeals Council of the Social Security
Administration (SSA) (Tr. 8), which was denied on March 12, 2014 (Tr. 1-6). Thus, the decision
of the ALJ stands as the final decision of the Commissioner. See 20 C.F.R. '' 404.981, 416.1481.
In the instant action, DeGroot first claims that the ALJ erred when she “improperly
characterized the thyroid conditions of the Plaintiff as non-severe.” (Doc. 18 at 46.) DeGroot
next argues that the ALJ erred by failing to “properly consider the subjective testimony of the
Plaintiff discrediting her testimony with a flawed and incomplete credibility analysis.” Id. at 46.
II. Applicable Law
II.A.

Standard of Review
The decision of the Commissioner must be affirmed if it is supported by substantial

evidence on the record as a whole. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401

1

DeGroot subsequently amended her alleged onset of disability date to July 10, 2009. (Tr. 12.)
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(1971); Estes v. Barnhart, 275 F.3d 722, 724 (8th Cir. 2002). Substantial evidence is less than a
preponderance of the evidence, but enough that a reasonable person would find it adequate to
support the conclusion. Johnson v. Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001). This “substantial
evidence test,” however, is “more than a mere search of the record for evidence supporting the
Commissioner’s findings.” Coleman v. Astrue, 498 F.3d 767, 770 (8th Cir. 2007) (internal
quotation marks and citation omitted). “Substantial evidence on the record as a whole . . .
requires a more scrutinizing analysis.” Id. (internal quotation marks and citations omitted).
To determine whether the Commissioner’s decision is supported by substantial evidence
on the record as a whole, the Court must review the entire administrative record and consider:
1.

The credibility findings made by the ALJ.

2.

The plaintiff’s vocational factors.

3.

The medical evidence from treating and consulting physicians.

4.

The plaintiff’s subjective complaints relating to exertional and
non-exertional activities and impairments.

5.

Any corroboration by third parties of the plaintiff’s
impairments.

6.

The testimony of vocational experts when required which is
based upon a proper hypothetical question which sets forth the
claimant’s impairment.

Stewart v. Secretary of Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir. 1992) (internal
citations omitted). The Court must also consider any evidence which fairly detracts from the
Commissioner’s decision. Coleman, 498 F.3d at 770; Warburton v. Apfel, 188 F.3d 1047, 1050
(8th Cir. 1999). However, even though two inconsistent conclusions may be drawn from the
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evidence, the Commissioner's findings may still be supported by substantial evidence on the
record as a whole. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001) (citing Young v.
Apfel, 221 F.3d 1065, 1068 (8th Cir. 2000)). “[I]f there is substantial evidence on the record as a
whole, we must affirm the administrative decision, even if the record could also have supported an
opposite decision.” Weikert v. Sullivan, 977 F.2d 1249, 1252 (8th Cir. 1992) (internal quotation
marks and citation omitted). See also Jones ex rel. Morris v. Barnhart, 315 F.3d 974, 977 (8th
Cir. 2003).
II.B.

Determination of Disability
To be eligible for DIB and SSI under the Social Security Act, a plaintiff must prove that she

is disabled. Pearsall v. Massanari, 274 F.3d at 1217; Baker v. Secretary of Health & Human
Servs., 955 F.2d 552, 555 (8th Cir. 1992). The Social Security Act defines disability as 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 12 months.” 42 U.S.C. §§
423(d)(1)(A), 1382c(a)(3)(A). An individual will be declared disabled “only if his physical or
mental impairment or impairments are of such severity that he is not only unable to do his previous
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),
1382c(a)(3)(B).
The SSA Commissioner has established a five-step process for determining whether a
person is disabled. See 20 C.F.R. '' 404.1520, 416.920; Bowen v. Yuckert, 482 U.S. 137, 141-42
(1987); Fines v. Apfel, 149 F.3d 893, 894-95 (8th Cir. 1998). First, it is determined whether the

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claimant is currently engaged in “substantial gainful employment.” If the claimant is, disability
benefits must be denied. See 20 C.F.R. '' 404.1520, 416.920 (b). Step two requires a
determination of whether the claimant suffers from a medically severe impairment or combination
of impairments. See 20 C.F.R '' 404.1520 (c), 416.920 (c). To qualify as severe, the
impairment must significantly limit the claimant=s mental or physical ability to do “basic work
activities.” Id. Age, education and work experience of a claimant are not considered in making
the Aseverity@ determination. See id.
If the impairment is severe, the next issue is whether the impairment is equivalent to one of
the listed impairments that the Commissioner accepts as sufficiently severe to preclude substantial
gainful employment. See 20 C.F.R. '' 404.1520 (d), 416.920 (d). This listing is found in
Appendix One to 20 C.F.R. 404. 20 C.F.R. pt. 404, subpt. P, App. 1. If the impairment meets or
equals one of the listed impairments, the claimant is conclusively presumed to be impaired. See
20 C.F.R. '' 404.1520 (d), 416.920 (d). If it does not, however, the evaluation proceeds to the
next step which requires an inquiry regarding whether the impairment prevents the claimant from
performing his or her past work. See 20 C.F.R. ' 404.1520 (e), 416.920 (e).
If the claimant is able to perform the previous work, in consideration of the claimant’s RFC
and the physical and mental demands of the past work, the claimant is not disabled. See id. If the
claimant cannot perform her previous work, the final step involves a determination of whether the
claimant is able to perform other work in the national economy taking into consideration the
claimant’s residual functional capacity, age, education and work experience. See 20 C.F.R. ''
404.1520 (f), 416.920 (f). The claimant is entitled to disability benefits only if she is not able to
perform any other work. See id. Throughout this process, the burden remains upon the claimant
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until she adequately demonstrates an inability to perform previous work, at which time the burden
shifts to the Commissioner to demonstrate the claimant’s ability to perform other work. See
Beckley v. Apfel, 152 F.3d 1056, 1059 (8th Cir. 1998).
The evaluation process for mental impairments is set forth in 20 C.F.R. '' 404.1520a,
416.920a. The first step requires the Commissioner to Arecord the pertinent signs, symptoms,
findings, functional limitations, and effects of treatment@ in the case record to assist in the
determination of whether a mental impairment exists. See 20 C.F.R. '' 404.1520a (b) (1),
416.920a (b) (1). If it is determined that a mental impairment exists, the Commissioner must
indicate whether medical findings Aespecially relevant to the ability to work are present or absent.@
20 C.F.R. '' 404.1520a (b) (2), 416.920a (b) (2). The Commissioner must then rate the degree of
functional loss resulting from the impairments in four areas deemed essential to work: activities
of daily living, social functioning, concentration, and persistence or pace. See 20 C.F.R. ''
404.1520a (b) (3), 416.920a (b) (3). Functional loss is rated on a scale that ranges from no
limitation to a level of severity which is incompatible with the ability to perform work-related
activities. See id. Next, the Commissioner must determine the severity of the impairment based
on those ratings. See 20 C.F.R. '' 404.1520a (c), 416.920a (c). If the impairment is severe, the
Commissioner must determine if it meets or equals a listed mental disorder. See 20 C.F.R. ''
404.1520a(c)(2), 416.920a(c)(2). This is completed by comparing the presence of medical
findings and the rating of functional loss against the paragraph A and B criteria of the Listing of the
appropriate mental disorders. See id. If there is a severe impairment, but the impairment does
not meet or equal the listings, then the Commissioner must prepare a residual functional capacity
(RFC) assessment. See 20 C.F.R. '' 404.1520a (c)(3), 416.920a (c)(3).
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III. The ALJ=s Determination
The ALJ found that DeGroot met the insured status requirements of the Social Security Act
through March 31, 2013. (Tr. 14.) She also found that DeGroot has not engaged in substantial
gainful activity since July 10, 2009, the amended alleged onset date. Id.
In addition, the ALJ concluded that DeGroot had several severe impairments, including:
fibromyalgia, degenerative disc disease of the cervical spine, bilateral carpal tunnel syndrome,
hepatitis C, stage II liver disease, social anxiety, and depression; but no “impairment or
combination of impairments that meets or medically equals the severity of one of the listed
impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1.” (Tr. 14-15.)
As to DeGroot’s RFC, the ALJ stated:
After careful consideration of the entire record, I find that the claimant has the residual
functional capacity to perform light work as defined in 20 CFR 404.1567(b) and
416.967(b) except: the claimant would be limited to walking or standing for 4 hours, in an
8-hour day. She can occasionally crawl or climb ladders, ropes, and scaffolds. She can
frequently perform all remaining postural activities. She can perform frequent bilateral
overhead reaching. She can perform frequent bilateral gross and fine manipulation. She
would require an avoidance of concentrated exposure to excessive vibration, concentrated
chemicals, or concentrated hazards. She would be limited to simple, routine, repetitive
tasks and incidental contact with the public.
(Tr. 16.)
The ALJ found that DeGroot’s allegations of total disability were not fully credible. (Tr.
18-19.) Specifically, the ALJ stated that DeGroot’s “wide range of reported activities from her
testimony and function reports, the reports of resolved symptoms after neck and carpal tunnel
surgeries, and the consistent reports of stable mental health symptoms, also render the claimant’s
allegations of disabling symptoms and limitations not fully credible.” Id.
The ALJ further found that DeGroot is unable to perform any past relevant work. (Tr. 19.)

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She also concluded, based on vocational expert testimony, that there are jobs that exist in
significant numbers in the national economy that DeGroot can perform. Id.
The ALJ=s final decision reads as follows:
Based on the application for a period of disability and disability insurance benefits filed on
August 10, 2011, the claimant is not disabled under sections 216(i) and 223(d) of the Social
Security Act.
Based on the application for supplemental security income filed on August 10, 2011, the
claimant is not disabled under section 1614(a)(3)(A) of the Social Security Act.
(Tr. 20.)
IV. Discussion
As noted above, DeGroot raises two claims in this action for judicial review of the ALJ’s
decision denying benefits. The undersigned will discuss DeGroot’s claims in turn.
IV.A. Severity Determination
DeGroot first argues that the ALJ committed reversible error when she found DeGroot’s
thyroid condition was non-severe and further erred by failing to include limitations caused by this
impairment in the RFC assessment. DeGroot also contends that the ALJ’s assessment of her
thyroid condition as “thyroiditis”2 is a mischaracterization of her thyroid problems.
Defendant argues that DeGroot’s thyroid condition resolved with surgery and medication,
and that there is no evidence that it resulted in work-related functional limitation.
In determining the severity of DeGroot’s thyroid condition, the ALJ found as follows:
The record contains a diagnosis of history of thyroiditis. However, the evidence does not
support that this condition causes more than minimal functional limitations. Further, the
record does not demonstrate any secondary issues or complications which would
reasonably support functional limitations. Accordingly, this impairment is not severe.
(Tr. 14.)

2

Inflammation of the thyroid gland. Stedman’s Medical Dictionary, 1988 (28th Ed. 2006).
Page 8 of 20 

To be considered severe, an impairment must significantly limit a claimant’s ability to do
basic work activities. See 20 C.F.R §§ 404.1520(c), 416.920(c). “An impairment is not severe if
it amounts only to a slight abnormality that would not significantly limit the claimant's physical
or mental ability to do basic work activities.” Kirby v. Astrue, 500 F.3d 705, 707 (8th Cir. 2007).
Basic work activities mean the abilities and aptitudes necessary to do most jobs, including
physical functions; capacities for seeing, hearing, and speaking; understanding, carrying out, and
remembering simple instructions; use of judgment; responding appropriately to supervision,
coworkers and usual work situations; and dealing with changes in a routine work setting. 20
C.F.R. §§ 404.152l(b); 416.92l(b). Although DeGroot has “the burden of showing a severe
impairment that significantly limited her physical or mental ability to perform basic work
activities, . . . the burden of a claimant at this stage of the analysis is not great.” Caviness v.
Massanari, 250 F.3d 603, 605 (8th Cir. 2001).
DeGroot’s thyroid issues began in December 2010. DeGroot saw Geetha Komatireddy,
M.S., at Ozark Rheumatology for follow-up regarding fibromyalgia on December 23, 2010. (Tr.
352-54.) Laboratory testing revealed a thyroid stimulating hormone (“TSH”) level3 of almost 0,
which Dr. Komatireddy indicated was probably indicative of hyperthyroidism.4 (Tr. 352.) Dr.
Komatireddy referred DeGroot to an endocrinologist for evaluation of her “abnormal thyroid
function.” (Tr. 354.)
DeGroot saw Phenu V. Zachariah, D.O., at Cape Diabetes and Endocrinology, on

3

A diagnostic test to differentiate primary and secondary hypothyroidism. Stedman’s at 1989.
Normal values are between 0.34 and 4.82 microunits per milliliter. (Tr. 359.)
4
An abnormality of the thyroid gland in which secretion of thyroid hormone is unusually increased
and no longer under regulatory control of hypothalamic-pituitary centers; characterized by a
hypermetabolic state, usually with weight loss, and tremulousness; may progress to severe
weakness and wasting. Stedman’s at 928.
Page 9 of 20 

December 29, 2010. (Tr. 251-52.) Dr. Zachariah indicated that DeGroot had been having some
dysphagia5 due to esophageal issues, some ongoing dysphonia,6 weight gain, heat and cold
intolerance, and fatigue. (Tr. 251.) Dr. Zachariah diagnosed DeGroot with abnormal thyroid
function among other things. (Tr. 252.) Dr. Zachariah indicated that DeGroot likely had
thyroiditis, but additional laboratory testing would be performed. Id. DeGroot saw Dr.
Zachariah on February 28, 2011, at which time she reported some dysphagia associated with
sinusitis issues over the past month. (Tr. 246.) Upon examination, Dr. Zachariah noted some
hand tremors, which DeGroot reported occurred intermittently when her anxiety seemed to be
more out of control. Id. Dr. Zachariah diagnosed DeGroot with thyroiditis and abnormal thyroid
function among other things. (Tr. 246-47.)
DeGroot underwent a thyroid uptake scan on March 9, 2011, which revealed a low thyroid
uptake and mildly asymmetric thyroid lobes. (Tr. 285.)
DeGroot presented to Dr. Zachariah on August 29, 2011, at which time she reported
occasional fever with associated chills, chronic fatigue, heat and cold intolerance, and right hand
tremors. (Tr. 958.) Dr. Zachariah concluded that DeGroot likely suffered from a condition other
than thyroiditis, potentially secondary hypothyroidism. (Tr. 958-59.) He noted that a thyroid
nodule was palpated on physical exam, and that an ultrasound would be performed to confirm.
(Tr. 959.) On November 7, 2011, Dr. Zachariah performed an ultrasound of the thyroid, which
revealed a multinodular goiter.7 (Tr. 956.) On January 10, 2012, DeGroot reported dysphagia,
dysphonia, fatigue, and chronic heat intolerance. (Tr. 954.) Dr. Zachariah diagnosed DeGroot
with thyroiditis as her TFTs were normal, and multinodular goiter with compression symptoms.

5

Difficulty in swallowing. Stedman’s at 599.
Altered voice production. Stedman’s at 599.
7
An enlargement of the thyroid gland, appearing with a number of separate nodules in the gland.
See Stedman’s at 824.
6

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(Tr. 954-55.) He referred DeGroot to an ENT for evaluation and potentially a surgical
intervention. (Tr. 955.) Dr. Zachariah recommended surgery due to the size of the nodules. Id.
DeGroot presented to Judy Pedigo, FNP, on February 17, 2012, with complaints of
tremors. (Tr. 496.) Ms. Pedigo indicated that the tremors could possibly be related to DeGroot’s
thyroid. Id.
DeGroot saw D. Curtis Coonce, M.D., at SEMO Otolaryngology, on February 14, 2012,
for evaluation of her thyroid nodules. (Tr. 658-60.) DeGroot complained of dysphagia, nausea,
headaches, seizures of unknown type, and excessive fatigue. (Tr. 569.) Dr. Coonce noted
multinodular goiter upon examination. (Tr. 660.) He recommended a total thyroidectomy based
on her family history of thyroid cancer. Id. On February 20, 2012, DeGroot underwent a total
thyroidectomy performed by Dr. Coonce. (Tr. 661-62.)
DeGroot saw Dr. Zachariah on March 15, 2012, at which time she reported that her
dysphagia issue had much improved since surgery. (Tr. 952.) The pathology noted no evidence
of malignancy. Id. DeGroot reported some nausea and hand tremors, although these symptoms
improved somewhat since surgery. Id. DeGroot continued to experience headaches and fatigue.
Id. Dr. Zachariah assessed DeGroot’s thyroiditis, hypothyroidism secondary to total
thyroidectomy, abnormal TFTs, and multinodular goiter status post total thyroidectomy. (Tr.
952-53.) Dr. Zachariah prescribed Levoxyl.8 (Tr. 953.)
On May 15, 2012, DeGroot saw Ms. Pedigo with complaints of tremors. (Tr. 495.) Ms.
Pedigo indicated that she would refer DeGroot to a neurologist. Id. She stated that the tremors
“seem to be intentional tremor and I am not sure that it is still not related to her thyroid but I think
she needs someone in that specialty to investigate.” Id.

8

Levoxyl is indicated as replacement or supplemental therapy in hypothyroidism. See Physician’s
Desk Reference (“PDR”), 1780 (63rd Ed. 2009).

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On May 17, 2012, DeGroot reported that her fatigue had improved, but her hand tremors
were still persistent and unchanged since surgery. (Tr. 950.) Dr. Zachariah noted bilateral hand
tremors upon examination. Id. Dr. Zachariah’s assessment was that DeGroot’s thyroiditis had
resolved following a total thyroidectomy; that she had hypothyroidism secondary to total
thyroidectomy; her thyroid function was normal; and that the tremors were not attributable to a
thyroid hormone issue. (Tr. 950-51.) Dr. Zachariah referred DeGroot to a neurologist for
investigation of her tremors. (Tr. 951.)
On May 31, 2012, DeGroot saw neurologist R.L. Stahly, D.O. for evaluation of her
tremors. (Tr. 504-06.) Dr. Stahly indicated that DeGroot’s tremors had been “mildly improved”
following her thyroidectomy, although she still experienced trouble with handwriting as well as
involuntary movements and tremors, especially at rest. (Tr. 504.) Dr. Stahly stated that the
resting component that DeGroot described may reflect underlying secondary Parkinsonian
symptoms due to Abilify.9 Id. DeGroot’s father and paternal grandfather had histories of
tremors. (Tr. 505.) Dr. Stahly diagnosed DeGroot with familial tremor disorder, possible
schizoaffective disorder10 with hallucinations, degenerative disc disease, hypothyroidism, and
fibromyalgia. (Tr. 504.) Dr. Stahly prescribed low-dose Mysoline11 for DeGroot’s familial
tremor. Id. He noted that DeGroot appeared to be overmedicated related to her treatment of
fibromyalgia and possible schizoaffective disorder, and recommended that she talk with her
psychiatrist regarding discontinuing Abilify if possible. Id. Dr. Stahly also scheduled an MRI of

9

Abilify is indicated for the treatment of schizophrenia, manic or mixed episodes of bipolar
disorder, and major depressive disorder. PDR at 881.
10
An illness manifested by an enduring major depressive, manic, or mixed episode along with
delusions, hallucinations, disorganized speech and behavior, and negative symptoms of
schizophrenia. Stedman’s at 570.
11
Mysoline is an anticonvulsant drug indicated for the treatment of seizures. See WebMD,
http://www.webmd.com/drugs (last visited September 11, 2015).

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the brain. (Tr. 506.)
DeGroot’s psychiatrist, Talia Haiderzad, M.D., discontinued the Abilify on June 29, 2012.
(Tr. 904.)
DeGroot presented to Dr. Zachariah on July 17, 2012, at which time she reported nausea,
palpitations, fevers, chills, tremors, fatigue, and headaches. (Tr. 948.) DeGroot attributed the
fevers and chills to hepatitis C. Id. Dr. Zachariah diagnosed DeGroot with hypothyroidism
secondary to total thyroidectomy, multinodular goiter status post-surgery, and tremors. (Tr.
948-49.) He adjusted DeGroot’s dosage of thyroid medication based on her weight loss. (Tr.
949.)
DeGroot saw Dr. Zachariah on October 3, 2012, at which time she reported chills, fatigue,
and fever due to hepatitis C; nausea; hand tremors; headaches; nervousness; numbness; anxiety;
and depression. (Tr. 944.) Dr. Zachariah diagnosed DeGroot with acquired hypothyroidism,
post-surgical. Id. He continued DeGroot’s thyroid medication. (Tr. 947.)
DeGroot saw Natasha Ware, M.D., at Ferguson Medical Group, on December 5, 2012, for
a court-ordered medical evaluation. (Tr. 937-42.) DeGroot had been involved in a motor
vehicle accident. (Tr. 937.) DeGroot complained of weakness, difficulty sleeping, joint and
back pain, difficulty concentrating, tremors, anxiety, and depression. (Tr. 938-39.) Upon
examination, Dr. Ware noted pronounced resting tremor in the bilateral fingers, hands, and wrists.
(Tr. 939.) Dr. Ware diagnosed DeGroot with, among other things, resting tremor. (Tr. 940.)
She indicated that this condition required further evaluation, as it has a “marked impact on quality
of life.” Id. DeGroot returned on January 29, 2013, at which time she continued to complain of
tremors. (Tr. 922.) DeGroot reported that Dr. Stahly told her the tremors were “nothing.” Id.
Dr. Ware noted bilateral tremors in DeGroot’s hands and fingers, and also diffuse muscle

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movement in her forearms. Id. Dr. Ware diagnosed DeGroot with resting tremor, and referred
her to a neurologist for further evaluation. (Tr. 924-25.)
The medical evidence summarized above reveals that DeGroot received extensive
treatment for her thyroid condition from December 2010 through the date of the hearing.
Notably, DeGroot’s thyroid treatment involved the surgical removal of her thyroid due to a
multinodular goiter, hypothyroidism secondary to the thyroidectomy, and thyroid hormone
replacement medication, facts the ALJ omits in her opinion. DeGroot reported the following
symptoms as a result of her thyroid condition: dysphagia, dysphonia, fatigue, fever, chills, nausea,
headaches, heat and cold intolerance, and tremors. Some of DeGroot’s thyroid symptoms, such
as the compression symptoms of dysphagia and dysphonia, resolved after the thyroidectomy.
DeGroot, however, continued to complain of headaches, fatigue, tremors, fever, and chills
following surgery. (Tr. 952, 495, 950, 504, 948, 944.) In sum, DeGroot’s thyroid impairment
resulted in extensive treatment and significant symptoms, which would likely result in more than
minimal functional limitations.

Defendant argued that the ALJ considered all of DeGroot’s credible symptoms in assessing

her RFC. Where an ALJ errs by failing to find an impairment to be severe, such error is
harmless if the ALJ finds the claimant to suffer from another severe impairment, continues in the
evaluation process, and considers the effects of the impairment at the other steps of the process.
See Coleman v. Astrue, No. 4:11CV2131 CDP, 2013 WL 665084, at *10 (E.D. Mo. Feb. 23,
2013).
At Step 2 of the sequential analysis here, the ALJ found DeGroot to have a number of
severe impairments, including fibromyalgia, degenerative disc disease of the cervical spine,
bilateral carpal tunnel syndrome, hepatitis C, stage II liver disease, social anxiety, and

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depression.
The ALJ proceeded to Step 3 of the sequential analysis and found DeGroot’s
impairments not to meet or equal the criteria of one of the listed impairments.

In determining

DeGroot’s RFC, the ALJ considered her chronic neck, back, and diffuse body pain related to her
spinal impairment and fibromyalgia; and hand pain related to her bilateral carpal tunnel
syndrome.

(Tr. 18.) The ALJ indicated that DeGroot required an avoidance of concentrated

chemicals due to her hepatitis C. Id.

With regard to her mental impairments, the ALJ limited

DeGroot to simple, routine, repetitive tasks and incidental contact with the public due to her
social anxiety and difficulty concentrating. Id.

The Defendant contends that some of the effects of DeGroot’s thyroid condition were
adequately addressed by limitations the ALJ imposed due to other impairments.

For example,

Defendant notes that DeGroot’s concentration difficulties were addressed by the ALJ’s limitation
to only simple, routine, repetitive work.

The Defendant further suggested that the ALJ’s

consideration of DeGroot’s carpal tunnel syndrome, which resulted in the ALJ finding DeGroot
could perform frequent bilateral gross and fine manipulation addressed any limitation DeGroot
may have due to her tremors.

The undersigned disagrees.

The ALJ did not specifically consider the effects of DeGroot’s thyroid impairment, as a
non-severe impairment, when determining DeGroot’s RFC.

The limitations the ALJ imposed

resulting from DeGroot’s other severe impairments do not render the ALJ’s error harmless
because they do not adequately address the symptoms from her thyroid condition.
The ALJ limited DeGroot to frequent bilateral gross and fine manipulation due to her
carpal tunnel syndrome.
two-thirds of the time…”

In vocational terms, “frequent” means “occurring from one-third to
SSR 83-10, 1983 WL 31251, * 6 (1983).

DeGroot has consistently

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complained about hand tremors since August 2011, when she reported them to her
endocrinologist, Dr. Zachariah. (Tr. 958.)

She has received treatment for her tremors from

Ms. Pedigo, a nurse practitioner, who indicated that the tremors could be related to DeGroot’s
thyroid impairment. (Tr. 496.) DeGroot has seen a neurologist, Dr. Stahly, for her hand
tremors, after they did not resolve following her thyroid removal surgery. Dr. Stahly indicated
that DeGroot’s tremors cause difficulty with handwriting as well as involuntary movements.
(Tr. 504.) On December 5, 2012, Dr. Ware noted “pronounced” tremor in DeGroot’s bilateral
fingers, hands, and wrists.

(Tr. 939.)

Dr. Ware indicated that the condition required further

evaluation as it has a “marked impact on quality of life.”

Id. On January 29, 2013, DeGroot’s

last treatment note, Dr. Ware noted bilateral tremors in DeGroot’s hands and fingers, and diffuse
muscle movement in her forearms.

(Tr. 922.) Dr. Ware referred DeGroot to a neurologist for

further evaluation.
Although the origin of DeGroot’s tremors is not entirely clear from the record, DeGroot
has consistently complained of hand tremors from February 2011 through the date of the hearing.
DeGroot also testified at the administrative hearing that she experienced hand tremors. (Tr. 45.)
Despite this evidence of hand tremors, whether as a symptom of DeGroot’s thyroid condition or
another condition, the ALJ did not discuss this impairment in her opinion. Given the medical
evidence discussed above, it is questionable whether DeGroot could perform bilateral gross and
fine manipulation one third to two thirds of the workday or that she could perform the positions
of “hand packer” or “production worker assembler” as found by the ALJ.
Further, the ALJ did not incorporate any limitations resulting from DeGroot’s fatigue,
fever, chills, nausea, headaches, and heat and cold intolerance. It is true that some of these
symptoms could be attributable to DeGroot’s other impairments. For example, on July 17, 2012,

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Dr. Zachariah indicated that DeGroot attributed her fever and chills to her hepatitis C. (Tr. 948.)
Regardless, the ALJ did not discuss any of these symptoms in her opinion, and they would be
expected to result in work-related limitations. Where an ALJ errs in her failure to consider one of
a claimant’s impairments, the resulting RFC assessment is called into question inasmuch as it does
not include all of the claimant’s limitations. See Holmstrom v. Massanari, 270 F.3d 715, 722 (8th
Cir. 2001).
In sum, the ALJ did not adequately consider DeGroot’s thyroid condition, either at step
two or later in the sequential analysis. The ALJ did not discuss the fact that DeGroot underwent
extensive treatment for her thyroid condition including surgery and reported significant symptoms
resulting from the condition. DeGroot’s tremors were not considered either, whether as a
symptom of DeGroot’s thyroid condition or an independent impairment, despite extensive
evidence of treatment for such. The ALJ’s error was not harmless because she did not consider
the effects of DeGroot’s thyroid condition together with all impairments both severe and
non-severe in determining her RFC. Thus, the case must be remanded so that the ALJ may
conduct a thorough evaluation of the severity of DeGroot’s thyroid condition at step two of the
sequential analysis. Regardless of whether the ALJ finds DeGroot’s thyroid condition to be
severe on remand, the ALJ should include the effects of this impairment, including DeGroot’s
tremors, when determining DeGroot’s RFC.
IV.B. Credibility Analysis
DeGroot also argues that the ALJ erred in finding her testimony not fully credible without
applying the proper credibility factors. Specifically, DeGroot contends that, under Polaski v.
Heckler, 739 F.2d 1320 (8th Cir. 1984), the ALJ was required to consider DeGroot’s work history
and the type, dosage, and side effects of her medications.

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In evaluating a claimant’s credibility, the ALJ must consider all evidence relating thereto,
including the claimant’s prior work record and third party observations as to the claimant's daily
activities; the duration, frequency and intensity of the symptoms; any precipitating and
aggravating factors; the dosage, effectiveness and side effects of medication; and any functional
restrictions. Halverson v. Astrue, 600 F.3d 922, 931 (8th Cir. 2010); Polaski, 739 F.2d at 1322.
While an ALJ need not explicitly discuss each Polaski factor, he nevertheless must acknowledge
and consider these factors before discounting a claimant’s subjective complaints. Wildman v.
Astrue, 596 F.3d 959, 968 (8th Cir. 2010). If the ALJ’s credibility determination is supported by
good reasons and substantial evidence, the Court must defer to this determination. Renstrom v.
Astrue, 680 F.3d 1057, 1064 (8th Cir. 2012).
In this case, the ALJ did not discuss DeGroot’s work history or the dosage or side effects of
her many medications. The record reveals DeGroot has a lengthy work record with substantial
earnings. (Tr. 140-53.) The ALJ did not include any discussion in her opinion of DeGroot’s
work record. In addition, DeGroot has been prescribed numerous pain medications during the
relevant period, and has regularly visited a pain management clinic for treatment of her numerous
physical impairments. (Tr. 363-437.) DeGroot has also taken psychotropic medications for her
mental impairments. (Tr. 891-919.) The ALJ also omitted any discussion of DeGroot’s many
prescription medications, which, like DeGroot’s work record, enhances her credibility.
The ALJ instead relied on the objective medical evidence and DeGroot’s “wide range of
reported activities” to discredit the credibility of DeGroot’s subjective complaints. (Tr. 18.) The
ALJ noted that the medical record revealed DeGroot’s symptoms resolved after neck and carpal
tunnel surgeries, and that DeGroot consistently reported stable mental health symptoms. Id.
The ALJ cited some support in the medical record for these findings. (Tr. 17-18.) The ALJ

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noted that DeGroot testified that she performed the following activities: going grocery shopping,
driving a car, performing household cleaning, preparing meals, doing laundry and dishes,
watching television, reading magazines, socializing with her family, and taking care of her dogs.
(Tr. 17.) DeGroot testified that she leaves her home once every two to three weeks to get
groceries (Tr. 36, 179); when she shops for groceries she has problems being around people,
cannot breathe, and does not make eye contact (Tr. 36); she microwaves meals (Tr. 47); she takes
breaks while washing dishes (Tr. 47-48); her friends come over to help her clean occasionally (Tr.
47); a friend mows her yard (Tr. 48); her mother comes to her home to visit her (50); and she has
two dogs that she feeds but does not take on walks (Tr. 50)—she indicated that she is no longer
able to train, exercise, and groom her dogs as she had in the past (Tr. 177). The factors cited by
the ALJ are not “good reasons” for discrediting DeGroot’s subjective complaints of pain and
limitations. The ALJ failed to discuss the relevant factors of DeGroot’s work history and
medications, and her summary of the objective medical evidence was incomplete, as it did not
adequately consider DeGroot’s thyroid condition.
As a result of the foregoing, this matter will be reversed and remanded to the
Commissioner so the ALJ may properly evaluate DeGroot’s thyroid condition. Upon remand, the
ALJ will perform a new credibility analysis according to the requirements of Polaski. In doing
so, the ALJ should consider all of the Polaski factors, including DeGroot’s work history and the
dosage, effectiveness and side effects of her numerous prescription medications.
V. Conclusion
For the reasons discussed above, the Commissioner’s decision is not based upon
substantial evidence on the record as a whole and the cause is therefore remanded to the
Commissioner for further consideration in accordance with this Memorandum and Order. Upon

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remand, the ALJ shall properly consider DeGroot’s thyroid disorder, including DeGroot’s
tremors, at step two; re-evaluate the credibility of DeGroot’s subjective complaints under the
requirements of Polaski, including consideration of DeGroot’s work history and prescription
medications; and, reassess DeGroot’s RFC. If necessary, the ALJ shall obtain additional medical
evidence addressing DeGroot’s ability to work.
Therefore, for the reasons stated above,
IT IS HEREBY ORDERED that the decision of the Commissioner is REVERSED, and
this cause is REMANDED for further proceedings.
A separate Judgment in accordance with this Memorandum and Order is entered this same
date.

ABBIE CRITES-LEONI
UNITED STATES MAGISTRATE JUDGE
Dated this 28th day of September, 2015.

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