Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-4_04-cv-04111/USCOURTS-arwd-4_04-cv-04111-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (DIWC)

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IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

TEXARKANA DIVISION

AMY D. PHILYAW PLAINTIFF

vs. Civil No. 04-4111

JO ANNE B. BARNHART,

Commissioner, Social Security Administration DEFENDANT

MEMORANDUM OPINION

Factual and Procedural Background:

Amy Philyaw (hereinafter "Plaintiff"), has appealed the final decision of the

Commissioner of the Social Security Administration (hereinafter "Commissioner"), denying her

claim for disability insurance benefits, (hereinafter "DIB"), pursuant to §§ 216(i) and 223 of

Title II of the Social Security Act (hereinafter "the Act"), 42 U.S.C. §§ 416(i) and 423. In this

judicial review, the Court must determine whether there is substantial evidence in the

administrative record to support the Commissioner’s decision. 42 U.S.C. § 405(g).

Both parties have filed appeal briefs (Doc. #5 & 6). The history of the administrative

proceedings is contained in the respective appeal briefs and will not be recounted herein, except

as is necessary. 

Plaintiff alleges that she is disabled due to: obesity; history of breast cancer, post

simple right mastectomy; diabetes mellitus; coronary artery disease, post coronary artery by

pass surgery; chest wound dehiscene; pain; stress; angina; right arm pain and limitation of

rotation; nausea; sweats; inability to sleep; dizziness; swelling; shortness of breath; fatigue; acid

reflux; depression; side effects of medication; small right paracentral disc protrusion at C4-5;

and, suspected mild central or right paracentral bulging at C5-6. The issue before this Court is

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whether the decision of the Commissioner is supported by substantial record evidence. The

Plaintiff asserts that the Administrative Law Judge (hereinafter "ALJ"), erred in rendering a

decision finding Plaintiff not disabled. (Doc. #1 &5). 

The Plaintiff’s administrative hearing was conducted on August 22, 2003 (T. 33-58). 

The ALJ issued his final written decision denying Plaintiff’s applications for benefits on January

26, 2004 (T. 17-24). Plaintiff then sought review by the Appeals Council (T. 12). The Appeals

Council denied Plaintiff’s request for review on June 18, 2004 (T. 7-10).

From this adverse decision, the Plaintiff appeals (Doc. #1). This matter is before the

undersigned by consent of the parties (Doc. #2).

Relevant Law:

Our role on review is to determine whether the Commissioner's findings are supported

by substantial evidence on the record as a whole. See Prosch v. Apfel, 201 F.3d 1010, 1012 (8th

Cir. 2000); see also Craig v. Apfel 212 F.3d 433, 435-436 (8th Cir. 2000). Substantial

evidence is relevant evidence that a reasonable mind would accept as adequate to support the

Commissioner's conclusion. See Haggard v. Apfel, 175 F.3d 591, 594 (8th Cir. 1999). In

considering whether existing evidence is substantial, we consider evidence that detracts from

the Commissioner's decision as well as evidence that supports it. See Prosch, 201 F.3d at 1012.

We may not reverse the Commissioner's decision merely because substantial evidence exists in

the record that would have supported a contrary outcome. See id.; Woolf v. Shalala, 3 F.3d

1210, 1213 (8th Cir. 1993). Even if this Court might have weighed the evidence differently, the

decision of the ALJ may not be reversed if there is enough evidence in the record to support the

decision. Browning v. Sullivan, 958 F.2d 817, 822 (8th Cir. 1992). 

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The Commissioner has established, by regulation, a five-step sequential evaluation for

determining whether an individual is disabled.

The first step involves a determination of whether the claimant is involved in substantial

gainful activity. 20 C.F.R. § 416.920(b). If the claimant is so involved, benefits are denied; if

not, the evaluation goes to the next step.

Step two involves a determination, based solely on the medical evidence, of whether

claimant has a severe impairment or combination of impairments. Id., § 416.920(c); see 20

C.F.R. § 416.926. If not, benefits are denied; if so, the evaluation proceeds to the next step.

The third step involves a determination, again based solely on the medical evidence, of

whether the severe impairment(s) meets or equals a listed impairment which is presumed to be

disabling. Id., § 416.920(d). If so, benefits are awarded; if not, the evaluation continues.

Step four involves a determination of whether the claimant has sufficient residual

functional capacity, despite the impairment(s), to perform past work. Id., § 416.920(e). If so,

benefits are denied; if not, the evaluation continues.

The fifth step involves a determination of whether the claimant is able to perform other

substantial and gainful work within the economy, given the claimant’s age, education and work

experience. Id., § 404.920(f). If so, benefits are denied; if not, benefits are awarded.

In addition, whenever adult claimants allege mental impairment, the application of a

special technique must be followed at each level of the administrative review process. See 20

C.F.R. § 416.920a(a).

The Commissioner is then charged with rating the degree of functional limitation, and

applying the technique to evaluate mental impairments. See 20 C.F.R. § 416.920a(d). 

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Application of the technique must be documented by the Commissioner at the ALJ hearing and

Appeals Council levels. See 20 C.F.R. § 416.920a(e). 

Discussion:

The record reflects that the ALJ found that the medical evidence established that

Plaintiff suffered from the following severe impairments: obesity; history of breast cancer;

diabetes mellitus; and, coronary artery disease, status post coronary artery bypass graft (T. 20).

 Throughout his decision, the ALJ singularly considered some of Plaintiff’s alleged

impairments, with single sentences or paragraphs being devoted to the analysis of each

impairment (T. 17-24). In doing so, the ALJ discussed Plaintiff’s alleged impairment at issue,

in conjunction with Plaintiff’s treatment for same. However, he failed to consider the

combined effect of these, and other documented conditions. For instance, the ALJ mentioned

Plaintiff’s allegations of obesity, diabetes mellitus, cervical MRI results, coronary artery disease,

scar tissue, sternal suture wire pain and dehiscence, and breast cancer singulary (T. 19), but

never considered the combined effect to the impairments he found to be severe. Nor did the

ALJ consider the combination of Plaintiff’s impairments in conjunction with the allegations of

pain (T. 41, 42, 43, 45, 52, 55, 56, 67, 91, 98, 108, 109, 110, 111, 112, 120, 126, 127, 128, 129,

130, 158, 163, 164, 165, 179, 216, 218, 219, 231, 264, 265, 279, 286, 292, 326), nausea (T. 46,

48, 165, 178, 188), sweats (T. 46, 165, 178), inability to sleep (T. 47, 48, 56, 112), fatigue (T.

47, 48, 49, 51, 56, 91, 98, 110, 112, 127, 128, 129, 130, 210, 325), dizziness (T. 48), swelling

(T. 54, 55, 67, 98, 120, 219), shortness of breath (T. 329), or medication side effects (T. 46, 47,

48, 128, 110).

20 C.F.R. § 423 (d)(2)(B) provides:

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In determining whether an individual's physical or mental impairment or

impairments are of a sufficient medical severity that such impairment or

impairments could be the basis of eligibility under this section, the

Commissioner of Social Security shall consider the combined effect of all of the

individual's impairments without regard to whether any such impairment, if

considered separately, would be of such severity. If the Commissioner of Social

Security does find a medically severe combination of impairments, the combined

impact of the impairments shall be considered throughout the disability

determination process.

The ALJ is required to consider all impairments he finds to be severe. Likewise, he is

required to consider the combined effect of all impairments he finds to be severe. See 42 U.S.C.

§ 1382c(a)(3)(F); See also 20 C.F.R. § 404.1523. In this instance, the ALJ found the Plaintiff’s 

history, diagnoses and/or treatment for obesity, history of breast cancer, diabetes mellitus, and

coronary artery disease, post coronary bypass graft, to be severe impairments. Nonetheless,

despite his solitary statement that these impairments represent severe impairments, he failed to

otherwise consider the issue of whether this severe combination of impairments, together with 

the alleged pain, nausea, sweats, inability to sleep, fatigue, dizziness, swelling, shortness of

breath, or medication side effects result in a finding of disability. The apparent failure to

consider these subjective allegations in relation to what he deemed to be severe impairments

necessarily leads to the conclusion that the ALJ failed in his duty to consider the combined

effect of all of Plaintiff’s impairments. 

The ALJ must consider the impairments in combination and not fragmentize them in

evaluating their effects. Delrosa v. Sullivan, 922 F.2d 480, 484 (8th Cir. 1991), citing Johnson

v. Secretary of Health & Human Servs., 872 F.2d 810, 812 (8th Cir. 1989). In the present case,

therefore, the ALJ was obligated to consider the combined effect of [Plaintiff]'s physical

impairments. Id. at 484, citing Reinhart v. Secretary of Health & Human Servs., 733 F.2d 571,

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573 (8th Cir. 1984) and Wroblewski v. Califano, 609 F.2d 908, 914 (8th Cir. 1979). As has

been noted, the Plaintiff alleged numerous impairments. Under these circumstances, the Social

Security Act requires the Commissioner to consider all impairments without regard to whether

any such impairment, if considered separately, would be of sufficient medical severity to be

disabling. Cunningham v. Apfel, 222 F.3d 496, 501 (8th Cir. 2000). 

A thorough review of the record indicates that the ALJ failed to properly analyze

Plaintiff’s subjective allegations. In determining whether the ALJ properly disregarded

Plaintiff’s subjective complaints, such as pain, the Court must determine if the ALJ properly

followed the requirements of Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984)

(subsequent history omitted), in evaluating her pain and credibility. 

The absence of an objective medical basis which supports the degree of severity

of subjective complaints alleged is just one factor to be considered in evaluating

the credibility of the testimony and complaints. The adjudicator must give full

consideration to all of the evidence presented relating to subjective complaints,

including the claimant's prior work record, and observations by third parties and

treating and examining physicians relating to such matters as:

1. the claimant's daily activities;

2. the duration, frequency and intensity of the pain;

3. precipitating and aggravating factors;

4. dosage, effectiveness and side effects of medication;

5. functional restrictions.

The adjudicator is not free to accept or reject the claimant's subjective complaints

solely on the basis of personal observations. Subjective complaints may be

discounted if there are inconsistencies in the evidence as a whole. 

Polaski v. Heckler, 739 F.2d at 1322 (emphasis in original).

However, in addition to the requirement that the ALJ consider the Plaintiff’s allegations

of pain, he also has a statutory duty to assess the credibility of plaintiff. Nelson v. Sullivan, 966

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F.2d 363, 366 (8th Cir. 1992). The ALJ may discredit subjective complaints of pain

inconsistent with the record as a whole. Ownbey v. Shalala, 5 F.3d 342, 344 (8th Cir. 1993). 

Further, in evaluating these factors, the ALJ must "discuss" these factors in the hearing

decision. Herbert v. Heckler, 783 F.2d 128, 131 (8th Cir.1986)(citing Polaski v. Heckler, 751

F.2d 943, 9580-950 (8th Cir.1984)). 

"While the claimant has the burden of proving that the disability results from a medically

determinable physical or mental impairment, direct evidence of the cause and effect relationship

between the impairment and the degree of claimant's subjective complaints need not be

produced." Polaski v. Heckler, 739 F.2d at 1322. 

To determine whether the ALJ properly applied the factors listed in Polaski, we must

determine whether the ALJ took into account all the relevant evidence, and whether that

evidence contradicted the claimant's own testimony so that the ALJ could discount the

testimony for lack of credibility. Benskin v. Bowen, 830 F.2d 878, 882 (8th Cir.1987). The

ALJ's credibility assessment must be based on substantial evidence. Rautio v. Bowen, 862 F.2d

176, 179 (8th Cir.1988). 

In this case, with respect to subjective allegations and nonexertional limitations, the ALJ

found plaintiff "not totally credible" (T. 23). Implicit in the ALJ’s task of making a credibility

determination is the requirement that he "discuss" the Polaski factors. Herbert v. Heckler, 783

F.2d at 130 (the Polaski cases and the Social Security Disability Reform Act of 1984 require

that the Commissioner set forth the inconsistencies in the objective medical evidence presented

and discuss the factors set forth in the Polaski settlement when making "credibility"

determinations concerning claimant’s subjective complaints of pain).

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1Darvocet is a centrally acting narcotic analgesic agent indicated for the relief of mild

to moderate pain. Physicians Desk Reference, pp. 403-405 (58th Edition 2004).

2Morphine is the principal and most active narcotic alkaloid of opium. See The Merck

Manual, p. 1054 (16th Edition 1992). Opium is highly addictive. See The Merck Manual,

pp.1185 (16th Edition 1992).

3MS Contin is a controlled release oral tablet containing morphine sulfate and is

indicated for the relief of moderate to severe pain. It is intended for use in patients expected

to require repeated dosing with potent opioid analgesics over a period of time. Adverse

reactions include, but are not limited to: dizziness, sedation, nausea, sweating and vomiting.

Physicians Desk Reference, pp. 2841-2843 (58th Edition 2004).

4Toprol-XL is indicated for the treatment of hypertension, angina pectoris and heart

failure. Adverse reactions include, but are not limited to: fatigue, dizziness, depression,

mental confusion, shortness of breath, nausea, diarrhea, digestive tract disorders, swelling

and chest pain. Physicians Desk Reference, pp.647-650 (58th Edition 2004).

5Tamoxifen is a nonsteriodal antiestrogen for women with ductal carcinoma and

women at high risk for breast cancer. The adverse reactions of Tamoxifen include, but are

not limited to: increased bone pain, increased tumor pain, swelling, depression, dizziness,

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Here, the ALJ fails to meaningfully examine the Polaski factor of dosage and side effects

of medication. See Polaski v. Heckler, 739 F.2d at 1321-22. The ALJ must discuss and point

out the inconsistencies in the record, in order to make a credibility determination. Cline v.

Sullivan, 939 F.2d 560, 565 (8th Cir.1991) ("it is not enough that inconsistencies may be said to

exist, the ALJ must set forth the inconsistencies in the evidence presented and discuss the

factors set forth in Polaski when making credibility determinations"); Herbert v. Heckler, 783

F.2d at 131 (even though evidence with respect to Polaski factors is in the record, those factors

must be discussed in the decision). 

Here, the Plaintiff regularly reported experiencing side effects of her medications. 

During the relevant time period, Plaintiff was prescribed Darvocet1, Morphine2, MS Contin3,

Toprol-XL4, Nitroglycerin, Tamoxifen5, Effexor6, and Amaryl7. Nearly all of Plaintiff’s

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fatigue and headache. Physicians Desk Reference, pp.678-683 (58th Edition 2004).

6Effexor is indicated for the treatment of major depressive disorder. Side effects

include, but are not limited to: hypertension, nausea, dizziness, insomnia, dry mouth,

nervousness, sweating and abnormal vision. Physicians Desk Reference, pp. 3413-3421 

(58th Edition 2004).

7Amaryl is an oral blood glucose lowering drug indicated as an adjunct to diet and

exercise for the control and treatment of non-insulin dependent diabetes. Side effects

include, but are not limited to: dizziness, asthenia, headache and nausea. Physicians Desk

Reference, pp.718-720 (58th Edition 2004).

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medications have side effects as reported by Plaintiff. However, the ALJ failed to discuss these

drugs, their side effects or the combination thereof within his decision. In fact, the ALJ stated

that the record shows "no protocol for pain management" (T. 21). Although it appears that the

record is devoid of any documents or treatment records from Plaintiff’s pain management

physician (T. 329), the record clearly establishes that Plaintiff was prescribed a number of pain

medications. The record also contains evidence of allegations of side effects from these

medications. However, the ALJ failed to conduct a proper analysis of this evidence pursuant to

Polaski.

A thorough review of the record reveals several other issues not considered by the ALJ. 

Upon remand, it is suggested that the ALJ properly analyze Plaintiff’s allegations of a lack of

financial means with which to obtain medication (T. 57, 286, 90, 262). Despite the fact that

Plaintiff sought and obtained assistance by way of treatment at UAMS and obtaining medicaid

coverage for her medical appointments, tests and hospitalizations, the record still reflects that

Plaintiff reported that she could not obtain all of her medications due to a lack of financial

means. 

Clearly, the ALJ has failed provide appropriate analysis. Therefore, this case must be

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remanded. Further, the parties are each reminded of their duty to fully and fairly develop the

record. Any missing medical records should be obtained and included in the administrative

record upon remand.

Conclusion:

Accordingly, we conclude that the decision of the Commissioner denying benefits to the

Plaintiff is not supported by substantial evidence and should be reversed. This matter should be

remanded to the Commissioner for proceedings consistent with this opinion.

ENTERED this 8th day of September, 2005.

/s/Bobby E. Shepherd 

Honorable Bobby E. Shepherd 

 United States Magistrate Judge 

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