Moore v. Astrue
MEMORANDUM AND ORDER IT IS HEREBY ORDERED that the decision of the Commissioner is AFFIRMED and plaintiff's Complaint is dismissed with prejudice. Judgment shall be entered accordingly. Signed by Magistrate Judge Frederick R. Buckles on 9/26/2012. (NCL)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
MICHAEL J. ASTRUE, Commissioner
of Social Security,
Case No. 4:11CV1446 FRB
MEMORANDUM AND ORDER
This cause is before the Court on plaintiff’s appeal of
an adverse determination by the Social Security Administration.
All matters are pending before the undersigned United States
Magistrate Judge, with consent of the parties, pursuant to 28
U.S.C. § 636(c)
On October 9, 2009, the Social Security Administration
denied plaintiff Stephanie Moore’s June 26, 2009, application for
Supplemental Security Income, filed pursuant to Title XVI of the
Social Security Act, 42 U.S.C. §§ 1381, et seq.
(Tr. 58, 60-64,
At plaintiff’s request, a hearing was held before an
Administrative Law Judge (ALJ) on May 19, 2010, at which plaintiff
and a vocational expert testified.
On June 21, 2010,
In the application, plaintiff claimed she became disabled on
December 1, 2008. Plaintiff subsequently amended her alleged onset
date to June 25, 2009. (Tr. 130.)
the ALJ denied plaintiff’s claim for benefits.
June 27, 2011, the Appeals Council denied plaintiff’s request for
review of the ALJ’s decision.
The ALJ’s decision is
thus the final decision of the Commissioner.
42 U.S.C. § 405(g).
Evidence Before the ALJ
At the hearing on May 19, 2010, plaintiff testified in
response to questions posed by the ALJ and counsel.
At the time of the hearing, plaintiff was thirty-three
years of age.
Plaintiff is single and has no children.
lives in an apartment with a friend who pays the rent.
Plaintiff obtained a GED and received vocational training in
culinary arts. (Tr. 32-33.) Plaintiff receives food stamps. (Tr.
Plaintiff has applied for Medicaid.
Plaintiff’s Work History Report shows plaintiff to have
worked cleaning dorms from November 1994 to August 2007 while
From September 2007 to January 2008, plaintiff
plastic. Plaintiff worked at Popeye’s Chicken from January to June
2008 preparing and cooking chicken as well as performing cleaning
Plaintiff testified that she was self-
employed in 2009 cleaning houses, yards, and her church. Plaintiff
testified that she stopped such work in June 2009 because of
problems with her back and legs, she lacked transportation, and
because she felt hot all of the time as though she would pass out.
(Tr. 34-35, 41.)
Plaintiff testified that she has been unable to work
since June 2009 because of her thyroid, legs, feet, heel spurs, and
heart. Plaintiff testified that she has muscle spasms and that her
medication causes her to become drowsy and tired.
testified that her eyes are blurry and run a lot.
testified that with her work while incarcerated, she was required
to take a break every hour because of problems with her legs and
heart, caused by thyroid issues.
Plaintiff testified that the
prison officials did not want her to overdo it.
Plaintiff testified that she saw a psychiatrist for
subsequently determined that she had issues with depression and
Plaintiff testified that her doctor told
her that it all may be related to her thyroid condition.
testified that she is currently depressed and cries.
testified that she shakes when she is upset but does not lash out.
Plaintiff testified that she has difficulty getting out of bed on
some days and that she spends four days a week in bed.
Plaintiff testified that her thyroid condition causes her
to feel tired, have eye pain, have pain in her lower back, and have
muscle spasms throughout her body.
Plaintiff testified that she
experiences muscle spasms every day or every other day and tries to
rub them out when they begin.
five to ten minutes.
Plaintiff testified that they last
Plaintiff testified that her eyes are blurry
every day and that she places a cold towel over her eyes to help.
Plaintiff testified that she experiences dizziness when she rises
from a seated position or from lying down.
that her physician has stated that resolving her thyroid condition
may resolve the problems she is having with her heart rate.
Plaintiff testified that her physician would like for
her to undergo additional testing but that she cannot obtain such
tests without Medicaid.
Plaintiff testified that her knees crack and that it is
difficult to bend them when she walks.
Plaintiff testified that
she has difficulty standing for long periods of time due to the
Plaintiff testified that she can stand for about five
minutes before feeling the need to sit.
testified that she cannot run but can walk the distance of a block
if she takes a break.
Plaintiff testified that she has difficulty
sitting on account of pain in her back but that she is okay if she
is able to move while sitting.
Plaintiff testified that she could
sit for up to thirty minutes at one time.
Plaintiff testified that
she has difficulty bending over at the waist because of her back
Plaintiff testified that she could squat if she had to,
concentration and focus are okay if she is not involved in a long
As to her daily activities, plaintiff testified that she
gets out of bed at 10:00 a.m. on those days that she does not stay
in bed for the day.
Plaintiff testified that she does not shower
on a daily basis because of her body pain.
that she vacuums and makes the bed, but takes breaks while doing
Plaintiff testified that she goes grocery shopping with her
roommate so that she can get out of the house.
that she leaves the house three or four times a month.
testified that she watches television but does not read. Plaintiff
testified that people do not come to visit because she has no
Plaintiff testified that she visits her mother at her
Plaintiff testified that she has no hobbies other
than watching movies.
Plaintiff testified that she
has a driver’s license but has not driven for two years because she
does not have access to a car and because her doctor advised her
not to drive due to her eyes and medication.
throughout the day and takes three or four naps a day lasting about
ten minutes each.
Plaintiff testified that she lies down for long
periods of time because she is tired and it is “hard for [her] to
Testimony of Vocational Expert
hearing in response to questions posed by the ALJ.
Mr. Dolan characterized plaintiff’s past work as a fast
food worker as light and unskilled, and as a self-employed day
worker as medium and unskilled.
The ALJ asked Mr. Dolan to assume a person of plaintiff’s
age, education and work experience and to further assume that such
a person was “limited to work within the light exertional category;
who needs to have occupations that involve only simple, routine,
repetitive tasks with only occasional decision making required,
with no interaction with the public.”
testified that such a person could not perform any of plaintiff’s
Mr. Dolan testified, however, that such a person could
perform work as a housekeeper or cleaner, and that 8,000 such jobs
existed in the St. Louis area; as a hand packager, with 2,000 such
jobs in the St. Louis area; and as a cafeteria attendant, with
about 500 such jobs in the St. Louis area.
The ALJ then asked Mr. Dolan to assume an individual with
the same limitations but with an additional limitation that she be
limited to occupations that have only occasional changes in the
The ALJ then asked Mr. Dolan to assume an individual who
was limited to the sedentary level of exertion, “with simple,
routine, repetitive tasks required only[,] . . . and no interaction
with the public.”
Mr. Dolan testified that such a
person could perform work as an assembler, and that about 2,000
such jobs existed in the St. Louis area.
individual to be limited to a “work environment that’s free of
fast-paced production quotas; with simple work-related decisions
only; and few, if any, workplace changes; with no interaction with
Mr. Dolan responded that such a person
restriction on public interaction.
Mr. Dolan further testified that an individual in the
unskilled labor market could miss work up to two days a month and
still maintain employment, but that being absent two days every
unskilled labor market:
one fifteen-minute break during the first
half of the day, a thirty-minute meal break, and a fifteen-minute
break during the second half of the day.
incarcerated at the Missouri Department of Corrections (MDOC),
plaintiff actively participated in group psychotherapy on eight
occasions. On each occasion, plaintiff’s mental status examination
was within normal limits and plaintiff was assessed as having a
An EKG taken on August 1, 2006, was normal.
Plaintiff visited an MDOC physician on August 5, 2006,
who noted plaintiff’s TSH levels associated with her hypothyroid
condition to have changed.2
Plaintiff’s Methimazole3 was adjusted
and plaintiff was instructed to complete her Propranolol.4
On October 21, 2006, the MDOC physician noted plaintiff’s
Hypothyroidism is condition in which the thyroid gland is
underactive and does not produce enough thyroid hormone. Medline
Methimazole (Tapazole) is used to treat hyperthyroidism, a
condition that occurs when an overactive thyroid gland produces too
much thyroid hormone. Medline Plus (last reviewed Sept. 1, 2010)
Propranolol is a beta blocker used to treat high blood
pressure, abnormal heart rhythms, heart disease, and certain types
Medline Plus (last revised Oct. 1, 2010)
hyperthyroidism to be improving.5
decrease her PTU.6
Plaintiff was instructed to
Methimazole was prescribed.
Laboratory testing performed on December 18, 2006, showed
plaintiff’s thyroid levels to be within normal limits.
Plaintiff visited an MDOC physician on January 3, 2007,
exophthalmos of the eyes and minimal goiter.
hyperthyroidism under good control and asymptomatic. Plaintiff was
instructed to continue with Methimazole.
Plaintiff underwent a physical examination by the MDOC on
February 9, 2007.
Plaintiff complained of joint pain and nausea.
Mild proptosis of the eyes was noted.
Examination of the mouth and
throat revealed evidence of goiter.
Plaintiff was diagnosed with
hyperthyroidism for which it was noted that she was on suppressive
Plaintiff was also diagnosed with bilateral bunions.
Plaintiff visited an MDOC physician on March 31, 2007,
and had no complaints.
Examination showed no exophthalamos of the
Throughout the administrative record, the treatment notes
refer to plaintiff’s thyroid condition as either “hypothyroidism”
or “hyperthyroidism.” The Court’s summary of the medical evidence
identifies the condition as it is stated in the respective medical
PTU (Propylthiouracil) is used to treat hyperthyroidism.
Medline Plus (last revised June 15, 2011).
Continued improvement of plaintiff’s hyperthyroidism was
Plaintiff was noted to be asymptomatic and the condition
was under good control.
Plaintiff’s prescription for Methimazole
Plaintiff returned to an MDOC physician on June 23, 2007,
and reported that she was doing well and had no tachycardia.
Plaintiff was continued in her diagnosis of hyperthyroidism and her
prescription for Methimazole was renewed.
On July 26, 2007, plaintiff appeared for a group therapy
encounter at MDOC during which it was noted that she participated
and cooperated with the aftercare/discharge planning group and work
skills group appropriately.
Mental status examination was within
Plaintiff had no suicidal or homicidal thoughts.
On August 4, 2007, it was noted that laboratory testing
showed plaintiff’s thyroid levels to be normal. Plaintiff reported
that she was leaving the MDOC.
continue on Methimazole.
Plaintiff was instructed to
Plaintiff was released from the MDOC on
August 27, 2007, and was given four Methimazole pills upon release.
Plaintiff was admitted to the emergency room at Forest
Park Hospital on December 20, 2008, with complaints of left sided
Plaintiff had no other complaints.
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An x-ray and CT scan showed a
kidney stone, and plaintiff underwent a cystoscopy with placement
of a left ureteral stent.
Plaintiff was discharged from the
hospital on December 22, 2008.
Plaintiff visited People’s Health Centers on December 29,
2008, for evaluation of her goiter and thyroid. Plaintiff’s recent
stent placement was noted.
Physical examination was
unremarkable. Plaintiff was instructed to drink a lot of fluid and
was referred to the Urology Clinic at St. Louis Connect Care.
Plaintiff returned to People’s Health Centers on January
6, 1999, for follow up.
Physical examination was unremarkable.
Plaintiff was instructed to follow up with St. Louis Connect Care.
Plaintiff visited People’s Health Centers on January 21,
2009. Plaintiff’s hyperthyroidism was noted and plaintiff reported
It was noted that plaintiff had been without
medication for eight months.
Plaintiff was prescribed Propranolol
and Methimazole and was referred to the Endocrinology Clinic.
Plaintiff was instructed again to follow up with the Urology Clinic
regarding her ureteral stent.
On January 30, 2009, plaintiff visited St. Louis Connect
Care for follow up of her kidney stone condition.
reported her current medications to be Propranolol and Methimazole/
Plaintiff reported her medical history to include joint
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problems and thyroid disease.
Plaintiff currently complained of
continued flank pain and of hematuria.
Physical examination was
A KUB7 was ordered and Ditropan8 was prescribed.
Plaintiff was instructed to return in three weeks.
Plaintiff returned to St. Louis Connect Care on February
Plaintiff reported having no pain but felt pelvic
It was determined that plaintiff would undergo stent
removal at the Urology Clinic.
On March 19, 2009, plaintiff visited Dr. Brody at St.
Plaintiff related her past relevant history and reported that she
stopped taking medication for her condition upon being released
from prison in August 2007.
Plaintiff reported that testing
performed in December 2008 showed her thyroid to be overactive and
Methimazole and Metoprolol9 were prescribed, but that she did not
take the medication. Plaintiff reported that she had palpitations,
trouble breathing, and felt hot and sweaty.
Plaintiff had no
A KUB is an x-ray of the abdomen taken to examine the
kidneys, ureters, and bladder. Medline Plus Abdominal X-ray (last
updated Feb. 10, 2010).
Ditropan is used to control an overactive bladder. Medline
Metoprolol is a beta blocker used to treat high blood
pressure and to prevent chest pain. Medline Plus (last revised
July 1, 2010).
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complaints of pain.
Plaintiff was prescribed Methimazole and
Propranolol and was instructed to get a radioactive iodine (RAI)
Plaintiff called Dr. Brody’s office on May 19, 2009, and
reported that she missed her appointment for the RAI scan.
An RAI scan performed June 17, 2009, showed markedly
elevated results consistent with hyperthyroidism.
thyroid scan showed mild thyromegaly.
Plaintiff returned to Dr. Brody on June 24, 2009, for
follow up and reported that she was shaking.
that she was not sleeping well and that she experienced occasional
Physical examination showed no exophthalmos, but
extraocular movements were noted to be weak.
Mild tremor was
Dr. Brody diagnosed plaintiff with hyperthyroidism and
determined to treat plaintiff with RAI.
to stop Propranolol.
Plaintiff was instructed
Metoprolol was prescribed.
instructed to refrain from taking Methimazole until after her RAI
In a letter dated June 24, 2009, Dr. Brody wrote:
She suffers form hyperthyroidism.”
Plaintiff returned to People’s Health Centers on July 22,
2009, for evaluation of dysmenorrhea and goiter.
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were noted. Plaintiff was instructed to continue with Propranolol,
evaluated for hyperthyroidism and bilateral knee and leg pain.
Physical examination was unremarkable.
X-rays of the knees were
(Tr. 261, 263, 270, 275-76.)
On July 28, 2009, plaintiff was given RAI therapy for
treatment of Graves’ disease.
Plaintiff visited Dr. Brody on September 2, 2009, and
complained of pain in the lower abdomen and in the low back.
Plaintiff also reported breaking out in hives on her arms and legs
after her iodine treatment.
Plaintiff reported that she was not
sleeping well, felt hot, had palpitations, felt nervous, and was
Physical examination showed an enlarged thyroid.
hyperthyroidism and prescribed Metoprolol.
Vicodin was first prescribed by People’s Health Centers on
January 6, 2009, in relation to plaintiff’s kidney stone. (Tr.
Naproxen is used to relieve tenderness, swelling, and
ankylosing spondylitis, and pain from other causes. Medline Plus
(last revised June 15, 2012).
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In a letter dated September 2, 2009, Dr. Brody wrote:
“To Whom it May Concern, Please consider Stephanie Moore for
She suffers multiple symptoms from hyperthyroidism.”
On September 24, 2009, plaintiff underwent a consultative
Psychologist Alison Burner noted plaintiff’s complaints to be of
having thyroid problems and a learning disability.
disability and dropped out of school in the eighth grade.
Burner noted plaintiff’s medical history of thyroid problems, and
plaintiff reported that she takes eight medications.
noted, however, that some prescriptions had expired several years
prior and some were for antibiotics.
Ms. Burner also noted that
plaintiff’s most recent prescription was for high blood pressure
and was dated May 2009.
Examination showed plaintiff’s affect to
Plaintiff’s full scale IQ was measured to be 78,
which placed plaintiff in the borderline range of intellectual
Ms. Burner noted plaintiff to display no significant
strengths or weaknesses and that all of plaintiff’s skills appeared
to be evenly developed.
Ms. Burner concluded that there did not
employment. Ms. Burner opined that plaintiff’s school difficulties
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were more likely related to being a slow learner rather than from
a learning disability.
No psychological diagnosis was made.
Technique Form for disability determinations on September 29, 2009,
functioning resulted in moderate difficulties in maintaining social
functioning; mild restrictions of activities of daily living; no
difficulties in maintaining concentration, persistence, or pace;
and no repeated episodes of decompensation.
completed that same date, Ms. Toll opined that, in the area of
understanding and memory, plaintiff was moderately limited in her
ability to understand and remember detailed instructions, but was
not otherwise limited.
In the area of sustained concentration and
persistence, Ms. Toll opined that plaintiff was moderately limited
in her ability to carry out detailed instructions, in her ability
to complete a normal workday and workweek without interruptions
from psychologically based symptoms, and in her ability to perform
at a consistent pace without an unreasonable number and length of
rest periods, but was not otherwise limited.
In the area of social
interaction, Ms. Toll opined that plaintiff was moderately limited
in her ability to interact appropriately with the general public,
but was not otherwise limited.
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Plaintiff visited Dr. Brody on October 14, 2009, and
reported no complaints of pain.
Plaintiff reported that she
continued to feel nervous, had hives, had restless legs, and
continued to have palpitations.
stopped taking Metoprolol.
to be enlarged.
It was noted that plaintiff
Examination showed plaintiff’s thyroid
Mild tremor was noted.
Plaintiff was diagnosed
with hyperthyroidism and was instructed to stop smoking. Dr. Brody
prescribed Propranolol and referred plaintiff to the Ophthalmology
Plaintiff returned to Dr. Brody on November 11, 2009, and
complained of headaches and of experiencing chest pain on the left
side radiating to the back.
Plaintiff also reported experiencing
shaking, nervousness, and palpitations, but that such symptoms were
not bad with Propranolol.
Physical examination showed the thyroid
to be slightly enlarged and no eye symptoms.
No tremors were
Dr. Brody diagnosed plaintiff with hypothyroidism and
Propranolol, to try to stop smoking, and to return in six weeks.
Plaintiff visited Dr. Brody on December 23, 2009, and
complained of leg pain, especially in the knees.
reported having occasional palpitations and left sided chest pain.
Levothyroxine is used to treat hypothyroidism and goiter.
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Dr. Brody noted plaintiff’s previous diagnosis of hypothyroidism
and her treatment for hyperthyroidism. Plaintiff reported that she
was sleeping okay.
Plaintiff reported that she was taking stress
medications and muscle relaxants as prescribed by Dr. Najib.
Physical examination showed plaintiff’s thyroid to be slightly
No eye symptoms were noted.
No tremors were noted.
Crepitus was noted about the left knee with pain about both knees.
Dr. Brody diagnosed plaintiff with hypothyroidism.
problems of the left knee were to be ruled out.
instructed plaintiff to continue with her current medications and
to return in one month.
Plaintiff visited Dr. Brody on January 10, 2010, and
complained of left knee pain, with such pain reported to be at a
Plaintiff also reported having sleeping difficulty,
blurred vision, and muscle pain.
Dr. Brody noted plaintiff’s
previous diagnosis of hypothyroidism.
Physical examination showed
Plaintiff was instructed to return in six weeks.
On April 19, 2010, plaintiff visited Dr. Robert P. Poetz
at the request of counsel for a consultative examination.
Poetz noted plaintiff’s history of hyperthyroidism.
reported that she experiences shaking in her hands and legs,
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fatigue, and sleep difficulties on account of the condition.
Plaintiff also reported that she was transported to the hospital on
one occasion when she began to shake and her throat closed up.
Poetz also noted plaintiff’s history of kidney stones and plaintiff
reported that she experiences continued pain on the left side with
occasional pain on the right.
Plaintiff reported having pain and
knots across her lower back which were extremely painful to the
Plaintiff reported that she had been hospitalized on
several occasions because of kidney stones and that she had been
advised that she currently had small kidney stones on the right
Plaintiff reported to Dr. Poetz that she had been diagnosed
with depression and anger issues and had been under psychiatric
care in the past, with such care including medication.
reported being full of fear and expressed concern that she will
reported that she was currently seeking psychiatric care but was
having difficulty due to lack of insurance and income.
also complained of bilateral knee and lower leg pain and reported
that she experiences popping and cracking in both knees with
occasional locking of the left knee.
Plaintiff also reported
having pain in her calves with numbness/tingling into her ankles.
Plaintiff reported a history of hypertension for which she received
treatment while incarcerated.
Plaintiff reported that her heart
races and that her medication had been discontinued, but that she
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experiences bunions and calluses on her feet, astigmatism in her
right eye, and a knot on the dorsum of her left wrist which causes
her ring finger to lock.
Plaintiff’s current medications were
Laboratory tests showed poorly controlled cholesterol, and an
increased heart rate but no other abnormalities of the heart.
Physical examination showed plaintiff to walk with a normal gait.
Plaintiff was able to move all joints of the upper and lower
Crepitus was noted about the bilateral knees
with hypertrophy and effusion.
Plaintiff’s feet and hands were
noted to be neurovascularly intact.
Plaintiff had good range of
motion about the spine, and straight leg raising was negative.
Plaintiff was noted to be tachycardic.
was unremarkable with deep tendon reflexes intact, and sensory and
motor examination showing no deficits.
Dr. Poetz noted plaintiff
to have an anxious demeanor and to be tearful at times.
reported having a “thinking problem” and that she had difficulty
Cyclobenzaprine is a muscle relaxant used to relax muscles
and relieve pain and discomfort caused by strains, sprains, and
other muscle injuries. Medline Plus (last revised Oct. 1, 2010)
There is no indication in the record as to when this medication was
prescribed, by whom, or for what condition.
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Plaintiff reported having had two suicidal thoughts but no plan,
with the last such thought occurring in 2000.
Upon conclusion of
the examination, Dr. Poetz diagnosed plaintiff with hypothyroidism;
left ureteral stone with obstruction, status-post placement left
hyperlipidemia; major depressive disorder, untreated; borderline
intellectual functioning; and bilateral knee pain with possible
degenerative joint disease.
Dr. Poetz recommended that plaintiff
avoid prolonged sitting, standing, walking, stooping, bending,
squatting, twisting, and climbing; avoid stressful situations; and
avoid any activity that exacerbates symptoms or is known to cause
progression of the disease process.
Dr. Poetz recommended that
plaintiff be on a beta blocker for tachycardia, undergo aggressive
treatment of her severely uncontrolled hypertension, take an SSRI
or SNRI for depression, be on statin therapy for treatment of
hypyerlipidemia, undergo evaluation of her knee pain including xrays, and take anti-inflammatory medications.
Dr. Poetz opined
that plaintiff was unable to maintain gainful employment due to her
multiple health conditions.
In a Medical Source Statement completed that same date,
April 19, 2010, Dr. Poetz set out his diagnoses of plaintiff and
opined that plaintiff could sit for six hours in an eight-hour
workday, stand for one hour in an eight-hour workday, and walk for
one hour in an eight-hour workday. Dr. Poetz opined that plaintiff
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could continuously lift and carry one to two pounds, frequently
lift and carry five pounds, occasionally lift and carry ten pounds,
and could never lift and carry twenty or more pounds.
opined that plaintiff had no manipulative limitations nor any
limitations with balance.
Dr. Poetz reported that plaintiff
experienced pain on account of her knees and kidney stones and that
such pain was objectively indicated by reduced range of motion, and
subjectively indicated by complaints of pain, weight loss or gain,
Dr. Poetz opined that plaintiff’s pain would
preclude her from focusing on simple tasks during a full-time work
Dr. Poetz further opined that plaintiff’s impairments
would require her to lie down or take a nap during a workday and
would require her to take more than three breaks during a workday
on account of fatigue and lack of focus.
Dr. Poetz opined that
plaintiff’s impairments would cause plaintiff to miss work each
month on three or more occasions.
Dr. Poetz opined that the
limitations described lasted or could be expected to last twelve or
more months and have existed since at least December 2008.
The ALJ’s Decision
determined plaintiff’s borderline intellectual functioning and
hypothyroidism/Graves’ disease to constitute severe impairments,
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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, Subpt. A, App’x 1.
The ALJ found plaintiff to
have the residual functional capacity (RFC) to perform light work
but with limitations to occupations involving simple, routine, and
repetitive tasks that are low stress in nature.
The ALJ defined
such jobs as those with only occasional changes in decision making
and changes in work settings, and no interaction with the public.
The ALJ determined plaintiff not able to perform her past relevant
skills, job skills, and RFC, the ALJ determined plaintiff able to
perform other work that exists in significant numbers in the
packager, and cafeteria attendant.
The ALJ thus found plaintiff
not to be under a disability since June 25, 2009.
To be eligible for Supplemental Security Income 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.
"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
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expected to last for a continuous period of not less than 12
42 U.S.C. § 1382c(a)(3)(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
substantial gainful work which exists in the national economy." 42
U.S.C. § 1382c(a)(3)(B).
Commissioner engages in a five-step evaluation process.
C.F.R. § 416.920; Bowen v. Yuckert, 482 U.S. 137, 140-42 (1987).
The Commissioner begins by deciding whether the claimant is engaged
in substantial gainful activity.
disability benefits are denied.
If the claimant is working,
Next, the Commissioner decides
whether the claimant has a “severe” 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. The Commissioner then determines
whether claimant's impairment(s) meets or is equal to one of the
impairments listed in 20 C.F.R., Subpart P, Appendix 1.
impairments, she is conclusively disabled. At the fourth step, the
Commissioner establishes whether the claimant can perform her past
If so, the claimant is not disabled.
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Commissioner evaluates various factors to determine whether the
claimant is capable of performing any other work in the economy.
If not, the claimant is declared disabled and becomes entitled to
The decision of the Commissioner must be affirmed if it
is supported by substantial evidence on the record as a whole.
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).
evidence is less than a preponderance but enough that a reasonable
person would find it adequate to support the conclusion.
v. Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001).
evidence test,” however, is “more than a mere search of the record
for evidence supporting the Commissioner’s findings.”
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.”
quotation marks and citations omitted).
supported by substantial evidence on the record as a whole, the
Court must review the entire administrative record and consider:
The credibility findings made by the ALJ.
The plaintiff's vocational factors.
The medical evidence from treating and
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The plaintiff's subjective complaints
relating to exertional and non-exertional
activities and impairments.
Any corroboration by third parties of the
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) (quoting Cruse v. Bowen, 867 F.2d 1183, 1184-85
(8th Cir. 1989)).
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).
even 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.
“[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).
Here, plaintiff claims that the ALJ’s decision is not
Specifically, plaintiff contends that the ALJ erred in his analysis
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of the medical evidence of record, and specifically, the medical
opinions of Drs. Brody and Poetz.
Plaintiff further contends that
the ALJ’s RFC determination is not supported by medical evidence,
and the ALJ erred by failing to include a narrative discussion
supporting his RFC conclusions.
The Court will address each of
plaintiff’s arguments in turn.
In his written decision, the ALJ acknowledged Dr. Brody’s
two letters in which he requested that plaintiff be considered
disabled due to symptoms associated with hyperthyroidism.
determined not to accord great weight to these letters.
The ALJ also acknowledged Dr. Poetz’s consultative opinion that
plaintiff’s limitations prevented her from maintaining gainful
The ALJ assigned very little evidentiary weight to
Plaintiff claims that the ALJ erred in
his treatment of these medical opinions.
In evaluating opinion evidence, the Regulations require
the ALJ to explain in the decision the weight given to any opinions
See 20 C.F.R. § 416.927(f)(2)(ii).14
Citations to 20 C.F.R. § 416.927 are to the 2010 version of
the Regulations which were in effect at the time the ALJ rendered
the final decision in this cause. This Regulation’s most recent
amendment, effective March 26, 2012, reorganizes the subparagraphs
relevant to this discussion but does not otherwise change the
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require that more weight be given to the opinions of treating
physicians than other sources.
20 C.F.R. § 416.927(d)(2).
treating physician's assessment of the nature and severity of a
claimant's impairments should be given controlling weight if the
opinion is well supported by medically acceptable clinical and
laboratory diagnostic techniques and is not inconsistent with other
substantial evidence in the record.
Id.; see also Forehand v.
Barnhart, 364 F.3d 984, 986 (8th Cir. 2004).
This is so because a
treating physician has the best opportunity to observe and evaluate
a claimant's condition,
since these sources are likely to be the
medical professionals most able to provide a
claimant's] medical impairment(s) and may
bring a unique perspective to the medical
evidence that cannot be obtained from the
objective medical findings alone or from
reports of individual examinations, such as
20 C.F.R. § 416.927(d)(2).
However, a medical source’s opinion that an applicant is “unable to
work” involves an issue reserved for the Commissioner and is not
the type of opinion which the Commissioner must credit.
Barnhart, 392 F.3d 988, 994-95 (8th Cir. 2005).
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controlling weight, the Commissioner must look to various factors
in determining what weight to accord the opinion. 20 C.F.R. §
Such factors include the length of the treatment
relationship and the frequency of examination, the nature and
physician provides support for his findings, whether other evidence
in the record is consistent with the treating physician's findings,
Regulations further provide that the Commissioner “will always give
good reasons in [the] notice of determination or decision for the
weight [given to the] treating source's opinion.”
In his decision here, the ALJ determined not to accord
great weight to Dr. Brody’s letters in which he opined that
plaintiff was disabled due to symptoms arising from her thyroid
A review of the ALJ’s decision in toto shows the ALJ to
have reached this conclusion after summarizing the evidence of
record and noting that such evidence failed to show any objective
signs of limiting deficits in relevant areas of, inter alia,
neurological functioning, muscular functioning, range of motion,
functioning, and visual functioning.
In addition, the ALJ noted
that no medically acceptable clinical and laboratory diagnostic
techniques demonstrated any disabling limitations.
As such, the ALJ did not err in failing to accord Dr. Brody’s
- 29 -
opinion less than controlling weight.
Forehand, 364 F.3d at 986.
20 C.F.R. § 416.927(d)(2);
See also Cox v. Barnhart, 345 F.3d 606,
608 (8th Cir. 2003) (“It is the ALJ’s job to reach a decision as
the claimant’s legal disability by evaluating the objective medical
evidence before him.”).
complained of fatigue, poor sleep, and shaking on account of her
plaintiff’s condition to be mild in nature and, further, that
plaintiff neither sought nor received aggressive treatment for the
These reasons for discounting Dr. Brody’s
conclusory opinion of disability are supported by substantial
evidence on the record as a whole and constitute “good reasons”
under § 416.927(d)(2).
See Owen v. Astrue, 551 F.3d 792, 799 (8th
Cir. 2008) (objective evidence of mild impairment supported ALJ’s
conclusion not to give treating physician’s opinion controlling
weight); Kirby v. Astrue, 500 F.3d 705, 709 (8th Cir. 2007) (ALJ
entitled to discount opinion where opinion is based largely on
claimant's subjective complaints rather than on objective medical
evidence)15; Vandenboom v. Barnhart, 421 F.3d 745, 749 (8th Cir.
Although plaintiff does not challenge the ALJ’s credibility
determination here, a review of the ALJ’s decision nevertheless
shows that, in a manner consistent with and as required by Polaski
v. Heckler, 739 F.2d 1320 (8th Cir. 1984) (subsequent history
omitted), the ALJ thoroughly considered the subjective allegations
of plaintiff’s disabling symptoms on the basis of the entire record
before him and set out numerous inconsistencies detracting from the
- 30 -
2005) (failure to document objective medical evidence to support
subjective complaints justified giving less weight to treating
physician’s opinion); Chamberlain v. Shalala, 47 F.3d 1489, 1495
(8th Cir. 1995) (failure to seek aggressive medical care not
suggestive of disabling condition); Rautio v. Bowen, 862 F.2d 176,
179 (8th Cir. 1988) (failure to seek aggressive treatment and
limited use of prescription medications not suggestive of disabling
Finally, as noted above, a medical source’s opinion that
an applicant is “unable to work” involves an issue reserved for the
Commissioner and is not the type of opinion which the Commissioner
Ellis, 392 F.3d at 994-95.
A treating physician’s
finding that a claimant is totally disabled is entitled to no
deference “because it invades the province of the Commissioner to
make the ultimate disability determination.”
Renstrom v. Astrue,
680 F.3d 1057, 1065 (8th Cir. 2012) (internal quotation marks and
Accordingly, the ALJ was permitted to disregard Dr.
Brody’s conclusory opinion, unsupported by the objective medical
evidence, that plaintiff was disabled on account of her thyroid
credibility of such allegations. The ALJ may disbelieve subjective
complaints where there are inconsistencies on the record as a
whole. Battles v. Sullivan, 902 F.2d 657, 660 (8th Cir. 1990).
The ALJ's credibility determination is supported by substantial
evidence on the record as a whole, and thus the Court is bound by
the ALJ's determination. Robinson v. Sullivan, 956 F.2d 836, 841
(8th Cir. 1992).
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The ALJ therefore did not err in his treatment of such
opinion set out in Dr. Brody’s letters.
Plaintiff claims that the ALJ erred by failing to analyze
Dr. Poetz’s opinion under the factors set out in 20 C.F.R. §
416.927(d) in determining what weight to accord the opinion.
plaintiff at counsel’s request.
The Regulations do not require an ALJ to specifically
discuss in his written decision the § 416.927(d) factors when
determining what weight to accord an opinion rendered by a nontreating, consulting physician.
Instead, the Regulations require
the ALJ to only consider such factors.
Specific discussion is
physician's opinion less than controlling weight.
As such, an
ALJ's failure to specifically discuss the § 416.927(d) factors in
necessarily lead to the conclusion that he failed to consider them,
and does not in itself render the ALJ's decision suspect.
arguable deficiency in opinion-writing technique does not require
reversal of an ALJ's decision if such deficiency had no bearing on
the outcome of the proceeding.
(8th Cir. 2008).
Hepp v. Astrue, 511 F.3d 798, 806
Given the ALJ's thorough discussion of all the
- 32 -
conducted by Dr. Poetz, the ALJ's acknowledgment that Dr. Poetz
performed a one-time consultative examination, and Dr. Poetz’s
conclusions therefrom — it cannot be said that the ALJ failed to
consider the § 416.927(d) factors in determining what weight to
accord Dr. Poetz’s opinion.
To the extent plaintiff argues that the ALJ erred in
according Dr. Poetz’s opinion very little evidentiary weight, a
review of the ALJ’s decision in conjunction with the record as a
whole shows the ALJ not to have erred.
First, as noted by the ALJ,
the objective medical findings made within the evaluation itself
plaintiff experienced significant functional limitations and was
physical examination showed that plaintiff could walk with a normal
gait, could move all joints of the upper and lower extremities
well, had good range of motion about the spine, was neurovascularly
intact about the hands and feet, had negative straight leg raising,
and was neurologically intact with deep tendon reflexes and sensory
findings, Dr. Poetz opined that plaintiff could not engage in
prolonged sitting, standing, walking, stooping, bending, squatting,
twisting, or climbing; could not focus on account of pain; was
required to lie down or nap throughout the day; and could not lift
- 33 -
in excess of ten pounds.
Because of the inconsistencies between
Dr. Poetz’s findings made during his evaluation of plaintiff and
his resulting opinion, the ALJ did not err in according little
weight to Dr. Poetz’s opinion.
See Wagner v. Astrue, 499 F.3d 842,
opinions that are internally inconsistent are entitled to less
limitations as opined by Dr. Poetz appeared largely to be based on
evidence. See Renstrom, 680 F.3d at 1064 (ALJ entitled to discount
opinion where opinion is based largely on claimant's subjective
complaints rather than on objective medical evidence); Kirby, 500
F.3d at 709 (same).16
Finally, as with Dr. Brody’s opinion of
disability, the ALJ properly noted that Dr. Poetz’s opinion that
plaintiff could not be gainfully employed addressed an issue
reserved to the Commissioner. An ALJ need not credit a physician’s
ultimate conclusion that a claimant is disabled.
F.3d at 1065; Ellis, 392 F.3d at 994-95.
Accordingly, the ALJ did not err in his treatment of Dr.
Poetz’s opinions regarding plaintiff’s limitations of function and
her inability to engage in gainful employment.
See supra n.15.
- 34 -
determination inasmuch as, by discounting the opinions of Drs.
Brody and Poetz, no medical evidence supported his RFC findings.
Plaintiff also claims that the ALJ erred by failing to include in
his decision a narrative discussion describing how the evidence
supported his RFC conclusions.
Dunahoo v. Apfel, 241 F.3d 1033, 1039 (8th Cir.
Eichelberger v. Barnhart, 390 F.3d 584, 591 (8th Cir. 2004).
ALJ determines a claimant’s RFC based on all relevant, credible
evidence in the record, including medical records, the observations
description of her symptoms and limitations. Goff v. Barnhart, 421
F.3d 785, 793 (8th Cir. 2005); Eichelberger, 390 F.3d at 591; 20
C.F.R. § 416.945(a). A claimant’s RFC is a medical question,
however, and some medical evidence must support the ALJ’s RFC
Massanari, 259 F.3d 707, 711-12 (8th Cir. 2001).
The ALJ is
“required to consider at least some supporting evidence from a
evidence that addresses the claimant’s ability to function in the
Hutsell, 259 F.3d at 712 (internal quotation marks and
An ALJ’s RFC assessment which is not properly
- 35 -
informed and supported by some medical evidence in the record
The RFC assessment must include a narrative
supports each conclusion, citing specific
medical facts (e.g., laboratory findings) and
nonmedical evidence (e.g., daily activities,
adjudicator must discuss the individual’s
ability to perform sustained work activities
in an ordinary work setting on a regular and
continuing basis (i.e., 8 hours a day, for 5
days a week, or an equivalent work schedule),
and describe the maximum amount of each work
related activity the individual can perform
based on the evidence available in the case
record. The adjudicator must also explain how
any material inconsistencies or ambiguities in
considered and resolved.
SSR 96-8p, 1996 WL 374184, at *7 (S.S.A. July 2, 1996) (footnote
A review of the ALJ’s decision and the relevant evidence of record
shows the ALJ to have engaged in the proper analysis as to
determination and, for the following reasons, such determination is
supported by substantial evidence on the record as a whole.
First, a review of the ALJ’s decision shows him not to
have discounted any of the objective medical evidence of record,
but only the unsupported conclusory opinions that plaintiff was
disabled and unable to be gainfully employed. As such, plaintiff’s
assertion that the failure to credit Drs. Brody’s and Poetz’s
- 36 -
opinions regarding plaintiff’s disability left the record devoid of
medical evidence to support the ALJ’s adverse finding is without
Nevertheless, plaintiff claims that no medical evidence
supports the ALJ’s findings regarding plaintiff’s ability to lift
and perform the exertional demands of light work.17 The undersigned
notes, however, that upon review of the medical evidence of record,
the ALJ determined there to be no medically determinable impairment
which could result in plaintiff’s claimed back or knee pain, or
muscle or joint pain.
Plaintiff does not challenge this
The Commissioner’s assessment of a claimant’s RFC can
consider “only functional limitations and restrictions that result
from an individual’s medically determinable impairment[.] . . . It
is incorrect to find that an individual has limitations beyond
those caused by . . . her medically determinable impairment(s) and
any related symptoms[.]”
SSR 96-8p, 1996 WL 374184, at *1.
Indeed, a finding of disability can be based only on a medically
determinable physical or mental impairment.
Marolf v. Sullivan,
Light work involves lifting no more than 20
pounds at a time with frequent lifting or
carrying of objects weighing up to 10 pounds.
Even though the weight lifted may be very
little, 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
20 C.F.R. § 416.967(b).
- 37 -
981 F.2d 976 (8th Cir. 1992).
An ALJ is only required to rely on
those impairments which he finds credible and supported by the
He is not obligated to rely on limitations not supported
by the medical evidence of record.
See Cruze v. Chater, 85 F.3d
1320, 1323 (8th Cir. 1996); Lorenzen v. Chater, 71 F.3d 316, 318
(8th Cir. 1995); Montgomery v. Chater, 69 F.3d 273, 275 (8th Cir.
determinable impairment which would cause the postural limitations
as alleged by plaintiff such that she could not perform the
exertional demands of light work.
As such, the ALJ did not err by
failing to discuss alleged functional limitations and restrictions
ALJ to do so.
To the contrary, it would have been error for the
SSR 96-8p, 1996 WL 374184, at *1.
Plaintiff also claims that, after determining he could
not rely on the opinions of the only treating and examining
physicians of record, the ALJ should have recontacted Dr. Brody for
additional or clarifying information.
An ALJ is not required,
however, to seek such information from a treating physician unless
a crucial issue is undeveloped.
Goff, 421 F.3d at 791 (citing
Stormo v. Barnhart, 377 F.3d 801, 806 (8th Cir. 2004)).
Regulations provide that the ALJ should recontact a treating
universal.” Hacker v. Barnhart, 459 F.3d 934, 938 (8th Cir. 2006).
Instead, the Regulations provide that the ALJ should recontact
- 38 -
claimant’s] treating physician or psychologist or other medical
source is inadequate” for the ALJ to determine whether the claimant
20 C.F.R. § 416.912(e).
There is no need to
recontact a treating physician where the ALJ can determine from the
record whether the claimant is disabled.
Hacker, 459 F.3d at 938.
As set out above, there was sufficient medical evidence in the
record from which the ALJ could determine plaintiff’s RFC resulting
from plaintiff’s medically determinable impairments.
therefore did not err in failing to recontact plaintiff’s treating
physician to obtain additional or clarifying information relating
Finally, to the extent plaintiff claims that the ALJ
supporting his RFC conclusions, the undersigned notes the Eighth
Circuit’s recent statement that the Court’s role is to “review the
record to ensure that an ALJ does not disregard evidence or ignore
potential limitations[.] . . . [W]e do not require an ALJ to
mechanically list and reject every possible limitation.”
Astrue, 648 F.3d 605, 615 (8th Cir. 2011).
While the ALJ did not
limitation immediately followed by a discussion of the supporting
evidence, such a rigid format is not required by Social Security
Ruling 96–8p, as plaintiff seems to suggest.
- 39 -
The ALJ conducted a
thorough analysis of all of the medical evidence, non-medical
evidence, and the consistency of such evidence when viewed in light
of the record as a whole, and formulated a specific RFC that took
into account all of plaintiff's limitations caused by her medically
determinable impairments that the ALJ found credible and supported
determination, the ALJ’s RFC assessment must stand.
See Steed v.
Astrue, 524 F.3d 872, 876 (8th Cir. 2008).
For the reasons set out above on the claims raised by
plaintiff on this appeal, the ALJ did not legally err in his
decision is supported by substantial evidence on the record as a
As such, plaintiff’s claims of error should be denied.
Hensley v. Barnhart, 352 F.3d 353, 355 (8th Cir. 2003).
as there is substantial evidence to support the Commissioner's
decision, this Court may not reverse the decision merely because
substantial evidence exists in the record that would have supported
a contrary outcome or because another court could have decided the
Gowell v. Apfel, 242 F.3d 793, 796 (8th Cir.
2001); Browning v. Sullivan, 958 F.2d 817, 821 (8th Cir. 1992).
plaintiff was not disabled should be affirmed.
Therefore, for all of the foregoing reasons,
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Commissioner is AFFIRMED and plaintiff's Complaint is dismissed
Judgment shall be entered accordingly.
UNITED STATES MAGISTRATE JUDGE
Dated this 26th day of September, 2012.
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