Pickle v. Colvin
MEMORANDUM AND ORDER - IT IS HEREBY ORDERED, ADJUDGED and DECREED that the final decision of the Commissioner denying social security benefits be AFFIRMED. Judgment shall be entered accordingly. Signed by Magistrate Judge Terry I. Adelman on 9/26/14. (KJS)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
REBECCA A. PICKLE,
CAROLYN W. COLVIN, Commissioner
of Social Security,
No. 4:13CV949 TIA
MEMORANDUM AND ORDER
OF UNITED STATES MAGISTRATE JUDGE
This cause is on appeal from an adverse ruling of the Social Security Administration. The
suit involves an Application for Disability Insurance Benefits under Title II of the Social Security
Act. Claimant has filed a Brief in Support of her Complaint; the Commissioner has filed a Brief in
Support of her Answer; and Claimant filed a Reply thereto. The parties consented to the
jurisdiction of the undersigned pursuant to 28 U.S.C. § 636(c).
Claimant Rebecca A. Pickle filed Applications for Disability Insurance Benefits under
Title II of the Act, 42 U.S.C. §§ 401 et. seq. (Tr. 168-77).1 Claimant states that her disability
began on November 2, 2007,2 as a result of degenerative disc disease of lumbar 4 and lumbar 5
vertebrae. (Tr. 90). On initial consideration, the Social Security Administration denied Claimant's
claims for benefits. (Tr. 90-95). Claimant requested a hearing before an Administrative Law
"Tr." refers to the page of the administrative record filed by the Defendant with her Answer
(Docket No. 11/filed August 2, 2013).
On December 5, 2011, Claimant filed a Notice of Amended Onset changing the onset date
from October 15, 2007 to November 2, 2007. (Tr. 178, 199).
Judge (“ALJ”). On October 22, 2009, a hearing was held before the ALJ who issued an
unfavorable decision on December 22, 2009. (Tr. 28-47, 73-81). Thereafter, Claimant filed a
Request for Review of Hearing Decision, and the Appeals Council granted the request for review,
vacated the hearing decision, and remanded the case to the ALJ to address certain matters on
March 18, 2011. (Tr. 86, 87-89). In relevant part, the Appeals Council directed the ALJ to
resolve the following:
The record is unclear regarding the nature and severity of the claimant’s mental
impairment(s).... Specifically, the claim file does not contain an assessment from a
consultative examiner, treating physician, or a medical source from the State
Agency on the claimant’s mental status.
...Specifically, the hearing decision indicates, in part, that the medical record for
the post-February 2009 period does not show any visits to a psychiatrist,
psychologist, or a therapist. A review of the records, however, shows that the
claimant has been receiving mental health treatment via various medications for
fluctuations in her mood from her treating physician, Philip Dean, M.D. Rationale
with cited medical evidence is needed to support why the claimant’s alleged mental
impairment does not meet the duration requirement.
Update the medical evidence on the claimant’s impairments in order to complete
the administrative record ... regarding consultative examination and existing
Give further consideration to the claimant’s maximum residual functional capacity
during the entire period at issue and provide rationale with specific references to
evidence of record in support of assessed limitations.
Further, evaluate the claimant’s subjective complaints and provide rationale in
accordance with the disability regulations pertaining to evaluation of symptoms.
Further, evaluate the claimant’s mental impairment(s) in accordance with the
special technique described in 20 CFR 404.1520a, documenting application of the
technique in the decision by providing specific findings and appropriate rationale
for each of the functional areas...
If warranted by the expanded record, obtain evidence from a vocational expert to
clarify the effect of the assessed limitations on the claimant’s occupational base.
(Tr. 87-88) (internal citations omitted).
On December 5, 2011, a supplemental hearing was held before an ALJ. (Tr. 48-70).
Claimant testified and was represented by counsel. (Id.). Vocational Expert Delores Gonzalez
also testified at the hearing. (Tr. 61-67, 133-36). Thereafter, on March 12, 2012, the ALJ issued
a decision denying Claimant’s claims for benefits. (Tr. 12-21). The Appeals Council on March
21, 2013 found no basis for changing the ALJ’s decision and denied Claimant’s request for review
of the ALJ’s decision after considering the brief of representative. (Tr. 1-6, 260-63). The ALJ's
determination thus stands as the final decision of the Commissioner. 42 U.S.C. § 405(g).
Evidence Before the ALJ
A. Hearing on October 22, 2009
1. Claimant's Testimony
At the hearing on October 22, 2009 , Claimant testified in response to questions posed by
the ALJ and counsel. (Tr. 28-47). Claimant lives in her parents home with her parents, two
sisters, and her son in a single family home. (Tr. 31).
Claimant testified that she attended outpatient treatment at Alternative Behavioral Care
for prescription abuse in 2006, but the ALJ noted how she needs to provide the records
supporting her prescription drug abuse problem. (Tr. 34-38). She testified that she has severe
back pain from a herniated disc. (Tr. 38). After she had a microdiscectomy in 2005, her pain did
not improve and increasingly escalated to the point where cannot bend or stand for more than one
or two hours at a time. Claimant testified that she is either on the couch 24/7 or in the emergency
room. After her second surgery, she indicated that she is in bed two to three days a week. (Tr.
38). She experiences debilitating side effects from the medications such as dizziness and
drowsiness. (Tr. 39). Ms. Hammond, a therapist at Psych Care Consultants, has treated her after
her recent divorce and but not the last couple of months due to her loss of insurance. (Tr. 39).
In response to the ALJ noting her history of opioid dependence, Claimant explained how it
was related to her back pain. (Tr. 39). Claimant can lift a gallon of milk and is able to bathe on
her own. (Tr. 41). She cooks, shops for brief periods, and drives. (Tr. 41). She does her own
personal finances and for exercise does some light stretching. (Tr. 42) . Her hobbies include
watching television, playing board games with her son, and helping her son with his homework.
She has a lot of friends and family, and she visits. (Tr. 42). After picking her son up from school,
she may take him to get ice cream or go to the toy store for twenty to thirty minutes. (Tr. 43).
Dr. Dean treats Claimant for failed back syndrome. (Tr. 44). Since the fall of 2008, she
has had some repeated hospitalizations for treatment of depression. (Tr. 45). Claimant explained
how there was some problem adjusting her depression medications, because she has problems
with reactions to medications. Her use of narcotics was during a period of experiencing severe
back pain. (Tr. 45).
Claimant testified that she had to give up her nursing license because of narcotics. (Tr.
45). She could not physically work as a nurse or any other kind of employment. (Tr. 46).
B. Hearing on December 5, 2011
1. Claimant's Testimony
At the hearing on December 5, 2011 , Claimant testified in response to questions posed by
the ALJ and counsel. (Tr. 48-70). At the outset of the hearing, counsel amended the onset date
of disability to November 2, 2007 from October 15, 2007. (Tr. 50-51). Claimant lives in her
parents home with her parents, and her sister. (Tr. 51). She has a nursing degree, but her license
expired in 2010. (Tr. 52).
Claimant had one DUI in 2007 and received outpatient treatment for drugs at Alternative
Behavioral Care in 2007. (Tr. 53). The ALJ noted that the record shows she was also treated in
2006 and 2009 for psychiatric treatment. (Tr. 54).
Claimant testified that she worked at Barnes-Jewish for three years and stopped working
in November 2007. (Tr. 55). Counsel indicated that Claimant’s diagnosed physical impairments
include failed back syndrome, chronic pain, degenerative disc disease, and sleep disorder and her
mental impairments include bipolar disorder, major depressive disorder, and anxiety. (Tr. 55-56).
She is not currently being treated by a psychiatrist or psychologist, but Dr. Philip Dean, a
neurologist, prescribes her pain medication and psychiatric medications. (Tr. 56). She testified
that she does not have the money to pay for counseling for her mental impairments. (Tr. 56).
Claimant testified that her narcotic pain medication is the lowest dose of Oxycontin. (Tr. 59). In
response to the ALJ’s question regarding how she is still taking narcotic pain medication even
though she is addicted, Claimant explained how she has requested to be weaned off the
medication. (Tr. 59-60). The ALJ reminded Claimant how her testimony is being compared to
the medical records for the purpose of making a credibility determination. (Tr. 60). She has not
consumed alcohol for three to four years. (Tr. 60).
Claimant testified that she can shower and dress herself, but on a bad day, she cannot
shower. (Tr. 57). The ALJ noted how her testimony is differing from the testimony she provided
at the previous hearing. (Tr. 57). Claimant apologized for giving only testimony as to her present
condition not covering a time from her alleged onset date to the present. (Tr. 58). She spends a
lot of time lying on the coach watching television and about every thirty minutes she changes her
position. (Tr. 59). Claimant testified that she is not able to last eight hours without lying down.
She usually has to lie down three to four times in an eight hour day. (Tr. 59).
2. Testimony of Vocational Expert
Vocational Expert Delores Gonzalez testified at the hearing. (Tr. 61-67, 133-36). Ms.
Gonzalez found Claimant’s records and testimony show she has work experience as a nurse. (Tr.
61). Ms. Gonzalez noted how Claimant worked as a registered nurse, classified as medium,
skilled work with diabetes education as part of her job duties. (Tr. 62). Based on Claimant’s
testimony, the nursing skills as she performed them would have ranged from light to medium.
(Tr. 64). Ms. Gonzalez listed customer service, bandaging, disinfecting, interviewing, injecting,
inoculating, taking pulses, supervisory skills without managerial, clerical, computer skills as
transferable work skills. (Tr. 64-65). The ALJ noted how her “medical records suggest that she
is functionally limited to light exertional work. She should avoid ropes, ladders, and scaffolding.
She can occasionally do stooping, crouching and crawling. She should avoid hazardous heights.”
(Tr. 66). The ALJ opined that “[a]lthough the claimant has not for quite a while received any
type of psychiatric care, despite her allegations of a disabling mental impairment, I will extend to
her the lightest possible latitude in developing her functional capacity and limit her to unskilled
work.” (Tr. 66). Ms. Gonzalez opined with those limitations, Claimant cannot perform any of
her past relevant work. (Tr. 66).
The ALJ asked Ms Gonzalez to assume that
a hypothetical individual with the claimant’s educational background, vocational
profile and residual functional capacity has the ability to perform [any jobs] that
exist in significant numbers on a regional and national level? If yes, please identify
those jobs by providing the DOT number, the number of positions available on a
regional and national level.
(Tr. 66). Ms. Gonzalez cited an order caller, a light and unskilled job with 2,815,240 jobs
available nationally,68,140 available in Missouri, and 31,070 available in the St. Louis
metropolitan area; a furniture rental consultant, light and unskilled, with 416.950 jobs available
nationally, 7,310 in Missouri, and 4,170 in the St. Louis metropolitan area; and a private company
mail clerk, light and unskilled, with 131,750 jobs available nationally, 3,430 in Missouri, and
1,680 in the St. Louis metropolitan area. (Tr. 66-67).
Claimant’s counsel asked Ms. Gonzalez the following:
... if you assume that Ms. Pickle needs to sit and stand frequently and that she can
neither sit nor stand for more than 30 minutes at a time, that she needs to lie down
several times during an eight-hour day, is she still able to do these three jobs that
(Tr. 67-68). Dr. Cook opined
Well, usually people work two hours, take a short break, work another two hours,
lunch hour, two hours, break, two hours. You know, if that’s possible, then those
jobs could be performed. The jobs that I cited were done with a sit-stand option,
so the person could change positions at will, however, if the person needs to take
breaks where the person would need to lie down at will, not within the parameters
of the breaks that are normally given, customarily given, then the person would
need to be accommodated and not be able to work competitively.
(Tr. 68). Claimant testified that two hours is the longest she has gone without taking a break to
lie down. (Tr. 68).
3. Open Record
At the end of the hearing, the ALJ noted she would leave the record open for three weeks
so that counsel could submit records from Barnes-Jewish evidencing her last date she worked.
(Tr. 69). Counsel provided that requested documentation showing that Claimant's employment
status had been inactive as of October 5, 2006 at BJC Healthcare. (Tr. 258). The evidence
submitted from Lincoln County Medical Center showed she had worked as a part-time registered
nurse from September 29, 2006 through December 26, 2006. (Tr. 259).
4. Forms Completed by Claimant
In the undated Disability Report - Adult, Claimant reported being unable to lift anything
heavier than a carton of milk and stopping work because of her disability. (Tr. 204-12). In the
undated Disability Report - Appeal, she reported being unable to work because of her severe back
pain and severe depression. (Tr. 216-24). She has to lie down and elevate her left leg
periodically. (Tr. 221). Claimant cooks easy meals taking no more than fifteen minutes to
prepare. She spends time with her child reading and coloring and doing workbooks. During her
bouts with depression, she does not visit friends or relatives. (Tr. 221).
In the Missouri Supplemental Questionnaire completed on October 19, 2009, she included
as her activities playing board games, coloring, reading with her son, talking on the phone, visiting
with friends, and watching movies/television. (Tr.237-44).
In the case analysis dated February 15, 2008, Ms. Otterson noted that the “[e]vidence in
file reveals that hypertension has been diagnosed, and is treated with medications.... There is no
evidence of end organ damage due to hypertension.” (Tr. 269).
On June 15, 2005, Claimant sought treatment in the emergency room at St. Joseph
Hospital West for sudden onset of symptoms of lower back pain and injury. (Tr. 416-20).
Examination showed paraspinal tenderness. (Tr. 416). The doctor diagnosed her with acute
lumbar strain and prescribed Flexeril and Percocet. (Tr. 417). The doctor noted how she is able
to ambulate normally. (Tr. 417).
Dr. Stanley Martin treated Claimant on June 28, 2005 at the request of Dr. Hoffman for
LLE pain. (Tr. 274). The neurologic examination showed her to be alert and full oriented and
normal memory and attention span. Dr. Martin noted her gait to be normal and she is able to
walk on heels, toes and in tandem without difficulty. (Tr. 274). The June 16, 2005, MRI showed
a left L5-S1 disc herniation with an inferiorly migrated fragment, and mild degenerative changes
at L4-5 and at T12-L1. (Tr. 275). Dr. Martin found she has syndrome consistent with a left S1
radiculopathy, and her symptoms are related to the disc abnormality at L5-S1. Dr. Martin
recommended doing a left L5-S1 micro discectomy and offered to perform the procedure the next
day, but Claimant declined wishing to wait a week until after the closing on her house. Dr. Martin
noted how she is willing to accept the risk of permanent weakness or chronic pain due to the
delay. (Tr. 275). On July 5, 2005, Dr. Martin performed a left L5-S1 micro-surgical discectomy.
(Tr. 272-73). In follow-up treatment on July 13, Dr. Martin found her to be doing satisfactorily,
and her symptoms to be consistent with inflammation of the nerve root postoperatively and
prescribed Motrin 800 mg. (Tr. 271). She reported marked improvement in her LLE pain on
July 28. (Tr. 270). Examination showed good strength in both lower extremities and able to
walk on her heels and toes. Dr. Martin released her to part-time work as a prn nurse but limited
her lifting to no more than thirty pounds and ordered physical therapy twice a week for two
weeks. Dr. Martin noted she did not have to return routinely but only for further problems. (Tr.
On February 1, 2006, Dr. Saaid Khjasteh noted she has a problem with narcotics. (Tr.
On February 12, 2006, Claimant presented at the emergency room at Lincoln County
Medical Center complaining of lumbar back pain starting after she lifted her thirty-five pound
child a couple of days earlier. (Tr. 563- 74).
In the February 15, 2006 assessment, Elizabeth Brown, a social worker at Alternative
Behavior Center, Claimant reported stress in her marriage, and her spouse lives in the basement.
(Tr. 379-80). Listed in the substance abuse history is narcotics, and job related problems as a
result of addiction. (Tr. 380). In the assessment, Ms. Brown noted Claimant “is addressing
addiction to prescription medication” and experiencing marital stress.” (Tr. 383). In the
Substance Abuse History, she reported using narcotics frequently. (Tr. 1391). In the Mental
Health/Psychiatric Treatment History, Claimant reported she had none. (Tr. 1392). In the
assessment, the Ms. Brown noted how she is addressing addiction to prescription medication and
experiencing marital stress causing depressed feelings. (Tr. 1394). In the treatment plan, it is
noted Claimant has employment problems and license issues due to stealing drugs. (Tr. 14223).
In the February 15, 2006 Treatment Plan Review, the following is noted as goals and plans: “...
admitted narcotic dependancy to administration. Plan to see EAP officer today (and) file
necessary paperwork with Mo. State Board of Nursing.” (Tr. 1426). In the plan, Dr. Khjasteh
noted she would need a new job without narcotics access. (Tr. 1426).
In the February 22, 2006 treatment note, Dr. Saaid Khjasteh listed her chemical
dependency to be narcotics, and she reported telling the hospital about her use. (Tr. 1387).
In the March 24, 2006 Discharge Summary, a case manager at Alternative Behavioral
Care noted how Claimant had been treated for abusing narcotics, and she should increase her
exercise regimen to four times a week. (Tr. 1379-80). She admitted to abusing prescription
drugs , her drug of choice being Dilaudid, while at work and getting the prescription drugs from
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work. (Tr. 1381, 1383).
On May 26, 2006, Claimant returned to Dr. Martin complaining of low back pain. (Tr.
268). She reported doing well postoperatively and having good improvement until she
experienced severe low back pain after playing volleyball. She first sought treatment in the
emergency room and received prescriptions for Vicodin, Flexeril, and Naprosyn, but she has run
out of the medications. Examination showed no tenderness of her lumbar spine and moderate
bilateral paralumbar muscular spasm to palpation. (Tr. 268). Dr. Martin diagnosed her with
acute lumbar soft tissue injury. (Tr. 269). Dr. Martin prescribed Percocet at her request, and he
prescribed Valium. (Tr. 269). In follow-up on June 13, she reported continued low back pain
and little relief from the medications. (Tr. 267). Examination showed no costovertebral
tenderness, and good strength in all of her extremities. Dr. Martin found her symptoms best fit
with a lumbar soft tissue injury, and he arranged for physical therapy treatment three times a week
for two weeks and prescribed Percocet. (Tr. 267).
On June 15, 2007, Claimant returned and reported doing well until about a month earlier
“when again, after no trauma or clear inciting event, she re-developed low back pain.” (Tr. 265).
She reported being off work for several months but not due to the low back pain. Examination
showed no tenderness of her lumbar spine and no costovertebral angle tenderness. (Tr. 265). Dr.
Martin observed her gait to be normal and found her to have good strength in all four extremities
without focal weakness. (Tr. 266). The May 24 MRI showed mild degenerative changes at L4-5.
Dr. Martin found her syndrome to be consistent with a lumbar soft tissue injury. She asked for a
Percocet refill, and he provided a refill of 60 tablets on a prn basis and asked her to return in three
to four weeks if she is not improving. (Tr. 266).
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On July 16, 2007, Claimant sought treatment from Dr. Kristin Phillbrick for low back pain
and requested pain medication so she could tolerate physical therapy. (Tr. 281). She reported
being a stay at home mom, registered nurse. Dr. Phillbrick prescribed 40 tablets of Percocet. (Tr.
281). On July 26, she reported continued pain with physical therapy helping for a few hours. (Tr.
280). Examination showed no vertebral spine tenderness, normal motor strength, and normal
gait. Dr. Phillbrick prescribed 60 tablets of Percocet and made a referral to St. Peters’ bone and
joint. (Tr. 280).
On September 11, 2007, Dr. Robert Backer noted how Claimant sought treatment for
chronic disabling back pain developing in the last year. (Tr. 278, 353-55). Dr. Backer found her
examination showed no signs for radiculopathy, and the MRI showed degenerative changes at
L5/S1, and he recommended a lumbar diskogram. (Tr. 278, 353-55).
From September 19, 2007 through March 11, 2008, Claimant received treatment at Pain
Management Services at Western Anesthesiology Associates on referral by Dr. Backer on ten
dates for low back pain. (Tr. 318-49). During the initial treatment on September 19, she
reported being currently unemployed and denied having used narcotics or undergoing drug or
alcohol rehabilitation or having abused prescription drugs. (Tr. 321-22). Examination showed
limited range of motion of the lumbar spine with flexion and extension and lower extremity
strength of 5/5. (Tr. 323). Dr. Brian Smith observed Claimant to have a normal gait and noted
she did not appear to be depressed and have any undue anxiety. (Tr. 324). In the assessment, Dr.
Smith included degenerative disc disease and lumbar disc protrusions, at L4-5 and L5-S1. He
had Claimant execute a narcotic contract and discontinued Oxycontin and prescribed Opana. (Tr.
324). On September 21, Dr. Smith performed a lumbar selective epidural steroid injection and
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discontinued Opana due to her vomiting with Opana and prescribed Oxycotin. (Tr. 318-19).
Claimant reported her pain as unchanged and no significant improvement from injection on
October 9. (Tr. 326). She underwent diagnostic lumbar discograms. (Tr. 326). The lumbar
discogram showed sensitive disc at L4-5 and L5-S1 with an essentially normal appearing control
disc at L3-4. (Tr. 327-28).
On November 9, 2007, Claimant sought treatment in the emergency room at St. Joseph
Hospital West for lower back pain. (Tr. 402- 408). Examination showed no tenderness to
palpitation to her back and mild pain with movement. (Tr. 402). She presented again the next
day and reported worsening pain and abdominal discomfort. (Tr. 469-559). Dr. Ranes found she
had intractable back pain “secondary to the fact that she has not been able to tolerate her home
doses of OxyContin. She is currently stable on patient-controlled analgesia. (Tr. 472). The CT
scan of her abdomen showed normal abdomen. (Tr. 502).
On November 13, 2007, Claimant reported going to the emergency room for pain and
receiving Dilaudid since her last visit on October 9. (Tr. 334). While in the emergency room, she
was treated with an IV PCA of Hydromorphone. (Tr. 334). Dr. Smith found she has
degenerative disc disease with discogenic pain involving L4-5 and L5-S1 discs with positive
discograms at these levels. (Tr. 335). Dr. Smith noted that inasmuch as she has tolerated
Hydromorphone better than any other narcotic, he continued Hydromorphone for pain. He also
provided samples and a prescription for Cymbalta for depression and noted it may provide some
additional pain relief. (Tr. 335). She returned on December 4 for mediation refills. (Tr. 336).
She reported running out of Oxycontin early because of vomiting. (Tr. 337). On December 18,
she called the office complaining of increased low back pain. (Tr. 340). She admitted tolerance
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to the pain medication may be an issue. (Tr. 340). Dr. Smith increased her Oxycontin dosage.
On December 4, 2007, Claimant sought treatment in the emergency room at St. Joseph
Hospital West for nausea and vomiting and reported recently switching from dilaudid to
oxycontin. (Tr. 409-14). She reported being out of her oxycontin medication, but the emergency
room doctor would not provide an oxycontin prescription but gave her a few percocet for relief
until she can follow up with Dr. Smith. (Tr. 410). After iv infusing, she reported feeling better.
In follow-up treatment on January 2, 2008, Dr. Smith continued her medication regimen.
(Tr. 342-43). On January 9, 2008, Dr. Smith noted since seeing Claimant last, she sought
treatment in the emergency room at St. Johns Mercy Medical Center for severe intrathecal back
pain, and Dr. Backer recommended performing a two level anterior fusion, and Dr. Page
increased her Oxycontin dosage to 160 mg. (Tr. 344). She noted some improvement of her pain.
(Tr. 344). Dr. Smith observed she appeared to be less depressed and less anxious compared to
her last office visit. (Tr. 345).
On January 3, 2008, Claimant was admitted through the emergency room for pain control
and reported disabling back pain even though she has been in pain management and tried epidural
steroids. (Tr. 301, 303). Examination showed lumbar spine to be nontender to palpation and
significant lumbar paraspinous muscle tenderness throughout the entire lumbar region. (Tr. 305).
She reported being a stay-at-home mom and previously working as a registered nurse. (Tr. 305).
Dr. Backer increased he Cymbalta dosage as she reported added stress to her life, because her
husband is considering a divorce. (Tr. 306). Dr. Backer noted that she is currently taking high,
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large doses of narcotics, 80 mg of Oxycontin three times a day and 50 mg of Percocet twice a
day. (Tr. 301). She had two incidental falls in the past days, one slipping in some mud.
Examination showed motor strength of 5/5. (Tr. 301). August MRI showed degenerative change
at L5-S1 with modic changes in the vertebral bodies of L5-S1, and Dr. Backer found she has
chronic disabling pain with degenerating disks. (Tr. 302).
On January 16, 2008, Dr. Backer performed a 2 level anterior lumbar interbody fusion at
L4-L5, L5-S1 for her chronic disabling low back pain. (Tr. 284-86). She reported Oxycontin and
Valium as her medications. (Tr. 286). Degenerative disk with disabling low back pain L4-5, L5S1 is listed as postoperative diagnosis. (Tr. 293). The January 31, 2008, radiology report
showed stable anterior fusions at L4-L5 and L5-S1. (Tr. 283). Dr. Backer discussed with her
how he would not give her narcotics longer than three months postoperatively. (Tr. 364-65).
On January 31, 2008, Claimant returned to Dr. Backer’s office for treatment. (Tr. 356).
The image of her lumbar spine showed stable anterior fusions. (Tr. 360).
On February 27, 2008, Claimant reported some partial improvement with her pain status
post an anterior lumbar fusion. (Tr. 346). She is taking 120 mg of Oxycontin twice a day and
questioning if Cymbalta has been beneficial as treatment for her depression. (Tr. 346). Dr. Smith
discontinued Cymbalta and prescribed Paxil. (Tr. 347).
On March 6, 2008, Dr. Backer refilled her Oxycontin during an office visit. (Tr. 358).
On March 11, 2008, Claimant reported doing reasonably well after anterior fusion but
then developing severe intractable left lower extremity pain. (Tr. 348). Dr. Smith observed she
appears to be in significant pain ambulates with a left side limp. (Tr. 348-49). Dr. Smith
performed a lumbar selective nerve root steroid injection and noted her depression to be
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somewhat improved on Paxil. (Tr. 349). She reported taking significantly larger amounts of
Oxycontin due to her severe pain and her insurance will not allow her to have any more
Oxycontin until the prescription is due. As a consequence, Dr. Smith opined that she is not going
to be able to abruptly stop such large doses of narcotics, he prescribed MS Contin to take in
place. (Tr. 349).
The March 26, 2008 MRI showed mild central canal narrowing unchanged at L4-L5
without evidence of significant disc bulging, and interval surgery with anteriorly located hardware
L4-L5 and L5-S1. (Tr. 361-62).
In the March 28, 2008 letter to Dr. Smith, Dr. Backer noted having a follow-up MRI
showing post operative changes and talking to Claimant who sounded quite well. (Tr. 365). She
would follow-up with him on an as needed basis. (Tr. 365).
On May 9, 2008, Claimant sought treatment in the emergency room at St. Joseph Hospital
West for nausea and vomiting and unable to keep food down for two to three days and unable to
take regular dose of oxycodone. (Tr. 427-68). Dr. Kristin Phillbrick noted given her tolerance to
opioids, her current doses of dilaudid are not adequate to manage pain. (Tr. 429).
On June 22, 2008, Claimant received treatment in the emergency room at Lincoln County
Medical Center after an intentional overdose. (Tr. 584-647). A nurse observed Claimant to have
an even, steady gait with no difficulties in ambulating noted. (Tr. 592). The attending physician,
Dr. Joy Stowell noted the exact timing of when the overdose occurred to be questionable. (Tr.
597). She complained how her back pain causes her to lie down most of the time and prevents
her from playing with her son. She reported not being able to work for the last two years. (Tr.
597). Dr. Stowell admitted her to ICU for observation and noted suicide attempt with
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polysubstance. (Tr. 598). Dr. Stowell had Claimant transferred to CenterPointe Hospital for
psychiatric care. (Tr. 645, 1080).
On June 23, 2008, Claimant was transferred to CenterPointe Hospital for psychiatric
stabilization after being hospitalized for voicing suicidal thoughts with an attempt by overdosing.
(Tr. 1080-1146). At the time of discharge, she noted how she is planning on divorcing her
husband, going on disability, and living with her mother. (Tr. 1080). The treating doctor noted
how she has tried different antidepressants by her pain doctor, but she has not sought treatment by
an outpatient psychiatrist. (Tr. 1085). The doctor admitted her for safety monitoring and
therapeutic milieu. (Tr. 1087). She noted she preferred Wellbutrin and hoped this would help her
with smoking cessation. (Tr. 1087).
On July 8, 2008, Claimant was transferred to CenterPointe Hospital from the inpatient
psychiatric unit after treatment for signs of depression with a suicide attempt and an overdose on
pills. (Tr. 1062-1079). She reported being separated from her husband, her child is living with
her parents, she is taking heavy addictive medications, and she is unable to work because of the
pain. (Tr. 1062). The Final Diagnoses in the Discharge Summary date July 16, 2008 lists major
depressive disorder without psychosis and rule out bipolar affective disorder, chronic pain, and
unemployed. (Tr. 1063).
On July 21, 2008, Claimant sought treatment at CenterPointe Hospital for increased
depression after being served her divorce papers the day prior to admission. (Tr. 969-1062). She
feared of taking an overdose and felt like she needed treatment at the hospital. (Tr. 969). She
reported emotional abuse for the last three to five years. (Tr. 970). Occupational problems is
listed in the discharge diagnoses. (Tr. 970). She reported being on disability due to back pain.
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(Tr. 972). Divorce process, relationship and unable to work are listed in the admission diagnoses.
On August 22, 2008, Claimant sought treatment at CenterPointe Hospital for worsening
depression and was admitted for treatment for six days. (Tr. 901-68). She is going through a
divorce and just learned her estranged husband is being transferred to Alabama. (Tr. 901, 906).
She reported being on disability due to back pain. (Tr. 906). The doctor observed she had
normal posture and gait, and noted she is preoccupied with the impending losses and stressors.
(Tr. 907). Mental status examination showed her concentration to be intact as evidenced by her
ability to follow three step directions, and her insight and judgment to be fair as evidenced by her
understanding of need for treatment. (Tr. 907).
On September 2, 2008, Claimant was admitted to CenterPointe Hospital’s Acute IOP
Program after stepping down from CenterPointe Hospital after being treated for a suicide attempt.
(Tr. 876-900). Her depression had increased over the last six months due to marital discord and
loss of her child from a custody dispute. (Tr. 876).
On October 22,2008, Claimant sought treatment at CenterPointe Hospital for increased
depression, lack of motivation, and suicidal ideation and was admitted for five days. (Tr. 818-75).
She reported going through a bad divorce and battling for custody of her son. (Tr. 818). The
following notation is made in the social history:
Social and Background History: She is currently staying with her parents. She is
separated. She has a five-year-old son. She has a RN degree. She is a Registered
Nurse, but has not been working for the past many years. Currently, she is
unemployed, retired, legal problems, battling son’s custody, and going through
(Tr. 825). She was admitted to psychiatric inpatient unit for assessment, stabilization, and
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medication adjustment. (Tr. 826).
On November 13, 2008, Claimant sought treatment at CenterPointe Hospital. (Tr. 673759). She reported her medications not working and her symptoms worsening. (Tr. 673). She is
having suicidal ideation with thoughts to overdose on medication. Her stressors include going
through a divorce and chronic back pain. “The patient also feels that she does not want to work
anymore.” (Tr. 673). She has been diagnosed with bipolar disorder and has had at least four
inpatient psychiatric admissions in the past two years. (Tr. 673). She reported undergoing a
nasty divorce, battling over custody, and currently not working. (Tr. 679, 681). She smokes a
package of cigarettes each day. (Tr. 673).
At the time of discharge on November 20, Dr. Malik found her mood to be stabilized and
her anxiety and depression to be decreased. (Tr. 673). She reported no side effects from
medications including OxyContin, Seroquel, Topamax, Wellbutrin, Ambien, Colace, Prozac,
Geodon, and Motrin, (Tr. 673-74). Bipolar affective disorder mixed and history of substance
abuse and problems with primary support group are listed in the discharge diagnoses. (Tr. 674).
On December 10, 2008, Claimant sought treatment at CenterPointe Hospital after having
hallucinations for six days and was admitted for treatment for six days. (Tr. 751-817). She has a
history of bipolar affective disorder and polysubstance dependency. (Tr. 751). Her major
stressor is she is currently going through a divorce, a custody hearing, and economic problems.
(Tr. 751-52, 763). She reported being a registered nurse but currently not working. (Tr. 754).
On December 22, 2008, Dr. Philip Dean treated Claimant and prescribed Oxycontin for
prn use for back pain breakthroughs. (Tr. 1267). On December 29, she reported disturbed
nocturnal sleep leading to daytime drowsiness. (Tr. 1278). She reported having fun over
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Christmas. (Tr. 1279).
From October 27, 2008 through February 16, 2009, Jennifer Hammond, a therapist, saw
Claimant five times. (Tr. 1148-52). In the psychological evaluation, she reported divorce and
custody as her psychosocial stressors. (Tr. 1150). In follow-up treatment on November 4, she
reported going shopping with her son. (Tr. 1149). On January 3, 2009, she reported totaling her
car and ended up in the hospital and being worried about having money for her attorney bills. (Tr.
1148). She has been spending time with her son and even had dinner with her husband for her
son’s sake. On February 16, she reported problems sleeping and going to family events and doing
stuff. (Tr. 1148).
On January 22, 2009, Dr. Dean examined Claimant. (Tr. 1285). Dr. Dean lowered her
Seroquel dose and observed she seems fairly stable. (Tr. 1288). She reported verbal counseling
helps. (Tr. 1288).
In the February 19, 2009 treatment note, Dr. Dean found her moods and back pain to be
improving. (Tr. 1216). She reported doing better on current medications without any side
effects. (Tr. 1217). On March 19, Dr. Dean noted how she is doing better, and she should follow
up with Dr. Malik. (Tr. 1228). On April 6, Claimant reported taking care of her son and
exercising together. (Tr. 1236). She complained of neck pain consistent with cervical radicular
pain, and Dr. Dean noted she needs to have a MRI for evaluation. She reported filing disability
papers on that day and slipping and falling the day before. (Tr. 1237, 1879). Although her
depression was bad last year, Claimant reported being much improved on medications. (Tr.
1237). In follow-up treatment on April 20, she reported experiencing headaches and doing better
on current medication regimen without any side effects. (Tr. 1248).
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On May 14, 2009, Dr. Scott Roos treated Claimant for elevated blood pressure and
lumbar disc degeneration. (Tr. 1309). Examination showed no skeletal tenderness or joint
deformity. (Tr. 1312). Neurological examination showed Claimant to be alert and oriented. She
was oriented to time, place, person, and situation, and her affect was normal. Dr. Roos noted she
had normal insight and exhibits normal judgment. (Tr. 1312).
In the May 18, 2009 letter to Dr. Malik, Dr. Dean provided a medical status update. (Tr.
On June 15, 2009, Dr. Philip Dean treated Claimant for anxiety and elevated blood
pressure. (Tr. 1161). She reported being a nonsmoker and exercising. (Tr. 1161). Dr. Dean
noted how no narcotic prescriptions would be refilled over the phone, and how any "lost
prescriptions" would require a new appointment. (Tr. 1162). Dr. Dean noted he could see her
without insurance if need be with many free samples or low cost programs from drug companies.
(Tr. 1163). He observed her gait to be normal and found her to be oriented to place and time and
person. (Tr. 1163). She complained of back pain due to disc disease. (Tr. 1164). Dr. Dean
noted how she had several psych admissions in 2008, but she is now very stable except for
insomnia since off of Seroquel. She reported not being able to see Dr. Malik lately because he is
out of town a lot. (Tr. 1164).
In a June 23, 2009 letter directed to Dr. Dean, Clinical Services at CVS Caremark noted
concern about Claimant’s medication regimen and urges changes to be made. (Tr. 1167). In the
Prescriber Response Form, Dr. Dean noted “You are ‘preaching to the choir.’ I m getting her off
of polypharmcy. Direct your concern to her other doctors! I already know!” (Tr. 1168). In
follow-up treatment on August 3, Dr. Dean lowered her Seroquel dose, and noted she seemed
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stable. She reported verbal counseling helping. (Tr. 1177-78). Dr. Dean counseled her to stop
smoking. (Tr. 1181).
In the August 31, 2009 letter to Dr. Malik, Dr. Dean noted how Claimant was doing well
after her stressful divorce and had little in a way of depressed moods. (Tr. 1192). Dr. Dean
noted her back pain due to disc disease may slowly respond to medicines and/or physical therapy.
Examination showed normal motor and sensory function and a normal gait, (Tr. 1192). On
September 28, Dr. Dean treated Claimant and adjusted her medication regimen. (Tr. 1207).
On October 26, 2009, Dr. Dean noted her back pain due to disc disease may slowly
respond to medications and/or physical therapy. (Tr. 1493). She expressed concern about health
insurance, and Dr. Dean explained he could still see her without insurance if need be with many
free samples or low cost programs from drug companies. (Tr. 1494). Dr. Dean noted her bipolar
to be “very stable except for insomnia since off Seroquel.” (Tr. 1493).
In the November 19, 2009 treatment note, Claimant reported vomiting for the last twelve
hours after eating a bad steak. (Tr. 1821). On December 14, Dr. Dean treated Claimant for
bipolar and back pain. (Tr. 1814). She reported doing very well. (Tr. 1816).
In the January 11, 2010 treatment note, Dr. Dean noted Claimant to be medicine
noncompliant. (Tr. 1787-99). She admitted how she was “doing not bad,” because the
medications help with her chronic back pain. (Tr. 1800). She fell on the ice two weeks earlier.
(Tr. 1800). On January 28, Claimant reported her mood to be better despite he Beck Depression
Inventory score. (Tr. 1791). She reported although her depression was really bad last year, the
depression has much improved on medications. (Tr. 1791). After falling on the concrete
driveway, she experienced throbbing pain. (Tr. 1793). In the February 8,treatment note, she
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reported having “little in way of depressed moods for many days at a time. No crying spells.”
(Tr. 1786). Dr Dean observed her gait to be normal. Dr. Dean found her back pain may slowly
respond to medicines and/or physical therapy. (Tr. 1786).
In the February 22, 2010 letter addressed to Claimant’s counsel, Dr. Dean opined as
I am responding to your request for a report in connection with Rebecca A.
Pickle’s Social Security Appeal. I have treated Becky from December 22, 2008 to
the present date for failed back syndrome. In my opinion, Becky is disabled and
unable to engage in any substantial gainful employment and has been unable to do
so since her most recent back surgery in January, 2008. She underwent two back
surgeries, the first being a laminectomy at L5-S1 performed by Dr. Stanley Martin
in July 2005, and then a fusion at L4-5 and L5-S1 in January, 2008 by Dr. Robert
Due to chronic pain, Becky cannot sit nor stand for more than 30 minutes
at a time. I have observed her when she was not aware I was doing so. There is
no “mismatch” of her exam room behavior versus her parking lot gait. She cannot
lift more than 10 to 15 pounds....
In my opinion, Becky does not exhibit any drug-seeking behavior. She has
requested that I lower or minimize her prescription medications faster than I felt
comfortable with. At times, we have lowered her medications too quickly and she
had panic attacks and insomnia and had to go back up slowly on the psychiatric
medication, not on her opioids. She had anxiety disorder and depressive disorder
prior to her back surgeries. She became suicidal after her divorce proceedings
began in 2008 and was hospitalized several times at Centerpoint Hospital with Dr.
Becky has bipolar disorder and depression and will need medication for this
condition for the rest of her life. She had four in-patient hospitalizations in the two
years prior to 2008, according to Dr. Malik’s records.
Due to her lumbar disc removal and fusions at two levels, with decreased
range of motion of her back, she cannot easily bend over or carry heavy objects. It
is possible she could perform some type of home-based work at a desk with
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On March 4, 2010, Dr. Dean prescribed choloral hydrate for sleep insomnia. (Tr. 1782).
She reported doing much better after starting Zantac one month earlier. (Tr. 1784). She reported
wanting to do duties of cooking. (Tr. 1784). In a follow-up visit on March 25, Claimant
reported not having depressed moods for many days at a time and no crying spells. (Tr. 1777).
Dr. Dean noted her cerebellar and gait to be normal. (Tr. 1777). Dr. Dean noted how she has
taken herself off many medications and encouraged her to be compliant in the future. (Tr. 1780).
On April 8, she reported falling down the basement stairs while carrying a food tray. (Tr. 117374). On May 3, Claimant reported her bipolar to be very stable except she is experiencing
insomnia since off Seroquel. (Tr. 1767). She noted the verbal counseling at CenterPointe
Hospital. (Tr. 1768). In the May 27 treatment note, Dr. Dean noted her Beck Depression
Inventory score seemed somewhat high and lowered her Seroquel dose. (Tr. 1761-63).
In the June 24, 2010 treatment note, Claimant reported medications provide relief for her
chronic back pain and having problems sleeping. (Tr.1890). Her mood is not bad considering her
marital relationship problems, and her son is moving to Kentucky because her former husband has
primary custody. (Tr. 1890). On July 29, Claimant reported not feeling motivated and having
difficulty sleeping. (Tr. 1885). Her back pain is causing problems with her activities of daily
living. (Tr. 1885). In the office visit on August 12, Claimant reported not sleeping and not taking
her blood pressure medication. (Tr. 1880). She has pain in her back, and has to go to Kentucky
to visit her son, because her estranged husband took him to Louisville. (Tr. 1880).
The September 14, 2010 radiology report of her lumbar spine identified no acute
abnormalities. (Tr. 1609, 1716).
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In the September 9, 2010 treatment note, Claimant reported mid back pain interfering with
her daily activities. (Tr. 1872). On September 27, she reported driving her vehicle off the
shoulder into the culvert when she looked down to pick up her phone. (Tr. 1867). Her head hit
the windshield in the accident and the air bag deployed, but she did not lose consciousness. She
has lower back pain Claimant concerned she might have a concussion, because she has blurred
vision and dizziness. (Tr. 1867). In follow-up treatment on October 25, she reported having a
motor vehicle accident on September 22 and having moderate back pain. (Tr. 1861).
The October 28, 2010 MRI of her lumbar spine showed status post anterior spinal fusion
at L4-L5 and L5-S1 with stable hardware, no large disc herniation, canal stenosis, minimal
annular bulge at L3-4, mild facet osteoarthritis at L4-5, and no abnormal enhancement. (Tr.
In the December 2 treatment note, Dr. Dean found her blood pressure to be high. (Tr.
1856). She had a motor vehicle accident on November 26, and reported her back pain persists.
On January 3, 2011, Claimant reported having back pain and no bowel movement for two
weeks. (Tr. 1851). In the February 4 treatment note, Dr. Dean found her blood pressure to be
high. (Tr. 1845). On February 24, Claimant reported having migraine headaches and shortness of
breath. (Tr. 1841).
During treatment in the emergency room on March 5, 2011, the musculoskeletal
examination showed a full range of motion of all four extremities. (Tr. 1618).
In the March 17, 2011 treatment note, Claimant reported smoking, and her boyfriend will
never steal medications again. (Tr. 1885). On March 28, Dr. Dean refilled her Oxycontin and
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Seroquel prescriptions. (Tr. 1881). In the April 25 treatment note, Claimant reported having
severe stomach pains and vomiting. (Tr. 1825).
On April 15, 2011, Claimant sought treatment in the emergency room for diffuse
abdominal cramping. Examination showed a normal range of motion along her entire spine and
non-tender. (Tr. 1637).
On April 18, 2011, Dr. Scott Roos treated Claimant for hypertension, abdominal
discomfort, and anxiety/depression. (Tr. 1662). Examination showed no motor weaknesses and
her balance and gait intact. (Tr. 1664-65). In the assessment, Dr. Roos noted her degenerative
disc to be chronic and stable. (Tr. 1668).
On May 26, 2011, Claimant reported having moderate back discomfort and improved
moods on Seroquel. (Tr. 1954). In the June 23 treatment note, Claimant reported tension with
her parents, because she is dating her boyfriend again after an earlier break up. (Tr. 1946). Her
son was supposed to spend the summer with her, but he returned to his father. On July 21,
Claimant complained of back pain, and Dr. Dean refilled her Oxycontin prescription. (Tr. 1936).
In the August 18 treatment note, Dr. Dean noted the last time Claimant saw Dr. Malik was in the
hospital. (Tr. 1932). She indicated that she could not work without pain medications, and the
$250 a month income makes it impossible to afford medications. (Tr. 1933).
In the October 13, 2011 treatment note, Dr. Dean nothing helping her headaches. (Tr.
1919). On October 21, Claimant reported having severe headaches. (Tr. 1909).
The ALJ's Decision
The ALJ found that Claimant met the insured status requirements of the Social Security
Act on November 2, 2007, and she remained insured throughout the period of the decision. (Tr.
- 26 -
17). Claimant has not engaged in substantial gainful activity since November 2, 2007. The ALJ
found that the medical evidence establishes that Claimant has the impairments of degenerative
lumbar disc disease and a bipolar disorder (the sleep disorder is considered a symptom of the
bipolar disorder). (Tr. 17). The ALJ found that Claimant’s condition has not met or medically
equaled a listing in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 18). The ALJ found that
since November 2, 2007, Claimant has had the residual functional capacity to perform a limited
range of unskilled light work, except she can only stoop, crouch, and crawl on an occasional
basis; has to avoid climbing of ladders, ropes, and scaffolds; and has to avoid hazardous heights.
The ALJ further noted she is able to understand, remember and carry out at least simple
instructions and non-detailed tasks. (Tr. 18).
The ALJ found Claimant unable to perform her past relevant work and does not have any
transferrable skills. (Tr. 20). Claimant is a younger individual with more than a high school
education and is able to communicate in English. (Tr. 20). Next, the ALJ found considering her
age, education, work experience, and residual functional capacity, there are a significant number
of jobs in the local and national economies she could perform including an order caller and a mail
clerk. (Tr. 20-21).
In a disability insurance benefits case, the burden is on the claimant to prove that he or
she has a disability. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001). Under the
Social Security Act, a disability is defined 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
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of not less than 12 months.” 42 U.S.C. §§ 423(d)(1)(A) and 1382c(a)(3)(A). Additionally, the
claimant will be found to have a disability “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) and
1382c(a)(3)(B); see also Bowen v. Yuckert, 482 U.S. 137, 140 (1987).
The Commissioner has promulgated regulations outlining a five-step process to guide an
ALJ in determining whether an individual is disabled. First, the ALJ must determine whether the
individual is engaged in “substantial gainful activity.” If she is, then she is not eligible for
disability benefits. 20 C.F.R. § 404. 1520(b). If she is not, the ALJ must consider step two which
asks whether the individual has a “severe impairment” that “significantly limits [the claimant’s]
physical or mental ability to do basic work activities.” 20 C.F.R. § 404.1520(c). If the claimant is
not found to have a severe impairment, she is not eligible for disability benefits. If the claimant is
found to have a severe impairment the ALJ proceeds to step three in which he must determine
whether the impairment meets or is equal to one determined by the Commissioner to be
conclusively disabling. If the impairment is specifically listed or is equal to a listed impairment,
the claimant will be found disabled. 20 C.F.R. § 404.1520(d). If the impairment is not listed or is
not the equivalent of a listed impairment, the ALJ moves on to step four which asks whether the
claimant is capable of doing past relevant work. If the claimant can still perform past work, she is
not disabled. 20 C.F.R. § 404.1520(e). If the claimant cannot perform past work, the ALJ
proceeds to step five in which the ALJ determines whether the claimant is capable of performing
other work in the national economy. In step five, the ALJ must consider the claimant’s “age,
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education, and past work experience.” Only if a claimant is found incapable of performing other
work in the national economy will she be found disabled. 20 C.F.R. § 404.1520(f); see also
Bowen, 482 U.S. at 140-42 (explaining five-step process).
Court review of an ALJ’s disability determination is narrow; the ALJ’s findings will be
affirmed if they are supported by “substantial evidence on the record as a whole.” Pearsall, 274
F.3d at 1217. Substantial evidence has been defined as “less than a preponderance, but enough
that a reasonable mind might accept it as adequate to support a decision.” Id. The court’s review
“is more than an examination of the record for the existence of substantial evidence in support of
the Commissioner’s decision, we also take into account whatever in the record fairly detracts
from that decision.” Beckley v. Apfel, 152 F.3d 1056, 1059 (8th Cir. 1998). The Court will
affirm the Commissioner’s decision as long as there is substantial evidence in the record to
support his findings, regardless of whether substantial evidence exists to support a different
conclusion. Haley v. Massanari, 258 F.3d 742, 747 (8th Cir. 2001).
In reviewing the Commissioner's decision, the Court must review the entire administrative
record and consider:
The credibility findings made by the ALJ.
The claimant's vocational factors.
The medical evidence from treating and consulting physicians.
The claimant'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
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is based upon a proper hypothetical question which sets forth the claimant's
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 ALJ’s decision whether a person is disabled under the standards set forth above is
conclusive upon this Court “if it is supported by substantial evidence on the record as a whole.”
Wiese , 552 F.3d at 730 (quoting Finch v. Astrue, 547 F.3d 933, 935 (8th Cir. 2008).
“Substantial evidence is less than a preponderance but is enough that a reasonable mind would
find it adequate to support the conclusion.” Wiese, 552 F.3d at 730 (quoting Eichelberger v.
Barnhart, 390 F.3d 584, 589 (8th Cir. 2004)). When reviewing the record to determine whether
the Commissioner’s decision is supported by substantial evidence, however, the Court must
consider evidence that supports the decision and evidence that fairly detracts from that decision.
Id. The Court may not reverse that decision merely because substantial evidence would also
support an opposite conclusion, Dunahoo v. Apfel, 241 F.3d 1033, 1037 (8th Cir. 2001), or it
might have “come to a different conclusion.” Wiese, 552 F.3d at 730. Thus, if “it is possible to
draw two inconsistent positions from the evidence and one of those positions represents the
agency’s findings, the [Court] must affirm the agency’s decision.” Wheeler v. Apfel, 224 F.3d
891, 894-95 (8th Cir. 2000). See also Owen v. Astrue, 551 F.3d 792, 798 (8th Cir. 2008) (the
ALJ’s denial of benefits is not to be reversed “so long as the ALJ’s decision falls within the
available zone of choice”) (internal quotations omitted).
Claimant contends that the ALJ's decision is not supported by substantial evidence on the
record as a whole, because the ALJ's RFC does not include limitations resulting from her bipolar
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disorder. Claimant also contends that the ALJ failed to accord appropriate weight to her treating
Weight Given to Treating Doctor
Claimant argues that the ALJ’s decision is not supported by substantial evidence on the
record inasmuch as the ALJ failed to give the treating source’s opinion proper weight.
The undersigned finds that the ALJ considered Dr. Dean’s opinion and gave sleight weight
to his opinion in her written opinion as follows:
In February 2010, Dr. Dean opined that the claimant’s lumbar condition
had precluded her from engaging in any substantial gainful employment since
January 2008.... This opinion is given slight weight because it is grossly
inconsistent with th exam results he obtained, namely, normal motor function,
normal reflexes, an absent Romberg’s test, an absent Gower’s sign, a normal gait,
and normal sensory function except at the C6-7 dermatone.... It is also internally
inconsistent: despite having sais she could not perform any substantial gainful
employment, he stated that she could lift up to fifteen pounds and sit as well as
stand thirty minutes at a time; he further stated that she may be able to perform
“home-based work at a desk with flexible hours.” The opinion is also inconsistent
with other evidence of record (see below as well as above).
(Tr. 19) (internal citations omitted).
"A treating physician's opinion is given controlling weight if it ‘is well-supported by
medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the
other substantial evidence in [a claimant's] case record.'" Tilley v. Astrue, 580 F.3d 675, 679 (8th
Cir. 2009) (quoting 20 C.F.R. §404.1527(d)(2) (alteration in original). "[W]hile a treating
physician's opinion is generally entitled to substantial weight, such an opinion does not
automatically control because the [ALJ] must evaluate the record as a whole." Wagner v. Astrue,
499 F.3d 842, 849 (8th Cir. 2007) (internal quotations omitted). Thus, "‘an ALJ may grant less
weight to a treating physician's opinion when that opinion conflicts with other substantial medical
- 31 -
evidence contained within the record.'" Id. (quoting Prosch v. Apfel, 201 F.3d 1010, 1013-14 (8th
A treating physician's opinion may be, but is not automatically, entitled to controlling
weight. 20 C.F.R. § 404.1527(d)(2). Controlling weight may not be given unless the opinion is
well-supported by medically acceptable clinical and laboratory diagnostic techniques. SSR 96-2P,
1996 WL 374188 (July 2, 1996). Even a well-supported medical opinion will not be given
controlling weight if it is inconsistent with other substantial evidence in the record. Id. "The
record must be evaluated as a whole to determine whether the treating physician's opinion should
control." Tilley, 580 F.3d at 679. When a treating physician's opinions "are inconsistent or
contrary to the medical evidence as a whole, they are entitled to less weight." Halverson v.
Astrue, 600 F.3d 922, 930 (8th Cir. 2010( (quoting Krogmeier v. Barnhart, 294 F.3d 1019, 1023
(8th Cir. 2002)). "A treating physician's opinion does not automatically control, since the record
must be evaluated as a whole." Perkins v. Astrue, 2011 WL 3477199, *2 (8th Cir. 2011)
(quoting Medhaug v. Astrue, 578 F.3d 805, 815 (8th Cir. 2009)). The ALJ is charged with the
responsibility of resolving conflicts among the medical opinions. Finch v. Astrue, 547 F.3d 933,
936 (8th Cir. 2008).
Additionally, Social Security Ruling 96-2p states in its "Explanation of Terms" that it "is
an error to give an opinion controlling weight simply because it is the opinion of a treating source
if it is not well-supported by medically acceptable clinical and laboratory diagnostic techniques or
if it is inconsistent with other substantial evidence in the case record." 1996 WL 374188, at *2
(S.S.A. July 2, 1996). SSR 96-2 clarifies that 20 C.F.R. §§ 404.1527 and 416.927 require the
ALJ to provide "good reasons in the notice of the determination or decision for the weight given
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to a treating source's medical opinion(s)." Id. at *5.
The ALJ found Dr. Dean’s opinion set forth in the February 22, 2010 letter opining that
her lumbar condition had precluded her from engaging in any substantial employment since
January 2008 to be inconsistent with his own exam results and treatment notes. The undersigned
finds no such limitations or findings precluding engaging in employment are found in any of his
treatment notes. “It is permissible for an ALJ to discount an opinion of a treating physician that is
inconsistent with the physician’s clinical treatment notes.” Davidson v. Astrue, 578 F.3d 838, 843
(8th Cir. 2009), or when it consists of conclusory statements, Wildman v. Astrue, 596 F.3d 959,
964 (8th Cir. 2010). See also Clevenger v. S.S.A., 567 F.3d 971, 975 (8th Cir. 2009) (affirming
ALJ’s decision not to follow opinion of treating physician that was not corroborated by treatment
notes); Chamberlain v. Shalala, 47 F.3d 1489, 1494 (8th Cir. 1995) (“The weight given a treating
physician’s opinion is limited if the opinion consists only of conclusory statements.”). Dr. Dean’s
opinions are not supported by his treatment notes and are conclusory. See McCoy v. Astrue, 648
F.3d 605, 617 (8th Cir. 2011) (rejecting claimant’s challenge to lack of weight given treating
physician’s evaluation of claimant’s mental impairments when “evaluation appeared to be based,
at least in part, on [claimant’s] self-reported symptoms, and, thus, insofar as those reported
symptoms were found to be less than credible, [the treating physician’s] report was rendered less
credible.”). In the February 8, 2010 treatment note, Dr Dean observed her gait to be normal.
Dr. Dean found her back pain may slowly respond to medicines and/or physical therapy.
First, to the extent Dr. Dean opined that Claimant is disabled, a treating physician’s
opinion that a claimant is not able to work “involves an issue reserved for the Commissioner and
therefore is not the type of ‘medical opinion’ to which the Commissioner gives controlling
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weight.” Ellis v. Barnhart, 392 F.3d 988, 994 (8th Cir. 2005). The ALJ acknowledged that Dr.
Dean was a treating source, but that his opinion was not entitled to controlling weight because it
is internally inconsistent and inconsistent with the objective medical evidence in the record. See
Travis v. Astrue, 477 F.3d 1037, 1041 (8th Cir. 2007) (“If the doctor’s opinion is inconsistent
with or contrary to the medical evidence as a whole, the ALJ can accord it less weight.”). As
noted by the ALJ, Dr. Dean’s opinion is internally inconsistent inasmuch as he opines she cannot
perform any substantial gainful employment but then concludes by opining she may be able to
perform home-based work at a desk with flexible hours.
The ALJ acknowledged that Dr. Dean was a treating source, but that his opinion was not
entitled to controlling weight, because it was not well-supported by medically acceptable clinical
and laboratory techniques. The undersigned notes no examination notes accompanied the
February 22, 2010 letter. Opinions of treating doctors are not conclusive in determining disability
status and must be supported by medically acceptable clinical or diagnostic data. Chamberlain v.
Shalala, 47 F.3d 1489, 1494 (8th Cir. 1995); 20 C.F.R. § 404.1527(d)(3) (providing that more
weight will be given to an opinion when a medical source presents relevant evidence, such as
medical signs, in support of his or her opinion).
Second, Dr. Dean’s opinion is inconsistent with his treatment notes. Davidson v. Astrue,
578 F.3d 838, 842 (8th Cir. 2009) (“It is permissible for an ALJ to discount an opinion of a
treating physician that is inconsistent with the physician’s clinical treatment notes.”). An ALJ may
“discount or even disregard the opinion of a treating physician ... where a treating physician
renders inconsistent opinions that undermine the credibility of such opinions.” Prosch v. Apfel,
201 F.3d 1010, 1013 (8th Cir. 2000); Hackler v. Barnhart, 459 F.3d 934, 937 (8th Cir. 2006)
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(holding that where a treating physician’s notes are inconsistent with his or her RFC assessment,
controlling weight is not given to the RFC assessment). The ALJ properly accorded Dr. Dean’s
limitations in the letter little weight inasmuch as his findings were inconsistent with, and
unsupported by, the evidence of record. See Travis v. Astrue, 477 F.3d 1037, 1041 (8th Cir.
2007) (“If the doctor’s opinion is inconsistent with or contrary to the medical evidence as a
whole, the ALJ can accord it less weight.”) (citation and internal quotation omitted). A review
of his treatment notes shows he never imposed any functional limitations on Claimant.
As noted by the ALJ, the objective medical evidence showed post-operative medical
images of her lumbar spine showed unremarkable results except for some sclerosis in the lower
lumbar region and possible edematous change. The most recent imaging of her lumbar spine, the
October 28, 2010 MRI, showed status post anterior spinal fusion at L4-L5 and L5-S1 with stable
hardware, no large disc herniation, canal stenosis, minimal annular bulge at L3-4, mild facet
osteoarthritis at L4-5, and no abnormal enhancement. Moreover, the musculoskeletal
examinations showed essentially normal results for a lumbar standpoint and consistently showed
she had normal motor, a normal gait, normal reflexes, and an absence of lumbar tenderness. On
April 18, 2011, Dr. Roos’ examination showed no motor weaknesses and her balance and gait
intact. In the assessment, Dr. Roos noted her degenerative disc to be chronic and stable.
As noted by the ALJ, Claimant reported helping her young son with homework, playing
board games, attending his school activities, and visiting with others. Likewise at the hearing,
Claimant testified she is able to shop and able to stand for an hour at a time.
Further, no examining physician in any treatment notes stated that Claimant was disabled
or unable to work or imposed mental limitations on Claimant’s capacity for work. See Young v.
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Apfel, 221 F.3d 1065, 1069 (8th Cir. 2000) (significant that no examining physician submitted
medical conclusion that claimant is disabled or unable to work); Edwards v. Secretary of Health &
Human Servs., 809 F.2d 506, 508 (8th Cir. 1987) (examining physician’s failure to find disability
a factor in discrediting subjective complaints). The absence of objective medical basis to support
Claimant’s subjective descriptions is an important factor the ALJ should consider when evaluating
those complaints. Renstrom v. Astrue, 680 F.3d 1057, 1065 (8th Cir. 2012); Stephens v. Shalala,
50 F.3d 538, 541 (8th Cir. 1995)(lack of objective findings to support pain is strong evidence of
lack of a severe impairment); Barrett v. Shalala, 38 F.3d 1019, 1022 (8th Cir. 1994)(the ALJ was
entitled to find that the absence of an objective medical basis to support claimant’s subjective
complaints was an important factor in evaluating the credibility of her testimony and of her
complaints). Thus, the ALJ did not err in giving slight weight to his findings. Renstrom, 680
F.3d at 1065 (ALJ properly gave treating physician’s opinion non-controlling weight when that
opinion was largely based on claimant’s subjective complaints and was inconsistent with other
medical experts). As such, the undersigned finds that the ALJ gave proper weight to Dr. Dean’s
The undersigned finds that the ALJ's determination is supported by substantial evidence on
the record as a whole. "It is not the role of [the reviewing] court to reweigh the evidence
presented to the ALJ or to try the issue in this case de novo." Wiese v. Astrue, 552 F.3d 728, 730
(8th Cir. 2009) (citation omitted). "If after review, [the court] find[s] it possible to draw two
inconsistent positions from the evidence and one of those positions represents the Commissioner's
findings, [the court] must affirm the denial of benefits." Id. (quoting Mapes v. Chater, 82 F.3d
259, 262 (8th Cir. 1996)). Accordingly, the decision of the ALJ denying Claimant's claims for
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benefits should be affirmed.
Residual Functional Capacity
Claimant contends that the ALJ's decision is not supported by substantial evidence on the
record as a whole, because the ALJ's RFC does not include limitations resulting from her bipolar
A claimant's RFC is what he can do despite his limitations. Dunahoo v. Apfel, 241 F.3d
1033, 1039 (8th Cir. 2001). The claimant has the burden to establish his RFC. Eichelberger v.
Barnhart, 390 F.3d 584, 591 (8th Cir. 2004). The ALJ determines a claimant's RFC based on 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. Goff v.
Barnhart, 421 F.3d 785, 793 (8th Cir. 2005); Eichelberger, 390 F.3d at 591; 20 C.F.R. §
404.1545(a). The ALJ is "required to consider at least some supporting evidence from a [medical
professional]" and should therefore obtain medical evidence that addresses the claimant's ability to
function in the workplace. Hutsell v. Massanari, 259 F.3d 707, 712 (8th Cir. 2001) (internal
quotation marks and citation omitted). An ALJ's RFC assessment which is not properly informed
and supported by some medical evidence in the record cannot stand. Id.
The ALJ opined that Claimant since November 2, 2007, Claimant has had the residual
functional capacity to perform a limited range of unskilled light work, except she can only stoop,
crouch, and crawl on an occasional basis; has to avoid climbing of ladders, ropes, and scaffolds;
and has to avoid hazardous heights. The ALJ further noted she is able to understand, remember
and carry out at least simple instructions and non-detailed tasks. Next, the ALJ found considering
her age, education, work experience, and residual functional capacity, there are a significant
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number of jobs in the local and national economies she could perform including an order caller
and a mail clerk. (Tr. 20-21).
At the outset, the undersigned notes that the fact that Claimant did not allege any mental
impairments in her application for disability benefits is significant, even though she submitted
medical evidence of treatment for bipolar disorder starting more than seven months after her
alleged onset date. In her application for disability benefits, Claimant alleged disability due to
degenerative disc disease of lumbar 4 and lumbar 5 vertebrae. The ALJ found Claimant has the
severe impairments of degenerative lumbar disc disease and a bipolar disorder with sleep disorder
as a symptom and concluded that the impairments, alone or in combination, are not of listing
level. A review of Claimant’s application shows that she failed to allege mental impairments as a
basis for disability. See Dunahoo v. Apfel, 241 F.3d 1033, 1039 (8th Cir. 2001) (failure to allege
disabling mental impairment in application is significant, even if evidence of depression was later
developed). The undersigned concludes that the ALJ did not err in discounting Claimant’s mental
impairments. See Kirby v. Astrue, 500 F.3d 705, 707-09 (8th Cir. 2007) (impairment is not
severe if it is only slight abnormality that would not significantly limit mental ability to do basic
work activities; claimant bears the burden of establishing impairment’s severity). The ALJ opined
that Claimant at the hearing as follows:
With respect to the claimant’s mental condition, the medical record is silent from
November 2, 2007 through June 21, 2008. It shows that she was hospitalized fro
psychiatric reasons eight times for a total of seventy-seven days during the June 22
to December 16, 2008 period. The hospitalizations lasted from two to eight days
on six occasions, thirteen days on one occasion, and twenty-three days on one
occasion. Hospital records show that she was diagnosed with bipolar disorder and
that her primary stressors were a pending divorce and a custody dispute.
However, the medical record for the post-December 16, 2008 period does not
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show any psychiatric hospitalization, while an evaluation of the claimant’s mental
status conducted at Psych Care Consultants in January 2009 did not demonstrate
any deficits or abnormalities other than a mildly depressed mood and some anxiety.
The medical record for the post-February 2009 period does not show that the
claimant made any visits to a psychiatrist, psychologist, or even a therapist. Her
only mental health treatment in this period was medication prescribed by a
physician, Dr. Dean, who noted in October 2009 that her bipolar disorder was
“very stable except for insomnia,” the insomnia apparently being due to the
claimant’s discontinuance of Seroquel.
(Tr. 19) (internal citations omitted). The ALJ opined that her mental impairments did not
significantly limit her ability to perform basic work activities beyond that considered in the RFC.
First, Claimant never alleged that her mental impairments were disabling, and she
presented no medical evidence substantiating this claim. Indeed, the medical evidence is devoid of
any support. As noted by the ALJ, Dr. Dean found her bipolar disorder to be stable except for
insomnia caused by her discontinuance of Seroquel..3
In her decision the ALJ thoroughly discussed the medical evidence of record, lack of
mental restrictions, activities of daily living, and inconsistencies in the record. See Gray v. Apfel,
As noted by the ALJ, Claimant's increased symptoms coincided with times of high stress.
Indeed, the treatment notes show that Claimant's condition improved with treatment with
situational stressors such as occupational problems, legal problems, custody dispute, marital
stress, child-related issues, and marital separation and pending divorce causing increased
symptoms. Indeed, Claimant reported increased depression after being served her divorce papers
the day prior to admission during treatment at CenterPointe Hospital. She complained of her
depression increasing over the last six months due to marital discord and loss of her child from a
custody dispute. The undersigned finds based on the medical record her depression to be
somewhat situational. Situational depression, however, is not disabling. See Gates v. Astrue, 627
F.3d 1080, 1082 (8th Cir. 2010) (ALJ properly found depression not disabling where it "was
situational in nature, related to marital issues, and improved with a regimen of medication and
counseling); Dunahoo v. Apfel, 241 F.3d 1033, 1039-40 (8th Cir. 2001) (holding that depression
was situational and not disabling because it was due to denial of food stamps and workers
compensation and because there was no evidence that it resulted in significant functional
limitations). In the February 8,treatment note, she reported having "little in way of depressed
moods for many days at a time."
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192 F.3d 799, 803-04 (8th Cir. 1999) (ALJ properly discredited claimant’s subjective complaints
of pain based on discrepancy between complaints and medical evidence, inconsistent statements,
lack of pain medications, and extensive daily activities). The ALJ then addressed several
inconsistencies in the record to support his conclusion that Claimant’s complaints were not
Specifically, the ALJ noted that no treating physician in any treatment notes stated that
Claimant was disabled or unable to work or imposed mental limitations on Claimant’s capacity for
work. See Young v. Apfel, 221 F.3d 1065, 1069 (8th Cir. 2000) (significant that no examining
physician submitted medical conclusion that claimant is disabled or unable to work); Edwards v.
Secretary of Health & Human Servs., 809 F.2d 506, 508 (8th Cir. 1987) (examining physician’s
failure to find disability a factor in discrediting subjective complaints). The absence of objective
medical basis to support Claimant’s subjective descriptions is an important factor the ALJ should
consider when evaluating those complaints. Renstrom v. Astrue, 680 F.3d 1057, 1065 (8th Cir.
2012); Stephens v. Shalala, 50 F.3d 538, 541 (8th Cir. 1995)(lack of objective findings to support
pain is strong evidence of lack of a severe impairment); Barrett v. Shalala, 38 F.3d 1019, 1022
(8th Cir. 1994)(the ALJ was entitled to find that the absence of an objective medical basis to
support claimant’s subjective complaints was an important factor in evaluating the credibility of
her testimony and of her complaints). Further, the ALJ noted that Claimant first was seen for
psychiatric evaluation in June 2008.
Likewise, the ALJ noted how the medical record is devoid of any evidence showing that
Claimant’s condition has deteriorated or required aggressive medical treatment after December
2008. Chamberlain v. Shalala, 47 F.3d 1489, 1495 (8th Cir. 1995) (failure to seek aggressive
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medical care is not suggestive of disabling pain); Walker v. Shalala, 993 F.2d 630, 631-32 (8th
Cir. 1993)( lack of ongoing treatment is inconsistent with complaints of disabling condition). The
medical record shows that after December 16, 2008, Claimant did not have any psychiatric
hospitalizations, and the medical record she only had a mildly depressed mood and some anxiety.
Claimant did not seek any treatment from a psychiatrist, psychologist, or therapist during that
time. Dr. Dean prescribed medication and he found on October 26, 2009 Claimant’s bipolar “very
stable except for insomnia since off Seroquel.”
The ALJ also properly considered the inconsistencies between Claimant’s allegations and
her daily activities. See Haley v. Massanari, 258 F.3d 742, 748 (8th Cir. 2001) (“[i]nconsistencies
between subjective complaints of pain and daily living patterns diminish credibility”); Riggins v.
Apfel, 177 F.3d 689, 693 (8th Cir. 1999) (finding that activities such as driving, shopping,
watching television, and playing cards were inconsistent with the claimant's complaints of
disabling pain). Another inconsistency in the record would be Claimant’s testimony regarding her
inability to walk more than fifty feet at a time or stand more than thirty minutes at a time as she
testified at the hearing. A review of the record shows she never reported such limitations during
treatment. Contradictions between a claimant’s sworn testimony and what he actually told
physicians weighs against the claimant’s credibility. Karlix v. Barnhart, 457 F.3d 742, 748 (8th
Cir. 2006) (finding a lack of credibility when claimant’s testimony regarding drinking consumption
conflicted with medical documentation). As such, the undersigned finds that the discrepancies
between Claimant’s testimony and what she told doctors is supported by substantial evidence.
After engaging in a proper credibility analysis, the ALJ incorporated into Claimant's RFC
those impairments and restrictions found to be credible. See McGeorge v. Barnhart, 321 F.3d
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766, 769 (8th Cir. 2003) (the ALJ "properly limited his RFC determination to only the
impairments and limitations he found credible based on his evaluation of the entire record."). The
ALJ determined that the medical evidence supported a finding that Claimant could perform
a limited range of unskilled light work. The ALJ further noted she is able to understand,
remember and carry out at least simple instructions and non-detailed tasks. The vocational expert
testified in response to hypothetical questions, that incorporated the same limitations as the RFC,
and opined that such individual could perform work as an order caller and a mail clerk.
As demonstrated above, a review of the ALJ's decision shows the ALJ not to have denied
relief solely on the lack of objective medical evidence to support her finding that Claimant is not
disabled. Instead, the ALJ considered all the evidence relating to Claimant's subjective
complaints, including the various factors as required by Polaski, and determined Claimant's
allegations not to be credible. Although the ALJ did not explicitly discuss each Polaski factor in
making his credibility determination, a reading of the decision in its entirety shows the ALJ to
have acknowledged and considered the factors before discounting Claimant's subjective
complaints. See Brown v. Chater, 87 F.3d 963, 966 (8th Cir. 1996). Inasmuch as the ALJ
expressly considered Claimant's credibility and noted numerous inconsistencies in the record as a
whole, and the ALJ's determination is supported by substantial evidence, such determination
should not be disturbed by this Court. Id.; Reynolds v. Chater, 82 F.3d 254, 258 (8th Cir. 1996).
Because the ALJ gave multiple valid reasons for finding Claimant's subjective complaints not
entirely credible, the undersigned defers to the ALJ's credibility findings. See Leckenby v. Astrue,
487 F.3d 626, 632 (8th Cir. 2007) (deference given to ALJ's credibility determination when it is
supported by good reasons and substantial evidence); Guilliams v. Barnhart, 393 F.3d 798,
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801(8th Cir. 2005).
The undersigned finds that the ALJ considered Claimant's subjective complaints on the
basis of the entire record before her and set out the inconsistencies detracting from Claimant's
credibility. 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 pointed out
inconsistencies in the record that tended to militate against the Claimant's credibility. See
Guilliams, 393 F.3d at 801 (deference to ALJ's credibility determination is warranted if it is
supported by good reasons and substantial evidence). Those included Claimant's
lack of mental restrictions, activities of daily living, the medical evidence of record, and
inconsistencies in the record. 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. See
Cox v. Barnhart, 471 F.3d 902, 907 (8th Cir. 2006); Robinson v. Sullivan, 956 F.2d 836, 841 (8th
Cir. 1992). Accordingly, the ALJ did not err in discrediting Claimant's subjective complaints of
pain. See Hogan v. Apfel, 239 F.3d 958, 962 (8th Cir. 2001)(affirming the ALJ's decision that
claimant's complaints of pain were not fully credible based on findings, inter alia, that claimant's
treatment was not consistent with amount of pain described at hearing, that level of pain described
by claimant varied among her medical records with different physicians, and that time between
doctor's visits was not indicative of severe pain).
The substantial evidence on the record as a whole supports the ALJ's decision. Where
substantial evidence supports the Commissioner's decision, the decision may not be reversed
merely because substantial evidence may support a different outcome. Woolf v. Shalala, 3 F.3d
1210, 1213 (8th Cir. 1993) (quoting Locher v. Sullivan, 968 F.2d 725, 727 (8th Cir. 1992)).
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For the foregoing reasons, the ALJ’s decision is supported by substantial evidence on the
record as a whole. Inasmuch as there is substantial evidence to support the ALJ'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 case
differently. Gowell v. Apfel, 242 F.3d 793, 796 (8th Cir. 2001). Accordingly, the decision of the
ALJ denying Claimant’s claims for benefits should be affirmed.
Therefore, for all the foregoing reasons,
IT IS HEREBY ORDERED, ADJUDGED and DECREED that the final decision of
the Commissioner denying social security benefits be AFFIRMED.
Judgment shall be entered accordingly.
/s/ Terry I. Adelman
UNITED STATES MAGISTRATE JUDGE
Dated this 26th
day of September, 2014.
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