Squires v. Colvin

Filing 27

MEMORANDUM: The ALJ erred in evaluating Squires' credibility and in analyzing the opinion evidence of record in this case, resulting in an RFC determination that was not supported by substantial evidence on the record as a whole. The matter will, therefore, be remanded for further consideration. Signed by Magistrate Judge Abbie Crites-Leoni on 3/22/2018. (JMC)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
MELISSA SQUIRES,
Plaintiff,
vs.
NANCY A. BERRYHILL,
Acting Commissioner of Social Security,
Defendant.

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) Case No. 4:16 CV 2046 ACL
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MEMORANDUM
Plaintiff Melissa Squires brings this action pursuant to 42 U.S.C. ' 405(g), seeking judicial
review of the Social Security Administration Commissioner’s denial of her application for
Disability Insurance Benefits (“DIB”) under Title II of the Social Security Act.
An Administrative Law Judge (“ALJ”) found that, despite Squires’ severe physical and
mental impairments, she was not disabled as she had the residual functional capacity (“RFC”) to
perform jobs that existed in significant numbers in the national economy.
This matter is pending before the undersigned United States Magistrate Judge, with
consent of the parties, pursuant to 28 U.S.C. § 636(c). A summary of the entire record is
presented in the parties’ briefs and is repeated here only to the extent necessary.
For the following reasons, the decision of the Commissioner will be reversed and
remanded to the Commissioner.
I. Procedural History
Squires filed an application for DIB on June 24, 2015, claiming that she became unable to

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work on November 10, 2011,1 because of depression, post-traumatic stress disorder (“PTSD”),
arthritis, lower back pain, hip pain, shoulder impingement, bilateral foot pain, ankle pain, joint
pain, and fibromyalgia. (Tr. 271.) Squires was 44 years of age on her alleged onset of disability
date. Id. Her claims were denied initially. (Tr. 126-34.) Following an administrative
hearing, Squires’ claim was denied in a written opinion by an ALJ, dated July 18, 2016. (Tr.
11-26.) Squires then filed a request for review of the ALJ’s decision with the Appeals Council of
the Social Security Administration (SSA), which was denied on November 2, 2016. (Tr. 7, 1-6.)
Thus, the decision of the ALJ stands as the final decision of the Commissioner. See 20 C.F.R. ''
404.981, 416.1481.
In the instant action, Squires first argues that the “basis for the RFC is unclear and it is not
supported by substantial evidence.” (Doc. 21 at 4.) She next claims that the ALJ “erroneously
afforded Dr. Ghosh’s opinion ‘little’ weight.” Id. at 8. Finally, Squires argues that the ALJ
“failed to make a proper credibility determination.” Id. at 21.
II. The ALJ=s Determination
The ALJ first noted that Squires meets the insured status requirements of the Social
Security Act through March 31, 2020, and has not engaged in substantial gainful activity since
January 1, 2014, her amended alleged onset date. (Tr. 13.)
In addition, the ALJ concluded that Squires had the following severe impairments:
degenerative disc disease; right shoulder impingement; fracture and reconstruction of the left
distal radial ulnar joint; left ankle anterior talofibular ligament tear; asthma; obesity; depression;
anxiety; and PTSD. Id. The ALJ found that Squires did not have an impairment or combination

1

Squires subsequently amended her alleged onset date of disability to January 1, 2014. (Tr. 11.)
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of impairments that meets or medically equals the severity of one of the listed impairments. (Tr.
15.)
As to Squires’ RFC, the ALJ stated:
After careful consideration of the entire record, I find that the
claimant has the residual functional capacity to perform sedentary
work as defined in 20 CFR 404.1567(a) in that she can perform
occasional lifting up to 10 pounds and the frequent lifting/carrying
less than 10 pounds; standing or walking 2 hours out of an 8 hour
workday and sitting 6 hours out of an 8 hour workday. In addition,
she requires a sit/stand option allowing a change in position every
30 minutes for a few minutes a time while remaining at the
workstation. She can never climb on ladders, ropes, or scaffolds.
She can no more than occasionally climb on ramps and stairs. She
can no more than frequently stoop, kneel, crouch, or crawl.
Overhead reaching is limited to frequent. Handling is limited to
frequent. She should avoid even moderate exposure to vibration,
wetness, humidity, and pulmonary irritants, such as gas, fumes,
odors, dusts, and workspace with poor ventilation. She should
avoid concentrated exposure to work hazards, such as unprotected
heights and being around dangerous, moving machinery. She [is]
able to understand, remember, and carry out simple to moderately
complex instructions consistent with semi-skilled work. She can
tolerate occasional interaction with coworkers and supervisors.
She can have no contact with the general public.
(Tr. 18.)
The ALJ found that Squires’ allegations regarding the extent of her limitations were not
entirely credible. (Tr. 19.) In determining Squires’ RFC, the ALJ indicated that she was
assigning “little weight” to the opinions of treating rheumatologist Sanjay Ghosh, M.D. (Tr. 22.)
The ALJ further found that Squires was unable to perform past relevant work, but was
capable of performing other jobs existing in the national economy, such as addresser and
document preparer. (Tr. 24-25.) The ALJ therefore concluded that Squires was not under a
disability, as defined in the Social Security Act, from January 1, 2014, through the date of the

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decision. (Tr. 25.)
The ALJ’s final decision reads as follows:
Based on the application for a period of disability and disability
insurance benefits protectively filed on June 24, 2015, the claimant
is not disabled under sections 216(i) and 223(d) of the Social
Security Act.
(Tr. 26.)
III. Applicable Law
III.A. Standard of Review
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 of the evidence, but enough that a reasonable person would find it adequate to
support the conclusion. Johnson v. Apfel, 240 F.3d 1145, 1147 (8th Cir. 2001). This “substantial
evidence test,” however, is “more than a mere search of the record for evidence supporting the
Commissioner’s findings.” Coleman v. Astrue, 498 F.3d 767, 770 (8th Cir. 2007) (internal
quotation marks and citation omitted). “Substantial evidence on the record as a whole . . .
requires a more scrutinizing analysis.” Id. (internal quotation marks and citations omitted).
To determine whether the Commissioner’s decision is supported by substantial evidence
on the record as a whole, the Court must review the entire administrative record and consider:
1.

The credibility findings made by the ALJ.

2.

The plaintiff’s vocational factors.

3.

The medical evidence from treating and consulting physicians.

4.

The plaintiff’s subjective complaints relating to exertional and
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non-exertional activities and impairments.
5.

Any corroboration by third parties of the plaintiff’s
impairments.

6.

The testimony of vocational experts when required which is
based upon a proper hypothetical question which sets forth the
claimant’s impairment.

Stewart v. Secretary of Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir. 1992) (internal
citations omitted). The Court must also consider any evidence which fairly detracts from the
Commissioner’s decision. Coleman, 498 F.3d at 770; Warburton v. Apfel, 188 F.3d 1047, 1050
(8th Cir. 1999). However, even though two inconsistent conclusions may be drawn from the
evidence, the Commissioner's findings may still be supported by substantial evidence on the
record as a whole. Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001) (citing Young v.
Apfel, 221 F.3d 1065, 1068 (8th Cir. 2000)). “[I]f there is substantial evidence on the record as a
whole, we must affirm the administrative decision, even if the record could also have supported an
opposite decision.” Weikert v. Sullivan, 977 F.2d 1249, 1252 (8th Cir. 1992) (internal quotation
marks and citation omitted). See also Jones ex rel. Morris v. Barnhart, 315 F.3d 974, 977 (8th
Cir. 2003).
III.B. Determination of Disability
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 that has lasted or can be expected to last for a continuous period of not less than
twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A); 20 C.F.R. § 416.905. A claimant
has a disability when the claimant is “not only unable to do his previous work but cannot,
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considering his age, education and work experience engage in any other kind of substantial gainful
work which exists … in significant numbers either in the region where such individual lives or in
several regions of the country.” 42 U.S.C. § 1382c(a)(3)(B).
To determine whether a claimant has a disability within the meaning of the Social Security
Act, the Commissioner follows a five-step sequential evaluation process outlined in the
regulations. 20 C.F.R. § 416.920; see Kirby v. Astrue, 500 F.3d 705, 707 (8th Cir. 2007). First,
the Commissioner will consider a claimant’s work activity. If the claimant is engaged in
substantial gainful activity, then the claimant is not disabled. 20 C.F.R. § 416.920(a)(4)(i).
Second, if the claimant is not engaged in substantial gainful activity, the Commissioner
looks to see “whether the claimant has a severe impairment that significantly limits the claimant’s
physical or mental ability to perform basic work activities.” Dixon v. Barnhart, 343 F.3d 602,
605 (8th Cir. 2003). “An impairment is not severe if it amounts only to a slight abnormality that
would not significantly limit the claimant’s physical or mental ability to do basic work activities.”
Kirby, 500 F.3d at 707; see 20 C.F.R. §§ 416.920(c), 416.921(a).
The ability to do basic work activities is defined as “the abilities and aptitudes necessary to
do most jobs.” 20 C.F.R. § 416.921(b). These abilities and aptitudes include (1) physical
functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or
handling; (2) capacities for seeing, hearing, and speaking; (3) understanding, carrying out, and
remembering simple instructions; (4) use of judgment; (5) responding appropriately to
supervision, co-workers, and usual work situations; and (6) dealing with changes in a routine work
setting. Id. § 416.921(b)(1)-(6); see Bowen v. Yuckert, 482 U.S. 137, 141 (1987). “The
sequential evaluation process may be terminated at step two only when the claimant’s impairment
or combination of impairments would have no more than a minimal impact on her ability to work.”

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Page v. Astrue, 484 F.3d 1040, 1043 (8th Cir. 2007) (internal quotation marks omitted).
Third, if the claimant has a severe impairment, then the Commissioner will consider the
medical severity of the impairment. If the impairment meets or equals one of the presumptively
disabling impairments listed in the regulations, then the claimant is considered disabled, regardless
of age, education, and work experience. 20 C.F.R. §§ 416.920(a)(4)(iii), 416.920(d); see Kelley
v. Callahan, 133 F.3d 583, 588 (8th Cir. 1998).
Fourth, if the claimant’s impairment is severe, but it does not meet or equal one of the
presumptively disabling impairments, then the Commissioner will assess the claimant’s RFC to
determine the claimant’s “ability to meet the physical, mental, sensory, and other requirements” of
the claimant’s past relevant work. 20 C.F.R. §§ 416.920(a)(4)(iv), 416.945(a)(4). “RFC is a
medical question defined wholly in terms of the claimant’s physical ability to perform exertional
tasks or, in other words, what the claimant can still do despite his or her physical or mental
limitations.” Lewis v. Barnhart, 353 F.3d 642, 646 (8th Cir. 2003) (internal quotation marks
omitted); see 20 C.F.R. § 416.945(a)(1). The claimant is responsible for providing evidence the
Commissioner will use to make a finding as to the claimant’s RFC, but the Commissioner is
responsible for developing the claimant’s “complete medical history, including arranging for a
consultative examination(s) if necessary, and making every reasonable effort to help [the claimant]
get medical reports from [the claimant’s] own medical sources.” 20 C.F.R. § 416.945(a)(3).
The Commissioner also will consider certain non-medical evidence and other evidence listed in
the regulations. See id. If a claimant retains the RFC to perform past relevant work, then the
claimant is not disabled. Id. § 416.920(a)(4)(iv).
Fifth, if the claimant’s RFC as determined in Step Four will not allow the claimant to
perform past relevant work, then the burden shifts to the Commissioner to prove that there is other

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work that the claimant can do, given the claimant’s RFC as determined at Step Four, and his or her
age, education, and work experience. See Bladow v. Apfel, 205 F.3d 356, 358-59 n.5 (8th Cir.
2000). The Commissioner must prove not only that the claimant’s RFC will allow the claimant to
make an adjustment to other work, but also that the other work exists in significant numbers in the
national economy. Eichelberger v. Barnhart, 390 F.3d 584, 591 (8th Cir. 2004); 20 C.F.R. §
416.920(a)(4)(v). If the claimant can make an adjustment to other work that exists in significant
numbers in the national economy, then the Commissioner will find the claimant is not disabled. If
the claimant cannot make an adjustment to other work, then the Commissioner will find that the
claimant is disabled. 20 C.F.R. §416.920(a)(4)(v). At Step Five, even though the burden of
production shifts to the Commissioner, the burden of persuasion to prove disability remains on the
claimant. Stormo v. Barnhart, 377 F.3d 801, 806 (8th Cir. 2004).
The evaluation process for mental impairments is set forth in 20 C.F.R. '' 404.1520a,
416.920a. The first step requires the Commissioner to “record the pertinent signs, symptoms,
findings, functional limitations, and effects of treatment” in the case record to assist in the
determination of whether a mental impairment exists. See 20 C.F.R. '' 404.1520a(b)(1),
416.920a(b)(1). If it is determined that a mental impairment exists, the Commissioner must
indicate whether medical findings “especially relevant to the ability to work are present or absent.”
20 C.F.R. '' 404.1520a(b)(2), 416.920a(b)(2). The Commissioner must then rate the degree of
functional loss resulting from the impairments in four areas deemed essential to work: activities
of daily living, social functioning, concentration, and persistence or pace. See 20 C.F.R. ''
404.1520a(b)(3), 416.920a(b)(3). Functional loss is rated on a scale that ranges from no
limitation to a level of severity which is incompatible with the ability to perform work-related
activities. See id. Next, the Commissioner must determine the severity of the impairment based

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on those ratings. See 20 C.F.R. '' 404.1520a(c), 416.920a(c). If the impairment is severe, the
Commissioner must determine if it meets or equals a listed mental disorder. See 20 C.F.R. ''
404.1520a(c)(2), 416.920a(c)(2). This is completed by comparing the presence of medical
findings and the rating of functional loss against the paragraph A and B criteria of the Listing of the
appropriate mental disorders. See id. If there is a severe impairment, but the impairment does
not meet or equal the listings, then the Commissioner must prepare an RFC assessment. See 20
C.F.R. '' 404.1520a(c)(3), 416.920a(c)(3).
IV. Discussion
As set out above, Squires argues that the ALJ erred in determining her RFC, weighing the
opinion of Dr. Ghosh, and assessing the credibility of Squires’ subjective complaints. Squires’
claims will be discussed in turn, beginning with the ALJ’s credibility analysis.
A.

Credibility
Before determining a claimant’s RFC, the ALJ must first evaluate the claimant’s

credibility. Wagner v. Astrue, 499 F.3d 842, 851 (8th Cir. 2007); Tellez v. Barnhart, 403 F.3d
953, 957 (8th Cir. 2005). In so doing, the ALJ must consider all evidence relating to the
claimant’s subjective complaints, including the claimant’s prior work record and third party
observations as to the claimant’s daily activities; the duration, frequency and intensity of the
symptoms; any precipitating and aggravating factors; the dosage, effectiveness and side effects of
medication; and any functional restrictions. Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir.
1984) (subsequent history omitted). When rejecting a claimant’s subjective complaints, the ALJ
must make an express credibility determination detailing her reasons for discrediting the
testimony. Renstrom v. Astrue, 680 F.3d 1057, 1066 (8th Cir. 2012); Cline v. Sullivan, 939 F.2d
560, 565 (8th Cir. 19 91). “It is not enough that inconsistencies may be said to exist, the ALJ must

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set forth the inconsistencies in the evidence presented and discuss the factors set forth in Polaski
when making credibility determinations.” Cline, 939 F.2d at 565; see also Renstrom, 680 F.3d at
1066; Beckley v. Apfel, 152 F.3d 1056, 1059-60 (8th Cir. 1998). Where an ALJ explicitly
considers the Polaski factors but then discredits a claimant’s complaints for good reason, the
decision should be upheld. Hogan v. Apfel, 239 F.3d 958, 962 (8th Cir. 2001); see also Casey v.
Astrue, 503 F.3d 687, 696 (8th Cir. 2007). The determination of a claimant’s credibility is for the
Commissioner, and not the Court, to make. Tellez, 403 F.3d at 957; Pearsall, 274 F.3d at 1218.
Squires argues that the ALJ in the instant case did not make a credibility determination at
all, “and certainly failed to discuss the reasons for not finding claimant credible.” (Doc. 21 at 12.)
She contends that the ALJ did not discuss any inconsistencies nor did she discuss the Polaski
factors.
The ALJ made the following finding:
After careful consideration of the evidence, I find that the claimant’s medically
determinable impairments could reasonably be expected to cause the alleged
symptoms; however, the claimant’s statements concerning the intensity,
persistence and limiting effects of these symptoms are not entirely consistent with
the medical evidence and other evidence in the record for the reasons explained in
this decision.
(Tr. 19.) Although the ALJ did not explicitly cite or discuss the Polaski factors, she did point out
three perceived inconsistencies between Squires’ allegations and the evidence of record.
First, the ALJ discussed Squires’ daily activities. The ALJ stated that, in spite of Squires’
physical limitations, she “admitted that she is able to help prepare meals for her family,” enjoys
working puzzles and watching sports, and made plans to take her son to a football game in July
2014. (Tr. 19.) The ALJ found that Squires’ “participation in activities that require good
concentration is inconsistent with her allegations of significant limitations.” Id.
The ALJ next found that the objective medical evidence was inconsistent with Squires’
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subjective allegations. (Tr. 19.) She stated that, “[a]lthough the claimant’s medical record is
vast, it contains few objective findings to support significant limitations after her amended onset
date.” Id.
The undersigned finds that the credibility analysis undertaken by the ALJ is deficient and
lacks the support of substantial evidence. First, the record contradicts the ALJ’s finding that the
medical evidence contains few objective findings to support significant limitations. The ALJ’s
own summary of the medical evidence belies this finding. As noted by the ALJ, the medical
evidence in this case is vast. Squires alleges disability primarily due to back, neck, and shoulder
pain resulting from injuries she sustained in 2011 while on active duty with the United States
Army.2 A summary of the relevant objective evidence discussed by the ALJ is provided below.
In April 2014, physical examination findings revealed that Squires appeared to be in pain,
walked with an antalgic gait, and had difficulty sitting. (Tr. 20, 1016, 1020.) Squires also
exhibited signs of edema, muscle spasm, and limited range of motion in her cervical spine and
lumbar spine. Id. She received multiple steroid injections in her cervical spine the summer of
2014 to relieve pain related to cervical radiculopathy. (Tr. 20, 1312-1320.)
In September 2014, Squires consulted with spine specialist Terrence L. Piper, M.D.,
regarding neck surgery. (Tr. 20, 1321.) Upon physical examination, Dr. Piper noted positive
signs of shoulder impingement, and positive abduction and external rotation sign. Id. He stated
that Squires has components both of a shoulder and a neck problem. Id. Imaging of the cervical
spine revealed multilevel degenerative changes with central canal, neural foraminal narrowing,
and nerve encroachment. (Tr. 20, 1338.) Based on these findings, Dr. Piper recommended neck

2

Squires also alleged disability based on mental impairments, and the ALJ found that her
depression, anxiety, and PTSD were severe impairments. Because Squires does not challenge the
ALJ’s findings with regard to her mental limitations, the undersigned will limit the discussion in
the instant Memorandum to Squires’ physical impairments.
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surgery. (Tr. 20, 1326.)
Diagnostic imaging of Squires’ right shoulder revealed early acromioclavicular
degenerative joint disease, as well as signs of impingement and edema. (Tr. 21, 1339-42.)
The ALJ stated that physical examinations performed by rheumatologist Sanjay Ghosh,
M.D. in 2014 and 2015 revealed trace swelling and tenderness in Squires’ wrists, fingers, ankles,
knees, shoulders, and hips; and notes from 2016 revealed tenderness in the low back. (Tr. 21,
2530, 2729, 2736, 2740.)
In September 2015, primary care physician Aubra A. Houchin, D.O., noted on examination
that Squires walked stiffly, slowly, and with a limp; had difficulty getting up from a chair; had
tenderness in her low back; and had restricted range of motion in her right shoulder by 25 percent.
(Tr. 21, 2712.)
The ALJ noted that MRIs of the lumbar and cervical sections of Squire’s spine in May
2016 revealed “mild” degenerative changes. (Tr. 21, 2959-2962.) This imaging also revealed
mild canal narrowing at C3-4, C5-6, and C6-7 secondary to the degenerative changes, foraminal
narrowing at C4-5, C5-6, and C6-7 (Tr. 2962); and mild bilateral neuroforaminal stenosis at L3-L4
and L4-L5, and a disc bulge at L4-L5 (Tr. 2960.) Physical examinations Squires underwent in
May 2016 revealed limited range of motion of the neck and shoulders, as well as a positive
Spurling’s sign3 on the right side. (Tr. 21, 2885.)
Squires has a history of fracture and reconstruction of the left wrist in 2013. (Tr. 21, 376,

3

The Spurling test is an evaluation for cervical nerve root impingement in which the patient
extends the neck and rotates and laterally bends the head toward the symptomatic side; an axial
compression force is then applied by the examiner through the top of the patient's head; the test is
considered positive when the maneuver elicits the typical radicular arm pain. Stedman’s Medical
Dictionary 1729 (27th ed. 2000).

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1092.) A recent examination in May 2016 reflected continued instability in her left wrist. (Tr.
21, 2767.)
Squires also underwent a surgical repair of a left ankle ligament tear in January 2014. (Tr.
21, 1008, 1092.) Treatment notes from May 2015 reflected that Squires had residual pain in her
foot and ankle with some difficulty walking. (Tr. 21, 2108.) Additionally, physical examination
findings from one year later revealed crepitation and instability in this ankle. (Tr. 21, 2882.)
The objective medical evidence discussed above, shows objective findings were
consistently noted on examination and on imaging with regard to Squires’ multiple
musculoskeletal impairments. For example, the following objective findings are supportive of
Squires’ allegations of limitations: antalgic gait, edema, muscle spasm, limited range of motion,
signs of shoulder impingement, swelling, limp, difficulty getting up, difficulty walking, positive
Spurling’s sign, instability in the left wrist, crepitation and instability in the left ankle, and
narrowing of the spine on MRI. The ALJ’s statement that the record contained “few objective
findings to support significant limitations after her amended onset date” is not supported by the
record or even the ALJ’s summary of the medical evidence. The ALJ, therefore, erred in finding
Squires’ subjective complaints not credible on this basis.
The ALJ next discussed Squires’ daily activities. She found that Squires’ actions of
helping prepare meals for her family, working puzzles, watching sports, and making plans to take
her son to a football game were inconsistent with her allegations of disability. (Tr. 19.) A
claimant’s ability to engage in personal activities does not generally constitute substantial
evidence that she has the functional capacity to engage in SGA. See, e.g., Wagner v. Astrue, 499
F.3d 842, 851 (8th Cir. 2007). But a claimant’s daily activities may undermine her credibility.
See, e.g., Harris v. Barnhart, 356 F.3d 926, 930 (8th Cir. 2004) (“It was also not unreasonable for

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the ALJ to note that Harris’s daily activities, including part-time work, cleaning house, attending
church, and dining out with her boyfriend, were inconsistent with her claim of disabling pain.”).
The ALJ cited a September 3, 2015 reference in treatment notes that Squires reported that she and
her husband planned to take their son to a football game on August 30, 2015. (Tr. 1491.) While
this level of activity would appear inconsistent with her subjective allegations, the undersigned
notes that there is no indication in the record that Squires did in fact take her son to the game.
Overall, Squires’ reported daily activities are not inconsistent with her subjective allegations.
Finally, the ALJ stated that Squires “complained of pain over her whole body; yet, she
admitted that she had not taken any medications to relieve her pain on the day of the hearing.” Id.
At the hearing, Squires testified that she takes Dilaudid4 for pain, but it causes her to experience
drowsiness. (Tr. 63.) She stated: “I didn’t take it today so I could be—so I could interact with
the Judge and that’s probably why I’m having so much pain right now.” (Tr. 63-64.) Squires
testified that she can take the Dilaudid every four hours as needed, and that she had been taking it
at least three times a day. (Tr. 65.) The ALJ did not include any of this testimony in her opinion.
An ALJ is required to consider medication side effects in the credibility analysis. Porch v.
Chater, 115 F.3d 567, 572 (8th Cir. 1997).
Further, consistent with Squires’ testimony, the ALJ stated that she had observed Squires
“constantly moving from sitting to standing, and it appeared that she had difficulty finding a
comfortable position.” (Tr. 19.) The hearing transcript also reveals that Squires laid down on
the floor twice during the hearing before the ALJ. (Tr. 87, 100.) Thus, the fact that that Squires
opted not to take one dosage of a strong narcotic pain medication that causes drowsiness prior to
the hearing so that she could interact with the ALJ does not detract from her credibility. There is

4

Dilaudid is an opioid (narcotic) analgesic indicated for the treating of moderate to severe pain.
See WebMD, http://www.webmd.com/drugs (last visited March 12, 2018).
Page 14 of 18 

no indication in the medical record that Squires was noncompliant with her prescribed
medications.
Where alleged inconsistencies upon which an ALJ relies to discredit a claimant’s
subjective complaints are not supported by and indeed are contrary to the record, the ALJ's
ultimate conclusion that the claimant’s symptoms are less severe than she claims is undermined.
Baumgarten v. Chater, 75 F.3d 366, 368-69 (8th Cir. 1996).
The ALJ also failed to acknowledge Squires’ positive work history, consisting of
twenty-seven years of service in the Army. (Tr. 44.) This factor, along with the objective
medical evidence, the ALJ’s observations of Squires’ behavior during the hearing, and Squires’
use of strong pain medication, all support her credibility.
In light of the above, it cannot be said that the ALJ demonstrated in her written decision
that she considered all of the evidence relevant to Squires’ complaints or that the evidence she
considered so contradicted Squires’ subjective complaints that her testimony could be discounted
as not credible. Masterson v. Barnhart, 363 F.3d at 731,738-39 (8th Cir. 2004); Baumgarten, 75
F.3d at 370. As such, the ALJ’s adverse credibility determination is not supported by substantial
evidence on the record as a whole. Because the ALJ’s decision fails to demonstrate that she
considered all of the evidence before her under the standards set out in Polaski, this cause should
be remanded to the Commissioner for an appropriate analysis of plaintiff's credibility.
B.

Dr. Ghosh’s Opinion
Upon concluding that Squires’ subjective complaints were not credible, the ALJ turned to

the medical opinion evidence. The ALJ accorded the opinion of treating rheumatologist Dr.
Ghosh “little weight.”
“‘It is the ALJ’s function to resolve conflicts among the various treating and examining

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physicians.’” Tindell v. Barnhart, 444 F.3d 1002, 1005 (8th Cir. 2006) (quoting Vandenboom v.
Barnhart, 421 F.3d 745, 749-50 (8th Cir. 2005) (internal marks omitted)). Opinions from
medical sources who have treated a claimant typically receive more weight than opinions from
one-time examiners or non-examining sources. See 20 C.F.R. § 416.927(c)(1)-(2). However,
the rule is not absolute; a treating physician’s opinion may be disregarded in favor of other
opinions if it does not find support in the record. See Casey, 503 F.3d at 692.
If an ALJ declines to ascribe controlling weight to the treating physician’s opinion, she
must consider several factors in determining the appropriate weight for that source’s medical
opinion, including: 1) length and frequency of the treatment relationship; 2) nature and extent of
the treatment relationship; 3) evidence provided by the source in support of the opinion
(“supportability”); 4) consistency of the opinion with the record as a whole; and 5) the source’s
level of specialization. 20 C.F.R. §§ 404.1527(c); 416.927(c).
Dr. Ghosh completed a “Fibromyalgia/Arthritis Residual Functional Capacity
Questionnaire” on June 2, 2016. (Tr. 2754-2758.) Dr. Ghosh expressed the opinion that Squires
could walk less than one city block without rest or severe pain; sit for 15 to 20 minutes; stand for
no more than 5 minutes; sit for less than 2 hours in an 8-hour workday; stand or walk for less than
2 hours in an 8-hour workday; requires a job that permits shifting positions at will from sitting,
standing, or walking; requires unscheduled breaks; can never lift and carry any amount of weight
in a competitive work situation; has significant limitations in doing repetitive reaching, handling,
or fingering; and was likely to be absent from work more than four days per month as a result of
her impairments or treatment. (Tr. 2756-58.) The ALJ stated that Dr. Ghosh’s opinion “is not
consistent with his progress notes that reflect mostly normal exams with little more than joint
tenderness, which casts doubt on the overall reliability of his findings.” (Tr. 22.)

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Dr. Ghosh frequently noted tenderness and trace swelling in the fingers, wrists, and
shoulders (Tr. 2333, 2337, 2342, 2345, 2367); trace swelling in the ankles, knees, and shoulders
(Tr. 2337, 2342, 2357); and tenderness in the cervical and lumbar spine (Tr. 2345, 2349, 2362,
2726, 2729, 2733, 2736, 2740, 2357, 2362, 2367) on physical examinations. Dr. Ghosh indicated
that he had been treating Squires since June 2014 for fibromyalgia, spinal stenosis, and
spondylolisthesis. (Tr. 2754.) He described her prognosis as “poor.” Id. When asked to
identify the clinical findings or test results that show Squires’ impairments, Dr. Ghosh cited the
2016 MRI of the lumbar spine. Id. He indicated that Squires has the following symptoms:
multiple tender points, nonrestorative sleep, chronic fatigue, morning stiffness, depression,
tenderness, abnormal gait, hypothyroidism, and weight change. (Tr. 2754-55.)
To the extent the ALJ discounted Dr. Ghosh’s opinion inasmuch as his treatment notes
“reflect mostly normal exams. . .” (Tr. 22), “[i]t does not seem unusual that a physician would see
no need to make specific treatment notes on an unemployed patient’s need for work [restrictions]
during a routine medical examination.” Leckenby v. Astrue, 487 F.3d 626, 633 n.7 (8th Cir.
2007). This is especially true here where Squires’ medical records with Dr. Ghosh are replete
with consistent complaints of chronic pain despite multiple years of treatment with strong pain
medication, injections, surgeries, physical therapy, and chiropractic treatment. See id. at 633. In
addition, the May 2016 MRI of the lumbar spine to which Dr. Ghosh referred revealed
degenerative changes as well as bilateral neuroforaminal stenosis at L3-L4 and L4-L5; a disc bulge
at L4-L5 that had worsened slightly since the previous study; and new, mild narrowing of the right
lateral recess, affecting the traversing right L5 nerve root. (Tr. 2960.) It cannot be said
therefore, that the limitations found by Dr. Ghosh find no support in his treatment notes or other
evidence of record. Id.

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C.

RFC Assessment
Squires argues that the ALJ’s RFC determination failed to include limitations for her wrist,

ankle, and neck impairments, all of which require additional surgery; her right shoulder
impairment; and the pain resulting from her combination of impairments.
Because “[s]ubjective complaints . . . are often central to a determination of a claimant’s
RFC,” Fredrickson v. Barnhart, 359 F.3d 972, 976 (8th Cir. 2004), an ALJ’s RFC assessment
based on a faulty credibility determination is called into question because it does not include all of
the claimant’s limitations. See Holmstrom v. Massanari, 270 F.3d 715, 722 (8th Cir. 2001).
This is especially true in the instant case, where the ALJ’s credibility assessment was based in
large part on a mischaracterization of the objective medical evidence.
In addition, given the ALJ’s improper determination to discount the opinion of treating
physician Dr. Ghosh, it cannot be said that the resulting RFC assessment is supported by
substantial evidence on the record as a whole. See generally Leckenby, 487 F.3d at 635.
VII. Conclusion
The ALJ erred in evaluating Squires’ credibility and in analyzing the opinion evidence of
record in this case, resulting in an RFC determination that was not supported by substantial
evidence on the record as a whole. The matter will, therefore, be remanded for further
consideration.
/s/ Abbie Crites-Leoni
ABBIE CRITES-LEONI
UNITED STATES MAGISTRATE JUDGE
Dated this 22nd day of March, 2018.

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