Johnson v. Astrue

Filing 20

MEMORANDUM AND ORDER: IT IS HEREBY ORDERED that the decision of the Commissioner is affirmed. A separate judgment in accordance with this Memorandum and Order is entered this same date. Signed by Honorable Catherine D. Perry on February 13, 2012. (BRP)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
DORIS F. JOHNSON
Plaintiff,
vs.
MICHAEL J. ASTRUE,
Commissioner of Social Security,
Defendant.

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Case No. 4:11CV597 CDP

MEMORANDUM AND ORDER
This is an action for judicial review of the Commissioner’s decision denying
Doris Johnson’s application for benefits under the Social Security Act. Johnson
applied for disability insurance benefits under Title II of the Act, 42 U.S.C. §§ 401,
et seq. She also applied for supplemental security income benefits under Title XVI
of the Act, 42 U.S.C. §§ 1381, et seq. Section 205(g) of the Act, 42 U.S.C. §
405(g), provides for judicial review of a final decision of the Commissioner under
Title II, and Section 1631(c)(3) of the Act, 42 U.S.C. § 1383(c)(3), provides for
judicial review of a final decision under Title XVI.
Johnson claims she is disabled due to, among other things, a degenerative
condition in her cervical spine, thyroid-related problems, a right foot injury, and

numbness in her hands. Johnson alleged an onset date of January 19, 20061 for her
disability. Because I find the decision denying benefits to be supported by
substantial evidence, I will affirm the decision of the Commissioner.
Procedural History
Johnson filed her applications for benefits on November 28, 2007. Her
applications were denied on February 19, 2008, and Johnson filed a timely written
request for a hearing. Following a hearing, an Administrative Law Judge found on
November 25, 2009 that Johnson was not disabled. The Appeals Council of the
Social Security Administration denied Johnson’s request for review on January 28,
2011. Therefore, the decision of the ALJ stands as the final decision of the
Commissioner.
Evidence Before the Administrative Law Judge
Medical Records
On January 19, 2006, Johnson visited the St. Louis County Department of
Health (SLCDH) with complaints of neck and bilateral leg pain. A nurse
practitioner treated her for elevated blood pressure, esophageal reflux,
osteoarthritis involving an unspecified site, and hyperlipidemia. She was

1

Johnson initially provided an alleged onset date of August 1, 2003 but later amended the
date to January 19, 2006. Additionally, the ALJ found a denial of benefits by a previous
administrative law judge to be res judicata through January 26, 2007.
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instructed to follow up in three months.
Johnson returned to SLCDH on March 10, 2006 due to breast soreness. The
report noted benign hypertension, esophageal reflux, hyperlipidemia, joint pain in
multiple sites, and an inflamed hair follicle.
Two months later, Johnson again visited SLCDH on May 26, 2006. The
report noted benign hypertension, esophageal reflux, hyperlipidemia, and joint pain
in multiple sites. It also noted joint pain in the ankle and foot. The physical exam
described her as otherwise normal.
Johnson next visited SLCDH on June 21, 2006 with a complaint of foot
pain. She was treated for plantar fascial fibromatosis and a calcaneal spur. Three
months later, she returned on September 27, 2006 for a breast exam. She stated
she lost her medication after moving from her house, and she had not taken any of
her medication for over a year. The treating nurse described Johnson as being in
good general health, but noted benign hypertension, esophageal reflux,
hyperlipidemia, ankle and foot joint pain, and limb pain. A mammogram and x-ray
were also ordered.
On December 7, 2006, Johnson saw William Feldner, D.O., at SLCDH due
to her right thumb catching. She described the problem as moderate. Dr. Feldner
diagnosed trigger finger of the right thumb, administered an injection, and applied
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a splint.
Six months later, Johnson returned to Dr. Feldner on June 21, 2007 with
complaints of neck and shoulder pain. X-rays and magnetic resonance imaging
(MRI) were ordered. The x-rays revealed a normal right hand but an osteoarthritic
left hand. A neck x-ray revealed a reversal of the cervical curve and moderate to
severe degenerative changes.
Johnson again visited SLCDH on August 16, 2007 and reported continued
neck pain. A subsequent MRI on September 13, 2007 revealed moderately severe
disc space degeneration and broad-based disc bulging. A September 20, 2007
follow-up with Dr. Feldner confirmed the disc degeneration. Brachial neuritis was
also diagnosed. Dr. Feldner further stated that not many good options existed for
the disc degeneration but a pain management evaluation would be the best course
of action.
On October 8, 2007, Johnson returned to SLCDH and saw Neesha D.
Kurian, M.D. Johnson reported weight gain and hot flashes. Additionally, she
asked for refills of her prescriptions since her medications had run out weeks
before the visit. Dr. Kurian diagnosed benign hypertension, hyperlipidemia, joint
pain in multiple sites, and esophageal reflux. Johnson was instructed to see a
nutritionist for obesity. A December 20, 2007 visit to an endocrinologist also
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revealed hypothryoidism.
Johnson again saw Dr. Feldner on December 27, 2007 with complaints of
left shoulder pain. Dr. Feldner noted a decreased range of shoulder motion and
painful movements. He injected the joint with a steroid.
On January 11, 2008, Johnson saw Dr. Kurian at SLCDH for an annual
gynecological examination. The report noted that Johnson felt well with minor
complaints. Johnson also reported not exercising, but said she had an active
lifestyle taking care of her grandson. She also reported sleeping six hours per night
with some difficulty due to pain, though Tylenol provided some help. Dr. Kurian
noted hyperlipidemia, benign hypertension, esophageal reflux, and shoulder pain.
Upon a referral from Dr. Kurian, Johnson visited a nutritionist on January 14,
2008, who advised Johnson on ways to improve her diet. Exercise was also
recommended. A few days later, she visited a podiatrist at SLCDH due to a severe
bunion.
Johnson visited Barnes Jewish Pain Management Clinic on February 19,
2008 for neck pain and intermittent shoulder, low back, hip, thigh, knee and calve
pain. Jeremy Scarlett, M.D., reported that Johnson did not wish to have surgery
but would consider neck injections. He also noted normal strength throughout and
benign obesity. Dr. Scarlett diagnosed Johnson with chronic pain, cervical
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spondylosis without myelopathy, fibromyalgia, and unspecified insomnia. He
prescribed lyrica for fibromyalgia and physical therapy. He also ordered a followup in two weeks for a cervical epidural steroid injection.
On February 29, 2008, Johnson returned to SLCDH for a follow-up visit for
hyperlipidemia. The exam noted full range of motion in all joints, normal overall
strength, and normal joints and muscles. Benign hypertension was noted, as well
as hyperlipidemia and postmenopausal bleeding. Johnson was also urged to
improve her diet. Six days later, Johnson underwent a colonoscopy. This exam
revealed a normal colon with the exception of very minute polyps, which were
removed during the procedure. The report also described Johnson as a normal
healthy patient with a pain level of zero on a 0/10 scale.
Johnson next visited SLCDH on March 12, 2008. Following a complaint of
blurred vision, glasses were prescribed for astigmatism. She returned on March
17, 2008 due to postmenopausal bleeding. A biopsy of the uterus lining was
ordered. Upon receiving the results of this biopsy, medication was prescribed on
March 31, 2008.
On May 30, 2008, Johnson returned to SLCDH for a follow-up examination
and medication refills. The nurse noted benign hypertension, hyperlipidemia, and
esophageal reflux. Prescriptions were refilled for these conditions.
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Johnson next visited Dr. Feldner on June 26, 2008 due to moderate right
shoulder pain. He noted decreased range of motion and painful movements. He
diagnosed bicipital tenosynovitis and prescribed ice, rest, and exercises. When told
that Johnson had filed for disability, Dr. Feldner noted that Johnson had shoulder
pain, but he did not feel she had any disability.
Approximately eight months later, Johnson returned to SLCDH on February
3, 2009 with a complaint of hypertension. Prescriptions were refilled for benign
hypertension, hyperlipidemia, esophageal reflux, acute sinusitis, and bicipital
tenosynovitis. As previously directed, Johnson was also instructed to follow-up
with a gynecologist due to her postmenopausal bleeding.
On February 17, 2009, Johnson visited a gynecologist at SLCDH. She
underwent a routine gynecological exam. Johnson stated she had no complaints
this visit. The physician ordered a pelvic ultrasound. The report also noted that
Johnson had been noncompliant with medication. Johnson returned to SLCDH on
June 11, 2009 due to postmenopausal bleeding. The report again noted
noncompliance with medication.
Johnson next visited SLCDH on August 20, 2009 with complaints of left
wrist and thumb pain. Dr. Feldner diagnosed radial styloid tenosynovitis and left
thumb trigger finger. Splinting and medication were ordered.
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Testimony Before the ALJ
Johnson’s Testimony
At the September 16, 2009 administrative hearing, Johnson testified she was
55 years old with a general equivalency degree. Johnson stated she lived with her
sister and brother, who both received disability benefits. She stated she was five
feet tall and weighed 191 pounds, and she received Medicaid and food stamps.
Johnson testified that her last job was at a secondhand store, which fired her
for not testing a microwave prior to selling it. She also stated she had previously
worked as a sales clerk, but she could not currently perform such a job as she
needed to have her feet elevated throughout the day since elevating her feet
reduced her ankle swelling. Johnson stated she was “supposed to have operations”
on her feet, but she “cannot let them cut” on her. She relayed a fear of surgery
based on the surgical outcomes of two cousins.
Johnson further testified that pain in her neck made any movement painful.
She stated even combing her hair, opening a milk bottle, or bending over to get a
shoe resulted in pain. Johnson said she could only stand for about ten to fifteen
minutes before needing to sit, and she could only sit for fifteen minutes.
Moreover, she surrounds herself with pillows when seated.
Johnson also alerted the ALJ to further pain from fibromyalgia and
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degenerative arthritis. She stated these conditions caused her pain in other areas of
her body, such as her shin and feet. She stated that doctors had wanted to perform
surgery on her neck, but she refused the procedure since they couldn’t “guarantee
it’s going to be well.” Johnson stated the pain in her neck is dull and deep, and
even sore to the touch.
Johnson said her sister mostly cooks for her, but she washes her own plate
and utensils. She also washes herself and does her own laundry. However, her
sister does most other household chores such as dusting, vacuuming, and shopping.
Additionally, she stated she does not have a driver’s license and has not driven a
car since 2003.
Lastly, Johnson stated that she cannot write more than seven minutes
consecutively due to cramping or numbness in her hand.
Vocational Expert’s Testimony
The ALJ received additional testimony from John A. Granfeld, a vocational
expert. When asked to describe Johnson’s previous work, Dr. Granfeld testified
that she was previously a sales attendant, a sorter, a housekeeper, and a medical
records clerk. He respectively classified these jobs as light and unskilled, light
with an SVP of 2 (unskilled), light with an SVP of 2, and sedentary with an SVP of
4 (semi-skilled).
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Johnson later clarified her duties as a medical records clerk. She stated she
never sat during her work at the medical clinic, but her duties instead entailed
gathering and delivering folders to doctors’ offices. Dr. Grenfeld found this
description to be consistent with a messenger instead of a medical records clerk.
He stated this would be classified as light work with an SVP of 2. However, Dr.
Grenfeld also stated this job is not listed in the Dictionary of Titles.
Legal Standard
A court determines on review whether the Commissioner’s findings are
supported by substantial evidence on the record as a whole. Moore v. Astrue, 572
F.3d 520, 522 (8th Cir. 2009). Substantial evidence is less than a preponderance
but enough for a reasonable mind to find adequate support for the ALJ’s
conclusion. Id. When substantial evidence exists to support the Commissioner’s
decision, a court may not reverse simply because evidence also supports a contrary
conclusion. Clay v. Barnhart, 417 F.3d 922, 928 (8th Cir. 2005). This standard of
review requires consideration of evidence supporting the Commissioner’s decision
as well as evidence detracting from it. Wiese v. Astrue, 552 F.3d 728, 730 (8th Cir.
2009). However, if the evidence allows for two inconsistent positions, and one of
these positions represents the ALJ’s findings, the court must affirm the ALJ’s
decision. Perkins v. Astrue, 648 F.3d 892, 897 (8th Cir. 2011).
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To determine whether substantial evidence supports the decision, the Court
must review the administrative record as a whole and consider:
(1) the credibility findings made by the ALJ;
(2) the education, background, work history, and age of the claimant;
(3) the medical evidence from treating and consulting physicians;
(4) the plaintiff’s subjective complaints relating to exertional and nonexertional impairments;
(5) any corroboration by third parties of the plaintiff’s impairments; and
(6) the testimony of vocational experts, when required, which is based upon
a proper hypothetical question.
Stewart v. Sec’y of Health and Human Serv., 957 F.2d 581, 585-86 (8th Cir. 1992).
Social security regulations define 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 twelve months. 42
U.S.C. § 416(i)(1); 42 U.S.C. § 1382c(a)(3)(A); 20 C.F.R. § 404.1505(a); 20
C.F.R. § 416.905(a). Determining whether a claimant is disabled requires the
Commissioner to evaluate the claim based on a five-step procedure.
First, the Commissioner must decide whether the claimant is engaging in
substantial gainful activity. If so, she is not disabled.
Second, the Commissioner determines if the claimant has a severe
impairment which significantly limits the claimant’s physical or mental ability to
do basic work activities. If the impairment is not severe, the claimant is not
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disabled.
Third, if the claimant has a severe impairment, the Commissioner evaluates
whether it meets or exceeds a listed impairment found in 20 C.F.R. Part 404,
Subpart P, Appendix 1. If the impairment satisfies a listing in Appendix 1, the
Commissioner will find the claimant disabled.
Fourth, if the claimant has a severe impairment and the Commissioner
cannot make a decision based on the claimant’s current work activity or on medical
facts alone, the Commissioner determines whether the claimant can perform past
relevant work. If the claimant can perform past relevant work, she is not disabled.
Fifth, if the claimant cannot perform past relevant work, the Commissioner
must evaluate whether she can perform other work in the national economy. If not,
the claimant is declared disabled. 20 C.F.R. § 404.1520; § 416.920.
When evaluating evidence of pain or other subjective complaints, the ALJ is
never free to ignore the subjective testimony of the claimant, even if it is
uncorroborated by objective medical evidence. Basinger v. Heckler, 725 F.2d
1166, 1169 (8th Cir. 1984). However, the ALJ may disbelieve a claimant’s
subjective complaints when they are inconsistent with the record as a whole. See,
e.g., Battles v. Sullivan, 902 F.2d 657, 660 (8th Cir. 1990). When considering
subjective complaints, the ALJ must consider the factors set out in Polaski v.
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Heckler, 739 F.2d 1320, 1321-22 (8th Cir. 1984), which include:
the claimant’s prior work record, and observations by third parties and
treating and examining physicians relating to such matters as: (1) the
claimant’s daily activities; (2) the duration, frequency and intensity of the
pain; (3) precipitating and aggravating factors; (4) dosage, effectiveness and
side effects of medication; [and] (5) functional restrictions.
Id.; see also Buckner v. Astrue, 646 F.3d 549, 558 (8th Cir. 2011).
The ALJ’s Findings
Based on all the evidence, the ALJ found Johnson was not disabled from
January 19, 2006 through the date of the decision. Specifically, the ALJ made the
following determinations:
1.

The claimant met the insured status requirements of the Social
Security Act through June 30, 2007.

2.

The claimant had not engaged in substantial gainful activity since
January 19, 2006, the alleged onset date.

3.

The claimant had the severe impairments of degenerative disc disease
of the cervical spine and left trigger thumb.

4.

The claimant did not have an impairment that met or medically
equaled a listed impairment in Appendix 1. See 20 C.F.R. Pt. 404,
Subpt. P, App. 1.

5.

The claimant had a residual functional capacity (RFC) to perform the
full range of light work defined in 20 C.F.R. § 404.1567(b) and §
416.967(b).

6.

The claimant was capable of performing past relevant work as a
medical records clerk, sales attendant, sorter, and housekeeper. This
work did not require the performance of work-related activities
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precluded by the claimant’s RFC. 20 C.F.R. § 404.1565; § 416.965.
7.

The claimant has not been under a disability, as defined by the Social
Security Act, from January 19, 2006 through the date the decision.

The ALJ noted that a physician at Barnes Jewish Pain Management Clinic
had diagnosed Johnson with fibromyalgia in February of 2008, “although there
was no report of positive trigger points.” The ALJ stated that little objective
evidence in the record supported this diagnosis, and it appeared “to have been
made on the claimant’s subjective complaints only.” He noted there was no
medical evidence of loss of strength in any extremity or any trigger point
tenderness.
In further assessing Johnson’s subjective pain complaints, the ALJ did not
find them credible. After considering the objective medical evidence, the ALJ
found the medically determined impairments could cause the alleged symptoms,
but the persistence or limiting effects of the symptoms “are not credible to the
extent they are inconsistent with the above” RFC. The ALJ noted that Johnson
performed many normal activities of life such as shopping, some household chores,
and taking care of herself. He also noted her unimpressive work record and a
significant motivation to seek benefits. The ALJ further noted Johnson’s refusal of
surgery for her cervical problems.

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Discussion
Johnson’s contentions can be consolidated into three principal arguments.
First, Johnson argues the ALJ failed to consider required credibility factors when
assessing Johnson’s subjective complaints of pain. Second, Johnson argues the
ALJ improperly determined Johnson’s severe impairments due to his findings on
Johnson’s fibromyalgia. Lastly, Johnson argues the ALJ made an improper RFC
determination by failing to consider Johnson’s obesity, mental health issues, and
sensitivity to vibrations and extreme cold.
Subjective complaints of pain
Since evidence of pain is subjective in nature, an ALJ “cannot simply reject
complaints of pain because they were not supported by objective medical
evidence.” Ford v. Astrue, 518 F.3d 979, 982 (8th Cir. 2008). Instead, the ALJ is
required to consider all evidence relating to the complaints. Id. Under the
framework set forth in Polaski, an ALJ must consider the following factors when
evaluating a claimant’s credibility:
(1) the claimant’s daily activities; (2) the duration, intensity, and frequency
of pain; (3) the precipitating and aggravating factors; (4) the dosage,
effectiveness, and side effects of medication; (5) any functional restrictions;
(6) the claimant’s work history; and (7) the absence of objective medical
evidence to support the claimant’s complaints.
Buckner, 646 F.3d at 558. An ALJ is not required to explicitly discuss each

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Polaski factor. Id. Further, an ALJ cannot discount a claimant’s allegations of
pain based solely on a lack of objective medical evidence to support them, but may
find a lack of credibility based on inconsistencies in the evidence as a whole. Id.
The “credibility of a claimant’s subjective testimony is primarily for the ALJ to
decide, not the courts.” Moore, 572 F.3d at 525 (quoting Holmostrom v.
Massanari, 270 F.3d 715, 721 (8th Cir. 2001)). Consequently, courts should defer
to the ALJ’s credibility finding when the ALJ explicitly discredits a claimant’s
testimony and gives good reason to do so. Buckner, 646 F.3d at 558.
The ALJ found that Johnson’s medically determinable impairments could
have reasonably caused her described symptoms, but the intensity, persistence and
limiting effects of the symptoms were not credible. It is true that the ALJ did not
discuss every one of the Polaski factors, and he did not cite to Polaski. Contrary to
Johnson’s argument, though, the ALJ was not required to discuss every factor.
Also, a failure to explicitly cite to Polaski is not alone grounds for remand if the
ALJ adequately considers some of the required factors. See Buckner, 646 F.3d at
558 (affirming an ALJ’s credibility determination despite no citation to Polaski
since the ALJ still discussed four Polaski factors).
In fact, the ALJ did discuss the following four Polaski factors: Johnson’s
daily activities; her work history; the lack of objective medical evidence to support

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her complaints; and the duration, intensity, and frequency of pain. Regarding
Johnson’s daily activities, the ALJ found she was able to perform many normal
activities, including some household chores and taking care of herself. In
discussing her work history, the ALJ found Johnson’s work record less than
impressive, and said she appeared to have a motivation to seek benefits. See
Buckner, 646 F.3d at 558 (upholding the ALJ’s credibility determination based in
part on the ALJ’s finding that a sporadic work history indicated claimant “was not
strongly motivated to engage in meaningful productive activity”). He further noted
that an award of disability would likely result in greater income than Johnson
earned in most years by working. Considering the objective medical evidence, the
ALJ found that Johnson’s impairments could reasonably cause her symptoms, but
the symptoms were not credible concerning the intensity, persistence and limiting
effects of the symptoms. The ALJ also considered fibromyalgia as a cause of the
frequency and duration of Johnson’s subjective pain, but ruled it out based on an
examination of the medical record as a whole.
Further review of the entire administrative record lends additional support
the ALJ’s findings. Although Johnson did state she spent most of her time
watching television and reading, she also performed some daily activities such as
washing her own dishes, bathing herself, and doing her own laundry. Additionally,

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during a 2008 examination by Dr. Kurian she stated she had an active lifestyle
chasing after her grandson. Moreover, during many of the medical examinations
during the relevant time period she offered no complaints of pain. Other medical
records described her pain as localized to a certain area, and still others state that
she was in good general health. See Johnson v. Astrue, 628 F.3d 991, 995-97 (8th
Cir. 2011) (finding physican reports such as “no joint swelling,” “no other
complaints,” and “doing well” to be inconsistent with the levels of pain and fatigue
described at the hearing). Johnson also stated she had to elevate her feet
throughout the day, but no physician ordered this recommendation. See Moore,
572 F.3d at 525 (finding self-imposed limitations not undertaken at the direction of
any physician to be inconsistent with a disability claim). In fact, when Dr. Feldner,
one of Johnson’s treating physicians, discovered Johnson intended to apply for
disability, he remarked that Johnson had some shoulder pain but no disability.
In addition to discussing these four Polaski factors, the ALJ further found
that Johnson refused to have surgery to correct her cervical problems. The record
confirms this, and it also indicates Johnson did not take her medication for over a
year and never received recommended physical therapy. Such a failure to follow a
recommended course of treatment lends further support to a finding of lack of
credibility. Guilliams v. Barnhart, 393 F.3d 798, 802 (8th Cir. 2005).

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A review of the entire administrative record reveals inconsistencies between
Johnson’s allegations of pain and the evidence as a whole. Johnson certainly had
pain, as was acknowledged by the ALJ, but the inconsistencies in the record
support the ALJ’s finding that Johnson’s subjective complaints were not credible.
Consequently, Johnson’s first argument fails.
Johnson’s possible fibromyalgia
Johnson also argues the ALJ erred by reaching a medical conclusion that
Johnson did not have fibromyalgia. In discussing Johnson’s possible fibromyalgia,
the ALJ acknowledged she had been diagnosed with the disease. However, the
ALJ found little objective evidence in the record supported the diagnosis, and that
the diagnosis appeared to have been based on Johnson’s subjective complaints. An
examination of the record as a whole supports this finding.
The Eighth Circuit has “long recognized that fibromyalgia has the potential
to be disabling.” Forehand v. Barnhart, 364 F.3d 984, 987 (8th Cir. 2004).
Diagnosis of fibromyalgia can be elusive due to the subjective nature of the
symptoms. Tilley v. Astrue, 580 F.3d 675, 681 (8th Cir. 2009). Such symptoms
include generalized aching, widespread tenderness of muscles, muscle stiffness,
fatigue, and poor sleep. The Merck Manual 375 (19th ed. 2011).
Despite the elusive nature of the disease, techniques do exist for

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fibromyalgia’s diagnosis. The disease is classically diagnosed when pain exists on
both sides of the body, both above and below the waist, from an axial distribution,
and when point tenderness is found in at least eleven of eighteen specified tender
points. Stedman’s Medical Dictionary 671 (27th ed. 2000). While most experts
no longer require a specific number of tender points to make the diagnosis when
other sufficient symptoms are present, tenderness at specific sites typically remains
part of an objective diagnosis. The Merck Manual, supra, at 375.
Here, Dr. Scarlett, the pain management specialist who diagnosed Johnson,
noted pain sensitivity in several areas during a sensory examination. However, the
record does not indicate Dr. Scarlett performed any examination of tender points.
The ALJ referenced such a lack of tender point tenderness, which supports his
finding that the diagnosis was based on subjective complaints. Also, despite Dr.
Scarlett’s diagnosis on February 19, 2008, Johnson never returned to see Dr.
Scarlett. Moreover, none of Johnson’s other doctors subsequently mentioned
fibromyalgia, even though she visited SLCDH only ten days after Dr. Scarlett’s
diagnosis. During the months immediately following Dr. Scarlett’s prescription of
Lyrica for the disease, medical reports do reference such a prescription. However,
the last reference to the drug appears during a visit on May 30, 2008, despite many
medical visits following this date. Furthermore, when Johnson requested

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medication refills during a February 3, 2009 visit, Lyrica was not mentioned.
“[N]ot every diagnosis of fibromyalgia warrants a finding that a claimant is
disabled.” Perkins, 648 F.3d at 900. Compare id. at 900-01 (upholding an ALJ’s
determination that fibromyalgia was not a severe impairment after a single
diagnosis of the disease from a pain management specialist) with Tilley, 580 F.3d
at 681 (holding the ALJ erred in failing to fully consider fibromyalgia when
multiple doctors repeatedly diagnosed the claimant with the disease). Taken as a
whole, the evidence supports the ALJ’s finding that Johnson did not have the
medically determinable impairment of fibromyalgia. Johnson’s second point fails.
RFC Determination
Johnson next argues the ALJ’s RFC determination was not supported by
substantial evidence. The RFC is the most a claimant can do despite limitations
and is based on all relevant evidence in the case record. 20 C.F.R. §
404.1545(a)(1). Here, the ALJ concluded that Johnson could perform a full range
of light work. Johnson contends this determination was made in error since the
ALJ failed to consider Johnson’s obesity, mental health issues, and sensitivity to
vibrations and extreme cold. Yet substantial evidence supports the ALJ’s findings
with respect to each of these issues, as will be addressed below.
Johnson’s obesity

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Johnson argues the ALJ violated Social Security Ruling 02-01p by failing to
adequately consider obesity when making the RFC determination. When making
such a determination, SSR 02-01p instructs an ALJ to assess “the effect obesity has
upon the individual’s ability to perform routine movement and necessary physical
activity within the work environment.” Further, the “effects of obesity with other
impairments may be greater than might be expected without obesity.” Id.
A close review of the record shows only a few references to Johnson’s
obesity. Dr. Kurian first diagnosed Johnson with obesity on October 8, 2007, and
Johnson later visited a nutritionist to discuss her diet. The February 19, 2008 exam
by Dr. Scarlett also mentioned obesity, but stated it was benign. Notably, no
doctor imposed any limitations on Johnson due to obesity, and Johnson did not
testify that her obesity resulted in additional limitations. Consequently, the ALJ’s
failure to discuss Johnson’s obesity was not in error. See Forte v. Barnhart, 377
F.3d 892, 896-97 (8th Cir. 2004) (finding no error in the ALJ’s failure to discuss
documented obesity since no doctor imposed any limitations, and the claimant did
not testify that obesity imposed additional restrictions).
Johnson’s possible mental impairments
Johnson also argues the ALJ failed to discuss her possible mental
impairments, and that a consultative examination should have been ordered to

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further explore them. It is true that an ALJ must fully and fairly develop the
record. Mouser v. Astrue, 545 F.3d 634, 639 (8th Cir. 2008). However, an ALJ is
not obligated to investigate claims not presented in the application or offered at the
hearing. Id. No bright line rule exists for determining whether the ALJ fully
developed the record, but such an assessment must be made on a case-by-case
basis. Id.
Reviewing the record, scant evidence existed suggesting Johnson suffered
from any mental impairments. One 2005 exam mentioned depression, but this
exam occurred prior to the alleged onset date. Another exam mentioned posttraumatic memory problems, but Johnson never received any treatment for this,
and it was never mentioned again. Also, Johnson never mentioned any mental
impairments in her application or in her testimony. See Hensley v. Barnhart, 352
F.3d 353, 357 (8th Cir. 2003) (finding mere prescription of antidepressants
insufficient “to require the ALJ to inquire further” when claimant failed to mention
depression in his application and testimony). Therefore, the ALJ did not need to
further develop the record by ordering a consultative examination.
Sensitivity to vibrations and extreme cold
Johnson lastly contends the ALJ failed to include a limitation against
vibration or extreme temperatures, which she claims would affect her ability to

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perform her prior work. Johnson cites to a Physical Residual Functional Capacity
Assessment completed by a state agency evaluator, Donald Pfleger, in support of
this contention.
Social Security Ruling 96-6p states that an ALJ should not ignore medical
opinions derived from state agency evaluations. Medical opinions consist of
“statements from physicians and psychologists or other acceptable medical sources
that reflect judgments about the nature and severity of an individual's
impairment(s).” Id. For a person to be an acceptable medical source, they must be
a licensed physician, licensed psychologist, licensed optometrist, licensed
podiatrist, or qualified speech pathologist. 20 C.F.R. § 404.1513.
Here, there is no evidence that Pfleger, the author of the assessment,
possessed any credentials that would make him an acceptable medical source. His
name appears under medical consultant, but no initials follow his name
whichwould indicate medical qualifications. In such a situation, it would be wrong
for an ALJ to treat this assessment as a medical opinion. See Dewey v. Astrue, 509
F.3d 447, 449 (8th Cir. 2007) (holding that an ALJ erred by relying heavily on a
state medical consultant’s RFC assessment where there was no evidence the
consultant was a physician).
Even if Pfleger were a physician, a review of his assessment provides

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support for the ALJ’s determination. Pfleger’s assessment found the overall
medical evidence to not support Johnson’s claims. Additionally, Pfleger only
recommended that Johnson avoid concentrated exposure to extreme cold and
vibrations. The ALJ’s RFC determination that Johnson can perform the full range
of light work is not contradictory.
There is no evidence that Pfleger was an acceptable medical source, and
none of Johnson’s treating physicians ever placed limitations on Johnson relating
to vibrations or extreme cold. Consequently, Johnson’s final point fails.
The ALJ’s determination that Johnson suffered no disability after June 19,
2006 is supported by substantial evidence in the record as a whole. The decision
should therefore be upheld.
Accordingly,
IT IS HEREBY ORDERED that the decision of the Commissioner is
affirmed. A separate judgment in accordance with this Memorandum and Order is
entered this same date.

CATHERINE D. PERRY
UNITED STATES DISTRICT JUDGE

Dated this 13th day of February, 2012
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