Williams v. Social Security Administration

Filing 17

MEMORANDUM AND ORDER IT IS HEREBY ORDERED that the decision of the Commissioner is affirmed, and plaintiff's Complaint is dismissed with prejudice. Signed by Magistrate Judge Frederick R. Buckles on 9/27/2013. (NCL)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
JAMES ODIS WILLIAMS,

)
)
)
)
)
)
)
)
)
)
)

Plaintiff,
v.
CAROLYN W. COLVIN,1 Acting
Commissioner of Social
Security,
Defendant.

Case No. 4:11CV1666 FRB

MEMORANDUM AND ORDER
This matter is before the Court on plaintiff James Odis
William’s appeal of an adverse decision of 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).
I.

Background and Procedural History

Plaintiff James Odis Williams applied for Disability
Insurance Benefits (“DIB”) pursuant to Title II, and Supplemental
Security Income pursuant to Title XVI, of the Social Security Act,
42 U.S.C. § 401, et seq. (also “Act”), alleging that he became
disabled on August 1, 2007.
103-13).

(Administrative Transcript (“Tr.”) at

Plaintiff’s applications were denied, and he requested a

1

Carolyn W. Colvin became the Acting Commissioner of Social
Security on February 14, 2013. Pursuant to Rule 25(d) of the
Federal Rules of Civil Procedure, Carolyn W. Colvin should
therefore be substituted for Michael J. Astrue as the defendant
in this case. No further action needs to be taken to continue
this suit by reason of the last sentence of 42 U.S.C. § 405(g).
- 1 -

hearing before an administrative law judge (“ALJ”), which was held
on May 11, 2010.

(Tr. 23-45).

On July 29, 1010, the ALJ issued an unfavorable decision.
(Tr. 6-19).

On July 23, 2011, defendant agency’s Appeals Council

denied plaintiff’s request for review, and the ALJ’s decision thus
stands as the Commissioner’s final decision subject to review in
this Court.

42 U.S.C. § 405(g).

The issues that plaintiff has submitted for judicial
review in this case are that the ALJ failed to properly consider
residual functional capacity, failed to properly consider the
opinion of plaintiff’s treating physician Umesh Inampudi, M.D.,
failed to consider medication side effects, and failed to obtain a
medical

expert

contributed

to

to

determine

plaintiff’s

whether
heart

illegal

disease

and

drugs

caused

or

the

degree

of

limitation caused thereby.
II.
A.

Evidence Before The ALJ

Plaintiff’s Testimony
Plaintiff first responded to questions posed by the ALJ.

Plaintiff testified that he had an eleventh grade education, was
single, and had three children, ages 28, 29 and 30.

(Tr. 27).

He

testified that he had lived with his adult nephew for the past five
years.

(Tr. 28).

of income.

He received food stamps, but had no other source

(Tr. 30).
Plaintiff testified that he worked as a meat clerk in

different

grocery

stores

from

1995

until

2007.

(Tr.

28).

Plaintiff sometimes performed meat cutting duties, and was required
- 2 -

to lift up to 60 pounds.

(Id.)

Plaintiff last worked in 2007, and

stated that he left his last job because he “kept getting ill” and
was not “feeling right.”

(Tr. 29).

Plaintiff then responded to questions from his attorney.
Plaintiff testified that his blood pressure “gets out of control
every once in a while,” characterized by nosebleeds and pain behind
his ears, and testified that this occurred “[p]robably about every
day or every other day” and lasted until he took medicine.
29-30).

(Tr.

When asked why he sometimes did not take his blood

pressure medication, plaintiff testified: “[s]ometimes I can’t
afford the medication.

I go - - sometimes they give it to me but

the times when I miss it it’s because they won’t give me my
medication because I can’t afford it.”

(Tr. 30).

Plaintiff testified that he had diabetes and had begun
taking insulin “a couple months ago,” and also took Glucophage.2
(Tr. 31).

He testified that he had numbness and tingling in his

feet and fingers and low energy, felt thirsty, needed glasses, and
needed to use the bathroom frequently.

(Tr. 31-33).

During

plaintiff’s most recent visit to the clinic, he was told that his
blood sugar was high but that medication should bring it down.
(Tr.

31).

He

nutritionist.

was

also

following

a

diet

recommended

by

a

(Id.)

Plaintiff testified that he did not sleep well at night

2

Glucophage, or Metformin, is used alone or in combination
with other medications, including insulin, to control Type 2
diabetes.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a696005.html
- 3 -

and snored, and that he suffered from shortness of breath when
traveling stairs, walking or lifting, and carried a rescue inhaler
with him at all times.
weather

extremes

(Tr. 33-34).

caused

breathing

Plaintiff testified that

problems.

(Tr.

34).

He

testified that he could walk for one block and stand and sit for 30
to 60 minutes, and that traveling stairs caused knee pain.

(Id.)

He testified that he had intermittent pain in his elbows.

(Tr.

35).
Plaintiff testified that he sometimes helped his nephew
clean the bathroom, but that his nephew did the heavy chores such
as vacuuming and mopping, and did most of the grocery shopping.
(Id.)

He testified that his sister sometimes picked him up and

took him to see friends or relatives.
church or engage in hobbies.

(Id.)

(Tr. 35-36).

He did not attend

He testified that he

rose at seven o’clock, and went to bed at nine o’clock.

(Tr. 36).

He ate breakfast “and then you know just fiddle around and take my
medication and then watch TV, stuff like that.”

(Id.)

He took a

three-hour nap daily, stating that the medicine made him drowsy.
(Id.)
During questioning from the ALJ, plaintiff testified
that, in October of 2008 while helping a friend perform tree work,
he fell from a ladder and broke his left foot and big toe.
37).

(Tr.

Plaintiff testified that, when he went to the consultative

examination in March of 2009 he was limping as a result of having
fallen off the ladder.

(Tr. 38).

Plaintiff testified that he could lift 30 to 40 pounds
- 4 -

but could not carry it, and that he could lift and carry ten
pounds.

(Tr. 38-39).

He testified that he had swelling in his

feet, and that, twice per week, he needed to lay down with his feet
up.

(Tr. 39).
The ALJ then heard testimony from Vincent Stock, a

vocational expert (also “VE”) and licensed psychologist. Mr. Stock
classified

plaintiff’s

past

work

and,

after

considering

a

hypothetical and various questions posed by the ALJ, testified
regarding various jobs the hypothetical individual could perform.
(Tr.

40-43).

Mr.

plaintiff’s counsel.
B.

Stock

also

responded

to

questions

from

(Tr. 43-44).

Medical Evidence
Plaintiff’s list of prescription medications includes

Metformin,

Precose,3

Loustatin,4

and

Metoprolol.5

(Tr.

176).

Plaintiff also listed several medications under the nonprescription
medications heading, medications that are typically used to treat
various conditions including asthma, hypertension, and diabetes.
See (Id.)

3

Precose, or Acarbose, is used with diet alone or with diet
and other medications to treat Type 2 diabetes.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a696015.html
4

Lovastatin is used with diet, weight loss and exercise to
reduce the risk of heart attack and stroke and reduce the chance
for a need of heart surgery in people with heart disease or who
are at risk for developing heart disease.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a688006.html
5

Metoprolol is used to treat hypertension.
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/
a682864.html
- 5 -

On

June

3,

2007,

plaintiff

presented

to

St.

Louis

University Hospital with complaints of pain, swelling and itching
in his right leg.

(Tr. 232-33).

There is a notation that

plaintiff suspected his symptoms were caused by a spider.
234).

(Tr.

He was discharged but instructed to return within the next

eight to 12 hours for testing to rule out deep vein thrombosis.
(Tr. 232, 241).
June 5, 2007.
edema.

(Tr.

He returned to St. Louis University Hospital on

(Tr. 214-17).
218).

Upon examination, there was no pedal

Plaintiff

reported

hypertensive medication the preceding day.

having

taken

(Tr. 223).

anti-

Vascular

testing revealed no evidence for significant acute deep vein
thrombosis in the right leg.

(Tr. 227).

On November 17, 2007, plaintiff presented to St. Louis
University Hospital with complaints of chest pain.
258).

(Tr. 249-52,

It is noted that plaintiff had a history of hypertension,

cocaine abuse, cigarette smoking, and social use of alcohol.

(Tr.

258-59).

(Tr.

258).

Plaintiff reported having used crack two days ago.

Upon examination, plaintiff was in no respiratory distress,

cardiovascular, psychiatric, and musculoskeletal examination were
all within normal limits, and he had no pedal edema.

(Tr. 253-54).

Plaintiff’s pain resolved in the emergency room. (Tr. 258). Chest
x-ray revealed mild pulmonary vascular congestion, the appearance
of an enlarged heart, and no pneumothorax.

(Tr. 264).

The

impression was cardiomegaly and mild pulmonary vascular congestion.
(Id.)

Plaintiff was told to “stop all drug use!”

(Tr. 245).

The record indicates that plaintiff was seen at Grace
- 6 -

Hill Neighborhood Health Center on February 28, 2008 for a check
up. (Tr. 266). Examination was within normal limits, including no
observation of edema.

(Tr. 268).

On May 19, 2008, plaintiff was admitted to St. Joseph
Health Center after presenting with complaints of chest pain of a
three-minute duration after being arrested by police.
276, 278, 284, 286).

(Tr. 275,

Although plaintiff reported that he was

compliant with his medications and diet, Scott Wasserstrom, M.D.
noted that plaintiff had not taken his blood pressure medications
that morning (Tr. 276), and Huilin Li, M.D. noted that plaintiff
“had not been taking blood pressure medicines.”

(Tr. 278, 280).

These records contain another observation that plaintiff had not
taken his blood pressure medication.
noted

that

plaintiff

had

“poorly

probable medicine noncompliance.”

(Tr. 284).
controlled

Dr. Wasserstrom
hypertension

(Tr. 274-75).

and

Plaintiff’s

chest pain resolved, but his blood pressure remained elevated.
(Tr. 278, 280, 285).
in

no

acute

He had no edema in his extremities, and was

distress.

(Tr.

285).

Chest

x-ray

cardiomegaly, and no active disease in the chest area.

revealed
(Tr. 342).

Cardiac catheterization yielded normal results, including normal
left ventricular function.

(Tr. 275, 296).

When plaintiff was

discharged, his blood pressure was under control, he had no fever,
telemetry monitoring was negative, and lab testing, including a
toxicology screen, was unremarkable.

(Id.)

Dr. Wasserstrom

diagnosed “[h]ypertension with probable history of noncompliance,”
high cholesterol, and a history of emphysema. (Id.) Plaintiff was
- 7 -

advised to be active as tolerated, and to follow a special diet.
(Id.)

It was noted that his condition on discharge was improved

and stable.

(Tr. 275).

On July 28, 2008, plaintiff presented to St. Louis
University Hospital with complaints related to his left ring finger
after having closed it in a car door.
numbness or tingling.
handyman.

(Id.)

(Tr. 208).

(Tr. 194-99).

He denied

He reported his occupation as a
(Tr.

X-ray revealed soft tissue swelling but no fracture.

209).

Review of systems was within normal limits.

(Tr.

213).
On October 11, 2008, plaintiff presented to the emergency
room at St. Louis University Hospital with complaints related to a
fracture of his left great toe that occurred as a result of a fall
from

a

ladder.

cigarettes

and

(Tr.
was

not

180-84).

He

interested

reported

in

that

quitting.

he

smoked

(Tr.

184).

Examination was within normal limits, with the exception of pedal
edema.

(Tr.

186).

Plaintiff

was

given

prescription

pain

medication, and was told to take his blood pressure medications as
prescribed, and to follow up with his primary care provider.

(Tr.

183, 191-92).
On November 6, 2008, plaintiff presented to the emergency
room of Barnes Jewish Hospital with complaints of chest pain,
shortness of breath, and hypertensive urgency that began when he
became upset after being pulled over by police.

(Tr. 430).

Mark

S.W. Thoelke, M.D., noted that plaintiff’s symptoms abated but then
returned when he became upset after hearing another patient yell.
- 8 -

(Id.)

Plaintiff stated that he had experienced these symptoms in

the past and took blood pressure medication for relief.

(Id.)

Plaintiff initially denied using cocaine but later, when
confronted with a positive drug screen, admitted that he had used
cocaine the previous day.

(Tr. 430-31).

Dr. Thoelke recommended

that plaintiff undergo cardiac stress testing but that plaintiff
refused, stating that he had to leave the hospital due to a family
crisis.

(Tr. 431).

Dr. Thoelke advised plaintiff to stop using

cocaine

and

being

start

medications.

(Id.)

compliant

Dr.

Thoelke

with

his

opined

blood

that

pressure

plaintiff’s

hypertensive urgency was likely exacerbated by his cocaine use.
(Id.)

He noted that plaintiff had not checked his blood sugar last

night, and instructed plaintiff to take Glucophage and monitor his
blood sugar.

(Id.)

Plaintiff was advised to stop smoking, but it

is noted that he had no interest in attempting to do so.
431).

(Tr.

It is noted that plaintiff left against medical advice, and

was instructed to follow up with his primary care doctor within one
week.

(Tr. 432).
In January of 2009, plaintiff presented to the emergency

room at St. Mary’s Health Center with complaints of chest pain of
three to five seconds in duration.

(Tr. 356).

Plaintiff reported

that he had run out of hypertension medications while incarcerated.
(Id.)

Plaintiff was “slightly short of breath” and denied nausea,

vomiting, diarrhea, and angina-type symptoms in the last six
months.

(Id.)

In the emergency room, plaintiff was found to have

uncontrolled blood pressure, and was admitted for observation.
- 9 -

(Id.)

During his hospital stay, he did not have any more symptoms.

(Tr.

356).

His

medication.

(Id.)

(Id.)

blood

pressure

improved

when

he

received

EKG and cardiac enzyme testing were negative.

He was observed to be comfortable, and in no acute distress.

(Tr. 357).

There was no edema in his extremities.

The

(Id.)

assessment was atypical chest pain of unknown origin, type-2
diabetes, obesity, uncontrolled hypertension, and high cholesterol.
(Tr. 358).

He was discharged home with instructions to take

Lisinopril6 and Zocor,7 to take Maalox when he had episodes of chest
pain, and to have regular medical care, especially for diabetes
control.

(Id.)
On March 20, 2009, plaintiff presented to Inna Lee Park,

M.D.,

for

an

internal

medicine

examination.

(Tr.

389-95).

Plaintiff reported hypertension of five to ten year duration, and
stated that he was compliant with his medication.

(Tr. 389).

He

stated that he suffered from headaches every three to four days
that resolved when he took his medication.

(Id.)

He reported that

he was hospitalized three to four times per year for hypertension.
Plaintiff also reported diabetes of five to ten year

(Id.)

duration.
checked

(Id.)

and

did

Plaintiff stated that he had not had his eyes
not

know

of

any

eye

problems.

(Tr.

389).

6

Lisinopril, is used to treat hypertension.
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/
a692051.html
7

Zocor (Simvastatin) is used together with diet, weight loss
and exercise to reduce the amount of LDL cholesterol in the blood
and increase the amount of HDL cholesterol in the blood.
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a692030.html
- 10 -

Plaintiff reported numbness and tingling in his hands once per
week.

(Id.)

Plaintiff also reported shortness of breath and

asthma of a five to ten year duration.

(Id.)

He reported that he

used inhalers and that they helped, but that he had bad days about
once per week.

(Tr. 390).

He reported that he was short of breath

on a daily basis, and could walk one block and climb one flight of
stairs before becoming short of breath.

(Id.)

that standing and sitting were not a problem.

Plaintiff stated
(Id.)

that he tried to do sit-ups on a weekly basis.

He reported

(Id.)

Plaintiff

reported that, one year ago, he stopped doing yard work because of
his breathing difficulties.
impotence.

(Tr. 390).

Plaintiff complained of

(Id.)
Upon

examination,

Dr.

Park

found

plaintiff

to

be

comfortable with good knowledge of his medical issues and good
hygiene.

examination.
(Tr. 391).
normal.

He was obese, and had normal endurance for the

(Id.)

(Id.)

He had cataracts, left greater than right.

His lungs were clear, and cardiac examination was

(Id.)

He had bilateral ankle edema, but no varicosities,

brawny edema (change typical of chronic venous insufficiency),
stasis

changes,

or

ischemia.

(Id.)

Upon

musculoskeletal

examination, he was unable to make a fist with the right hand due
to a machine injury on the palmar aspect of the right hand and
inability to flex at the distal interphalangeal joints of the third
and fourth fingers.

(Id.)

He had mildly decreased range of motion

of the bilateral elbows, knees, wrists and left ankle, and there
was crepitus in the bilateral knees.
- 11 -

(Tr. 391).

There was no

evidence of joint inflammation and no muscular atrophy.

(Id.)

Plaintiff got on and off the examination table without difficulty.
(Id.)

Dr. Park noted that plaintiff had a limp due to a left foot

fracture, and could not stand on his toes or heels but could squat
to 90 degrees and recover independently. (Id.) Motor strength was
normal with the exception of the loss of complete hand grip, and
fine motor control, reflexes, sensory and cerebellar functioning
were intact.

(Tr. 391).

Dr. Park’s clinical impression was hypertension that was
uncontrolled and symptomatic on a weekly basis; fair to poorly
controlled

diabetes,

asthma

managed

by

inhalers,

diffuse

arthralgias with slightly decreased range of motion, right hand
injury with decreased grip on the right, and left foot injury with
decreased range of motion on the left.

(Tr. 392).

On April 21, 2009, plaintiff presented to the emergency
room of St. Louis University Hospital with complaints of shortness
of breath and chest pain with no precipitating factor.
(Id.)

He denied smoking and drug use.

(Tr. 456).

(Tr. 455).
Plaintiff’s

Lisinopril dosage was increased, his asthma was characterized as
stable, and he was instructed to resume taking Glucophage at home.
(Tr. 462).
On August 6, 2009, plaintiff presented to Grace Hill
Clinic, although there are no complaints reported.

(Tr. 502).

On

September 9, 2009, plaintiff returned to Grace Hill Clinic with
hypertension, and was seen by Umesh Inampudi, M.D.
is

noted

that

plaintiff

had

hypertension.

- 12 -

(Tr. 499).

(Id.)

It

Plaintiff

complained of eye pain but no vision loss, and review of all other
systems was negative.

(Tr. 499-500).

Plaintiff was instructed to

continue with his current medications.

(Tr. 500).

On November 18, 2009, plaintiff returned to Grace Hill
Clinic and was seen by Dr. Inampudi, who noted that plaintiff had
diabetes, hypertension, high cholesterol and asthma.

(Tr. 494).

It is noted that plaintiff’s asthma was allergic and seasonal.
(Id.)

There was pitting edema on the bilateral legs.

(Tr. 495).

There was no motor weakness or sensory loss, and balance and gait
were intact.

(Id.)

He was diagnosed with unspecified essential

hypertension that was “better” and it was noted that compliance was
discussed, as was diet and weight loss.

(Tr. 496).

diabetes was also described as “better.”

Plaintiff’s

(Id.)

On December 16, 2009, plaintiff returned to Grace Hill
Clinic and was seen by Dr. Inampudi, who noted that plaintiff had
diabetes and hypertension.

(Tr. 492).

redness and swelling to his left eye.

Plaintiff complained of

(Id.)

On January 14, 2010, plaintiff presented to the emergency
room of St. Louis University Hospital with complaints of shortness
of breath while in court.

(Tr. 449).

out of medication for three days.

He reported that he had been
(Id.)

He denied headache,

swelling, chest pain, and shortness of breath while lying flat.
(Id.)

Chest x-ray revealed a mildly enlarged heart.

(Tr. 453).

Plaintiff was given medication, and his symptoms resolved.
450-51).

(Tr.

He was discharged home with instructions to follow up

with his doctor in two to three days.
- 13 -

(Tr. 452).

On April 2, 2010, plaintiff was seen at Grace Hill Clinic
by

Dr.

Inampudi,

hypertension.

who

noted

(Tr. 486).

that

plaintiff

had

diabetes

It is noted that plaintiff’s risk

factors were high salt intake, and sedentary lifestyle.
Plaintiff

reported

that

and

he

was

adhering

to

(Id.)

medication

recommendations for diabetes and hypertension, but not adhering to
diet recommendations for either condition. (Id.) It is noted that
diabetes was managed with oral medication.

(Id.)

Plaintiff’s

active medications were listed as Ketoconazole (a topical cream to
treat fungal infection), aspirin, and Viagra.8
other review of systems was negative.
acute distress.

(Tr. 487).

(Id.)

(Tr. 486).

All

Plaintiff was in no

His lungs were clear, his heart rate

was regular, there was edema in his extremities, and there was no
skeletal

tenderness.

(Id.)

The

assessment

was

“[d]iabetes

mellitus without mention of complication,” “[u]nspecified essential
hypertension,” and obstructive sleep apnea.

(Id.)

Plaintiff was

advised to follow a strict diet and to begin using Lantus (injected
insulin) to manage his diabetes. (Id.) Regarding hypertension, it
is noted that it was “better” and that diet and weight loss had
been discussed.

(Tr. 487).

On April 23, 2010, Dr. Inampudi completed a Physician’s
Assessment For Social Security Disability Claim form.

(Tr. 518).

Dr. Inampudi listed plaintiff’s diagnoses as hypertension, insulin-

8

Viagra, or Sildenafil, is used to treat erectile
dysfunction.
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/
a699015.html
- 14 -

dependent diabetes, obstructive sleep apnea, high cholesterol,
obesity, osteoarthritis, and asthma.
that,

due

to

obesity,

sleep

apnea

(Id.)
and

Dr. Inampudi wrote

asthma,

plaintiff

difficulty with any activity due to shortness of breath.

had

(Id.)

Dr. Inampudi wrote that plaintiff’s condition imposed environmental
restrictions (such as working in extremes of temperature, humidity,
and dust, pollutants, chemicals, fumes, smoke, etc., due to asthma.
(Id.)

Dr. Inampudi wrote that, due to plaintiff’s “uncontrolled”

diabetes, hypertension, and asthma, it was unlikely plaintiff could
work as his endurance was low.

(Tr. 518).

Dr. Inampudi wrote that

plaintiff could not do any physical work due to “uncontrolled”
diabetes, hypertension, and asthma “at this time.”

(Id.)

In a Function Report dated February 18, 2007, plaintiff
described his daily activities as taking medicine, making phone
calls, and eating.

(Tr. 152).

He reported that he was able to

make sandwiches every day. (Tr. 154). Regarding household chores,
he reported that he could do very little at a time depending on how
he felt, and also stated that he became out of breath.
55).

(Tr. 154-

He wrote that he shopped in stores for food, but did not

drive because he did not have a license (Tr. 155).

He wrote that

his nephew helped him with all aspects of managing money, but that
his ability to handle money had not changed since the onset of his
condition.

(Tr. 155-56).

Describing his hobbies and interests,

plaintiff wrote that he watched television all day.

(Tr. 156).

went to a friend’s house once per week.

He wrote that

(Id.)

He

various abilities were limited due to a lack of air and chest pain,
- 15 -

and reported that he could walk for 20 feet before needing to rest.
(Tr. 157).

He wrote that he could pay attention all day, follow

written and spoken instructions well, and get along with authority
figures.

(Tr. 157-58).
III.

The ALJ’s Decision

The ALJ determined that plaintiff met the insured status
requirements of the Act through March 31, 2012.

(Tr. 11).

The ALJ

determined that plaintiff had the severe impairments of cocaineinduced

cardiomyopathy

hyperlipidemia,

and

non-insulin

chest
dependent

pain,

hypertension,

diabetes

mellitus,

obstructive sleep apnea, obesity, osteoarthritis and asthma, but
did not have an impairment or combination of impairments that met
or medically equaled a listed impairment.

(Tr. 11-12).

The ALJ

determined that plaintiff retained the residual functional capacity
(also “RFC”) to perform light work as defined in 20 C.F.R. §§
404.1567(b) and 416.927(b), meaning that he could lift and/or carry
20 pounds occasionally and 10 pounds frequently; stand and/or walk
six hours in an eight hour workday, sit a total of six hours in an
eight hour workday, could not climb ladders, ropes or scaffolds,
could have no exposure to dangerous unprotected heights or hazards,
could have no prolonged exposure to extreme heat or cold, could
occasionally balance, stoop, kneel, crouch and crawl, and could
have no concentrated exposure to pulmonary irritants.

(Tr. 13).

The ALJ determined that plaintiff could not perform his past
relevant work.

(Tr. 17).

The ALJ wrote that he considered the

Medical-Vocational Guidelines and had also considered vocational
- 16 -

expert

testimony

regarding

the

extent

to

which

plaintiff’s

additional limitations eroded the unskilled light occupational
base.

(Tr. 18).

The ALJ concluded that plaintiff was capable of

making a successful adjustment to other work that existed in
significant numbers in the national economy, and that a finding of
“not disabled” was therefore appropriate.
IV.

(Id.)

Discussion

To be eligible for Social Security Disability Insurance
Benefits and Supplemental Security Income under the Social Security
Act

(also

“Act”),

plaintiff

must

prove

that

he

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), 1382c(a)(3)(A). An individual
will

be

declared

disabled

“only

if

his

physical

or

mental

impairment or impairments are of such severity that he is not only
unable to do his previous work but cannot, considering his age,
education,

and

work

experience,

engage

in

any

other

kind

of

substantial gainful work which exists in the national economy.” 42
U.S.C. §§ 423(d)(2)(A), 1382c(a)(3)(B).
To

determine

whether

a

claimant

is

disabled,

Commissioner engages in a five-step evaluation process.
- 17 -

the

See 20

C.F.R. §§ 404.1520, 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.
working, disability benefits are denied.
decides

whether

the

claimant

has

a

If the claimant is

Next, the Commissioner
“severe”

impairment

or

combination of impairments, meaning that which significantly limits
his ability to do basic work activities.
impairment(s)

is

not

severe,

then

he

is

If the claimant’s
not

disabled.

The

Commissioner then determines whether the claimant’s impairment(s)
meet or equal any listed in 20 C.F.R., Subpart P, Appendix 1.

If

claimant’s impairment(s) is equivalent to a listed impairment, he
is conclusively disabled.

At the fourth step, the Commissioner

establishes whether the claimant can perform his past relevant
work.

If

so,

the

claimant

is

not

disabled.

Finally,

the

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
disability benefits.
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 adequate to support the conclusion.
Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001).

Johnson v.

The “substantial

evidence test,” however, is “more than a mere search of the record
- 18 -

for evidence supporting the Commissioner’s findings.”

Coleman v.

Astrue, 498 F.3d 767, 770 (8th Cir. 2007) (internal quotation marks
and citation 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).
If

substantial

evidence

exists

to

support

the

administrative decision, this Court must affirm that decision even
if the record also supports 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); see also Pearsall, 274
F.3d at 1217 (citing Young v. Apfel, 221 F.3d 1065, 1068 (8th Cir.
2000) (In the event that 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).
A.

RFC Determination
As

noted

above,

the

ALJ

determined

that

plaintiff

retained the residual functional capacity to perform light work
with some additional restrictions. Plaintiff claims that the ALJ’s
RFC determination is not supported by substantial evidence on the
record as a whole because the ALJ failed to properly consider
plaintiff’s age when determining disability; failed to consider the
symptoms from neuropathy when considering RFC; and failed to
consider that plaintiff had been diagnosed with edema.

- 19 -

Residual functional capacity is defined as that which a
person remains able to do despite his limitations.

20 C.F.R. §§

404.1545, 416.945, Lauer v. Apfel, 245 F.3d 700, 703 (8th Cir.
2001).

The ALJ must assess a claimant’s RFC based upon all

relevant,

credible

evidence

in

the

record,

including

medical

records, the observations of treating physicians and others, and
the claimant’s own description of his symptoms and limitations. 20
C.F.R. § 404.1545; Anderson v. Shalala, 51 F.3d 777, 779 (8th Cir.
1995); Goff, 421 F.3d at 793.
A claimant’s RFC is a medical question, and there must be
some medical evidence, along with other relevant, credible evidence
in the record, to support the ALJ’s RFC determination.

Id.;

Hutsell v. Massanari, 259 F.3d 707, 711-12 (8th Cir. 2001); Lauer,
245 F.3d at 703-04; McKinney v. Apfel, 228 F.3d 860, 863 (8th Cir.
2000).

Although an ALJ must determine the claimant’s RFC based

upon all relevant evidence, the ALJ is not required to produce
evidence and affirmatively prove that a claimant can lift a certain
weight or walk a certain distance.

Pearsall, 274 F.3d at 1217 (8th

Cir. 2001); McKinney, 228 F.3d at 863.
While

an

that

an

ALJ’s

RFC

determination

must

be

supported by some medical evidence, “the burden of persuasion to
prove disability and demonstrate RFC remains on the claimant.”
Vossen v. Astrue, 612 F.3d 1011, 1016 (8th Cir. 2010).
cannot meet this burden on his statements alone.

Plaintiff

There must be

medical signs and laboratory findings showing an impairment which
could reasonably be expected to produce the symptoms alleged and
- 20 -

which, when considered with all of the other evidence, would lead
to the conclusion that the claimant is disabled.

20 C.F.R. §§

404.1529, 416.929.
In

support

of

his

argument

that

the

ALJ

failed

to

properly consider his age, plaintiff cites the following statement
from

the

ALJ’s

decision:

“The

undersigned

cannot

find

the

claimant’s allegations that he is incapable of all work activity to
be credible because of significant inconsistencies in the record as
a whole.”

(Docket No. 13 at 13) (emphasis in original).

Noting

that he was considered “closely approaching advanced age” as of his
alleged

date

of

onset,

plaintiff

complains

that

the

ALJ

was

obligated to consider his age when considering his ability to
adjust to other work.

(Id.)

However, the ALJ’s decision includes

multiple references to the fact that the ALJ considered plaintiff’s
age when determining whether plaintiff was capable of making an
adjustment to other work. (Tr. 18).

The ALJ acknowledged his duty

to consider plaintiff’s age in making this determination, he noted
that he included plaintiff’s age in the hypothetical question he
posed to the VE, and he wrote that he had considered plaintiff’s
age, education, work experience and residual functional capacity in
reaching his conclusion that plaintiff was capable of adjusting to
other work.

(Id.)

The statement plaintiff cites in support of

this meritless argument was made in the context of analyzing
plaintiff’s credibility, not in the context of determining whether
plaintiff could make an adjustment to other work.
Plaintiff next contends that the ALJ erroneously failed
- 21 -

to consider the symptoms from neuropathy when considering RFC.
Plaintiff cites evidence documenting his complaints of tingling in
his

hands

and

feet,

and

concludes

consistent with diabetic neuropathy.

that

these

symptoms

are

Plaintiff also argues that

his erectile dysfunction is evidence that he has end-organ damage
from

diabetes.

Plaintiff’s

arguments

are

merely

speculative.

Plaintiff was never diagnosed with diabetic neuropathy.

The fact

that he has symptoms which are also experienced by people with
diabetic neuropathy does not demand the conclusion that plaintiff
has diabetic neuropathy.
end-organ damage.

Nor was plaintiff ever diagnosed with

None of plaintiff’s treatment providers opined

that plaintiff’s erectile dysfunction was related to diabetes or
that plaintiff’s erectile dysfunction was indicative of end-organ
damage.

In fact, on November 18, 2009, Dr. Inampudi characterized

plaintiff’s diabetes as “better” (Tr. 496), and on April 2, 2010,
diagnosed plaintiff with diabetes mellitus without complication.
(Tr. 486-87).
Plaintiff also complains that the ALJ “did not mention”
edema.

(Docket No. 13 at 14).

Contrary to plaintiff’s statement,

the ALJ did mention edema, acknowledging that it had been observed
upon examination. (Tr. 12). Plaintiff also complains that the ALJ
did not attempt to determine the cause of edema or the functional
limitations it caused.

However, the record contains no basis for

the ALJ to make such an inquiry.

No treatment provider listed

edema as a diagnosis, as plaintiff suggests.

Instead, edema was

occasionally noted as a finding upon examination.
- 22 -

When edema was

found on examination, it was not the focus of the examination nor
was concern expressed that edema was an ominous finding that
required special attention. No treatment provider attributed edema
to

any

particular

condition,

or

plaintiff’s ability to function.

indicated

that

it

limited

Plaintiff alleges no other

deficiencies in the ALJ’s RFC determination, and none appear after
careful evaluation and consideration along with the administrative
record.
B.

Dr. Inampudi’s Opinion
The ALJ rejected Dr. Inampudi’s opinion evidence after

determining that it was inconsistent with other evidence in the
record documenting that plaintiff’s conditions were controllable
with treatment.
not

cite,

and

Plaintiff alleges error, arguing that the ALJ did
the

record

does

not

contain,

support

for

the

conclusion that plaintiff’s impairments are well-controlled with
treatment.
A treating physician’s opinion is generally entitled to
substantial weight, but it does not automatically control, because
the ALJ must evaluate the record as a whole.

Davidson v. Astrue,

501 F.3d 987, 990 (8th Cir. 2007) (citing Charles v. Barnhart, 375
F.3d 777, 783 (8th Cir. 2004)).

According to the Regulations and

to Eighth Circuit precedent, a treating physician’s opinion must be
well-supported by medically acceptable clinical and laboratory
diagnostic techniques, and it must not be inconsistent with the
other

substantial

evidence

in

the

record.

20

C.F.R.

§§

404.1527(d), 416.927(d); Reed v. Barnhart, 399 F.3d 917, 920 (8th
- 23 -

Cir. 2005). “If the opinion fails to meet these criteria, however,
the ALJ need not accept it.”

Davidson v. Astrue, 578 F.3d 838, 842

(8th Cir. 2009) (internal citation omitted); see also Rogers v.
Chater, 118 F.3d 600, 602 (8th Cir. 1997); Ward v. Heckler, 786
F.2d 844, 846 (8th Cir. 1986) (If justified by substantial evidence
in

the

record

as

a

whole,

the

ALJ

can

discount

a

treating

physician’s opinion). When an ALJ discounts a treating physician’s
opinion, he should give “good reasons” for doing so. Davidson, 501
F.3d at 990 (citing Dolph v. Barnhart, 308 F.3d 876, 878 (8th Cir.
2002)).
Despite plaintiff’s argument, the ALJ did cite support
for the conclusion that plaintiff’s conditions were controllable.
The ALJ’s decision includes an exhaustive summary of the medical
information of record, including documentation of the evidence
demonstrating that plaintiff’s conditions were controlled with
medication and treatment. (Tr. 14-16). Later in his decision, the
ALJ considered Dr. Inampudi’s opinion, and wrote that it was
inconsistent

with

the

other

medical

information

of

record

documenting that plaintiff’s conditions were controllable with
proper treatment and medications.

(Tr. 16).

As the ALJ noted, the

January 2007 records from St. Mary’s Health Center document that
plaintiff

had

run

symptoms,

but

that

administered.

out
his

of

medication

symptoms

and

resolved

was
when

suffering
treatment

from
was

The undersigned notes that the records specifically

state: “[d]uring the hospital stay [plaintiff] did not have any
more symptoms.

His blood pressure was better when he received his
- 24 -

medication.”

(Tr. 356).

Plaintiff presented to St. Joseph’s

Health Center in May of 2008 with complaints of chest pain, and it
was noted that he was not taking his medication.

(Tr. 284).

Upon

discharge, however, after undergoing treatment, plaintiff’s blood
pressure was under control and his condition was characterized as
“improved and stable.”

(Tr. 275).

When plaintiff visited the

emergency room in January of 2010, it is noted that his symptoms
resolved when he was given medication.

(Tr. 450-51).

As the ALJ

observed, the administrative record documents numerous instances in
which plaintiff presented for treatment of symptoms and it was
observed that he had not taken his medications.

(Tr. 274-75, 276,

278, 280, 284, 356, 431, 449).
As

the

ALJ

observed,

this

evidence

supports

the

conclusion that when plaintiff’s conditions are uncontrolled, it is
because of medication noncompliance (and, as will be discussed
infra, sometimes cocaine use).

While plaintiff asserts that the

May 2008 St. Joseph’s Health Center records document that he was
compliant, review of those records show this statement to be
inaccurate.

During that visit, although plaintiff reported that

had been compliant with medications, his statement was revealed to
be untrue.

Dr. Wasserstrom observed that plaintiff had not taken

his medication that morning (Tr. 276), another doctor, Dr. Venkat,
observed

that

plaintiff

had

not

been

taking

blood

pressure

medicines (Tr. 278), and Dr. Wasserstrom ultimately opined that
plaintiff had “probable medicine noncompliance.”

(Tr. 275).

This is not the only occasion on which plaintiff was
- 25 -

untruthful

with

a

treatment

provider:

in

November

of

2008,

plaintiff told Dr. Thoelke that he had not used cocaine and
admitted cocaine use only after being confronted with a drug screen
positive for cocaine.

(Tr. 430-31).

In addition, while plaintiff

told Dr. Park that he had been compliant with medications since
being diagnosed with hypertension five to ten years ago (Tr. 389),
review

of

the

administrative

record

shows

otherwise.

While

plaintiff asserts that records from January 2009 document that his
medicines were changed while he was incarcerated, what is actually
documented is that plaintiff “[r]an out of his blood pressure
medications because [he] was incarcerated and he was complaining of
chest pain.”

(Tr. 356).

Regardless of the reason plaintiff was

not taking medication as prescribed, the fact remains that the
onset of his symptoms is most often caused by his failure to take
medication.

The record contains other evidence of plaintiff’s

tendency to be noncompliant with medical advice.

In November of

2008, plaintiff left the hospital against medical advice, despite
being warned that he might have heart disease and needed to undergo
testing. (Tr. 432).

All of the foregoing evidence supports the

ALJ’s decision to discredit Dr. Inampudi’s opinion evidence as
inconsistent with the other evidence of record, as does the fact
that

Dr.

Inampudi’s

opinion

contains

no

indication

of

what

medically acceptable clinical and laboratory diagnostic techniques
were used. See 20 C.F.R. §§ 404.1527(d), 416.927(d); Davidson, 578
F.3d at 842 (citing Hacker, 459 F.3d at 937) (if an opinion is not
well-supported by medically acceptable clinical and laboratory
- 26 -

diagnostic techniques and is inconsistent with the other medical
evidence, and ALJ need not accept it).
Plaintiff next argues that the ALJ should have considered
whether plaintiff missed doses of medication because he was unable
to afford it.
supports

the

Plaintiff contends that “substantial evidence
conclusion

that

Plaintiff

was

justified

in

not

strictly following a prescribed course of treatment because he did
not refuse treatment; he was denied medication secondary to an
inability to pay.”

(Docket No. 13 at 12).

The Eighth Circuit has held that “a lack of sufficient
financial resources to follow prescribed treatment to remedy a
disabling impairment may be ... an independent basis for finding
justifiable cause for noncompliance [with prescribed treatment].”
Tome v. Schweiker, 724 F.2d 711, 714 (8th Cir. 1984).

However,

this administrative record wholly fails to support the conclusion
that plaintiff’s noncompliance was justified. There is no evidence
that plaintiff ever sought medication and was refused due to an
inability to pay.
medical

Instead, the record shows that plaintiff sought

treatment

fairly

regularly,

including

emergency room and visiting Grace Hill Clinic.
plaintiff

left

Barnes

Jewish

Hospital

against

visiting

the

On one occasion,
medical

advice

because he chose to attend to a family matter, not because he could
not afford care.

(Tr. 432).

In addition, for at least part of the

relevant time period, plaintiff apparently had sufficient resources
to obtain cocaine and cigarettes. Such evidence is consistent with
the conclusion that plaintiff did not take his medication because
- 27 -

he did not want to, or because he did not think his conditions
caused symptoms that were severe enough to require medication. The
evidence of record is wholly inconsistent with plaintiff’s claim
that he did not take his medications because he could not afford
them.

See Brown v. Barnhart, 390 F.3d 535, 540 (8th Cir. 2004).
Plaintiff

suggests

that

the

fact

that

Dr.

Inampudi

prescribed injectable insulin supports Dr. Inampudi’s opinion that
plaintiff’s

diabetes

was

not

controllable

with

medication.

However, if Dr. Inampudi believed that plaintiff’s diabetes could
not be controlled with medication, then it is unlikely that he
would have prescribed medication.

Dr. Inampudi never recommended

that plaintiff needed to be hospitalized for elevated blood sugar,
he never referred plaintiff for treatment more intensive than that
offered at Grace Hill Clinic, and he never suggested that diabetes
was causing complications necessitating a more aggressive form of
treatment.

Also notable is the fact that Dr. Inampudi prescribed

injectable insulin during the same visit he observed that plaintiff
was not compliant with the recommended diabetic diet.
Dr. Inampudi’s opinion evidence is also inconsistent with
his own treatment records. During plaintiff’s course of treatment,
Dr. Inampudi characterized plaintiff’s diabetes and hypertension as
“better” (Tr. 496) and characterized his diabetes as having no
mention of complication.

(Tr. 487).

Dr. Inampudi repeatedly

documented that review of systems was negative (Tr. 486, 499-500),
and he advised plaintiff to continue on his current medication
regimen.

(Tr. 499-500).

Dr. Inampudi wrote that he discussed
- 28 -

compliance with plaintiff (Tr. 496), and noted that plaintiff was
not complying with dietary restrictions.

(Tr. 486).

Despite his

opinion evidence describing plaintiff’s diabetes and hypertension
as uncontrolled, Dr. Inampudi’s treatment records fail to document
serious concerns about controlling either condition, or that he
ever sent plaintiff to the hospital.

A treating physician’s

opinion must be consistent with his own treatment records in order
to be entitled to significant weight.

See Davidson, 578 F.3d at

842 (“It is permissible for an ALJ to discount an opinion of a
treating

physician

that

is

inconsistent

with

the

physician's

clinical treatment notes”).
Finally, Dr. Inampudi’s statement that plaintiff could
not do any work is not the type of opinion the Commissioner is
required to consider.

A medical source’s opinion that a claimant

is “disabled” or “unable to work” involves an issue reserved for
the Commissioner, and is therefore not the type of medical opinion
to which the Commissioner gives controlling weight.
Barnhart,

377

F.3d

801,

806

(8th

Cir.

2004)

See Stormo v.
(“[T]reating

physicians’ opinions are not medical opinions that should be
credited
gainfully

when

they

employed,

application

of

the

simply

state

because

that

a

are

merely

they

statute,

a

task

claimant

assigned

can

not

be

opinions

on

the

solely

to

the

discretion of the Commissioner”); 20 C.F.R. §§ 404.1527(e)(1),
416.927(e)(1).

The

ALJ

properly

- 29 -

considered

and

weighed

Dr.

Inampudi’s opinion.9
C.

Medication Side Effects
Noting that the ALJ’s decision confirmed the duty to

consider

medication

side

effects

when

assessing

credibility,

plaintiff contends that the ALJ failed to properly consider his
testimony that his medications made him drowsy and that he had low
energy.
Drugs.com,

In
a

support,
common

plaintiff

side

effect

argues
of

that,

three

(3)

“[a]ccording
of

to

Plaintiff’s

medications, metoprolol, lisinopril and trazodone, is drowsiness.
This supports Plaintiff’s contention that his medication makes him
tired, requiring a daily nap.”

(Docket No. 13 at 12).

An ALJ is required to consider medication side effects
(among other factors) when assessing credibility.
Heckler, 739 F.2d 1320, 1321-22 (8th Cir. 1984).

Polaski v.

In the case at

bar, the ALJ expressly acknowledged his duty to consider the “type,
dosage, effectiveness, and side effects of any medication the
claimant takes or has taken to alleviate pain or other symptoms.”
(Tr. 14). The ALJ then acknowledged plaintiff’s allegation that he
took a three-hour nap daily because his medications made him
9

Plaintiff’s brief includes recitation of Eighth Circuit
case law on the subjects of an ALJ’s duty to fully and fairly
develop the record and to re-contact a treating physician when
necessary. To the extent plaintiff can be understood to attempt
to develop arguments based upon these areas of the law, the
undersigned has reviewed the ALJ’s decision in light of the
administrative record and concludes that the ALJ fulfilled his
duty to ensure a fully and fairly developed record, and was under
no obligation to re-contact any of plaintiff’s treatment
providers.
- 30 -

sleepy, but concluded that this testimony was not supported by the
medical record.

(Id.)

This finding is supported by the record.

Plaintiff does not allege, and review of the record does not
reveal,

evidence

that

plaintiff

mentioned

to

his

treatment

providers that his medications caused drowsiness or sleepiness, or
that he required a three-hour daily nap.

Accordingly, the ALJ was

under no obligation to consider such side effects in his RFC
determination.

See Ownbey v. Shalala, 5 F.3d 342, 345 (8th Cir.

1993) (ALJ did not err in discrediting claimant’s testimony that
her medication caused dizziness and drowsiness where the record
contained no complaints of side effects to her physicians); Wildman
v. Astrue, 596 F.3d 959, 968 (8th Cir. 2010) (inconsistencies in
the record are proper considerations in assessing credibility).
While plaintiff cites information available on Drugs.com
as

supportive

of

his

testimony

that

his

medications

caused

drowsiness and that he required a three-hour daily nap, Drugs.com
contains no information specific to plaintiff. While Drugs.com may
indeed indicate that drowsiness is a common side effect, such an
indication cannot be extended to support the conclusion that every
person who takes those medications will suffer from drowsiness
and/or require a three-hour daily nap.

Finally, there is no

evidence supporting the conclusion that plaintiff’s alleged side
effects existed for a period of twelve consecutive months.

20

C.F.R. §§ 404.1509, 414.909; Shell v. Astrue, 4:11CV1201 MLM, 2012
WL 2191282, at *7 (E.D. Mo. May 15, 2012) (citing 20 CFR § 414.909)
- 31 -

(medication side effects must be expected to last for a continuous
period of at least 12 months to be considered disabling).
Plaintiff alleges no other error in the ALJ’s credibility
assessment.

Even so, the undersigned has fully analyzed the ALJ’s

credibility determination, and concludes that it is supported by
substantial evidence on the record as a whole.

In his decision,

the ALJ wrote that he had considered all symptoms and the extent to
which they could reasonably be accepted as consistent with the
objective

medical

evidence

and

other

evidence,

based

on

the

requirements of 20 C.F.R. §§ 404.1529 and 416.929, and SSRs 96-4p
and

96-7p.

description

(Tr.
of

13).

his

The

ALJ

obligations

then
in

included

considering

a

narrative

plaintiff’s

subjective allegations, and listed all of the relevant factors he
was required to consider.

(Tr. 13-14).

The ALJ then noted several

inconsistencies in the record that detracted from the credibility
of plaintiff’s subjective complaints.

Having reviewed the ALJ’s

credibility determination in light of the evidence of record, the
undersigned concludes that the ALJ’s adverse credibility assessment
is supported by substantial evidence on the record as a whole.
D.

Plaintiff’s Cocaine Use
Among those impairments the ALJ determined were severe

was “cocaine-induced cardiomyopathy10 and chest pain.”
10

(Tr. 11,

As the defendant correctly points out, the record contains
no diagnosis of cardiomyopathy, but it does document
cardiomegaly. Cardiomyopathy is a disease that weakens and
enlarges the heart muscle. Cardiomyopathy makes it harder to
- 32 -

14). Plaintiff contends that the ALJ erroneously failed to obtain
a medical expert to determine whether illegal drugs caused or
contributed

to

plaintiff’s

heart

disease

and

the

degree

of

limitation caused thereby. Plaintiff argues that the ALJ failed to
consider “medical records that found cardiomyopathy and chest pain
with no mention of cocaine use” and later states that the ALJ
“cited no medical evidence to prove Plaintiff’s chest pain and
cardiomegaly11 were caused by cocaine use.”

(Docket No. 13 at 15)

(footnote added).
Plaintiff’s contention that the ALJ “cited no medical
evidence” regarding cocaine use causing/contributing to plaintiff’s
cardiac condition and chest pain is wholly without merit.

In his

decision, the ALJ cited medical evidence supporting the conclusion
that plaintiff’s cardiac problems were caused or exacerbated by his
cocaine use.

(Tr. 14-15).

As the ALJ observed, on November 17,

2007, chest x-ray showed cardiomegaly and mild pulmonary vascular

pump blood and deliver it to the rest of the body. There are
many causes of cardiomyopathy, including coronary artery disease
and valvular heart disease. Cardiomyopathy can lead to heart
failure. See
http://www.mayoclinic.com/health/cardiomyopathy/DS00519.
Cardiomegaly, also known as “enlarged heart,” is not a disease,
but rather a symptom of another condition. See
http://www.mayoclinic.com/health/enlarged-heart/ds01129.
It is
most likely that the ALJ’s use of the word “cardiomyopathy” was a
typographical error. In his recitation of the medical evidence
of record, the ALJ correctly summarized plaintiff’s diagnosis of
cardiomegaly. (Tr. 14).
11

Plaintiff also appears to confuse the terms
“cardiomyopathy” and “cardiomegaly”
- 33 -

congestion that was thought to have been induced by plaintiff’s
cocaine use, and he was instructed to stop using drugs.

(Tr. 245).

On November 6, 2008, plaintiff was diagnosed with chest pain and
hypertensive urgency “likely exacerbated by the cocaine use,” which
was identified via a drug screen, and plaintiff was again told to
stop using cocaine.

(Tr. 428-29).

The ALJ also noted the May 2008

records from St. Joseph’s Health Center documenting that the
cardiac symptoms plaintiff experienced stemmed from an uncontrolled
hypertension
medications.

episode

in

which

(Tr. 15).

plaintiff

was

not

taking

his

As the ALJ concluded, this evidence

supports the conclusion that, absent plaintiff’s drug use and
medication noncompliance, his cardiac condition would not cause
significant work-related restrictions.
For all of the foregoing reasons, on the claims that
plaintiff

raises,

the

undersigned

determines

that

the

Commissioner’s decision is supported by substantial evidence on the
record as a whole, and should therefore be affirmed. Because there
is substantial evidence to support the decision, reversal is not
required

merely

because

substantial

evidence

may

support

a

different outcome, or because another court could have decided the
case

differently.

Gowell

v.

Apfel,

Cir.2001); Browning, 958 F.2d at 821.

- 34 -

242

F.3d

793,

796

(8th

Accordingly,
IT

IS

HEREBY

ORDERED

that

the

decision

of

the

Commissioner is affirmed, and plaintiff’s Complaint is dismissed
with prejudice.

_______________________________
Frederick R. Buckles
UNITED STATES MAGISTRATE JUDGE
Dated this 27th day of September, 2013.

- 35 -