Jackson v. Commissioner of Social Security

Filing 22

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the decision of the Commissioner is REVERSED, and this cause is REMANDED to the Commissioner for further proceedings. A separate Judgment in accordance with this Memorandum and Order is entered this same date. Signed by Magistrate Judge Nannette A. Baker on 01/13/2015. cc:Commissioner(CLK)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
NORTHERN DIVISION

LINDA K. JACKSON,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.

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No. 2:14-CV-22 NAB

MEMORANDUM AND ORDER
Plaintiff Linda K. Jackson brings this action under 42 U.S.C. § 405(g) for
judicial review of the Commissioner’s final decision denying her application for
disability insurance benefits (DIB) under Title II of the Social Security Act, 42
U.S.C. §§ 401, et seq. All matters are pending before the undersigned United
States Magistrate Judge, with consent of the parties, pursuant to 28 U.S.C. §
636(c). Because the Commissioner’s final decision is not supported by substantial
evidence on the record as a whole, it is reversed.
I. Procedural History
On January 13, 2011, the Social Security Administration denied plaintiff’s
September 22, 2010, application for DIB in which she claimed she became
disabled on August 23, 2010, because of irritable bowel syndrome (IBS), urinary

incontinence, headaches, hypertension, irregular heartbeat, depression, anxiety,
asthma, and gastroesophageal reflux disease (GERD). (Tr. 78, 89-95, 138-44,
182.) At plaintiff’s request, a hearing was held before an administrative law judge
(ALJ) on October 16, 2012, at which plaintiff and a vocational expert testified.
(Tr. 29-63.) On December 10, 2012, the ALJ issued a decision denying plaintiff’s
claim for benefits finding that plaintiff could perform other work as it exists in
significant numbers in the national economy. (Tr. 8-23.)1 On January 17, 2014,
after reviewing additional evidence, the Appeals Council denied plaintiff’s request
for review of the ALJ's decision. (Tr. 1-6.) The ALJ's determination thus stands as
the final decision of the Commissioner. 42 U.S.C. § 405(g).
In the instant action for judicial review, plaintiff claims that the ALJ’s
decision is not supported by substantial evidence on the record as a whole.
Plaintiff specifically argues that her mental impairment meets the criteria of Listing
12.07A(3) – Somatoform Disorders, and that the ALJ erred in failing to consider
this condition as a severe impairment. Plaintiff also contends that the ALJ erred in
finding her subjective complaints not to be credible. Finally, plaintiff argues that
the ALJ failed to consider the vocational expert’s testimony to the extent it
1

In his decision, the ALJ also refers to an application for supplemental security income (SSI)
that was purportedly filed by plaintiff in March 2011. (See Tr. 11.) The administrative transcript
does not contain such an application or any initial ruling(s) by the Social Security Administration
on an SSI application. In their pleadings, the parties refer only to plaintiff’s application for DIB.
In view of the record and the nature of the parties’ pleadings, the Court considers plaintiff’s
application for DIB to be the only application before it on judicial review.
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supported a finding that plaintiff’s limitations would prevent her from performing
any work. Plaintiff requests that the final decision be reversed and that she be
awarded benefits or that the matter be remanded for further consideration. For the
reasons that follow, the matter will be remanded for further proceedings.
II. Testimonial Evidence Before the ALJ
1.

Plaintiff’s Testimony
At the hearing on February 29, 2012, plaintiff testified in response to

questions posed by the ALJ and counsel.
At the time of the hearing, plaintiff was fifty-three years old. Plaintiff was
five feet, seven inches tall and weighed between 235 and 245 pounds. Plaintiff
was not married and had no children. She lived with her brother and received
financial help from her relatives. She attended college for one year. (Tr. 34-36.)
Plaintiff’s Work History Report shows that plaintiff worked as a
housekeeper in a hospital from January 1990 to May 1992. From October 1994 to
July 2002, plaintiff worked as a staple machine operator in manufacturing.
Plaintiff was a seasonal worker in retail from November 2002 to January 2003.
From June 2004 to December 2008, plaintiff worked as a machine operator in auto
parts manufacturing. (Tr. 269-74.) Plaintiff was laid off from this job because the
company was downsizing. Plaintiff thereafter applied for unemployment benefits.
(Tr. 38, 56.) After obtaining work in a warehouse, plaintiff was fired in August
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2009 because the work was fast-paced and she made too many mistakes. Plaintiff
had this job for less than a month. (Tr. 36-38, 54.) Plaintiff then collected
unemployment benefits, which ended in 2010 before she filed for disability. (Tr.
38, 57.)
Plaintiff testified that she applied for disability benefits because of
worsening intestinal problems, heart problems, and lack of stamina. Plaintiff
testified that she also had pain and swelling in her legs, knees, and ankles, which
cause difficulty with standing. (Tr. 39-40.) She also experienced swelling in her
hands and arms. (Tr. 42.)
Plaintiff testified that her intestinal problems require her to be near a
bathroom and that she worries about this circumstance whenever she plans to do
anything. Plaintiff testified that the urgency causes her to stop whatever she is
doing and seek the bathroom. Plaintiff testified that she experiences this
circumstance up to a dozen times a day, and no less than five times. Plaintiff
testified that she needs to be within twenty-five feet of a bathroom. (Tr. 46-47.)
Plaintiff testified that she experiences swelling in her legs after she stands
for an hour or two. The problem is especially significant in the right foot. Plaintiff
takes medication and elevates her legs for two to three hours a day for the
condition. Plaintiff also testified that her poor stamina limits her ability to engage
in any activity, and that she must sit after about thirty minutes of activity and
-4-

elevate her foot. (Tr. 40-42.)
Plaintiff testified that she also has problems with her right arm in that
repetitive use causes it to give out and the fingers and thumb of her right hand to
become “stuck” in position, thus causing her to be unable to grip things. (Tr. 49.)
Plaintiff also testified that she experiences headaches that are triggered by
fluorescent lights, headlights from oncoming cars, and neck strain when she moves
her head from side to side. (Tr. 50.) Plaintiff testified that her left eye is
somewhat immobile, which impedes her peripheral vision. Plaintiff testified that
wearing bifocal glasses helps when she drives. (Tr. 57.)
Plaintiff testified that she has worsening problems with memory,
concentration, and decision-making. Plaintiff testified that she panics when she
cannot find things such as her keys or pocketbook. Plaintiff testified that she gets
lost coming out of stores and panics when she cannot find her car. She avoids
going to stores when they are crowded. (Tr. 43-44.) Plaintiff testified that she puts
things off until the last minute because she feels she is “shoving the panic away”
by doing so. Plaintiff testified that she has difficulty dealing with people –
especially her relatives – because they do not understand her issues. (Tr. 51.)
Plaintiff testified that she experiences depression because of her physical
and financial condition. Plaintiff testified that she is not as happy as she used to be
and no longer has empathy. Plaintiff testified that she does not feel good about her
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sister supporting her financially, knowing that the circumstance is putting a
financial and emotional strain on her sister. (Tr. 44-46.)
B.

Testimony of Vocational Expert
Mary Harris, a vocational expert, testified at the hearing in response to

questions posed by the ALJ and counsel.
Ms. Harris classified plaintiff’s past work as a machine operator and as a
stapler as unskilled and medium. (Tr. 60.)
The ALJ asked Ms. Harris to consider an individual of plaintiff’s age,
education, and work experience who could perform the full range of light
exertional work except that she could not perform occupations that required
peripheral acuity and was limited to simple, routine, and repetitive tasks with no
production rate or pace work – meaning “no strict or fast paced production
requirements although competitive requirements would still exist.” The ALJ asked
Ms. Harris to further assume that the individual was limited to superficial
interaction with the public and coworkers. (Tr. 60-61.) Ms. Harris testified that
such a person could not perform plaintiff’s past work but could perform other work
in the economy such as light cleaner, of which 19,000 such jobs exist in the State
of Missouri and 865,000 nationally; office helper, of which 6,500 such jobs exist in
the State of Missouri and 200,000 nationally; and press tender, of which 6,800
such jobs exist in the State of Missouri and 342,000 nationally. (Tr. 61.)
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The ALJ then asked Ms. Harris to assume that the same individual would be
off task greater than ten percent during the work period or would have more than
two unscheduled or unexcused absences each month. Ms. Harris testified that such
a person could not perform any job in the national economy. (Tr. 62.)
Counsel asked Ms. Harris to assume that the person would make greater than
four errors performing simple, repetitive, and routine work. Ms. Harris testified
that such a person could not perform any production-type work. (Tr. 62.)
III. Medical Records Before the ALJ
Plaintiff visited the Hannibal Free Clinic on April 14, 2010, with reported
concerns regarding her general health as well as concerns about her heart, asthma,
and headaches. Plaintiff reported having health and financial stressors. Plaintiff
reported her medical history to include heart palpitations/arrhythmias, edema,
silent myocardial infarction, hypertension, and irritable bowel syndrome (IBS).
Review of systems showed plaintiff to have the following complaints: fatigue,
weakness, and weight gain since being laid off; a “lazy” left eye; dyspnea and
occasional cough; chest pain that radiates to her right shoulder, palpitations mostly
at night, dyspnea on exertion, heartburn, and edema; symptoms associated with
IBS, including diarrhea and constipation, as well as genitourinary symptoms;
arthritis in the right knee; dizziness with changes in position; and visual headaches
that radiate to the right shoulder. No notes of examination were made. (Tr. 455-7-

58.) Laboratory testing yielded results remarkable for cholesterol levels but
otherwise were normal. (Tr. 461-65.) On April 20, plaintiff was treated at the
Hannibal Clinic for chronic sinusitis, hypertension, and pharyngitis. (Tr. 454.)
On May 18, 2010, plaintiff received treatment at the Hannibal Clinic for
temporomandibular joint dysfunction (TMJ), sleep apnea, hypertension, pleurisy,
pharyngitis due to rhinitis, episodic tachycardia, and resolving eczema. Plaintiff
was referred to a dentist for her TMJ condition. Plaintiff’s medications at that time
included Bystolic, Lisinopril,2 Loratadine,3 Aquaphor, and Tylenol. (Tr. 449-50.)
Plaintiff returned to the Hannibal Clinic on June 15, 2010, with complaints
of ringing in her ears and headaches originating in her eyes. Plaintiff reported her
pain to be at a level five on a scale of one to ten. Plaintiff was diagnosed with
sinus headache and left lateral rectus (LR) palsy. Plaintiff was instructed to
continue with Loratadine and to take Nasonex. (Tr. 448.)
Plaintiff visited the eye clinic at University Hospital & Clinics on July 30,
2010, after being told that she had “nerve palsy” that affected her eyes. Plaintiff
reported changes to her eye alignment and that she had a blind spot. Plaintiff also
2

Bystolic and Lisinopril are used to treat high blood pressure. Medline Plus (last revised Aug. 1,
2009)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a608029.html (Bystolic); Medline
Plus (last revised Sept. 15, 2012)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/
a692051.html> (Lisinopril).
3

Loratadine is used to relieve the symptoms of hay fever. Medline Plus (last revised Oct. 1,
2010)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a697038.html>.
-8-

reported experiencing pain. It was noted that plaintiff failed the peripheral vision
test for her driver’s license. Plaintiff reported having problems with her peripheral
vision for years. Upon examination, plaintiff was diagnosed with alternating
exotropia, and plaintiff’s eyeglass prescription was adjusted. (Tr. 426-29.)
Plaintiff returned to the eye clinic on August 26, 2010, and underwent
recession of the left lateral rectus and resection of the left medial rectus.
Plaintiff tolerated the procedure well. (Tr. 436-43.) During follow up examination
on September 8, plaintiff reported continued soreness and some pain and strain
when looking to the side. Examination showed that plaintiff’s condition had
improved. (Tr. 430-31.)
Plaintiff returned to the Hannibal Clinic on September 14, 2010, and
reported her IBS to be worsening and that bladder leakage was likewise worsening.
Plaintiff also reported continued headaches. Plaintiff’s diagnoses included GERD,
anxiety with possible obsessive compulsive disorder (OCD), fibromyalgia, and
stress incontinence. Plaintiff was noted to be “very somatic!!” Oxybutynin4 was
added to plaintiff’s medication regimen. (Tr. 445-46.)
On October 12, 2010, plaintiff complained to the Hannibal Clinic that she
had ear pain, chest pain, and pain in her right arm. Tenderness was noted about the
4

Oxybutynin is used to treat overactive bladder. Medline Plus (last revised May 15, 2014)
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682141.html>.

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left acromioclavicular (AC) joint. Plaintiff also reported that Detrol5 did not help.
Plaintiff was noted to be very somatic. Plaintiff denied any delusions or
hallucinations, and her cognition was noted to be intact. Plaintiff was diagnosed
with anxiety, severe allergies, mixed incontinence, hypokalemia, GERD, and
hypertension. Plaintiff was instructed to increase her dosage of Detrol and to
continue with her other medications. Plaintiff was also prescribed Medrol dosepack.6 (Tr. 471.) During follow up examination on October 26, plaintiff was
continued in her previous diagnoses and was also diagnosed with chronic otalgia/
possible trigeminal neuralgia, headache, anxiety/depression, and panic disorder.
Plaintiff was continued on her medications and Neurontin7 was added to her
medication regimen. (Tr. 469.)
Plaintiff visited the Hannibal Clinic on November 10, 2010, and reported
that she was sleeping better but continued to have pain in her head. Plaintiff was
diagnosed with ankle swelling and neuropathy. Plaintiff was instructed to wear an
ace bandage daily and to continue to take Neurontin. It was questioned whether
plaintiff had sleep apnea. (Tr. 467.)
5

Detrol is used to treat overactive bladder. Medline Plus (last revised Feb. 15, 2014)<http://
www.nlm.nih.gov/medlineplus/druginfo/meds/a699026.html>.
6

Medrol is a corticosteroid used to relieve inflammation. Medline Plus (last reviewed Sept. 1,
2010)<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682795.html>.

7

Neurontin is used to treat postherpetic neuralgia. Medline Plus (last revised July 15, 2011)
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a694007.html>.
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On December 31, 2010, plaintiff underwent a consultative psychological
consultation for disability determinations. (Tr. 507-12.) Licensed psychologist
Patrick Finder observed plaintiff to initially be somewhat hesitant and angry and
not to respond to “small talk.” Plaintiff began to talk once the evaluation began
but exhibited significant pressure in her speech and was extremely tangential. Dr.
Finder observed plaintiff not to respond to questions and not to divert from what
she wanted to talk about, which was her physiological symptoms. Dr. Finder
observed plaintiff’s affect to be “plastic” and that she avoided eye contact.
Plaintiff was tearful a few times during the session and began to cry when she
spoke of a younger sister who had died from a form of heart disease about four
years prior. Plaintiff also reported that both her father and mother died from heart
disease, and that her mother was fifty-two years old when she died. Plaintiff
reported her own health history to include trauma to her right knee and a torn
Achilles tendon when she was teenager, with continued pain in her knee. Plaintiff
reported that her doctor advised that the knee is “bone on bone,” and plaintiff
stated that she could not put any pressure on the knee or stand for very long
without pain. Plaintiff also reported having calcification on her ligaments and that
she has been on a lifting restriction for the last two or three years. Plaintiff
reported her health conditions to also include damage to her esophagus because of
GERD, polyps on the colon that were removed, IBS, high blood pressure, arthritis,
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lung infection, asthma, chronic heat exhaustion, severe headaches, and heart issues
for which she needs a catheterization. Plaintiff reported that her doctors have
advised that there is nothing that can be done for her many physical issues, which
causes her to feel hopeless and helpless. It was noted that plaintiff took a
significant amount of Tylenol on a daily basis despite being advised not to because
of potential adverse effects. Dr. Finder noted plaintiff’s current medications to
also include Neurontin, Lisinopril, and Bystolic. As to her daily activities, plaintiff
reported that she gets up between 7:00 and 10:00 a.m., does a few little things
around the house, and mostly just sits and stares into space. Plaintiff reported that
she lives with a male friend; that “her son” does the heavy cleaning, such as
vacuuming, mopping, and laundry; and that she has no hobbies. (Tr. 507-10.)
Mental status examination showed plaintiff to be oriented times three and to
have no difficulty with simple math problems, comprehension, or abstract thinking.
Dr. Finder considered plaintiff to be of average intelligence. Plaintiff was noted to
be somewhat disheveled. Her affect was extremely flat and she had a plastic look
on her face throughout the evaluation. Plaintiff had a fixed stare and looked across
the room without ever making eye contact with Dr. Finder. Dr. Finder noted there
to be a significant amount of pressure in plaintiff’s speech and that it was almost
impossible to keep plaintiff focused or on target. Plaintiff often talked over Dr.
Finder and did not listen to questions, ignored the questions, or refused to answer
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them. Dr. Finder’s attempts to redirect plaintiff were ineffective. Plaintiff denied
feelings of depression, but Dr. Finder noted plaintiff to exhibit some signs of
depression such as flat affect, avoided eye contact, soft and low voice, difficulty
with sleep, difficulty with appetite, loss of focus, and difficulty with concentration.
Plaintiff denied any anxiety or symptoms of OCD and reported that she had no
difficulty in public or any type of social phobia. Dr. Finder noted plaintiff’s
conversations to be fixated on her physical problems and opined that plaintiff was
displacing her emotional issues onto her physical problems. (Tr. 510-11.)
Upon completion of the evaluation, Dr. Finder diagnosed plaintiff with
hypochondriasis, concluding that plaintiff met the criteria for condition, and
namely, being preoccupied with fears of serious disease that persist despite
appropriate medical evaluation and reassurance, and significant distress caused by
such preoccupation. Somatization disorder was to be ruled out. Dr. Finder
assigned a Global Assessment of Functioning (GAF) score of 50.8 Dr. Finder
observed that despite it appearing that plaintiff’s numerous physical symptoms
may be psychological in nature, they nevertheless had a serious impact on her
ability to function. (Tr. 511-12.) Dr. Finder concluded:
At this point in time, given her presentation in the interview, it is
8

A GAF score considers “psychological, social, and occupational functioning on a hypothetical
continuum of mental health/illness.” Diagnostic & Statistical Manual of Mental Disorders 34
(4th ed. Text Revision 2000). A GAF score between 41 and 50 indicates serious symptoms (e.g.,
suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in
social, occupational, or school functioning (e.g., no friends, unable to keep a job).
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doubtful that she would be employable. At the same time, she is not
involved in any type of mental health treatment and not taking any
type of psychotropic medication. She refuses to acknowledge any
psychological issues and blames everything on her physical problems.
It is not known whether she would be open to any type of mental
health treatment or psychological intervention. If she would consent
to mental health treatment, it is felt there is a good possibility that her
conditions might improve significantly.
(Tr. 512.)
On January 13, 2011, Stanley Hutson, Ph.D., a psychological consultant
with disability determinations, completed a Psychiatric Review Technique Form in
which he opined that plaintiff’s mental impairment was not severe in that her
depression and anxiety/panic disorder caused only mild restriction in activities of
daily living; mild difficulties in maintaining social functioning and in maintaining
concentration, persistence, or pace; and resulted in no repeated episodes of
decompensation of extended duration. (Tr. 474-84.)
Plaintiff returned to the Hannibal Clinic on March 16, 2011, and complained
of ear pain, difficulty breathing, and cough. Plaintiff was diagnosed with TMJ,
otitis externa, trigeminal neuralgia, and vasomotor instability. Plaintiff was
instructed to increase her Neurontin. (Tr. 495-96.)
Plaintiff visited Dr. Scott Simmons on September 29, 2011, for a refill of
blood pressure medication. Plaintiff also complained of headaches. Dr. Simmons
noted plaintiff’s current medications to include Neurontin, Bystolic, and Lisinopril/
HCTZ. Upon examination, Dr. Simmons diagnosed plaintiff with moderate
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maxillary sinusitis, edema, rosacea/acne, and left eye pain. Plaintiff was instructed
to start Nasonex and was referred to an eye clinic. (Tr. 486.)
Plaintiff returned to Dr. Simmons on October 13, 2011, and complained of
sinus congestion, ear pain, and headache. Plaintiff reported the headache to have
begun four days prior. Physical examination showed tenderness about the scalp
with palpation but no sinus tenderness. Examination of the ears was normal as was
examination of the chest and lungs. Plaintiff was prescribed an antibiotic and
prednisone. Dr. Simmons also noted plaintiff to have mild carpal tunnel syndrome
of the right wrist, but plaintiff declined a wrist splint. (Tr. 487-89.)
Plaintiff underwent an additional psychological consultation with Dr. Finder
in January 2012 for disability determinations. (Tr. 513-18.)9 Dr. Finder observed
plaintiff to be morbidly obese and to have some difficulty in rising, walking, and
sitting. Plaintiff responded appropriately and talked freely throughout the
evaluation. Plaintiff continued to talk at the conclusion of the evaluation, and Dr.
Finder found it difficult to escort her from the office because of her continued
talking. Dr. Finder noted it to be difficult to get plaintiff to talk about anything
other than her physical health complaints. Dr. Finder noted plaintiff’s
9

Although Dr. Finder’s report of this consultation is dated January 19, 2011, plaintiff avers that
the consultation actually occurred on January 19, 2012. In this report, Dr. Finder noted plaintiff
to be one year and one month older from the time of his previous consult, and he referred to his
previous consult as occurring about one year prior. That consultation occurred in December
2010. The undersigned considers the instant consultation to have occurred in January 2012,
therefore, and not in January 2011.
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conversations to be pressured and tangential. Plaintiff’s affect was flat, but she
maintained good eye contact. Plaintiff became tearful at times during the
evaluation. She reported on her health conditions, including continued pain in her
right knee, and reported that her doctors were unwilling to perform a knee
replacement because she was too young. Plaintiff reported additional health
conditions since her last evaluation, and specifically, gall bladder removal, pain in
her neck and jaw, hearing loss, difficulty with balance and coordination due to her
right leg being shorter than her left, and lactose intolerance. Plaintiff continued to
report that her physicians have told her that they can do nothing for her illnesses,
which causes her to feel hopeless about ever getting better or being able to work
again. Plaintiff reported that she does not like to take prescription pain medication
but takes ibuprofen throughout the day. Plaintiff also reported that she was
prescribed antidepressants about one year prior but stopped taking them because of
side effects. Dr. Finder noted plaintiff’s current medications to be Neurontin,
Detrol, and Lisinopril. As to her daily activities, plaintiff reported that she lives
with her brother and does little throughout the day. Plaintiff reported that she
cannot do things that involve her back because of severe pain she experiences due
to vertebrae in her back that rub together. Plaintiff reported that she enjoys
television but cannot watch for very long because it bothers her eyes. Plaintiff
reported that she no longer likes to leave the house because she feels people are
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looking at or talking about her. (Tr. 513-16.)
Mental status examination was essentially unchanged from the previous
evaluation, with the exceptions that plaintiff was relatively neat in appearance and
dress, and she maintained good eye contact. Dr. Finder noted plaintiff to continue
to exhibit signs of depression, including flat affect, tearfulness, difficulty with
sleep and appetite, difficulty with concentration and focus, and irritability.
Plaintiff denied most symptoms of anxiety and reported having no difficulty in
social situations or dealing with crowds. Dr. Finder diagnosed plaintiff with
hypochondriasis and dysthymic disorder. Somatization disorder was to be ruled
out. Dr. Finder continued in his GAF score of 50. (Tr. 516-17.) Dr. Finder noted
that plaintiff continued to be preoccupied with fears of various illnesses and that
such preoccupation was causing significant distress for her, noting that “[w]hatever
the source of her health fears, they are having a serious impact on her ability to
function.” (Tr. 518.) Dr. Finder concluded:
As last year, it needs to be pointed out that she is not involved in any
type of mental health treatment and not on any type of medication for
depression or anxiety. She more or less refuses to acknowledge her
symptoms of depression and blames all of her problems on her
physical health conditions. She did report to trying one antidepressant
but believed it was causing side-effects and stop[ped] the medication.
She was not involved in any type of counseling. The medication may
or may not have caused side effects. Her perception of the side effects
could well be part of the hypochrondriacal [sic] process.
Given her presentation, however, it is not expected that she would be
employable.
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(Id.)
Plaintiff visited Dr. Simmons on March 13, 2012, and complained of cough
and congestion and a recent onset of ear pain. Dr. Simmons noted plaintiff’s
medications to include Bystolic, Levaquin (an antibiotic), Lisinopril/HCTZ,
Nasonex, and Neurontin. Physical examination was normal in all respects. Dr.
Simmons diagnosed plaintiff with bronchitis and otitis media. Plaintiff was
instructed to call if her symptoms persisted or worsened. (Tr. 490-91.)
On August 31, 2012, plaintiff visited Dr. Simmons seeking treatment for a
recent insect bite. Physical examination was normal. No rashes, lesions, or
discoloration were noted. Plaintiff was instructed to call if her symptoms persisted
or worsened. (Tr. 492-93.)
On September 21, 2012, Dr. Finder completed a Mental Medical Source
Statement of Ability to Do Work-Related Activities (Mental MMS) in which he
opined that plaintiff’s impairment affected her ability to understand, remember,
and carry out instructions. Dr. Finder specifically opined that plaintiff was mildly
limited in her ability to understand and remember simple instructions and
moderately limited in her ability to carry out simple instructions; to understand,
remember, and carry out complex instructions; and to make judgments on simple
and/or complex work-related decisions. Dr. Finder also opined that plaintiff’s
impairment affected her ability to interact, specifically opining that plaintiff was
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moderately limited in her ability to interact appropriately with the public, with
supervisors, and with coworkers; and to respond appropriately to usual work
situations and changes in a routine work setting. Dr. Finder explained that plaintiff
was “extremely preoccupied with physical health issues[,which ] negatively
impacts her ability to focus on things outside of herself.” Dr. Finder further
explained that he believed many of plaintiff’s physical complaints were
psychosomatic in nature and that such physical complaints limited her ability to
engage in many aspects of daily life. Dr. Finder reported that plaintiff’s biopsychosocial history and mental status examination supported his conclusion.
Finally, Dr. Finder agreed that plaintiff’s disability onset date was August 23,
2010. (Tr. 503-05.)
IV. Additional Evidence Considered by the Appeals Council10
Plaintiff visited Dr. Simmons on September 26, 2012, with complaints
relating to chest and sinus congestion. Physical examination was normal in all
respects. Plaintiff was diagnosed with acute sinusitis and was instructed to call if
symptoms worsened or persisted. (Tr. 524-26.)
V. The ALJ's Decision
10

In determining plaintiff's request to review the ALJ’s decision, the Appeals Council
considered additional evidence that was not before the ALJ at the time of his decision. The
Court must consider this evidence in determining whether the ALJ’s decision is supported by
substantial evidence. Frankl v. Shalala, 47 F.3d 935, 939 (8th Cir. 1995); Richmond v. Shalala,
23 F.3d 1441, 1444 (8th Cir. 1994).
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The ALJ found that plaintiff met the insured status requirements of the
Social Security Act through March 31, 2014. The ALJ found plaintiff not to have
engaged in substantial gainful activity since August 23, 2010, the alleged onset
date of disability. The ALJ found plaintiff’s severe impairments to be obesity,
status post exotropia, anxiety, stress incontinence, fibromyalgia, GERD,
depression, panic disorder, schizoaffective disorder, OCD, panic disorder with
agoraphobia, and borderline personality disorder, but that plaintiff did not have an
impairment or combination of impairments that met or medically equaled an
impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 13-14.)11
The ALJ found plaintiff to have the RFC to perform light work12 “except no
peripheral acuity; limited to simple routine repetitive tasks; no production rate or
pace work although competitive production requirements would still exist; and
superficial interaction with public coworkers [sic].” (Tr. 16.) The ALJ found
plaintiff unable to perform her past relevant work. Considering plaintiff’s age,
education, work experience, and RFC, the ALJ determined that vocational expert
testimony supported a finding that plaintiff could perform other work as it exists in
11

With respect to plaintiff’s mental impairments, the ALJ stated that he specifically considered
Listing 12.04 – Affective Disorders, Listing 12.06 – Anxiety Related Disorders, and Listing
12.08 – Personality Disorders. (See Tr. 14.)
12

“Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying
of objects weighing up to 10 pounds. . . . [A] job is in this category when it requires a good deal
of walking or standing, or when it involves sitting most of the time with some pushing and
pulling of arm or leg controls.” 20 C.F.R. § 404.1567(b).
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significant numbers in the national economy, and specifically, cleaner, office
helper, and press tender. The ALJ thus found plaintiff not to be under a disability
from August 23, 2010, through the date of the decision. (Tr. 21-23.)
VI. Discussion
To be eligible for DIB under the Social Security Act, plaintiff must prove
that she is disabled. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001);
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). An individual will be declared disabled "only if [her]
physical or mental impairment or impairments are of such severity that [she] is not
only unable to do [her] previous work but cannot, considering [her] 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).
To determine whether a claimant is disabled, the Commissioner engages in a
five-step evaluation process. See 20 C.F.R. § 404.1520; Bowen v. Yuckert, 482
U.S. 137, 140-42 (1987). At Step 1, the Commissioner considers whether the
claimant is engaged in substantial gainful activity. If so, disability benefits are
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denied. At Step 2, the Commissioner decides whether the claimant has a “severe”
medically determinable impairment or combination of impairments, meaning that
which significantly limits her ability to do basic work activities. If the claimant's
impairment(s) is not severe, then she is not disabled. If the impairment(s) is
severe, the Commissioner then determines at Step 3 whether such impairment(s) is
equivalent to one of the impairments listed in 20 C.F.R., Subpart P, Appendix 1. If
claimant's impairment(s) meets or equals one of the listed impairments, she is
conclusively disabled. At Step 4, the Commissioner establishes whether the
claimant’s impairment(s) prevents her from performing her past relevant work. If
the claimant can perform such work, she is not disabled. Finally, if the claimant is
unable to perform her past work, the Commissioner continues to Step 5 and
evaluates various factors to determine whether the claimant is capable of
performing any other work in the economy. The claimant is entitled to disability
benefits only if she is not able to perform other work.
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 (1971); Estes v. Barnhart, 275 F.3d 722, 724 (8th Cir.
2002). Substantial evidence is less than a preponderance 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,”
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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
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though two inconsistent conclusions may be drawn from the evidence, the
Commissioner's findings may still be supported by substantial evidence on the
record as a whole. Pearsall, 274 F.3d at 1217 (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).
In this case, the ALJ erred by failing to consider plaintiff’s diagnosed
condition of hypochondriasis as a severe mental impairment and by failing to
consider the impact of this impairment when assessing plaintiff’s credibility and
RFC. The final decision of the Commissioner must therefore be reversed and the
matter remanded for further proceedings.
At Step 2 of the sequential analysis, the ALJ found plaintiff’s severe
impairments to be obesity, status post exotropia, anxiety, stress incontinence,
fibromyalgia, GERD, depression, panic disorder, schizoaffective disorder, OCD,
panic disorder with agoraphobia, and borderline personality disorder. Other than
generally referring to Dr. Finder’s diagnosis of “hypochondria” in determining
plaintiff’s RFC at Step 4, the ALJ did not discuss plaintiff’s diagnosed condition of
hypochondriasis or its effect on her functioning, despite substantial evidence on the
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record related thereto.
According to the Diagnostic & Statistical Manual of Mental Disorders (4th
ed. Text Revision 2000) (DSM-IV-TR), the essential feature of hypochondriasis
“is preoccupation with fears of having, or the idea that one has, a serious disease
based on a misinterpretation of one or more bodily signs or symptoms.” DSM-IVTR 504. “The unwarranted fear or idea of having a disease persists despite
medical reassurance[,]” and such “preoccupation with bodily symptoms causes
clinically significant distress or impairment in social, occupational, or other
important areas of functioning[.]” Id. Hypochondriasis is within the class of
somatoform disorders. Id. at 485. See also Smith v. Chater, 81 F.3d 165 n.2 (8th
Cir. 1996) (unpublished) (per curiam) (table).
The common feature of the Somatoform Disorders is the presence of
physical symptoms that suggest a general medical condition . . . and
are not fully explained by a general medical condition, by the direct
effects of a substance, or by another mental disorder . . . . [T]he
physical symptoms are not intentional (i.e., under voluntary control).
DSM-IV-TR at 485. Hypochondriasis is a nonexertional impairment that may
affect a claimant’s exertional abilities. Webber v. Secretary of Health & Human
Servs., 784 F.2d 293, 299 (8th Cir. 1986).
As outlined above, the record shows plaintiff to have claimed and reported
numerous physical ailments to her providers, both treating and consulting, as well
as in her hearing testimony and in her disability application. Such ailments include
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IBS, urinary incontinence, headaches, hypertension, irregular heartbeat, allergies,
GERD, polyps on the colon, arthritis, calcification of ligaments, lung infection,
asthma, chronic heat exhaustion, heart issues for which she needs a catheterization,
sinusitis, sleep apnea, fibromyalgia, neuralgia, eye pain, ear pain, swelling,
musculoskeletal pain, and general loss of stamina. When plaintiff returned to Dr.
Finder in January 2012, one year after her initial consultation with him, she
reported having suffered from additional ailments within that year, and namely,
gall bladder removal, neck and jaw pain, hearing loss, difficulty with balance and
coordination, and lactose intolerance. While the medical record provides little
objective support for this list of physical ailments, the ALJ had before him an
uncontradicted diagnosis of hypochondriasis rendered twice by a licensed
psychologist, with subjective support by plaintiff’s treating health providers that
plaintiff was “very somatic” during her examinations for physical complaints. As
noted above, this mental impairment causes plaintiff to believe that her physical
ailments are more serious than the clinical data would suggest, and she cannot
control this belief. In both of his consultation reports, Dr. Finder detailed his
clinical observations of plaintiff’s manifestation of this impairment, including her
preoccupation with her many reported physical ailments, her report of activities
being limited because of her physical condition, and her subjective denial of any
mental issues despite exhibiting symptoms objectively observed by Dr. Finder.
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Indeed, Dr. Finder noted plaintiff to “refuse[] to acknowledge any psychological
issues and blame[] everything on her physical problems.” (Tr. 518.) Because of
plaintiff’s firm belief that her issues involved only physical problems, Dr. Finder
questioned whether plaintiff would even participate in any type of mental health
treatment for her mental impairment.
Despite this objectively supported diagnosis of hypochondriasis with
findings that plaintiff was significantly limited thereby, the ALJ only referred to
this impairment in a cursory manner and appeared to dismiss its significance
because of plaintiff’s subjective denial of psychological symptoms, her lack of
mental health treatment, her perceived lack of cooperation during Dr. Finder’s
evaluations, and her satisfactory performance on diagnostic tests. (See Tr. 18-20.)
These reasons provided by the ALJ to diminish the significance of plaintiff’s
mental impairment are actually indicative of the mental impairment itself. To
discount the diagnosis for these reasons “misses the point of [plaintiff’s] serious
mental problem.” Easter v. Bowen, 867 F.2d 1128, 1130 (8th Cir. 1989). It cannot
be said, therefore, that the ALJ adequately considered plaintiff’s diagnosed mental
impairment of hypochondriasis when he determined her severe impairments at
Step 2 of the sequential analysis.13
13

Curiously, the ALJ did not include this diagnosed and objectively supported mental
impairment as a severe impairment at Step 2 of the sequential analysis, but included other mental
impairments that enjoy no similar support in the record, such as schizoaffective disorder, panic
disorder with agoraphobia, and borderline personality disorder. In addition, later in his decision,
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The ALJ’s failure to adequately consider the impact of plaintiff’s
hypochondriasis likewise affected his credibility determination and resulting RFC
assessment. The ALJ determined to credit plaintiff’s subjective complaints only to
the extent “the objective medical evidence of record allow[ed]” and found
plaintiff’s extreme allegations to simply not be supported by the record. (Tr. 19.)
Specifically, the ALJ noted plaintiff’s medical treatment to be limited and
conservative in nature, that plaintiff’s vision testing yielded normal results after
eye surgery, that plaintiff’s musculoskeletal complaints were not supported by
physical examination or clinical findings, that plaintiff’s diagnosis of fibromyalgia
was unsupported by any findings of actual pressure points, and that the record was
sparse as to results of physical examinations. (Tr. 18-20.) However, given the
nature of the somatoform disorder with which plaintiff was diagnosed, “[a]ny
shortcomings in the objective medical data that support her alleged physical
ailments are irrelevant since her primary disorder, as clinically diagnosed, causes
her to exaggerate her physical problems in her mind beyond what the medical data
indicate.” Easter, 867 F.2d at 1130.
The ALJ also discredited plaintiff’s subjective complaints because of the
inconsistency in her reports regarding her work history and her reasons for
stopping work. (Tr. 19.) The ALJ specifically noted plaintiff’s testimony that she
the ALJ noted no evidence of record to support plaintiff’s diagnosis of fibromyalgia (Tr. 20), but
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was laid off in 2008, received unemployment benefits, worked again for less than
one month, was fired for her difficulty to get along with coworkers and to keep up
with the pace of work, and thereafter again received unemployment benefits. The
ALJ noted that this recitation was inconsistent with plaintiff’s testimony that she
sought “similar work” when she was unemployed and her report to Dr. Finder that
she enjoyed working and stopped when her employer closed the factory. (Id.)
There is no substantial inconsistency in these reports. Plaintiff testified that she
sought “familiar” work “in automotive kinds of things” when she was unemployed,
including work that did not involve a lot of contact with people and that did not
require higher skills. (Tr. 55-56.) There is no indication in plaintiff’s testimony or
elsewhere that she sought work similar to the fast-paced warehouse work she
performed short-term from which she was fired. To the extent plaintiff’s report to
Dr. Finder that she lost her job in 2008 when the factory closed conflicts with her
testimony that the company was downsizing, this isolated inconsistency does not
rise to the level of substantial evidence sufficient to support a decision to discount
plaintiff’s subjective complaints. See Burress v. Apfel, 141 F.3d 875, 881 (8th Cir.
1998).14
he nevertheless determined this impairment to be severe at Step 2.
14
In her Brief in Support of the Answer, the Commissioner suggests that plaintiff’s receipt of
unemployment benefits and seeking other employment “cast doubt on her motivation for seeking
disability benefits,” citing Cox v. Apfel, 160 F.3d 1203, 1208 (8th Cir. 1998), for its holding that
accepting unemployment benefits entails an assertion of an ability to work and is inconsistent
with a claim of disability. (Deft.’s Brief, Doc. #21 at pp. 10-11.) Plaintiff last received
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The ALJ also determined plaintiff’s daily activities of cooking simple meals,
performing light household chores, shopping, and enjoying supportive social
relationships with her family and a “close interpersonal relationship with a
boyfriend” to be inconsistent with her subjective complaints of disabling
limitations. (Tr. 20.) It is well established, however, that a claimant “need not be
completely bedridden or unable to perform any household chores to be considered
disabled.” Easter, 867 F.2d at 1130; see also Reed v. Barnhart, 399 F.3d 917, 92224 (8th Cir. 2005); Burress, 141 F.3d at 881. Nor does a claimant’s ability to
maintain a relationship with her family discredit subjective claims that she does not
tolerate crowds or relate well with coworkers. See, e.g., Tate v. Apfel, 167 F.3d
1191, 1199 (8th Cir. 1999). Finally, there is no evidence in the record to support
the ALJ’s factual finding that plaintiff was in a “close interpersonal relationship
with a boyfriend.” Nevertheless, the daily activities recited by the ALJ provide an
insufficient basis upon which to find plaintiff’s complaints of disabling symptoms
not to be credible. In circumstances where, as here, a claimant is diagnosed with a
form of somatoform disorder such as hypochondriasis, her exaggeration of
symptoms and a lack of objective medical evidence supporting such symptoms are
not good reasons to discredit her complaints. See Tedford v. Colvin, No. C12unemployment benefits during the first quarter of 2010. (Tr. 38, 57, 150-51.) Plaintiff alleges
that she became disabled on August 23, 2010. As such, contrary to the Commissioner’s
suggestion, it cannot be said that plaintiff accepted unemployment benefits at a time when she
claimed she was disabled.
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4076-LTS, 2013 WL 3338477, at *16 (N.D. Iowa July 2, 2013).
When assessing plaintiff’s RFC, the ALJ accorded great weight to the
Mental Medical Source Statement (“MSS”) completed by Dr. Finder in September
2012 wherein he opined that plaintiff experienced only mild to moderate
limitations in her ability to perform the mental requirements of work. (Tr. 20.)
While Dr. Finder’s Mental MSS contained his opinion as to plaintiff’s mental
ability to perform work, it did not address her ability perform physical workrelated activities, which is the type of activity most affected by a somatoform
disorder. Tedford, 2013 WL 3338477, at *16. Indeed, plaintiff reported during her
evaluations with Dr. Finder that she was physically limited in her ability to stand,
bend, and engage in other exertional activities; and Dr. Finder concluded from
these evaluations that although plaintiff’s physical symptoms were psychological
in nature, they nevertheless seriously impacted her ability to function. Indeed, in
his Mental MSS to which the ALJ accorded great weight, Dr. Finder reported that
plaintiff’s physical complaints, albeit psychosomatic, limited her ability to engage
in many aspects of daily life. Other than discrediting plaintiff’s subjective physical
complaints, however, the ALJ did not address the extent to which plaintiff’s
physical abilities were affected by her mental impairment, despite Dr. Finder’s
reported observations. The ALJ’s failure to specifically address plaintiff’s physical
ability to function is especially significant here inasmuch as, as noted by the ALJ,
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the record contains no medical assessment regarding her physical limitations.
In sum, the ALJ’s Step 2 finding and credibility determination failed to take
into consideration the nature of plaintiff’s diagnosed mental impairment of
hypochondriasis, a somatoform disorder as defined in the DSM-IV-TR, and its
impact on plaintiff’s ability to perform the mental and physical requirements of
work. Because the ALJ’s RFC determination must be based on plaintiff’s ability
to perform the requirements of work “day in and day out, in the sometimes
competitive and stressful conditions in which real people work in the real world,”
McCoy v. Astrue, 648 F.3d 605, 617 (8th Cir. 2011) (internal quotation marks and
citation omitted), it cannot be said that the ALJ’s RFC assessment here is
supported by substantial evidence on the record as a whole where he failed to
consider the primary source of plaintiff’s alleged disability. See also Easter, 867
F.2d at 1130 (noting that employers are concerned with an employee’s “substantial
capacity, psychological stability, and steady attendance[.]”).
This matter will therefore be remanded so that plaintiff’s medically
determinable and diagnosed mental impairment of hypochondriasis can be taken
into account at Step 2 of the sequential analysis; can be properly considered at Step
3 in determining whether this impairment, considered alone and in combination
with plaintiff’s other impairments, meets or medically equals a listed impairment,
including Listing 12.07 – Somatoform Disorders; and can properly be taken into
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account at Step 4 in determining plaintiff’s credibility and RFC, given its nature of
producing physical symptoms and a preoccupation with fear of having a serious
disease based on a misinterpretation of such symptoms, but without a full medical
explanation. Against this backdrop, the ALJ will reassess plaintiff’s credibility as
well as the credibility of third-party observations; and shall reassess plaintiff’s
RFC based on the relevant and credible evidence of record relating to plaintiff’s
severe and non-severe impairments, including medical and non-medical evidence
as well as plaintiff’s own description of her symptoms and limitations. 20 C.F.R. §
404.1545(a). If necessary, the ALJ may obtain additional medical evidence and
conduct another hearing to more fully develop the record regarding plaintiff’s
hypochondriasis.
Accordingly, for all of the foregoing reasons,
IT IS HEREBY ORDERED that the decision of the Commissioner is
REVERSED, and this cause is REMANDED to the Commissioner for further
proceedings.

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A separate Judgment in accordance with this Memorandum and Order is
entered this same date.
Dated this 13th day of January, 2015.

/s/ Nannette A. Baker
NANNETTE A. BAKER
UNITED STATES MAGISTRATE JUDGE

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