Woodmancy v. Astrue

Filing 23

MEMORANDUM AND ORDER on Review of the Final Decision of the Commissioner of the Social Security Administration - The Commissioner of Social Security's decision is reversed. Ordered by Senior Judge Warren K. Urbom. (JAB)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEBRASKA
CYNTHIA D. WOODMANCY,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner of the Social Security
Administration,
Defendant.

)
)
)
)
)
)
)
)
)
)
)
)

8:12CV90

MEMORANDUM AND ORDER ON
REVIEW OF THE FINAL DECISION
OF THE COMMISSIONER OF THE
SOCIAL SECURITY
ADMINISTRATION

On March 6, 2012 , the plaintiff, Cynthia D. Woodmancy, filed a complaint
against the defendant, Michael J. Astrue, Commissioner of the Social Security
Administration. (ECF No. 1.)1 Woodmancy seeks a review of the Commissioner’s
decision to deny her applications for disability insurance benefits under Title II of the
Social Security Act (the Act), 42 U.S.C. §§ 401 et seq., and for Supplemental Security
Income (SSI) benefits under Title XVI of the Act, 42 U.S.C. §§ 1381 et seq. See 42
U.S.C. §§ 405(g) and 1383(c)(3) (providing for judicial review of the
Commissioner’s final decisions under Titles II and XVI). The Commissioner has
filed an answer to the complaint and a transcript of the administrative record. (See
ECF Nos. 5-8.) In addition, the parties have filed briefs in support of their respective

1

Carolyn W. Colvin has since been appointed to serve as Acting
Commissioner of the Social Security Administration, (see Notice of Substitution,
ECF No. 22), and as Astrue’s successor, Colvin is “automatically substituted as a
party,” Fed. R. Civ. P. 25(d).
1

positions. (See Pl.’s Br., ECF No. 14; Def.’s Br., ECF No. 20.) I have carefully
reviewed these materials, and I find that the case must be remanded for further
proceedings.

I.

BACKGROUND

On or about December 16, 2009, Woodmancy filed applications for disability
insurance benefits and SSI benefits. (Transcript of Social Security Proceedings
(hereinafter “Tr.”) at 137-150. See also id. at 64-65 (indicating that the applications
were filed on December 4, 2009).) The applications were denied on initial review,
(id. at 64-65, 72-80), and on reconsideration, (id. at 67-68, 83-92). Woodmancy then
requested a hearing before an ALJ. (Id. at 96-98.) The hearing was held on
September 19, 2011, (e.g., id. at 32), and, in a decision dated October 20, 2011, the
ALJ concluded that Woodmancy “has not been under a disability, as defined in the
Social Security Act, from October 31, 2009, through the date of this decision,” (id.
at 25 (citations omitted); see also id. at 13-26). Woodmancy requested that the
Appeals Council of the Social Security Administration review the ALJ’s decision.
(See id. at 8-9.) This request was denied, (see id. at 1-3), and therefore the ALJ’s
decision stands as the final decision of the Commissioner.

II.

SUMMARY OF THE RECORD

On a Disability Report form, Woodmancy claimed that she became disabled on
October 31, 2009, due to a heart attack. (Tr. at 178.) She claimed later that she was
also experiencing “intestinal incontinance [sic] on occasions,” weakness, “mental
confusion,” “continuing headaches increasing in intensity,” “continued bruises on left
cheek area,” panic attacks, and depression. (Id. at 223, 269. See also id. at 38-39.)
2

She was born in October 1952, and she completed the twelfth grade. (Id. at 173,
179.) She has past work experience as a dispatcher, telephone solicitor, information
clerk, and collection clerk. (Id. at 282.)
A.

Medical Evidence2

Woodmancy suffered a heart attack on October 31, 2009. (Tr. at 411-412.)
She was transported to Bergan Mercy Medical Center in Omaha, Nebraska, where an
“EKG revealed [the] presence of extensive anterolateral acute myocardial infarction
with hyperacute changes.” (Id. at 377.) Himanshu Agarwal, M.D., performed a left
heart catheterization, a coronary angiography, a left ventriculography, and an
emergency angioplasty, and he placed a stent in the left anterior descending artery.
(Id. at 375.)

Shortly thereafter, Charles Huh, M.D., diagnosed an upper

gastrointestinal bleed and ordered an emergency upper endoscopy. (Id. at 380.) The
endoscopy revealed a 1 centimeter ulcer “with a probable visible vessel” in “the
proximal stomach just below the GE junction” and a “probable Mallory Weiss tear
at the GE junction.” (Id. at 429.) The ulcer and tear were treated with injections of
epinephrine, and two clips were placed on the vessel. (Id.) Woodmancy “tolerated
the procedure well” and “was monitored in the intensive care unit in stable condition
without any immediate complications.” (Id.) Joseph Bast, M.D., then diagnosed a
nonoliguric acute kidney injury, (id. at 390), and on November 3, 2009, Woodmancy
underwent surgery for renal insufficiency, (id. at 427).
Woodmancy’s hospitalization continued throughout November and into

2

My review of the medical evidence emphasizes the records cited by the
parties in their briefs. (See Pl.’s Br. at 3-9, ECF No. 14; Def.’s Br. at 3-10, ECF
No. 20.) I note in passing that several of the records’ page numbers are not
legible.
3

December 2009. On November 6, 2009, a CT scan of the abdomen and pelvis
revealed a “Small bowel ileus,” “Thickening of the wall of the cecum,”
“Retroperitoneal hemotoma inferior to the right kidney, measuring at least 10 cm in
size,” “Left inguinal hematoma,” “Left lower lobe collapse,” and “Dilation of the
small bowel compatible with ileus.” (Id. at 311.) Woodmancy was diagnosed with
acute renal failure and underwent hemodialysis. (E.g., id. at 382.) On November 8,
2009, Thomas Connolly, M.D., diagnosed “pneumonia secondary to an extremely
resistant Acinetobacter baumannii,” which was treated with various medications. (Id.
at 382, 384.) Woodmancy also suffered respiratory failure, and a tracheostomy was
performed on November 19, 2009. (Id. at 423.)
Andrew Lee, M.D., met with Woodmancy on November 30, 2009, for a
rehabilitation consultation. (Id. at 386.) Dr. Lee noted that Woodmancy was
debilitated and was experiencing dysphagia, nausea, diarrhea, and “some vertigo that
will last for a couple of seconds when she initially sits up.” (Id. at 387.) He ordered
Woodmancy to “[c]ontinue with strengthening” and other therapies “as tolerated,”
and he ordered “speech therapy to do a cognitive evaluation given her probable
anoxic encephalopathy.” (Id. at 388.)
On December 2, 2009, studies of Woodmancy’s legs revealed acute deep vein
thrombosis of the right posterior tibial vein and soleal vein, acute deep vein
thrombosis of the left femoral vein, and acute thrombus in the left lesser saphenous
vein. (Id. at 418.) On December 16, 2009, examination of Woodmancy’s right leg
revealed a “[b]enign osteochondroma” of the right tibia, but T. Kevin O’Malley,
M.D., determined that it did not warrant surgical intervention. (Id. at 398-399.)
Woodmancy was discharged from the Bergan Mercy Medical Center on
December 21, 2009, with the following diagnoses: “ST elevation myocardial
4

infarction,” “Debility,” “Malnutrition,” “Anemia,” “Retroperitoneal hematoma,”
“Status post inferior vena caval (IVC) filter placement,” “Pulmonary embolism,”
“Right leg deep venous thrombosis,” and “Osteochondroma of the right lower
extremity.” (Id. at 402.) Maxwell Larweh, M.D., noted,
This 57-year-old woman was initially admitted by the cardiology
service with the above diagnosis. Her hospital course was complicated
by respiratory failure, retroperitoneal hematoma and persistent anemia.
She underwent multiple procedures including tracheostomy and IVC
filter placement. . . . She clinically improved with supportive care. . . .
She is being discharged to Nebraska Skilled Nursing Facility to continue
her rehabilitation.
(Id.)
Woodmancy began inpatient physical and occupational therapy at Nebraska
Skilled Nursing (NSN) on December 21, 2009. (E.g., id. at 491.) Records dated
shortly after Woodmancy’s admission to NSN indicate that she was suffering from
urinary incontinence, bowel incontinence, and loose stools, and she had difficulty
swallowing. (Id. at 708.) They also indicate that she was at high risk for falling, and
she began a program of physical therapy. (Id. at 538-539, 541-547.) A residency
assessment protocol summary bearing various dates between December 27, 2009, and
January 2, 2010, states that Woodmancy’s health issues caused her mood to
deteriorate; that her vision was impaired; that she had “generalized weakness” and
needed “limited assistance with most of her ADLs”; that she was “occasionally
incontinent of urine” and wore “a brief when out of bed”; and that she was receiving
treatment for depression. (Id. at 570-573, 878-881. See also id. at 565 (indicating
that on January 2, 2010, Woodmancy experienced bowel incontinence 2-3 times per
week and bladder incontinence 2 or more times per week).) A physical therapy
progress report dated January 14, 2010, states that Woodmancy continued to require
5

therapeutic exercise, neuromuscular reeducation, gait training, therapeutic activities,
and electrical stimulation. (Id. at 539.) The report also stated that Woodmancy “gets
severe coughing spells from activity,” “frequently reports nausea,” and “[h]as
continued deficits in strength.” (Id.) A treatment plan bearing certification dates
“from 12/22/2009 through 01/20/2010” states that precautions needed to be taken for
Woodmancy’s bowel incontinence, loose stools, and “fall risk.” (Id. at 800.) By
February 11, 2010, it appears that Woodmancy was able to ambulate with a steady
gait and care for herself independently. (Id. at 525.) She was discharged home on
February 12, 2010. (Id. at 667.)
On March 23, 2010, Samuel Moessner, M.D., examined Woodmancy to
determine her eligibility for disability benefits. (Id. at 574-589.) He noted that
Woodmancy was discharged from the skilled nursing unit in February 2010 “on
Plavix” and “hypertensive medication,” but she had “discontinued Plavix two or three
days ago due to the cost of medication.” (Id. at 577. See also id. at 589.) She was
also taking an antidepressant, though she was not seeing a counselor or psychiatrist.
(Id. at 578, 583.) Woodmancy reported that instability in her left leg had been
improving, but she was still using a cane due to “balance problems.” (Id. at 577, 579.
See also id. at 583.) She also reported that she felt weakness, fatigue, and exhaustion
“after about 15 minutes of activity such as making her bed or washing her dishes.”
(Id. at 578.) Woodmancy was able to bathe, feed, and dress herself independently,
however. (Id. at 578. See also id. at 579 (“She does do some light housework
including microwave cooking, does a little laundry, which is provided in the building.
She does make her bed and wash her dishes, but allows her daughter to come over for
major cleaning and to take her shopping.”).) She said that she could lift a maximum
of about ten pounds, and she could sit for one hour, stand for 15 minutes, and
6

“perhaps walk several blocks.” (Id. at 578.) She could use her hands “fairly well,”
but she “had some tremulousness in her hands.” (Id. at 578, 583.) She also had
“some degree of problems with stooping, climbing stairs, kneeling, crawling,
squatting, bending, twisting, and reaching.” (Id. at 578.) Woodmancy explained that
she could “do a lot of things, but they take a long time, [and she] has to sit down and
rest after unloading the dishwasher or making her bed.” (Id. at 579.) She also said
that she “has daily headaches on the left side of her head,” (id. at 581), and “some
urgency of diarrhea sometimes,” (id. at 582).
Woodmancy stated that she “is hoping to be able to get Disability, so she would
qualify for housing subsidy, food stamps, Medicare and other benefits.” (Id. at 580.)
She added that she did not think she could go back to work for her previous
employer, “although she can still use computers at home daily for a while.” (Id.)
Dr. Moessner noted that Woodmancy was “well-developed, well-nourished,
alert, pleasant, . . . in no acute distress, polite and friendly, but tearful at times.” (Id.
at 584.) He also noted that she moved about “fairly easily” and “could possibly get
along without the cane, but [she] uses it for balance support.” (Id. But see id. at 588
(indicating that testing revealed balance difficulties).) Woodmancy had “one 1+
edema around the feet and ankles and extending somewhat up into the calf regions.”
(Id. at 587.) There was “some soft tissue swelling around the knee suggesting
effusions,” and “generally the lower extremities from the pelvis downward show[ed]
some irregular soft tissue swelling suggesting venous insufficiency.” (Id.) Also,
there was “indurated lumpy swelling in the calf regions consistent with deep venous
thrombosis.” (Id.)
On March 31, 2010, Glen Knosp, M.D., reviewed the records and completed
a Physical Residual Functional Capacity Assessment. (Id. at 595-603.) Dr. Knosp
7

concluded on October 31, 2010, Woodmancy would be able to occasionally lift 10
pounds, frequently lift less than 10 pounds, stand or walk at least 2 hours in an 8-hour
workday, sit for about 6 hours in an 8-hour workday, and occasionally climb, balance,
stoop, kneel, crouch, and crawl. (Id. at 595, 596-597.) He wrote,
The clmt is alleging limitations from a recent heart attack. The
evidence in file does corroborate her allegations, but does not M/E a
listing. The evidence also shows she is unable to stand for long periods
of time, and her current use of a cane limits the amount of weight she
can carry. Her limitations are reasonable given the history, but they fail
to result in persistent or sustainable functional limitations. Prior to
10/31/09, evidence shows she was capable of at least sedentary work.
Recent evidence shows improvement, and it is expected that she will
continue to improve by 10/31/10. At that time, she can reasonably be
expected to perform sedentary work as outlined. Considering the overall
evidence, she should avoid strenuous activities and prolonged
ambulation, and her allegations appear to be credible.
(Id. at 602.)
On May 10, 2010, Woodmancy visited the Douglas County Department of
General Assistance Primary Health Care Network Clinic and received prescriptions
for metoprolol, Zocor, and Plavix. (Id. at 624.) She returned on May 20, 2010, with
complaints of ear ache, headaches, nocturia, and “occasional bowel incontinence.”
(Id. at 628.) She also mentioned that she was tired and experiencing “some emotional
disturbance.” (Id.) She returned again on June 7, 2010, and obtained refills of her
prescriptions. (Id. at 624.)
Bridget Larson, Ph.D., examined Woodmancy on July 14, 2010, and prepared
a psychological report. (Id. at 630-634.) Woodmancy told Dr. Larson that “she is no
longer the same person” since her October 2009 heart attack. (Id. at 631.) More
specifically, Woodmancy said that “she is easily frustrated, has problems with her
memory, and is extremely emotional.” (Id.) She added that she sometimes “fears if
8

she closes her eyes she will die again,” and “she typically experiences a panic attack
every evening when she is alone in her apartment and begins thinking of all she went
through.” (Id.) In addition, she said that she “dreads going out in public,” mainly
“because she has to wear adult diapers due to having had several accidents in public.”
(Id.) Woodmancy reported that she was taking Lexapro for anxiety, but she has never
been hospitalized for mental health treatment, nor has she ever been involved in
therapy. (Id. at 632.)
Woodmancy said that “she is able to complete all of her activities of daily
living, walks her dog at least three or four times a day around her apartment complex,
socializes daily with several neighbors in their apartments, and completes at least one
chore per day.” (Id. See also id. at 632-633.) She also said, however, that she
needed to use a cane to assist her in walking long distances, and “extensive motor
activity” caused her to experience “throbbing pain in her knees.” (Id. at 632.) In
addition, Woodmancy reported that her long term memory, short term memory, and
concentration were poor. (Id.)
Dr. Larson concluded that Woodmancy “does not appear to have any restriction
of daily activities nor does she have any difficulty maintaining social functioning.”
(Id. at 633.) She added, “[Woodmancy] appears to be able to remember simple and
complex instructions, and she can complete tasks under ordinary supervision. She
does not appear to have any difficulty relating appropriately to others. Cynthia’s
concentration and attention appears [sic] to be adequate, although she reported
difficulty in this area. Cynthia indicated that her symptoms exacerbate in the
evenings when she is at home alone and begins thinking of the trauma she
experienced following her heart attack. Cynthia would have no difficulty adapting
to changes in life or structure.” (Id. See also id. at 634.) Dr. Larson diagnosed
9

“Posttraumatic Stress Disorder, Chronic,” “Problems with lower back pain (By
Report),” and “Occupational problems,” and she determined that Woodmancy’s
current GAF score was 61. (Id.)3 Dr. Larson’s report concludes,
Prognosis is hopeful for Cynthia from a mental health standpoint.
She appears to have a history of experiencing severe anxiety associated
with her October 2009 heart attack. She indicated experiencing
recurrent and intrusive thoughts about the day of her heart attack and
subsequent recovery, has a sense of a possible foreshortened future, has
difficulty concentrating, experiences panic attacks and is irritable and
sad. She also avoids leaving her apartment complex due to her anxiety
and medical concerns. However, she does have several friends within
her apartment complex that she visits on a daily basis, and will run
errands if her daughter accompanies her. Cynthia is taking psychotropic
medication to assist in managing her symptoms. However, she is not
receiving any mental health therapy currently. If she were to receive
consistent mental health therapy in addition to her medication
management, her symptoms should improve significantly.
(Id.)
On November 30, 2010, Woodmancy visited Joseph B. Thibodeau, M.D., at the
Alegent Health Clinic in Omaha, Nebraska, with complaints of chest pain, chest
3

“The GAF is a numeric scale ranging from zero to one hundred used to
rate social, occupational and psychological functioning ‘on a hypothetical
continuum of mental health-illness.’” Pate-Fires v. Astrue, 564 F.3d 935, 937 n.1
(8th Cir. 2009) (quoting American Psychiatric Association, Diagnostic and
Statistical Manual of Mental Disorders 32 (4th ed. 1994) (hereinafter DSM-IV)).
“A GAF of 41 to 50 indicates the individual has ‘[s]erious symptoms . . . or any
serious impairment in social, occupational, or school functioning . . . .’” Id. at 938
n.2 (quoting DSM-IV at 32). “A GAF of 51 to 60 indicates the individual has
‘[m]oderate symptoms . . . or moderate difficulty in social, occupational, or school
functioning . . . .’” Id. at 938 n.3 (quoting DSM-IV at 32). A GAF of 61 to 70
indicates that the individual has “[s]ome mild symptoms . . . or some difficulty in
social, occupational, or school functioning . . . , but [is] generally functioning
pretty well . . . .” DSM-IV at 32.
10

tightness, lightheadedness, and weakness in her legs. (Id. at 887.) She reported that
she was smoking five or six cigarettes per day, but it appears that she was taking her
medications as directed.

(Id.)

After examining Woodmancy, Dr. Thibodeau

diagnosed “Typical angina,” “Coronary artery disease, history of acute MI and PCI,”
“Dyslipidemia,” “Previous history of out of hospital cardiac arrest,” and “Type 2
diabetes mellitus,” and he arranged for her to undergo a diagnostic cardiac
catheterization. (Id. at 887-888.)
Ann Narmi, M.D., performed a coronary angiography on December 3, 2010.
(Id. at 885-886.) The procedure “revealed mild irregularities to the proximal
circumflex artery but otherwise normal circumflex system,” “proximal LAD of 2030% stenosis,” “approximately 40% in-stent restenosis noted throughout the length
of the stents” already in place, “a 80-90% blockage of a very small diagonal artery
which was largely unchanged from a previous cardiac catheterization,” and a normal
right coronary artery. (Id. at 885.) Dr. Narmi also performed an echocardiogram on
January 3, 2011, which revealed a “[v]isually estimated left ventricular ejection
fraction [of] 60-65%”; “[i]mpaired relaxation pattern of LV diastolic filling”; and
normal left ventricular size, thickness, and function. (Id. at 883.)
Woodmancy’s physician referred her for psychotherapy, and on February 28,
2011, Shari Conner, Ph.D., of Catholic Charities conducted an initial diagnostic
interview. (Id. at 657-665.) Woodmancy indicated that she was seeking therapy to
decrease her crying spells, improve her self-concept and self-worth, improve her
social support, and decrease her anxiety symptoms. (Id. at 657.) She said that she
“had significant anxiety symptoms prior to her heart attack, including panic attacks,”
but these have “dramatically intensified due to her financial strain and many physical
changes (e.g., she is now incontinent, has trouble walking, and has more general
11

malaise).” (Id.) She also said that she was feeling depressed and hopeless, and that
her mother died two days before the interview. (Id.) Woodmancy reported suffering
from frequent headaches, dizziness, restless leg syndrome, a change in vision, a
change in her sense of smell, dental problems, COPD, abdominal pain, incontinence,
arthritis, left leg weakness, high blood pressure, coronary artery disease, and chest
pain. (Id. at 660.) Dr. Conner also noted that Woodmancy was suffering from
obsessions or intrusive thoughts; worrying; engaging in some compulsive behavior
(such as handwashing and binge eating); experiencing some irritability and
restlessness; and suffering from delusions, anxiousness, dissociation, paranoia, and
short-term memory problems. (Id. at 662.) Dr. Conner diagnosed “Major Depressive
Disorder, Recurrent, Severe,” “Anxiety Disorder NOS, with features of PTSD and
Panic Disorder,” “S/P myocardial infarction,” “COPD,” “Incontinence/nerve
damage,” “migraines,” and “disruptions in primary support relationships; insufficient
social support; financial stressors; chronic health issues; housing and occupational
concerns.” (Id. at 664.) She assigned Woodmancy a GAF score of 48, and she
recommended that Woodmancy begin weekly outpatient psychotherapy. (Id.)
Woodmancy attended her initial “mental health session” at Catholic Charities
on March 10, 2011. (Id. at 905.) Therapist Sheryl Scott noted that Woodmancy was
“tearful throughout the session” and “reported feeling frustrated with ‘the system’ as
she is having difficulty getting approval for disability.” (Id.) Woodmancy also
“reported having anxiety, racing thoughts and feeling depressed.” (Id.) Scott
determined that Woodmancy was “so fragile at this point that goals could not be
established during initial session,” but she agreed on a plan for the next session. (Id.)
Woodmancy attended another session with Scott and “community support
worker” Carole Schneider on March 23, 2011. (Id. at 904.) Scott wrote,
12

[Woodmancy] had difficulty making consistent eye contact. She talked
about the recent funeral of her mother and how she has been having a
“sad week.” Cynthia rated her depression an 8 on a scale of 1 to 10 and
identified that having money, resources and services would greatly
decrease her depression. She is focused on getting approved for
disability and Medicaid and has difficulty focusing on what she can do
today. Cynthia [is] going back to the past and talking about how
everything was taken from her and “they” have no right to tell her how
to feel about moving to a GA apartment or Section 8 Housing. Carole
Schneider joined the session and offered and explained ideas to Cynthia;
however, Cynthia [is] not receptive to GA or changing doctors or
applying for housing voucher.
(Id. See also id. (“‘If you think I am going to give up my apartment, I’m not. I’ve
worked my whole life just to be slapped in the face. I just want to go back to when
I was healthy and working.’ Cynthia is unable to focus on managing her depression
as she is very fixated on disability and services.”).)
Woodmancy attended another session with Scott on April 6, 2011, and
“brought a painting with her that she [had] worked on for the past two weeks.” (Id.
at 903.) She said that this was the first time she had painted since her heart attack,
and painting made her feel “relaxed and happy.” (Id.) Woodmancy “was encouraged
to do some art therapy, work on affirmations and continue reframing negative
thoughts into positive.” (Id.)
On April 20, 2011, Woodmancy told Scott that her doctor had changed her
medication from Celexa to Prozac, and she was “feeling more tearful and sad and
having difficulty not crying every day.” (Id. at 902.) Woodmancy also reported that
she had not been motivated to do artwork, she was having “racing thoughts and
‘creepy’ dreams,” she felt like a burden to her daughter, and she felt “angry about not
receiving disability.” (Id.)
Woodmancy told Scott on May 16, 2011, that “she was having a good day.”
13

(Id. at 901.) Nevertheless, Scott noted that Woodmancy was tearful “and ha[d]
difficulty letting go of intrusive thoughts related to her cardiac arrest. (Id.) Scott also
noted that Woodmancy suffered incontinence on her bus ride to the session, but “she
was able to work through this.” (Id.) She was tearful when discussing her reliance
upon her daughter for monetary support, and she noted that she was anxious in the
evening and suffering from insomnia. (Id.)
On June 2, 2011, Woodmancy told Scott that she felt depressed and lonely and
was missing her mother. (Id. at 900.) She attempted to paint but “was not feeling
creative.” (Id.) On June 16, Woodmancy reported that she was “feeling more
depressed and her physical condition appears to be worsening.” (Id. at 899.) She
talked about her incontinence, her difficulty walking, and her ability to do household
tasks “for only a short time before she is exhausted.” (Id.) “She realte[d] that she is
unable to find any meaning in her life and feels that God is punishing her for her past
and that is why she was revived during her heart attack.” (Id.) On June 23,
Woodmancy reported that she was “feeling very depressed,” as the second
anniversary of her sister’s death was approaching. (Id. at 898.) She also “related that
she is still being victimized by the disability board and doesn’t want to accept her
situation because that would mean dealing with who she is ‘now.’” (Id.) In addition,
she reported that she could not “get up the energy” to paint or sketch, and she did not
feel that obtaining a part time job would be “realistic.” (Id.)
Scott’s clinical note dated July 28, 2011, states that Woodmancy was
“extremely depressed and tearful today.” (Id. at 897.) She was incontinent on the
way to her session, and she needed assistance and dry clothing. (Id.) She reported
“feeling mortified and humiliated,” and she was “angry that she cannot get any
assistance from SSI.” (Id.) She also reported that she could not work “due to her
14

physical condition and she is afraid to work because she is incontinent, walks with
a cane, and cannot focus.” (Id.) She repeated that she believed God wanted to punish
her, and she felt “victimized, out of control and miserable.” (Id.) A note dated
August 11, 2011, indicates that Woodmancy continued to be tearful and anxious
about her physical problems, incontinence, low energy, and inability to focus. (Id.
at 896.) Scott noted that Woodmancy seemed “unwilling at this time to pursue any
leisure activities or techniques,” and “[s]he continues to focus on the negative and
states that she cannot see the good in her life at this time.” (Id.)
On August 25, 2011, Woodmancy told Scott that she felt better emotionally,
but was continuing to suffer incontinence and weakness in her upper body and legs.
(Id. at 895.) She was also experiencing headaches, and she reported that her blood
pressure was found to be “very high.” (Id.) She added that she had grown closer to
her sister, and “their relationship is important to her.” (Id.)
In a letter dated September 19, 2011, James Ortman, M.D., wrote “to confirm
that . . . Woodmancy does have problems with intermittent bowel and bladder
incontinence” that was “probably secondary to nerve injury at the time of a
retroperitoneal hematoma during a severe illness in 2009.” (Id. at 907.)
B.

Woodmancy’s Hearing Testimony

During the hearing before the ALJ on September 19, 2011, Woodmancy
testified that after she completed her inpatient rehabilitation, she still had
“considerable nerve damage” that affects her ability to walk and causes her to
experience bowel and bladder incontinence. (Tr. at 49-50. See also id. at 59
(indicating that Woodmancy was directed to use a cane “as needed” by Nebraska
Skilled Nursing).) She said that she has talked to Dr. Ortman about her incontinence
problems, (id. at 52), but it does not appear that Woodmancy was asked any questions
15

about whether she has sought or received any type of treatment for incontinence,
apart from wearing “protection,” (id. at 50). Woodmancy indicated that her heart was
now “good,” but she was disabled due to incontinence and her “exhaustion level.”
(Id. at 52-53.) She said that she “would like to find a little part-time job that would
fit into [her] physical capabilities right now,” perhaps working “three days a week for
a four hour shift each day,” but so far she had been unable to find such a position.
(Id. at 53-54.) She also testified that she only leaves her home approximately twice
per week because she is “too tired,” and she naps every day for 1-3 hours. (Id. at 5758.)
Woodmancy testified that she had been taking Lexapro for anxiety or
depression during her hospitalization, but she has since switched to Buspar and
Prozac. (Id. at 55-56.) She said that she has anxiety attacks “on almost a daily basis”
that last from twenty minutes to several hours. (Id. at 57.) She also said that she
suffers migraine headaches. (Id. at 58.)
C.

Vocational Expert’s Testimony

During the hearing, the ALJ asked a Vocational Expert (VE) to consider an
individual “who is 57 at the onset date” and “has a high school education” “who
needs sedentary work, and by that I mean, work that does not involve being on one’s
feet or standing or walking more than two hours in an eight hour day but could sit for
at least, if not more, than six hours a day; could occasionally do all postural activities:
Climb, balance, stoop, kneel, crouch, crawl; could occasionally do postural activities:
Climb, balance, and stoop; and from an environmental standpoint avoid concentrated
exposure to cold, heat, fumes, and hazards.” (Tr. at 60-61.) She then asked, “So with
that functional capacity, could such an individual return to any or all of the past
work?” (Id. at 61.) The VE responded, “All for past work, your honor.” (Id.)
16

Woodmancy’s counsel asked the VE, “based on the claimant’s testimony,
would she be able to return to her previous work?” (Id. at 62.) The VE responded
negatively, adding, “She said she would probably need to take frequent bathroom
breaks. Also, she takes naps from one to three hours during the day. She can have
panic attacks which could last several hours up to a few minutes.” (Id.)
D.

The ALJ’s Decision

An ALJ is required to follow a five-step sequential analysis to determine
whether a claimant is disabled. See 20 C.F.R. § 404.1520(a); id. § 416.920(a). The
ALJ must continue the analysis until the claimant is found to be “not disabled” at
steps one, two, four or five, or is found to be “disabled” at step three or step five. See
20 C.F.R. § 404.1520(a); id. § 416.920(a) In this case, the ALJ proceeded to step
four and found Woodmancy to be not disabled. (See Tr. at 14-26.)
Step one requires the ALJ to determine whether the claimant is currently
engaged in substantial gainful activity. See 20 C.F.R. § 404.1520(a)(4)(i), (b); id. §
416.920(a)(4)(i), (b). If the claimant is engaged in substantial gainful activity, the
ALJ will find that the claimant is not disabled. See 20 C.F.R. § 404.1520(a)(4)(i),
(b); id. § 416.920(a)(4)(i), (b). In the instant case, the ALJ found that Woodmancy
“has not engaged in substantial gainful activity since October 31, 2009, the alleged
onset date.” (Tr. at 15 (citations omitted).)
Step two requires the ALJ to determine whether the claimant has a “severe
impairment.” 20 C.F.R. § 404.1520(c); id. § 416.920(c). A “severe impairment” is
an impairment or combination of impairments that significantly limits the claimant’s
ability to do “basic work activities” and satisfies the “duration requirement.” See 20
C.F.R. § 404.1520(a)(4)(ii), (c); id. § 404.1509 (“Unless your impairment is expected
to result in death, it must have lasted or must be expected to last for a continuous
17

period of at least 12 months.”); id. § 416.920(a)(4)(ii), (c); id. § 416.909. Basic work
activities include “[p]hysical functions such as walking, standing, sitting, lifting,
pushing, pulling, reaching, carrying, or handling”; “[c]apacities for seeing, hearing,
and speaking”; “[u]nderstanding, carrying out, and remembering simple instructions”;
“[u]se of judgment”; “[r]esponding appropriately to supervision, co-workers and
usual work situations”; and “[d]ealing with changes in a routine work setting.” 20
C.F.R. § 404.1521(b); id. § 416.921(b). If the claimant cannot prove such an
impairment, the ALJ will find that the claimant is not disabled. See 20 C.F.R. §
404.1520(a)(4)(ii), (c); id. § 416.920(a)(4)(ii), (c). The ALJ found that Woodmancy
“has the following severe impairments: heart attack; hypertension; and deep vein
thrombosis.” (Tr. at 16 (citations omitted).)
Step three requires the ALJ to compare the claimant’s impairment or
impairments to a list of impairments. See 20 C.F.R. § 404.1520(a)(4)(iii), (d); id. §
416.920(a)(4)(iii); see also 20 C.F.R. Part 404, Subpart P, App’x 1. If the claimant
has an impairment “that meets or equals one of [the] listings,” the analysis ends and
the claimant is found to be “disabled.” See 20 C.F.R. § 404.1520(a)(4)(iii), (d); id.
§ 416.920(a)(4)(iii). If a claimant does not suffer from a listed impairment or its
equivalent, then the analysis proceeds to steps four and five. See 20 C.F.R. §
404.1520(a); id. § 416.920(a). The ALJ found that Woodmancy “does not have an
impairment or combination of impairments that meets or medically equals the severity
of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (Tr.
at 17 (citations omitted).)
Step four requires the ALJ to consider the claimant’s residual functional

18

capacity (RFC)4 to determine whether the impairment or impairments prevent the
claimant from engaging in “past relevant work.” See 20 C.F.R. § 404.1520(a)(4)(iv),
(e), (f); id. § 416.920(a)(4)(iv), (e), (f). If the claimant is able to perform any past
relevant work, the ALJ will find that the claimant is not disabled. See 20 C.F.R. §
404.1520(a)(4)(iv), (f); id. § 416.920(a)(4)(iv), (f).

The ALJ concluded that

Woodmancy “has the residual functional capacity to perform sedentary work as
defined in 20 CFR 404.1567(a) and 416.967(a), i.e., she can lift and carry 10 pounds
occasionally and less than 10 pounds frequently, sit 6 hours in an 8-hour workday,
and is not required to be on her feet for standing or walking more than 2 hours in an
8-hour workday. She can occasionally climb, balance, stoop, kneel, crouch, and
crawl, and she must avoid concentrated exposure to cold, heat, fumes, and hazards.”
(Tr. at 17.) The ALJ also found that Woodmancy “is capable of performing all past
relevant work including dispatcher, telephone solicitor, information clerk, and
collection clerk,” which “do not require the performance of work-related activities
precluded by the claimant’s residual functional capacity.” (Id. at 25 (citations
omitted).)

III.

STANDARD OF REVIEW

I must review the Commissioner’s decision to determine “whether there is
substantial evidence based on the entire record to support the ALJ’s factual findings.”
Johnson v. Chater, 108 F.3d 178, 179 (8th Cir. 1997) (quoting Clark v. Chater, 75

4

“‘Residual functional capacity’ is what the claimant is able to do despite
limitations caused by all of the claimant’s impairments.” Lowe v. Apfel, 226 F.3d
969, 972 (8th Cir. 2000) (citing 20 C.F.R. § 404.1545(a)). See also 20 C.F.R. §
416.945(a).
19

F.3d 414, 416 (8th Cir. 1996)). See also Collins v. Astrue, 648 F.3d 869, 871 (8th
Cir. 2011). “Substantial evidence is less than a preponderance but is enough that a
reasonable mind would find it adequate to support the conclusion.” Finch v. Astrue,
547 F.3d 933, 935 (8th Cir. 2008) (citations and internal quotation marks omitted).
A decision supported by substantial evidence may not be reversed, “even if
inconsistent conclusions may be drawn from the evidence, and even if [the court] may
have reached a different outcome.” McNamara v. Astrue, 590 F.3d 607, 610 (8th Cir.
2010). Nevertheless, the court’s review “is more than a search of the record for
evidence supporting the Commissioner’s findings, and requires a scrutinizing
analysis, not merely a ‘rubber stamp’ of the Commissioner’s action.” Scott ex rel.
Scott v. Astrue, 529 F.3d 818, 821 (8th Cir. 2008) (citations, brackets, and internal
quotation marks omitted). See also Moore v. Astrue, 623 F.3d 599, 602 (8th Cir.
2010) (“Our review extends beyond examining the record to find substantial evidence
in support of the ALJ’s decision; we also consider evidence in the record that fairly
detracts from that decision.”).
I must also determine whether the Commissioner’s decision “is based on legal
error.” Collins v. Astrue, 648 F.3d 869, 871 (8th Cir. 2011) (quoting Lowe v. Apfel,
226 F.3d 969, 971 (8th Cir. 2000)). “Legal error may be an error of procedure, the
use of erroneous legal standards, or an incorrect application of the law.” Id. (citations
omitted). No deference is owed to the Commissioner’s legal conclusions. See
Brueggemann v. Barnhart, 348 F.3d 689, 692 (8th Cir. 2003). See also Collins, 648
F.3d at 871 (indicating that the question of whether the ALJ’s decision is based on
legal error is reviewed de novo).

20

IV.

ANALYSIS

Woodmancy argues that the Commissioner’s decision must be reversed because
1) the ALJ failed to give controlling weight to Dr. Ortman’s opinion that
Woodmancy’s incontinence was secondary to nerve damage from a retroperitoneal
hematoma, and 2) the ALJ did not properly evaluate the credibility of Woodmancy’s
allegations of incontinence. (See Pl.’s Br. at 11, 17, ECF No. 14.) She adds that the
VE’s testimony establishes that the ALJ’s errors are not harmless. (Id. at 20.) I shall
analyze each of her arguments in turn.
A.

Whether Dr. Ortman’s Opinion Was Entitled to Controlling Weight
Woodmancy argues first that the ALJ erred by failing to give controlling

weight to Dr. Ortman’s opinion that Woodmancy has “problems with intermittent
bowel and bladder incontinence” that “is probably secondary to nerve injury at the
time of a retroperitoneal hematoma during a severe illness in 2009.” (Pl.’s Br. at 11,
ECF No. 14 (quoting Tr. at 907).)
The parties do not dispute that Dr. Ortman is Woodmancy’s treating physician.
“A treating physician’s opinion regarding an applicant’s impairment will be granted
controlling weight, provided the opinion is well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent with the other
substantial evidence in the record.” Samons v. Astrue, 497 F.3d 813, 817-818 (8th
Cir. 2007) (internal quotation marks omitted). “Even if the opinion is not entitled to
controlling weight, it should not ordinarily be disregarded and is entitled to
substantial weight.” Id. at 818 (citations and internal quotation marks omitted). “But
the ALJ may give a treating doctor’s opinion limited weight if it provides conclusory
statements only or is inconsistent with the record.” Id. (citations omitted). See also
Renstrom v. Astrue, 680 F.3d 1057, 1064 (8th Cir. 2012) (“An ALJ may discount or
21

even disregard the opinion of a treating physician where other medical assessments
are supported by better or more thorough medical evidence, or where a treating
physician renders inconsistent opinions that undermine the credibility of such
opinions.” (quoting Perkins v. Astrue, 648 F.3d 892, 897-98 (8th Cir. 2011))). The
ALJ must “give good reasons” for the weight given to a treating source’s opinion.
20 C.F.R. § 404.1527(c)(2); 20 C.F.R. § 416.927(c)(2).
The ALJ’s decision includes no discussion of the degree of weight that was
given to Dr. Ortman’s opinion, although scattered references to Dr. Ortman’s letter
do appear in various paragraphs. (See Tr. at 16, 21, 23.) On page 16 of the transcript,
the ALJ wrote, “[Woodmancy’s] treating source, Dr. Ortman, did report in a letter
received subsequent to the hearing that Ms. Woodmancy has had bladder and bowel
incontinence, but no records from Dr. Ortman are evident in the record to substantiate
this report.”5 Similarly, when discussing Woodmancy’s RFC, the ALJ wrote,
There were continual references in the office notes from the
therapist, Sheryl Scott, that the claimant was having incontinence issues,
but there was no medical evidence to show this beyond the one reference
on May 20, 2010, when she was initially seen at Douglas County Health
Center. A letter from the claimant’s treating source, James Ortman, MD,
dated September 19, 2011, received subsequent to the hearing,
confirmed that she had been experiencing intermittent bowel and
bladder incontinence, probably secondary to nerve injury at the time of
a retroperitoneal hematoma during a severe illness in 2009.
. . . There is only one mention of complaints of
incontinence and headaches in the record, i.e., when she
was seen on May 20, 2010, but no further indication of

5

I take it that this sentence is meant to provide an explanation for the ALJ’s
decision to exclude intermittent bowel and bladder incontinence from the list of
severe impairments at step two of the sequential analysis. (See Tr. at 16.)
22

ongoing care for these problems, until Dr. Ortman reported
after the hearing that she had been having bladder and
bowel incontinence.
(Id. at 21.) Later in the decision, the ALJ added,
In terms of the claimant’s alleged incontinence, the only mention
was made when she was seen initially at Douglas County Health Care
on May 20, 2010, again after the initial denial of her claim. The only
reference to this problem after that was made during the claimant’s
mental health therapy sessions and a letter from Dr. Ortman subsequent
to the hearing indicating that she had been having these problems. Even
then, Dr. Ortman did not suggest any limitations associated with this
condition.
(Id. at 23.)
Based on the foregoing references to the letter, and because the ALJ neither
listed “intermittent incontinence” as a severe impairment at step two of the sequential
analysis nor incorporated the limiting effects of intermittent incontinence into
Woodmancy’s RFC, I infer that the ALJ gave no weight to Dr. Ortman’s opinion.
After careful consideration, I find that the ALJ failed to cite good reasons for doing
so.
As noted previously, Dr. Ortman’s opinion is entitled to 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 the record.
It is not clear whether Dr. Ortman’s opinion is well-supported by medically
acceptable clinical and laboratory diagnostic techniques. I therefore find that the
opinion is not entitled to controlling weight.
It does not follow, however, that it was appropriate for the ALJ to disregard Dr.
Ortman’s opinion completely. On the contrary, the opinion is entitled to substantial
weight unless 1) other medical assessments are supported by better or more thorough
23

medical evidence, 2) the opinion is conclusory, or 3) the opinion inconsistent with the
record or the treating physician’s other opinions. E.g., Renstrom, 680 F.3d at 1064;
Samons, 497 F.3d at 818. There is no medical assessment in the record suggesting
that Woodmancy does not suffer from intermittent bowel or bladder incontinence.
Nor is Dr. Ortman’s opinion conclusory; rather, it states specifically the nature of
Woodmancy’s impairment and suggests its likely cause. (See Tr. at 907.) Thus,
grounds 1) and 2) do not provide a basis for disregarding Dr. Ortman’s opinion.
The ALJ appears to have discounted Dr. Ortman’s opinion on the ground that
Woodmancy’s incontinence was mentioned in only one medical record apart from the
therapy notes. (See Tr. at 16, 21, 23.) The Commissioner rightly concedes, however,
that this finding is incorrect. (See Defs.’ Br. at 13-14, ECF No. 20. See also supra
Part II.A (identifying references to incontinence in the medical records).) Moreover,
I can find no evidence in the record that is inconsistent with Dr. Ortman’s opinion.
The ALJ also noted that “Dr. Ortman did not suggest any limitations associated
with” Woodmancy’s incontinence. (Tr. at 23.) This is true in a literal sense, though
it seems to me that the limitations associated with “intermittent bowel and bladder
incontinence,” (Tr. at 907), are not difficult to infer. In any event, I remain persuaded
that the ALJ erred by rejecting Dr. Ortman’s opinion that Woodmancy suffers from
the condition, even if he did not articulate the limitations associated with it.
In summary, the ALJ appears to have disregarded completely Dr. Ortman’s
opinion that Woodmancy suffers from intermittent bowel and bladder incontinence
without providing sufficient reasons for doing so. The Commissioner’s decision must
therefore be reversed so that proper consideration may be given to Dr. Ortman’s
opinion.

24

B.

The ALJ’s Analysis of Woodmancy’s Credibility

Woodmancy also argues that the ALJ failed to evaluate properly the credibility
of Woodmancy’s allegations of incontinence. (Pl.’s Br. at 17-20, ECF No. 14.) I
agree.
“The credibility of a claimant’s subjective testimony is primarily for the ALJ
to decide, not the courts.” Moore v. Astrue, 572 F.3d 520, 524 (8th Cir. 2009)
(quoting Holmstrom v. Massanari, 270 F.3d 715, 721 (8th Cir. 2001)). “In assessing
a claimant’s credibility, the ALJ must consider: (1) the claimant’s daily activities; (2)
the duration, intensity, and frequency of pain; (3) the participating and aggravating
factors; (4) the dosage, effectiveness, and side effects of medication; (5) any
functional restrictions; (6) the claimant’s work history; and (7) the absence of
objective medical evidence to support the claimant’s complaints.” Id. (citing, inter
alia, Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984)). “An ALJ who rejects
[subjective] complaints must make an express credibility determination explaining
the reasons for discrediting the complaints.” Id. (citation omitted) (alteration in
original). The ALJ need not explicitly discuss each of the foregoing factors, however.
Id. (quoting Goff v. Barnhart, 421 F.3d 785, 791 (8th Cir. 2005)). “It is sufficient if
[the ALJ] acknowledges and considers [the] factors before discounting a claimant’s
subjective complaints.” Id. (quoting Goff, 421 F.3d at 791) (alteration in original).
“If an ALJ explicitly discredits the claimant’s testimony and gives good reason for
doing so,” courts “will normally defer to the ALJ’s credibility determination.” Jones
v. Astrue, 619 F.3d 963, 975 (8th Cir. 2010) (quoting Halverson v. Astrue, 600 F.3d
922, 932 (8th Cir. 2010)).
Woodmancy testified that she experienced bladder incontinence that caused
unexpected releases of urine in varying amounts; that she experienced bowel
25

incontinence, which she had “the hardest time dealing with”; and that she wore
“protection,” but her protection was inadequate to deal with episodes of bowel
incontinence. (Tr. at 50-51.)
In disregarding Woodmancy’s testimony, the ALJ first cited the lack of
objective medical evidence supporting her allegations. (Tr. at 21.) To be precise, the
ALJ did not find that there was an “absence of objective medical evidence to support
the claimant’s complaints.” Moore, 572 F.3d at 524 (emphasis added). Rather, the
ALJ appears to have concluded that because there is no indication of “ongoing care”
for incontinence, and because there is only one reference to incontinence in the
“medical records” (setting aside the therapist’s “notes,” which contain multiple
references to it), Woodmancy’s allegations of incontinence may be discounted
entirely. (See Tr. at 21.) In any case, it seems to me that the ALJ’s finding on this
point is tainted by: 1) the ALJ’s improper decision to disregard the opinion of
Woodmancy’s treating physician, and 2) the ALJ’s failure to recognize that
incontinence is referenced in more than one medical record. Given these errors, I
conclude that it was improper for the ALJ to discredit Woodmancy’s allegations on
the ground that her testimony is not supported by objective medical evidence.
The Commissioner argues that “[t]he ALJ correctly found that there was no
evidence of treatment or medication for [Woodmancy’s] alleged incontinence.”
(Def.’s Br. at 14, ECF No. 20.) The ALJ did state that Woodmancy “takes no
medication to manage her alleged incontinence,” (Tr. at 23), and this statement
appears to be accurate. The record shows, however, that Woodmancy wears
“protection” to deal with her incontinence problems, (e.g., Tr. at 50), and there is no
indication that any other form of treatment is available to her. The Commissioner
may choose to explore this point further on remand, but a fair reading of the current
26

transcript cannot support a finding that Woodmancy’s failure to take medication
undermines the credibility of her allegations of incontinence.
The Commissioner also argues that it was proper for the ALJ to disregard
Woodmancy’s testimony because Dr. Ortman “never described how her incontinence
affected her functional ability or limited her in any way.” (Def.’s Br. at 15, ECF No.
20.) It is true that Dr. Ortman’s letter does not discuss the implications of a diagnosis
of intermittent bowel and bladder incontinence. As I noted above, however, it seems
to me that the “functional abilit[ies]” affected by such a diagnosis are readily apparent
without elaboration. Furthermore, the record contains evidence from Woodmancy
and other sources describing disruptions that have been caused by her episodes of
incontinence. (See, e.g., Tr. at 50-51, 283, 897, 901.) In short, I am not persuaded
that Dr. Ortman’s failure to specify the ways in which intermittent incontinence can
limit a person does not provide a sufficient basis for disregarding Woodmancy’s
allegations.

Finally, the Commissioner argues that the ALJ made a number of additional
observations that do not relate directly to Woodmancy’s allegations of incontinence,
but nevertheless support the conclusion that Woodmancy is not a fully credible
witness. (See Def.’s Br. at 15-18, ECF No. 20.) Specifically, the Commissioner
states that Woodmancy’s daily activities, her “focus on receiving benefits,” and her
“late addition” of incontinence, weakness, mental confusion, and headaches to her
claim all undermine her credibility. (See id.)
The Commissioner’s points are well-taken. It is proper for the ALJ to consider
whether a claimant’s daily activities are consistent with her allegations of disability.
See, e.g., Renstrom v. Astrue, 680 F.3d 1057, 1067 (8th Cir. 2012) (“We have held
27

that acts which are inconsistent with a claimant’s assertion of disability reflect
negatively upon that claimant’s credibility.” (quoting Halverson v. Astrue, 600 F.3d
922, 932 (8th Cir. 2010))). It is also proper for the ALJ to consider whether a
claimant’s credibility is undermined by her motivation to qualify for benefits, cf.
Gaddis v. Chater, 76 F.3d 893, 895-96 (8th Cir. 1996) (indicating that the claimant
could be discredited based on evidence of a “strong element of secondary gain”), and
her failure to mention a particular impairment in the original application for benefits,
cf. Dunahoo v. Apfel, 241 F.3d 1033, 1039 (8th Cir. 2001) (“The fact that she did not
allege depression in her application for disability benefits is significant, even if the
evidence of depression was later developed.”). In the instant case, there is substantial
evidence indicating that Woodmancy’s motivation to qualify for benefits was so
strong that it interfered with her progress in therapy. (E.g., Tr. at 904-905.) This
undermines Woodmancy’s credibility generally. There is also evidence indicating
that Woodmancy was capable of a wide range of daily activities, and it is true that
Woodmancy’s initial claims for benefits did not list incontinence as an impairment.
These factors may also weigh against Woodmancy’s credibility–though the fact that
Woodmancy’s initial applications for benefits were filed before she left the hospital
to begin her inpatient rehabilitation seems to limit the significance of the latter point.
Nevertheless, I am persuaded that given the entire record–which includes consistent,
uncontradicted evidence that Woodmancy suffers from bowel and bladder
incontinence–the ALJ failed to give good reasons for discrediting Woodmancy’s
allegations of incontinence. This failure, coupled with the ALJ’s failure to give
proper weight to Dr. Ortman’s opinion, undermines the Commissioner’s decision to
exclude the effects of intermittent incontinence from Woodmancy’s RFC. The case
must therefore be remanded for further proceedings.
28

IT IS ORDERED that the Commissioner of Social Security’s decision is
reversed.
Dated May 6, 2013.
BY THE COURT

__________________________________________
Warren K. Urbom
United States Senior District Judge

29