Hayes v. Colvin

Filing 20

MEMORANDUM OPINION. Signed by Magistrate Judge Pamela Meade Sargent on 08/26/2014. (Bordwine, Robin)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF VIRGINIA
BIG STONE GAP DIVISION
RICKY LEE HAYES,
Plaintiff
v.

CAROLYN W. COLVIN,
Acting Commissioner of
Social Security,
Defendant

)
)
)
)
)
)
)
)
)

Civil Action No. 2:13cv00018
MEMORANDUM OPINION

By: PAMELA MEADE SARGENT
United States Magistrate Judge

I. Background and Standard of Review

Plaintiff, Ricky Lee Hayes, (“Hayes”), filed this action challenging the final
decision of the Commissioner of Social Security, (“Commissioner”), denying
plaintiff’s claims for disability insurance benefits, (“DIB”), and supplemental
security income, (“SSI”), under the Social Security Act, as amended, (“Act”), 42
U.S.C.A. §§ 423 and 1381 et seq. (West 2011 & West 2012). Jurisdiction of this
court is pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). This case is before the
undersigned magistrate judge by consent of the parties pursuant to 28 U.S.C.
§ 636(c)(1).

The court’s review in this case is limited to determining if the factual
findings of the Commissioner are supported by substantial evidence and were
reached through application of the correct legal standards. See Coffman v. Bowen,
829 F.2d 514, 517 (4th Cir. 1987). Substantial evidence has been defined as
“evidence which a reasoning mind would accept as sufficient to support a
-1-

particular conclusion. It consists of more than a mere scintilla of evidence but may
be somewhat less than a preponderance.” Laws v. Celebrezze, 368 F.2d 640, 642
(4th Cir. 1966). “‘If there is evidence to justify a refusal to direct a verdict were the
case before a jury, then there is “substantial evidence.”’” Hays v. Sullivan, 907
F.2d 1453, 1456 (4th Cir. 1990) (quoting Laws, 368 F.2d at 642).

The record shows that Hayes protectively filed his applications for SSI and
DIB on August 22, 2008, alleging disability as of July 26, 2008, due to arthritis in
the lower back and hips, pain in the back and hips, breathing problems,
hemorrhoids and degenerative bone disease in the back and hips. (Record (“R.”),
at 226-29, 232-33, 256, 267.) The claims were denied initially and upon
reconsideration. (R. at 63-94, 95-122, 127-32, 134, 137-38, 140-41.) Hayes then
requested a hearing before an administrative law judge, (“ALJ”). (R. at 143-44.)
Two hearings were held on Hayes’s claims. One was held on February 16, 2011;
the other was held on November 15, 2011. (R. at 27-48.) Hayes was represented
by counsel at both hearings. (R. at 27, 32.)

By decision dated December 30, 2011, the ALJ denied Hayes’s claims. (R.
at 14-26.) The ALJ found that Hayes met the disability insured status requirements
of the Act for DIB purposes through December 31, 2011.1 (R. at 17.) The ALJ
found that Hayes had not engaged in substantial gainful activity since July 26,
2008. (R. at 17.) The ALJ found that the medical evidence established that Hayes
had severe impairments, namely degenerative disc disease, degenerative joint
disease, chronic obstructive pulmonary disease, (“COPD”), major depressive
1

Therefore, Hayes must show that he became disabled between July 26, 2008, the
alleged onset date, and December 31, 2011, the date last insured, in order to be entitled to DIB
benefits.
-2-

disorder, borderline intellectual functioning and anxiety disorder, but the ALJ
found that Hayes did not have an impairment or combination of impairments that
met or medically equaled one of the listed impairments in 20 C.F.R. Part 404,
Subpart P, Appendix 1. (R. at 17-19.) The ALJ found that Hayes had the residual
functional capacity to perform simple, unskilled light work 2 that required no
concentrated exposure to fumes, odors, gases, dust and poor ventilation, no
exposure to hazards, only superficial contact with others and low-stress work,
which was defined as no high production quotas or strict time demands for
production. (R. at 19-25.) The ALJ found that Hayes was unable to perform any of
his past relevant work.

(R. at 25.) Based on Hayes’s age, education, work

experience, residual functional capacity and the testimony of a vocational expert,
the ALJ found that a significant number of jobs existed in the national economy
that Hayes could perform, including jobs as a cleaner, a mail clerk, a packer and a
counter clerk. (R. at 25-26.) Thus, the ALJ concluded that Hayes was not under a
disability as defined by the Act and was not eligible for DIB or SSI benefits. (R. at
26.) See 20 C.F.R. §§ 404.1520(g), 416.920(g) (2013).

After the ALJ issued his decision, Hayes pursued his administrative appeals,
but the Appeals Council denied his request for review. (R. at 1-3.) Hayes then filed
this action seeking review of the ALJ’s unfavorable decision, which now stands as
the Commissioner’s final decision. See 20 C.F.R. §§ 404.981, 416.1481 (2013).
This case is before this court on Hayes’s motion for summary judgment filed
December 23, 2013, and the Commissioner’s motion for summary judgment filed
January 27, 2014.

2

Light work involves lifting items weighing up to 20 pounds at a time with frequent
lifting or carrying of items weighing up to 10 pounds. If someone can perform light work, he
also can perform sedentary work. See 20 C.F.R. §§ 404.1567(b), 416.967(b) (2013).
-3-

II. Facts

Hayes was born in 1962, (R. at 63, 226, 256), which, at the time of the
ALJ’s decision, classified him as a “younger person” under 20 C.F.R. §§
404.1563(c), 416.963(c). Hayes attended school into the eleventh grade, but his
school records showed that he failed numerous high school courses. (R. at 327.)
According to Hayes, he has obtained his General Equivalency Development,
(“GED”), diploma. (R. at 330, 346.) Hayes has past work experience as an
underground coal miner. (R. at 330, 346.) Hayes testified at his 2011 hearing that
his pain, depression and anxiety had worsened since he was denied benefits on a
prior application in 2008. (R. at 36, 39.) Hayes stated that he experienced pain
throughout his back, in his hips and in his knees. (R. at 36.) Hayes admitted that he
took Lortab for pain and that it helped some. (R. at 37.) Hayes also stated that he
had trouble breathing. (R. at 36.)

Hayes testified that he could walk for five to 10 minutes before he would be
forced to stop. (R. at 37.) Hayes also stated that he could sit for only 10 to 15
minutes before the pain would force him to stand up and move around. (R. at 38.)
Hayes also testified that he had difficulty gripping and lifting items with his hands.
(R. at 38.)

Robert Jackson, a vocational expert, also was present and testified at
Hayes’s November 15, 2011 hearing. (R. at 42-46.) He classified Hayes’s past
work as a coal miner/laborer as medium3 to heavy4. (R. at 43-44.) The ALJ asked
3

Medium work involves lifting items weighing up to 50 pounds at a time with frequent
lifting or carrying of items weighing up to 25 pounds. If an individual can do medium work, he
also can do sedentary and light work. See 20 C.F.R. §§ 404.1567(c), 416.967(c) (2013).
-4-

Jackson to consider a hypothetical individual of Hayes’s age, education and work
experience, who could occasionally lift, carry and/or upwardly pull items weighing
up to 20 pounds and frequently lift, carry and/or upwardly pull items weighing up
to 10 pounds, stand and/or walk with normal breaks for a total of about six hours in
an eight-hour workday, sit with normal breaks for a total of about six hours in an
eight-hour workday, occasionally climb ramps, stairs, ladders, ropes and scaffolds,
occasionally balance, stoop, kneel, crouch and crawl and who must avoid
concentrated exposure to fumes, odors, dust, gases and poor ventilation, as well as
hazards such as dangerous moving machinery and unprotected heights. (R. at 44.)
The ALJ also asked Jackson to assume that this individual was limited to simple,
easy-to-learn unskilled work with only superficial contact with the public, coworkers and supervisors and who should be in a low-stress job, which was defined
as a job with no high production quotas or strict time demands for production such
as assembly line type of work. (R. at 45.)

Jackson testified that a significant number of jobs existed that such an
individual could perform, including jobs as a cleaner, a mail clerk, a packer, and a
counter clerk, all at the light unskilled level. (R. at 45-46.) Jackson also testified
that there would be no jobs available for a hypothetical individual who had no
ability to follow work rules, who would be absent from work more than two days a
month or who would have poor or no ability to demonstrate reliability. (R. at 46.)

4

Heavy work is defined as work that involves lifting no more than 100 pounds at a time
with frequent lifting or carrying of objects weighing up to 50 pounds. If an individual can do
heavy work, he also can do sedentary, light and medium work. See 20 C.F.R. §§ 404.1567(d),
416.967(d) (2013).
-5-

In rendering his decision, the ALJ reviewed records from Wise County
Public Schools; Norton Community Hospital; Mountain View Regional Medical
Center; Stone Mountain Health Services; William J. Hamil, M.Ed., LSPE; Wise
County Behavioral Health Services operated by Frontier Health; Howard S. Leizer,
Ph.D., a state agency psychologist; Joseph Leizer, Ph.D., a state agency
psychologist; Dr. Richad Surrusco, M.D., a state agency physician; Dr. William
Humphries, M.D.; B. Wayne Lanthorn, Ph.D., a licensed clinical psychologist; and
Edward E. Latham, Ph.D., a clinical psychologist.

The medical records show that Hayes was diagnosed with COPD as early as
2001. (R. at 358.) It also shows that Hayes has complained of chronic low back
pain for years. (R. at 371, 374, 376, 403, 405-14.) A bone scan performed on
Hayes’s cervical, thoracic and lumbar spine, anterior chest, shoulders and hands
revealed mild increased uptake in the right acromiocalvicular, (“AC”), joint and
left first metacarpal phalangeal joint, most likely due to arthritic changes in these
joints. (R. at 364.) An MRI of Hayes’s cervical spine performed on September 27,
2001, revealed normal results except for a mild disc bulge in the midline at the
C5-C6 level resulting in slight effacement of the thecal sac anterior to the spinal
cord with slight narrowing of the neural foramen on the left side at this level. (R. at
362.) An MRI of Hayes’s left shoulder taken the same day revealed mild to
moderate arthritic changes in the AC joint and peritendinitis around the rotator cuff
tendon. (R. at 362.) X-rays of Hayes’s lumbar spine taken on May 31, 2006,
showed no acute abnormality in his spine. (R. at 371.) X-rays of Hayes’s lumbar
spine and hips taken on December 4, 2007, showed minimal degenerative changes
of the lumbar spine with disc spaces within normal limits and no significant
abnormalities of his hips. (R. at 437.) In 2007, Hayes also was diagnosed with
depression. (R. at 407.)
-6-

Frontier Health Case manager Michael Sean Halcomb, B.A., completed an
Outpatient Admission – Intake of Hayes on August 3, 2007. (R. at 472-93.) Hayes
told Halcomb that he was seeking mental health treatment because his “nerves
[were] shot.” (R. at 472.) Hayes stated that he could not work due to an injury and
that he was seeking disability benefits. (R. at 472.) Hayes said that his wife
supported the family, and he felt bad about not being able to work and contribute
financially. (R. at 472.) Halcomb noted that Hayes walked slowly. (R. at 472.)
Hayes reported that he took two 7.5 mg Lortabs daily for back pain. (R. at 472.)
Hayes reported that the financial strain was causing marital difficulties. (R. at 472.)
Hayes also reported drinking about 12 beers per week for years. (R. at 472.)

The assessment noted that Hayes reported no involvement in any leisure or
recreational activities and stated that he would be encouraged to develop
appropriate diversion/leisure activities. (R. at 476.) The assessment stated that
Hayes was depressed about his then-current situation and was anxious about fears
of losing his home and his health. (R. at 477.) Hayes complained of moderate
decrease in energy or fatigue, moderate social withdrawal, moderate anxiety,
moderate jitteriness, mild panic attacks, severe worrying, moderate memory
impairment, mild racing thoughts, mild hallucinations, mild decreased appetite,
mild anger, moderate blunted or flat affect, severe depressed mood, severe feelings
of worthlessness, moderate feelings of helplessness and hopelessness, moderate
irritability, moderate loss of interest or pleasure, severe low self-esteem, mild
insomnia and moderate tearfulness. (R. at 481-83.) Halcomb diagnosed major
depressive disorder, single episode, severe, with psychotic features, and he placed

-7-

Hayes’s then-current Global Assessment of Functioning, (“GAF”), 5 score at 40.6
(R. at 485.)

Hayes saw Halcomb for individual therapy on September 4, 2007. (R. at
494.) Hayes reported increased feelings of depression and chronic worry over
financial problems. (R. at 494.) Halcomb stated that Hayes’s mood was depressed,
and his affect was flat. (R. at 494.) Halcomb encouraged Hayes to focus on
possible solutions to his problems rather than worrying. (R. at 494.)

William J. Hamil, M.Ed., LSPE, performed a psychological evaluation of
Hayes on March 15, 2008. (R. at 418-23.) Hayes complained of depression since
he had been forced to quit work due to health problems two years previously. (R. at
419.) Hayes told Hamil that he felt “down in the dumps all the time.” (R. at 419.)
Hayes stated that he avoided people and stayed to himself. (R. at 419.) He stated
that he could not handle stress anymore. (R. at 419.) Hayes stated that he suffered
from insomnia and could not sleep without medicine. (R. at 422.) He said he felt
worthless. (R. at 422.)

Hayes told Hamil that he withdrew from school in the eleventh grade to go
to work. (R. at 419.) Hayes denied ever being in special education classes and
reported earning his GED at age 20. (R. at 419.) Hayes stated that he had worked
5

The GAF scale ranges from zero to 100 and “[c]onsider[s] psychological, social, and
occupational functioning on a hypothetical continuum of mental health-illness.” DIAGNOSTIC
AND STATISTICAL MANUAL OF MENTAL DISORDERS FOURTH EDITION, (“DSM-IV”), 32
(American Psychiatric Association 1994).
6

A GAF of 31 to 40 indicates A[s]ome impairment in reality testing or communication ...
OR major impairment in several areas, such as work or school, family relations, judgment,
thinking, or mood. ...@ DSM-IV at 32.
-8-

27 years as an underground coal miner. (R. at 419.) Hayes said that he spent most
of his days watching television. (R. at 422.)

Hayes reported that he suffered from osteoarthritis, rheumatoid arthritis,
hypertension, bone spurs in his back and hips, degenerative disc disease,
hemorrhoids and high cholesterol. (R. at 419.) Hayes stated that he had received
outpatient mental health treatment at Wise County Behavioral Health Center for
the previous year. (R. at 420.) Hamil found Hayes’s affect to be appropriate. (R. at
420.) Hayes denied suicidal or homicidal ideations. (R. at 420.) No hallucinations
or delusions were elicited. (R. at 420.) Hamil stated that Hayes was alert and
oriented with intact attention, concentration and short-term memory and adequate
insight and judgment. (R. at 420.)

Hamil administered the Weschler Adult Intelligence Scale III, (“WAIS-III”),
on which he obtained a verbal IQ score of 89, a performance IQ score of 80 and a
full-scale IQ score of 84, placing him in the low average range of intellectual
functioning. (R. at 420-21.) Hamil also administered the Minnesota Multiphasic
Personality Inventory 2, (“MMPI-2”), which showed that Hayes was likely to
present with chronic pain and complain of being physically ill. (R. at 421.) He also
was likely to tend to worry a great deal, be irritable, anxious, moody, guilt prone,
brooding, unhappy and have episodes of depression. (R. at 421.)

Hamil diagnosed Hayes with suffering from a major depressive disorder,
single episode, moderate; arthritis; hypertension; degenerative disc disease;
hemmorrhoids; and high cholesterol. (R. at 423.) Hamil estimated Hayes’s then-

-9-

current GAF score at 50. 7 (R. at 423.) Hamil stated that Hayes should be able to
comprehend and follow simple and somewhat detailed job instructions and
perform simple and repetitive tasks. (R. at 423.) Hamil stated that Hayes’s
concentration and persistence appeared to be adequate to meet the demands of
simple or even detailed work-related decisions. (R. at 423.) Hamil said that Hayes
showed a markedly unsatisfactory ability to interact with others, especially to
accept instructions from supervisors and interact with co-workers and the public in
an appropriate manner, as evidenced by a desire to be alone. (R. at 423.) Hamil
also said that Hayes was markedly limited in his ability to deal with the usual stress
encountered in competitive work, adapt to changes in the workplace, to be aware
of normal hazards or to take appropriate precautions because of stress sensitivity.
(R. at 423.) Hamil stated that Hayes’s mood and physical problems might
markedly detract from his ability to maintain regular attendance, perform work
activities on a consistent basis, perform work activities without special/additional
supervision and meet an employment schedule such as completing a normal
workday/workweek without interruption. (R. at 423.)

Hamil recommended

continued mental health counseling and medication management by a psychiatrist.
(R. at 423.)

Hamil also completed an Assessment Of Ability To Do Work-Related
Activities (Mental) on Hayes. (R. at 424-26.) Hamil stated that Hayes had a poor
ability to make all occupational, performance and personal-social adjustments
except for a good ability to follow work rules, to maintain attention and
concentration and to understand, remember and carry out detailed, but not
complex, and simple job instructions. (R. at 424-25.) Hamil stated that Hayes
7

A GAF score of 41-50 indicates that the individual has serious symptoms or serious
impairments in social, occupational or school functioning.
-10-

would, on average, be absent more than two days a month due his mental
impairments or treatment. (R. at 426.)

Hayes has been treated at Stone Mountain Health Services for complaints of
chronic back pain since as early as 2007. (R. at 403-14.) Hayes was seen at Stone
Mountain Health Services in Appalachia on March 24, 2008, for a routine checkup.
(R. at 427-30.) Hayes stated that amitriptyline had improved his sleep and helped
him better cope during the daytime. (R. at 427.) Hayes was diagnosed with chronic
low back pain, hypertension, depression, insomnia and elevated triglycerides. (R.
at 429.)

Case manager James Dale Kegley, M.S., with Frontier Health, completed an
Outpatient Admission – Intake of Hayes on March 25, 2008. (R. at 438-64.) Hayes
told Kegley that he suffered from back problems, including degenerative disc
disease and bone spurs, which caused him constant pain in his back and hips. (R. at
458.) Hayes complained of depression due to being unable to work for about two
years due to his physical problems. (R. at 438.) Hayes said that his back gradually
got worse, forcing him to quit work as shuttle car operator in an underground coal
mine. (R. at 438.) Hayes said he had applied for disability and been denied twice.
(R. at 438.)

The assessment noted that Hayes reported no involvement in any leisure or
recreational activities and stated that he would be encouraged to develop
appropriate diversion/leisure activities. (R. at 442.) Hayes also reported that he had
difficulty in establishing or maintaining a personal social support system outside of
his family. (R. at 442.) Hayes stated that he was able to complete all activities of
daily living and independent living without intervention. (R. at 443.)
-11-

Hayes

complained of moderate decrease in energy or fatigue, mild social withdrawal,
moderate apathy, moderate depressed mood, moderate feelings of worthlessness,
helplessness and hopelessness, mild irritability, moderate loss of interest or
pleasure, moderate low self-esteem and mild tearfulness. (R. at 447-49.) Kegley
diagnosed adjustment disorder with depressed mood, and he placed Hayes’s thencurrent GAF score at 50. (R. at 451.) Kegley recommended that Hayes participate
in individual and group psychotherapy. (R. at 454.)

Hayes began individual therapy with Kegley on April 14, 2008. (R. at 467.)
Hayes told Kegley that his life “started going downhill” when he had to stop
working about two years previously. (R. at 467.) Hayes said that what bothered
him most was “not being able to do what I had been doing.” (R. at 467.) Hayes
said that it bothered him that he could not take care of his family (R. at 467.)
Kegley stated that Hayes’s mood was mildly depressed with congruent affect. (R.
at 467.) Kegley stated that Hayes moved continuously throughout the session as if
in physical pain. (R. at 467.)

Hayes saw Kegley again on April 29, 2008. (R. at 466.) Hayes said that he
was “just wore out” physically. (R. at 466.) Hayes stated that he and his wife were
getting behind in their bills and were barely able to make their house payment each
month. (R. at 466.) Hayes said he was troubled because he believed that he should
be the primary wage earner in the house rather than his wife. (R. at 466.) Hayes
stated that he missed work. (R. at 466.) Kegley stated that Hayes was moderately
depressed and moved frequently throughout the session as if in physical
discomfort. (R. at 466.)

-12-

It appears that after receiving records from Kegley on May 1, 2008, to assist
in his disability claim, Hayes did not return for any additional therapy. Hayes was
discharged based on this failure to attend further sessions on July 16, 2008. (R. at
499-508.)

Hayes saw Misty L. Bendall, F.N.P., at Stone Mountain Health Services
Appalachia Family Health Center, on October 20, 2008. (R. at 536-37.) Hayes
stated that he was doing fairly well, but had experienced chest pain two weeks
previously at rest. (R. at 536.) Hayes stated that he became short of breath,
nauseated and had pain going down his left arm. (R. at 536.) He also complained
of a cyst on his right inner knee. (R. at 536.) Bendall noted no tenderness in
Hayes’s lumbosacral spine on palpation. (R. at 536.) Bendall recommended a
referral to a cardiologist. (R. at 536.) As a result of cholesterol testing, Bendall
recommended a low cholesterol diet and increased exercise. (R. at 538.)

An MRI of Hayes’s lumbar spine taken on November 24, 2008, showed
good disc space preservation with no focal disc protrusions, extrusions or
herniations. (R. at 511-12.) Vertebral alignment was normal. (R. at 511.) Very
nominal anterior spondylitic lipping was noted, but otherwise the findings were
normal. (R. at 512.) Hayes had a adenosine stress myocardial perfusion scan
performed on November 25, 2008. (R. at 548-50.) This scan showed no evidence
of focal fixed or reversible ischemia and normal left ventricular ejection fraction.
(R. at 549.)

Dr. William Humphries, M.D., performed a consultative examination on
Hayes at the request of the state agency on December 30, 2008. (R. at 515-18.)
Hayes told Dr. Humphries that he had experienced constant pain in his back and
-13-

hips for the previous five or six years. (R. at 515.) Hayes stated that he did not
recall any specific injury. (R. at 515.) He said the pain was exacerbated by
standing, walking, bending, lifting or any use of his back. (R. at 515.) Hayes stated
that, on a good day, he could walk about one-quarter of a mile on level ground
without stopping. (R. at 515.) Hayes stated that he had occasional urinary and fecal
leaks, had severe hemorrhoid problems and occasionally had to disimpact himself.
(R. at 515.)

Hayes also complained of chest pain for the previous year. (R. at 515.)
Hayes stated that the pain was a knifelike sharp feeling in the upper left parasternal
region that would come and go. (R. at 515.) He stated that deep inspiration,
movement of the chest and upper extremities and exertion occasionally would
cause the pain to appear. (R. at 515.) Hayes also complained of increasing
shortness of breath over the previous four to five years, primarily on exertion. (R.
at 515.) Hayes also stated that he has experienced pain in his hand, knees, elbows
and shoulders intermittently for the previous five or six years. (R. at 516.)

Dr. Humphries noted that Hayes was alert and in no distress, answered
questions appropriately and related well to him. (R. at 516.) Dr. Humphries noted
that the range of motion in Hayes’s neck was slightly reduced with mild tenderness
to palpation of the base posteriorly of the cervical spine and the medial trapezius
musculature. (R at 516.) Dr. Humphries noted that the range of motion in Hayes’s
back was moderately reduced with mild dorsal kyphosis. (R. at 516.) There was
no scoliosis and no paravertebral muscle spasm.

(R. at 516.)

There was

tendernesss to palpation of the paraspinous muscles in the thoracic and lumbar
regions. (R. at 516.) Straight leg raise caused lumbar and hip discomfort bilaterally
at about 80 degrees in the sitting position. (R. at 516.) There was full range of
-14-

motion in both shoulders, elbows and wrists without significant tenderness, heat,
swelling or deformity. (R. at 517.) There was slightly reduced range of motion of
both hands and some mild synovial thickening of some of the MCP and IP joints of
the fingers of both hands. (R. at 517.) There was slightly reduced range of motion
in both hips with normal range of motion in both knees and ankles without
significant tenderness, heat, swelling or deformity except for mild synovial
thickening of some of the IP joints of the toes of both feet. (R. at 517.)

Dr. Humphries noted that Hayes got on and off of the examining table
without difficulty, but did guard his back movement. (R. at 517.) His grip strength
was 5/5 bilaterally, and radial, median and ulnar nerve functions were intact
bilaterally. (R. at 517.) No tremors or involuntary movements except occasional
tremor of outstretched hands on intention. (R. at 517.) Romberg’s sign was
negative. (R. at 517.) Fine manipulations were performed adequately bilaterally,
and Hayes’s gait was mildly antalgic on the left due to left hip and low back
discomfort. (R. at 517.) Muscle strength was within normal limits in all four
extremities. (R. at 517.) There was no specific motor or sensory loss in Hayes’s
extremities. (R. at 517.)

Dr. Humphries noted slightly diminished breath sounds in Hayes’s lungs
bilaterally, with no rales, wheezes or rhonchi. (R. at 517.) He also noted a slight
increase in diameter of the chest. (R. at 517.) Dr. Humphries noted a regular heart
rhythm without murmur, gallop or rubs and no peripheral edema. (R. at 517.) The
lower extremities reveal no significant venous stasis changes with adequate foot
perfusion bilaterally. (R. at 517.) Dr. Humphries did note that Hayes’s dorsalis
pedis pulses were thready on the left. (R. at 517.)

-15-

Dr. Humphries noted that Hayes was alert and oriented with intact memory
for recent and remote events. (R. at 518.) He stated that Hayes’s intelligence was
within the normal range and that his affect and grooming were appropriate. (R. at
518.) X-rays of Hayes’s hips taken the same day showed no bony, joint or soft
tissue abnormality. (R at 520.) X-rays of Hayes’s lumbar spine showed moderate
atherosclerosis. (R. at 521.)

Dr. Humphries diagnosed chronic thoracic/lumbar strain; atypical chest pain;
COPD, mild to moderate; and degenerative joint disease in both hands and feet and
possibly the knees, elbows and shoulders. (R. at 518.) Dr. Humphries stated that,
based on his objective findings, Hayes would be limited to sitting six hours in and
eight-hour workday, standing and walking six hours in an eight-hour workday and
lifting items weighing up to 10 pounds frequently and 25 pounds occasionally. (R.
at 518.) He stated that Hayes was limited to only occasional climbing, kneeling or
crawling with no restriction on stooping or crouching. (R. at 518.) Dr. Humphries
stated that Hayes should avoid heights, hazards and fumes and could not perform
repetitive production type of gripping and grasping with either upper extremity. (R.
at 518.)

Hayes had pulmonary function testing performed at Johnston Memorial
Hospital on January 26, 2009. (R. at 523-25.)

Hayes returned to see Bendall on January 26, 2009, complaining of chest
pain three to four times a week at varying times. (R. at 540-41.) Hayes reported
that he had undergone an MRI of his back, seen a cardiologist and had a stress test
performed, but he did not know the results of any of this testing. (R. at 540.)
Hayes asked to increase his dosage of Lortab, stating that he was taking three to
-16-

four a day. (R. at 540.) Bendall did note tenderness in Hayes’s lumbosacral spine
on palpation. (R. at 540.)

State agency physician Dr. Richard Surrusco, M.D., completed a Residual
Functional Capacity Assessment on Hayes on February 4, 2009. (R. at 89-91.)8
Based on his review of the medical evidence, Dr. Surrusco stated that Hayes could
frequently lift and carry items weighing up to 10 pounds and occasionally lift and
carry items weighing up to 20 pounds. (R. at 89.) Dr. Surrusco stated that Hayes
could stand and/or walk for a total of about six hours in an eight-hour workday and
sit for a total of about six hours in an eight-hour workday. (R. at 89.) He stated
that Hayes’s ability to push and/or pull was limited only by his lift and carry
restrictions. (R. at 89.) Dr. Surrusco stated that Hayes could occasionally climb
ramps, stairs, ladders, ropes and scaffolds, balance, kneel and crawl. (R. at 89-90.)
He stated that Hayes’s abilities to stoop and to crouch were unlimited. (R. at 90.)
Dr. Surrusco also stated that Hayes should avoid concentrated exposure to fumes,
odors, dusts, gases, poor ventilation and hazards such as machinery and heights.
(R. at 91.)

State agency psychologist Joseph Leizer, Ph.D., completed a Psychiatric
Review Technique, (“PRT”), on Hayes on February 4, 2009. (R. at 86-87.)9
Joseph Leizer stated that Hayes suffered from an affective disorder which resulted
in mild restrictions of activities of daily living, mild difficulties in maintaining

8

The only evidence of this contained in the Administrative Record is the summary
contained in the Disability Determination Explanation. (R. at 80-94.)
9

The only evidence of this contained in the Administrative Record is the summary
contained in the Disability Determination Explanation. (R. at 80-94.)
-17-

social functioning, mild difficulties in maintaining concentration, persistence or
pace and no repeated episodes of decompensation of extended duration. (R. at 87.)

Hayes saw Bendall again on April 27, 2009, complaining of a chest cold. (R.
at 542-43.) Bendall ordered a chest X-ray to rule out pneumonia and gave Hayes a
prescription for an antibiotic. (R. at 542.) Bendall also recommended that Hayes
start using an Advair inhaler. (R. at 543.) On August 20, 2009, Hayes reported that
he was doing well and that his medication had his pain down to a tolerable level.
(R. at 544.)

State agency psychologist Howard S. Leizer, Ph.D., completed a PRT on
Hayes on October 14, 2009. (R. at 103-04, 116-17.)10 Howard S. Leizer stated that
Hayes suffered from an affective disorder which resulted in mild restrictions of
activities of daily living, mild difficulties in maintaining social functioning, mild
difficulties in maintaining concentration, persistence or pace and no repeated
episodes of decompensation of extended duration. (R. at 116.)

B. Wayne Lanthorn, Ph.D., a licensed clinical psychologist, performed a
consultative evaluation on Hayes on December 1, 2009. (R. at 559-68.) Hayes told
Lanthorn that he could not do much due to pain in his back and hips, which had
worsened over the years. (R. at 560, 562.) Hayes told Lanthorn that his pain level
was an 8/9 on a 10-point scale on bad days and a 5/6 on good days. (R. at 562.)
Hayes stated that, on occasion, he would help do the laundry and do some light
housekeeping at home. (R. at 563.) Hayes gave a history of being seen at Wise

10

The only evidence of this contained in the Administrative Record is the summary
contained in the Disability Determination Explanation. (R. at 97-109, 110-22.)
-18-

County Behavioral Health Services by Kegley and by Crystal Burke, L.C.S.W., at
Stone Mountain Health Services for mental health therapy. (R. at 563.)

Lanthorn noted that Hayes was oriented, exhibited poor eye contact, and his
affect was flat and blunted. (R. at 561, 564.) He stated that Hayes walked stiffly
and moved about his chair frequently during the interview. (R. at 563.) Lanthorn
described Hayes’s mood as agitated depression and stated that he seemed tense and
on-edge. (R. at 564.) Lanthorn stated that Hayes exhibited no signs of ongoing
psychotic processes or any clinical indicators of delusional thinking. (R.at 564.)
Hayes denied ever having any hallucinations. (R. at 564.) Hayes said that he was
quite depressed, preferred to be alone and was often irritable. (R. at 564.) Hayes
said that his energy level was low and that he did not enjoy anything. (R. at 564.)
Hayes claimed to have significant problems with his concentration and short-term
memory. (R. at 564.) After 10 minutes, however, Hayes was able to recall four out
of five words presented to him earlier. (R. at 564.) Hayes said that he was often
anxious, on-edge, tense, fidgety, restless, shaky and jittery. (R. at 564.)

Lanthorn administered the Wechsler Adult Intelligence Scale – Fourth
Edition, (“WAIS-IV”), and the Minnesota Multiphasic Personality Inventory – 2,
(“MMPI-2”). (R. at 564-67.) Hayes had a verbal comprehension index score of 74,
a perceptual reasoning index score of 81, a working memory index score of 80, a
processing speed index score of 68 and a full-scale IQ score of 71. (R. at 564-65.)
Lanthorn stated that these scores placed Hayes in the borderline range of
intelligence. (R. at 564.) Lanthorn stated that Hayes gave a good effort and that he
thought these results were valid. (R. at 564.) Lanthorn stated that Hayes’s MMPI2 test results suggested that he lacked psychological insight and had a tendency to
repress or deny problems and unfavorable traits. (R. at 566.)
-19-

According to

Lanthorn, these test results also showed that Hayes was markedly depressed,
unhealthy, pessimistic about his future, felt inadequate, hopeless and lacked selfconfidence. (R. at 566.) The test results indicated that Hayes experienced confused
thinking, difficulties with logic and concentration and impaired judgment. (R. at
566.)

Lanthorn diagnosed Hayes as suffering from a major depressive disorder,
single episode, severe; anxiety disorder with generalized anxiety due to chronic
physical problems, pain, etc.; pain disorder associated with both psychological
factors and general medical conditions, chronic; and borderline intellectual
functioning. (R. at 567.) Lanthorn placed Hayes’s then-current GAF score at 5055.11 (R. at 567.) Lanthorn stated that, from a psychological point of view, Hayes’s
prognosis was guarded. (R. at 568.) He recommended that Hayes return to both
psychiatric and psychotherapeutic intervention at his local mental health center. (R.
at 568.)

Lanthorn stated that Hayes was severely depressed with anhedonia, lowenergy level, erratic to poor short-term memory and concentration, disrupted sleep
pattern and poor appetite. (R. at 568.)

Lanthorn stated that Hayes had mild

limitations on learning simple tasks in the workplace and mild to moderate
limitations on his ability to learn and perform more complicated tasks. (R. at 568.)
He stated that Hayes would have mild to moderate limitations in focusing his
concentration and persisting on task. (R. at 568.) Lanthorn stated that Hayes
would have moderate or greater limitations on interacting with others in the

11

A GAF score of 51-60 indicates that the individual has moderate symptoms or
moderate difficulty in social, occupational or school functioning. See DSM-IV at 32.
-20-

workplace to include co-workers, the public and supervisors and in dealing with
the changes and requirements of the workplace. (R. at 568.)

Lanthorn also completed a Medical Assessment Of Ability To Do WorkRelated Activities (Mental), on which he stated that Hayes had poor to no ability to
make all occupational, performance and personal-social adjustments other than a
fair ability to follow work rules, to function independently, to maintain attention
and concentration, to understand, remember and carry out simple job instructions
and to maintain personal appearance. (R. at 570-72.) He also stated that Hayes
would, on average, be absent from work more than two days a month due to his
impairments and/or treatment. (R. at 572.)

Hayes returned to see Bendall on February 22, 2010. (R. at 576-77.) Hayes
stated that he was doing fairly well and had come in simply to receive refills on his
medications. (R. at 576.) Bendall recommended a referral for an ultrasound of his
abdomen. (R. at 577.)

On March 11, 2010, Bendall completed an assessment of Hayes’s workrelated physical abilities. (R. at 578-80.) On this assessment, Bendall stated that
Hayes could lift and carry items weighing up to 10 pounds. (R. at 578.) She stated
that Hayes could stand and walk up to 45 minutes and sit up to 45 minutes in an
eight-hour workday. (R. at 578.) Bendall stated that Hayes could never climb,
stoop, kneel, balance, crouch or crawl. (R. at 579.) She also stated that Hayes’s
abilities to reach, to handle and to push or pull were affected by his impairments.
(R. at 579.) Bendall said that Hayes should avoid work around heights, moving
machinery, dust, fumes, humidity and vibration. (R. at 580.) Bendall also stated

-21-

that Hayes was likely to miss more than two days of work a month due to his
impairments and/or treatment. (R. at 580.)

Hayes saw Crystal Burke, LCSW, with Stone Mountain Health Services, on
March 29, 2010, for a behavioral health consult. (R. at 583-84.) Hayes told Burke
that he was injured at work and was placed on workers’ compensation. (R. at 583.)
He later was returned to light-duty work, but there was no light-duty work
available in the coal mines, so he lost his job. (R. at 583.) He stated that he had not
worked in about four years and that he was very depressed. (R. at 583.) He
reported an increase in stress over the previous few weeks, as his wife also lost her
job. (R. at 583.)

Hayes told Burke that he was in quite a bit of pain and took Lortab 10 mg
four times a day. (R. at 583.) He said that he also took amitriptyline 50 mg at night
which helped very little with sleep. (R. at 583.) Hayes stated that he was no longer
interested in any activities and mostly sat at home watching television. (R at 583.)
Burke noted that Hayes responded appropriately to questions, but he initiated very
little conversation. (R. at 583.) She noted that Hayes’s mood appeared depressed
with congruent effect. (R. at 583.) Burke stated that Hayes might benefit from
further antidepressant treatment. (R. at 583.)

Hayes was seen for an initial visit at the Davenport Clinic of Stone Mountain
Health Services on June 2, 2010. (R. at 606-08.) Hayes reported that his chronic
lumbar pain was well-controlled with medication. (R. at 606.) The only
abnormality noted on physical exam was a slightly antalgic gait. (R. at 607.)
Hayes was advised to decrease his dosage of Lortab. (R. at 608.) The provider

-22-

advised Hayes to seek a primary care physician because the provider was not
taking any chronic pain patients. (R. at 608.)

On July 14, 2010, Hayes sought treatment again at Stone Mountain Health
Services in Appalachia and began treating with Dr. T. Kaur, M.D. (R. at 626-28.)
Hayes stated that he returned to Appalachia for treatment because the provider at
the St. Paul clinic had decreased his pain medication and told him that the provider
would not write him a continuing prescription for pain medication. (R. at 626.)
Hayes stated that he had no interest in receiving epidural injections for his back
pain. (R. at 626.) Hayes complained of shortness of breath, wheezing, sharp chest
pain with breathing and chronic back pain. (R. at 626.) Examination revealed high
blood pressure, wheezing in Hayes’s upper right lung lobe and decreased range of
motion in his lumbar spine. (R. at 627.) Dr. Kaur returned Hayes’s Lortab 10 mg
dosage to four times a day. (R. at 628.)

Hayes returned to Dr. Kaur on August 13, 2010, stating that he needed a
refill of his Lortab prescription. (R. at 623-25.) On September 13, 2010, Hayes
also was given a prescription for Mobic for his chronic back pain. (R. at 622.) On
October 13, 2010, Hayes complained that his pain was so severe that he could not
sit still. (R. at 617.) Hayes also complained of urinary complaints this date,
including poor stream, imcomplete emptying and increased frequency of urination.
(R. at 617.) Hayes returned on November 16, 2010, stating that he needed refills
on his medications. (R. at 614-16.)

Hayes returned to see Burke on January 19, 2011. (R. at 630.) Hayes
complained of being unable to work with multiple frustrations due to financial
stressors. (R. at 630.) Hayes stated that his utilities had been stopped on more than
-23-

one occasion over the previous few months, and he was about to lose him home.
(R. at 630.) Hayes reported a “falling out” with his son because his son was
helping him financially and it placed too large a strain on the son’s family. (R. at
630.) Hayes reported feelings of hopelessness and worthlessness. (R. at 630.) He
denied suicidal ideation, but reported that he often felt he would be better off dead.
(R. at 630.) Burke noted that Hayes’s mood was significantly depressed with
congruent affect. (R. at 630.) Burke stated that Hayes’s symptoms of depression
appeared worse. (R. at 630.) Burke again encouraged Hayes to seek antidepressant
medication. (R. at 630.)

Burke completed a Medical Assessment Of Ability To Do Work-Related
Activities (Mental) on January 24, 2011. (R. at 632-34.) Burke stated that Hayes
had a poor or no ability to make all occupational, performance and personal-social
adjustments with the exception of a fair ability to understand, remember and carry
out simple job instructions, to relate predictably in social situations and to
demonstrate reliability. (R. at 632-33.) Burke stated that, on average, Hayes would
miss more than two days of work a month due to his impairments or treatment. (R.
at 634.)

Hayes saw Burke again on February 14, 2011. (R. at 648.)

Hayes

complained of pain and anxiety. (R. at 648.) Hayes reported that he mostly stayed
to himself, even avoiding his family. (R. at 648.) He stated that he felt irritable all
of the time. (R. at 648.) Burke reported that Hayes was very quiet, almost timid
during the interview, tearful and depressed. (R. at 648.)

Edward E. Latham, Ph.D., a clinical psychologist, performed a
psychological evaluation on Hayes on March 17, 2011. (R. at 636-38.) Hayes
-24-

reported that he worked until five years earlier when physical problems prevented
him from working in the coal mines. (R. at 636.) Hayes told Latham that he was
disabled due to arthritis and degenerative bone disease in his back and hips,
breathing problems and hemorrhoids. (R. at 636.) Hayes reported that he had
sought mental health treatment in the past and currently was treating with Burke.
(R. at 637.) Hayes reported little daily activity other than sitting and watching
television. (R. at 637.)

Hayes reported reduced will, motivation and pervasive loss of interest in
activities. (R. at 637.) He also reported fatigue, low energy, feelings of guilt and
uselessness, short-term memory and concentration deficits and sleep disturbance.
(R. at 637.) Hayes reported suicidal ideations, but no attempts or plans. (R. at
637.) He denied any psychotic experiences, hallucinations or delusions. (R. at
637.) Latham stated that Hayes presented no symptoms of bipolar disorder. (R. at
637.) Hayes denied any periods of excessive restlessness and activity, racing
thoughts, elevated mood for no reason, decreased need for sleep while feeling
energized or involvement in high-risk activity. (R. at 637.)

Hayes reported some anxiety and complained of being jumpy, easily startled
and hypervigilant. (R. at 637.) He stated that he avoided shopping and crowds out
of distress. (R. at 637.) Hayes stated that he had experienced panic-like episodes,
but could not say that they occurred once a week. (R. at 637.) Hayes denied any
obsessive or compulsive actions or any symptoms of post-traumatic stress disorder.
(R. at 637.)

Latham stated that Hayes was alert and adequately oriented with no
pathological disturbance in thought processes, content or perception. (R. at 637.)
-25-

Latham noted that Hayes’s mood was depressed, and his affect was appropriate
with respect to his thought content. (R. at 637.)

Latham noted that Hayes’s

cognitive abilities appeared to be low average to possibly borderline deficient. (R.
at 637.) Latham administered a self-report personality inventory, but he reported
that the results were invalid. (R. at 638.)

Latham diagnosed Hayes as suffering from major depression, single episode,
severe, without psychosis; and an anxiety disorder, not otherwise specified. (R. at
638.) Latham stated that Hayes was able to understand, retain and follow simple
instructions and do routine, repetitive tasks. (R. at 638.) He stated that Hayes’s
attention/concentration skills appeared to be impaired, but sufficient, for simple
tasks. (R at 638.) Latham stated that Hayes’s ability to relate interpersonally
appeared moderately impaired. (R. at 638.) He stated that Hayes’s ability to
handle everyday stressors appeared to be markedly impaired. (R. at 638.)

Latham also completed a Medical Source Statement Of Ability To Do
Work-Related Activities (Mental), on which he stated that Hayes had mild
limitations in his ability to understand, remember and carry out simple instructions
and to make judgments on simple work-related decisions, moderate limitations in
his ability to understand, remember and carry out complex instructions, to make
judgments on complex work-related decisions and to interact appropriately with
the public, supervisors and co-workers and marked limitations in his ability to
respond appropriately to usual work situations and to changes in a routine work
setting. (R. at 639-41.) Latham stated that Hayes described credible depression
symptoms, avoidance pattern and withdrawal. (R. at 640.)

-26-

Hayes returned to Stone Mountain Health Services in Appalachia on July 11,
2011, complaining of chest pain, racing heart rate and insomnia. (R. at 656.) Dr.
Kaur prescribed Elavil, in addition to Lortab. (R. at 656.) On September 26, 2011,
Hayes told Dr. Kaur that he drank two beers a day and denied any withdrawal
symptoms or cravings. (R. at 650.)

III. Analysis

The Commissioner uses a five-step process in evaluating DIB and SSI
claims. See 20 C.F.R. §§ 404.1520, 416.920 (2013). See also Heckler v. Campbell,
461 U.S. 458, 460-62 (1983); Hall v. Harris, 658 F.2d 260, 264-65 (4th Cir. 1981).
This process requires the Commissioner to consider, in order, whether a claimant
1) is working; 2) has a severe impairment; 3) has an impairment that meets or
equals the requirements of a listed impairment; 4) can return to his past relevant
work; and 5) if not, whether he can perform other work. See 20 C.F.R. §§
404.1520, 416.920. If the Commissioner finds conclusively that a claimant is or is
not disabled at any point in this process, review does not proceed to the next step.
See 20 C.F.R. §§ 404.1520(a), 416.920(a) (2013).

Under this analysis, a claimant has the initial burden of showing that he is
unable to return to his past relevant work because of his impairments. Once the
claimant establishes a prima facie case of disability, the burden shifts to the
Commissioner. To satisfy this burden, the Commissioner must then establish that
the claimant has the residual functional capacity, considering the claimant’s age,
education, work experience and impairments, to perform alternative jobs that exist
in the national economy. See 42 U.S.C.A. §§ 423(d)(2)(A), 1382c(a)(3)(A)-(B)
(West 2011 & West 2012); McLain v. Schweiker, 715 F.2d 866, 868-69 (4th Cir.
-27-

1983); Hall, 658 F.2d at 264-65; Wilson v. Califano, 617 F.2d 1050, 1053 (4th Cir.
1980).

By decision dated December 30, 2011, the ALJ denied Hayes’s claims. (R.
at 14-26.) The ALJ found that Hayes met the disability insured status requirements
of the Act for DIB purposes through December 31, 2011. (R. at 17.) The ALJ
found that Hayes had not engaged in substantial gainful activity since July 26,
2008. (R. at 17.) The ALJ found that the medical evidence established that Hayes
had severe impairments, namely degenerative disc disease, degenerative joint
disease, COPD, major depressive disorder, borderline intellectual functioning and
anxiety disorder, but the ALJ found that Hayes did not have an impairment or
combination of impairments that met or medically equaled one of the listed
impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (R. at 17-19.) The ALJ
found that Hayes had the residual functional capacity to perform simple, unskilled
light work that required no concentrated exposure to fumes, odors, gases, dust and
poor ventilation, no exposure to hazards, only superficial contact with others and
low-stress work, which was defined as no high production quotas or strict time
demands for production. (R. at 19-25.) The ALJ found that Hayes was unable to
perform any of his past relevant work. (R. at 25.) Based on Hayes’s age, education,
work experience, residual functional capacity and the testimony of a vocational
expert, the ALJ found that a significant number of jobs existed in the national
economy that Hayes could perform, including jobs as a cleaner, a mail clerk, a
packer and a counter clerk. (R. at 25-26.) Thus, the ALJ concluded that Hayes
was not under a disability as defined by the Act and was not eligible for DIB or
SSI benefits. (R. at 26.) See 20 C.F.R. §§ 404.1520(g), 416.920(g).

-28-

In his brief, Hayes argues that the ALJ’s finding as to his residual functional
capacity is not supported by the substantial evidence of record. (Plaintiff’s
Memorandum In Support Of His Motion For Summary Judgment, (“Plaintiff’s
Brief”), at 6-9.) Hayes also argues that the ALJ erred by failing to give full
consideration to the opinions of Lanthorn. (Plaintiff’s Brief at 9-11.)

As stated above, the court’s function in this case is limited to determining
whether substantial evidence exists in the record to support the ALJ’s findings.
This court must not weigh the evidence, as this court lacks authority to substitute
its judgment for that of the Commissioner, provided her decision is supported by
substantial evidence. See Hays, 907 F.2d at 1456. In determining whether
substantial evidence supports the Commissioner’s decision, the court also must
consider whether the ALJ analyzed all of the relevant evidence and whether the
ALJ sufficiently explained his findings and his rationale in crediting evidence. See
Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 439-40 (4th Cir. 1997).

Thus, it is the ALJ’s responsibility to weigh the evidence, including the
medical evidence, in order to resolve any conflicts which might appear therein.
See Hays, 907 F.2d at 1456; Taylor v. Weinberger, 528 F.2d 1153, 1156 (4th Cir.
1975.) Furthermore, while an ALJ may not reject medical evidence for no reason
or for the wrong reason, see King v. Califano, 615 F.2d 1018, 1020 (4th Cir. 1980),
an ALJ may, under the regulations, assign no or little weight to a medical opinion,
even one from a treating source, based on the factors set forth at 20 C.F.R. §§
404.1527(c), 416.927(c), if he sufficiently explains his rationale and if the record
supports his findings.

-29-

The ALJ must generally give more weight to the opinion of a treating
physician because that physician is often most able to provide Aa detailed,
longitudinal picture@ of a claimant=s alleged disability. 20 C.F.R. §§
404.1527(c)(2), 416.927(c)(2) (2013).

However, “[c]ircuit precedent does not

require that a treating physician=s testimony ‘be given controlling weight.’” Craig
v. Chater, 76 F.3d 585, 590 (4th Cir. 1996) (quoting Hunter v. Sullivan, 993 F.2d
31, 35 (4th Cir. 1992) (per curiam)). In fact, Aif a physician=s opinion is not
supported by clinical evidence or if it is inconsistent with other substantial
evidence, it should be accorded significantly less weight.@ Craig, 76 F.3d at 590.

In this case, there is little objective evidence to support Hayes’s allegations
of severe debilitating pain. While Hayes has treated with Stone Mountain Health
Services for years, it appears that these providers have done little by way of
physical examinations to confirm his complaints of back and hip pain. The medical
records of these visits make little mention of any physical examination other than
tenderness in the low back to palpation – a subjective complaint, rather than
objective finding. The records make no mention of range of motion testing,
straight leg raise testing or any muscle spasms or atrophy.

Dr. Humphries, on the other hand, performed range of motion testing in all
major joints, noting that the range of motion in Hayes’s neck was slightly reduced,
and the range of motion in Hayes’s back was moderately reduced. (R. at 516-17.)
While Dr. Humphries noted mild tenderness to palpation of the base posteriorly of
the cervical spine and tendernesss to palpation of the paraspinous muscles in the
thoracic and lumbar regions, he noted no muscle spasm. (R at 516.) Straight leg
raise caused lumbar and hip discomfort bilaterally at about 80 degrees in the sitting
position. (R. at 516.) There was slightly reduced range of motion in both hips with
-30-

normal range of motion in both knees and ankles without significant tenderness,
heat, swelling or deformity. (R. at 517.) There was full range of motion without
significant tenderness, heat, swelling or deformity in all other joints, other than
Hayes’s hands and feet. (R. at 517.)

Dr. Humphries noted that Hayes was in no distress and got on and off of the
examining table without difficulty, but did guard his back movement. (R. at 51617.) His grip strength was 5/5 bilaterally, and radial, median and ulnar nerve
functions were intact bilaterally. (R. at 517.)

Dr. Humphries also noted that

Hayes’s muscle strength was within normal limits in all four extremities. (R. at
517.) There was no specific motor or sensory loss in Hayes’s extremities. (R. at
517.) X-rays of Hayes’s hips taken the same day showed no bony, joint or soft
tissue abnormality. (R at 520.) X-rays of Hayes’s lumbar spine showed moderate
atherosclerosis. (R. at 521.)

Based on his objective findings, Dr. Humphries stated that Hayes would be
limited to sitting six hours in an eight-hour workday, standing and walking six
hours in an eight-hour workday and lifting items weighing up to 10 pounds
frequently and 25 pounds occasionally. (R. at 518.) He stated that Hayes was
limited to only occasional climbing, kneeling or crawling with no restriction on
stooping or crouching. (R. at 518.) Dr. Humphries stated that Hayes should avoid
heights, hazards and fumes and could not perform repetitive production type of
gripping and grasping with either upper extremity. (R. at 518.)

Based on the above, I find that the ALJ’s decision to give more weight to the
opinion of Dr. Humphries is supported by the evidence of record. I also find that

-31-

Dr. Humphries’s opinions support the ALJ’s finding as to Hayes’s physical
residual functional capacity.

Regarding Hayes’s mental impairments, the ALJ gave more weight to the
opinion of psychologist Latham.

Again, I find that this weighing of the

psychological evidence is supported by the evidence of record. Despite allegations
of disabling psychological problems, it appears that Hayes has not consistently
sought psychological treatment.

While Hayes has treated with antidepressant

medication, he has never consulted a psychiatrist with this regard. This may be
due to the fact that Hayes reported to his treating physician that the medication
prescribed helped with his symptoms. AIf a symptom can be reasonably controlled
by medication or treatment, it is not disabling.@ Gross v. Heckler, 785 F.2d 1163,
1166 (4th Cir. 1986).

Also, a review of Latham’s and Lanthorn’s opinions show that they are
fairly consistent. Lanthorn, however, placed more severe restrictions on Hayes’s
work-related mental abilities due in part to Hayes’s subjective complaints of
disabling pain.

In fact, Lanthorn diagnosed Hayes as suffering from a pain

disorder associated with psychological factors and general medical conditions. (R.
at 567.) As stated above, the ALJ’s weighing of the medical evidence as to
Hayes’s complaints of disabling pain and its effect on his work-related physical
abilities is supported by the record. That being the case, the ALJ’s decision with
regard to the weighing of the psychological evidence also is supported, in that the
ALJ’s weighing of the psychological evidence was dependent, at least in part, on
his rejection of Hayes’s subjective complaints of disabling pain.

-32-

Based on the above-stated reasons, I find that substantial evidence supports
the Commissioner’s decision to deny benefits. An appropriate order will be
entered.
ENTERED: This 26th day of August, 2014.

/s/

Pamela Meade Sargent
UNITED STATES MAGISTRATE JUDGE

-33-