Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_11-cv-00118/USCOURTS-almd-2_11-cv-00118-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

---

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

CHRISTINA M. SANCHEZ, )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:11cv118-CSC

) (WO)

MICHAEL J. ASTRUE, )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION

I. Introduction

The plaintiff applied for disability insurance benefits pursuant to Title II of the Social

Security Act, 42 U.S.C. §§ 401 et seq., and for supplemental security income benefits under

Title XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq., alleging that she was

unable to work because of a disability. Her application was denied at the initial

administrative level. The plaintiff then requested and received a hearing before an

Administrative Law Judge (“ALJ”). Following the hearing, the ALJ concluded that the

plaintiff was not under a “disability” as defined in the Social Security Act. The ALJ,

therefore, denied the plaintiff’s claim for benefits. The Appeals Council rejected a

subsequent request for review. The ALJ’s decision consequently became the final decision

of the Commissioner of Social Security (Commissioner). See Chester v. Bowen, 792 F.2d

1

Pursuant to the Social Security Independence and Program Improvements Act of 1994, Pub.L. No. 1

103-296, 108 Stat. 1464, the functions of the Secretary of Health and Human Services with respect to Social

Security matters were transferred to the Commissioner of Social Security.

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 1 of 10
129, 131 (11 Cir. 1986). Pursuant to 28 U.S.C. § 636(c), the parties have consented to th

entry of final judgment by the United States Magistrate Judge. The case is now before the

court for review pursuant to 42 U.S.C. §§ 405 (g) and 1383(c)(3). Based on the court's

review of the record in this case and the briefs of the parties, the court concludes that the

decision of the Commissioner should be affirmed.

II. Standard of Review

Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the

person is unable to

engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment which can be expected to result

in death or which has lasted or can be expected to last for a continuous period

of not less than 12 months . . . 

To make this determination, the Commissioner employs a five-step, sequential 2

evaluation process. See 20 C.F.R. §§ 404.1520, 416.920.

(1) Is the person presently unemployed?

(2) Is the person’s impairment severe?

(3) Does the person's impairment meet or equal one of the specific

impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?

(4) Is the person unable to perform his or her former occupation?

(5) Is the person unable to perform any other work within the economy?

An affirmative answer to any of the above questions leads either to the next

question, or, on steps three and five, to a finding of disability. A negative

answer to any question, other than step three, leads to a determination of “not

disabled.”

A “physical or mental impairment” is one resulting from anatomical, physiological, or 2

psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory

diagnostic techniques.

2

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 2 of 10
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11 Cir. 1986). th 3

The standard of review of the Commissioner’s decision is a limited one. This court

must find the Commissioner’s decision conclusive if it is supported by substantial evidence. 

42 U.S.C. § 405(g); Dyer v. Barnhart, 395 F.3d 1206, 1210 (11 Cir. 2005). Substantial th

evidence is “more than a scintilla,” but less than a preponderance: it “is such relevant

evidence as a reasonable person would accept as adequate to support a conclusion.”

Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158–59 (11 Cir. 2004) (quotation marks th

omitted). The court “may not decide the facts anew, reweigh the evidence, or substitute . .

. [its] judgment for that of the [Commissioner].” Phillips v. Barnhart, 357 F.3d 1232, 1240

n. 8 (11 Cir. 2004) (alteration in original) (quotation marks omitted). th

[The court must] . . . scrutinize the record in its entirety to determine the

reasonableness of the [Commissioner’s] . . . factual findings . . . No similar

presumption of validityattachesto the [Commissioner’s] . . . legal conclusions,

including determination of the proper standards to be applied in evaluating

claims.

Walker v. Bowen, 826 F.2d 996, 999 (11 Cir. 1987). th

III. DISCUSSION

A. Introduction. The plaintiff was 32 years old at the time of the hearing before the

ALJ and has a high school education. (R. 59). Following the hearing, the ALJ concluded 4

that the plaintiff has severe impairments of “low back pain of uncertain etiology; mood

McDaniel v. Bowen, 800 F.2d 1026 (11 Cir. 1986) is a supplemental security income case (SSI). 3 th

The same sequence applies to disability insurance benefits. Cases arising under Title II are appropriately

cited as authority in Title XVI cases. See e.g. Ware v. Schweiker, 651 F.2d 408 (5 Cir. 1981) (Unit A).

th

 Sanchez also attended some college but did not complete a degree.

4

3

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 3 of 10
disorder; generalized anxiety disorder; obesity; Temporomandibular joint disorder;

polysubstance dependence; asthma; attention deficit hyperactivity disorder; and insomnia.” 

(R. 14). The ALJ also concluded that the plaintiff’s substance use is a contributing factor

material to the determination of her disability. The ALJ then concluded that the plaintiff

could not return to her past relevant work as a courier, denture maker, or bank teller. (R.

25). Nonetheless, the ALJ concluded that the plaintiff was not disabled because the plaintiff

has the residual functional capacity to perform work in the national economy. (R. 26).

B. Plaintiff’s Claim. The sole issue presented by the plaintiff is whether the ALJ

“erred in failing to give any consideration to the diagnosis that [she] suffers from a

personality disorder, Borderline Personality Disorder.” (Pl’s Br., doc, # 10 at 1). Relying

on the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (FOURTH)(“DSMIV”), the plaintiff argues that because she has been diagnosed as suffering from Borderline

Personality Disorder, the ALJ erred by not considering this severe impairment. The court

concludes that even if the Commissioner’s failure to consider this impairment was error, it

was harmless error. See Diorio v. Heckler, 721 F.2d 726, 728 (11 Cir. 1983) (applying th

harmless error analysis in the Social Security case context).

The ALJ found that Sanchez suffered from severe impairments of mood disorder,

generalized anxiety disorder, and polysubstance dependence. (R. 14). He then concluded, 

that the plaintiff’s substance use is a contributing factor material to the determination of her

disability, and if she ceased using substances, these conditions would cause no more than

mild limitations on her ability to work. (R. 21). At the first administrative hearing on

4

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 4 of 10
October 19, 2009, Sanchez testified that, although she had previously used marijuana, she

had ceased use approximately two (2) months prior to the hearing. (R. 65). At the second

administrative hearing on August 26, 2010, Sanchez admitted to smoking marijuana at least

ten times since the last hearing because she was depressed. (R. 41.) 

During a physical consultative evaluation on March 17, 2010 with Dr. Golomb,

Sanchez admitted to continued marijuana use.

However, she has used marijuana daily since she was 15 years old. “My

therapist said it helped me maintain my health, especially when I was out of

my medicine. I smoke it out of a pipe bowl. I used cocaine when I was 19,

but not since.” “I believe I’m hooked on marijuana; I really like it. But the

social security doctor at my hearing on October 19, 2009, said I wouldn’t get

my disability if I used marijuana, because he said all my problems are due to

marijuana use - but I still use it now.

(R. 676).

Dr. Golomb’s opinion is illuminating because while he was assessing her physical

condition, he commented on her mental condition.

The medical evidence of record provided bythe DDS was reviewed, and these

findings were considered in the overall assessment of Christina M. Sanchez. 

She appeared to be mentally stable, with no signs characteristic of any

psychoneurotic illness at this time, and physically, there were no gross

abnormal objective findings. She gives a history of long-standing depression

and bi-polar illness, with many years of using antidepressants, anxiolytic and

potent analgesic medications, and I would conclude in saying that she in all

likelihood has become quite dependent on most of them, as she has used them

regularly, on a daily basis, for many years. Using the medications for their

intended use is questionable, and I certainly concur with a comment made by

another physician that the use of illicit drugs over the years may certainly have

had an impact on her emotional and mental status. Should she become

emotionally stable, she should be able to perform work-related activities such

as sitting, standing, walking, lifting, carrying and handling objects, with only

minor limitations. There is no problem with hearing or speaking, and she

5

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 5 of 10
could travel.

(R. 679). 

At the first administrative hearing,Dr. Douglas McKeown, a medical expert, testified. 

(R. 94-112). The ALJ specifically asked Dr. McKeown about Sanchez’s mental

impairments.

Q: Based on your review of the record, what are the Claimant’s mental

impairments that are demonstrable by medically acceptable clinical

and/or laboratory diagnostic techniques?

A: We have a 32-year-old individual, high school education, limited

college experience after that. Has been able to obtain a driver’s

license. Limited work history in the past. The record would document

a consultative examination run by Dr. Carl Kirkland (Phonetic) in

April of 2007, and they submitted today additional assessment done by

Dr. Kirkland in October of 2009. In 2007, Dr. Kirkland did reference

the Xanax, Soma and Lortab medications that the Claimant was taking. 

Considered a generalized anxiety disorder as the primary difficulties. 

In October of this year, recent report considered a bipolar disorder and

a personality disorder NOS. Of particular concern is the denial of any

substance abuse at all since teenage years, made apparently to Dr.

Kirkland, in both of those evaluations. There are records available

from Montgomery Mental Health that are referenced in the record. 

And the primary treatment there has been for a bipolar disorder with

medications that have included GEODON and atypical anti – excuse

me, an atypical antipsychotic disorder, Effexor, and anti-depressant,

Lamictal, generally a mood stabilizer, and Vistaril, and anxiolytic type

medication. And all the incidences throughout the record from

Montgomery Mental Health the GAF scores are all very high at 65 or

above. And the records would indicate basically mild mental health

related impairments. There’s also the reference in there to multiple

medications taken for chronic pain, including Lortab, Xanax, Soma,

Phenergan, and the like. Again, in the mental health records from

Montgomery Mental Health there’s no reference to ever any history of

substance use or abuse. There is in the record Baptist Hospital records

from September of 2007, Dr. David Harwood, who indicated in his

report there the significant presence of multiple substances including

6

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 6 of 10
opiates, polysubstances, benzodiazepines and also marijuana, and a

particular desire to – the Claimant did not want to deal with those

particular issues. Also the testimony today indicates regular use of

marijuana on a daily basis up until apparently two months ago, which

would indicate that is a very significant fact, and particularly

considering the mood disorders and primary diagnoses that she now

carries with Montgomery Mental Health. . . .

(R. 99-101). 

Dr. McKeown describes her mood disorders as “substance-induced.” (R. 101). He

testified that “[d]aily use of marijuana as described by the Claimant in [his] opinion would

still contribute it to being material, contributory and most likely the basis for her mood

disorder, which apparently has not been reported to any of her other treatment personnel.” 

(R. 104). 

Although the ALJ did not specify that he was including limitations caused by

Sanchez’ Borderline Personality Disorder, in his hypothetical questions to the vocational

expert, he included the following mental limitations.

. . . also limited to simple one and two-step tasks involving – well, actually

limited to simple, routine tasks, involving no more than simple, short

instructions and simple work-related decisions with few workplace changes. 

No more than occasional and non-transactional interaction with the public. 

No more than occasional interaction with co-workers. Able to sustain

concentration and attention for a two-hour period with customary breaks.

(R. 113-14). In so framing Sanchez’s limitations, the ALJ included functional limitations

5

attributable to borderline personality disorder.6

 The ALJ asked a substantially similar question at the second administrative hearing. See R. 51.

5

 Sanchez’s reliance on the DSM-IV description of Borderline Personality Disorder is misplaced,

6

particularly since the DSM-IV specifically indicates that symptoms of Borderline Personality Disorder may

develop with chronic substance use. Borderline Personality Disorder “must bedistinguished fromsymptoms

7

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 7 of 10
The vocational expert testified that such a person would not be able to perform her

past relevant work but that there exists in the national economy other jobs in significant

numbers that she could perform. (R. 114-15). The ALJ’s hypothetical questions to the

vocational expert included all functional limitations by presented by Sanchez’ mental

impairments. Thus, the court concludes that the ALJ adequately incorporated Sanchez’s

mental limitations in his hypothetical questions to the VE, and any error at step 2 of the

sequential analysis was remedied at step 5. See Jamison v. Bowen, 814 F.2d 585, 588 (11

th

Cir. 1987) (“the finding of any severe impairment, whether or not it qualifies as a disability

and whether or not it results from a single severe impairment or a combination of

impairments that together qualify as severe, is enough to satisfy the requirement of step

two.”) 

Moreover, Sanchez has failed to demonstrate that she suffers from limitations not

considered by the ALJ in his questioning of the VE or in his ultimate determination that she

was not disabled. “Even though Social Security courts are inquisitorial, not adversarial, in

nature, claimants must establish that they are eligible for benefits.” Ingram v. Comm'r of

Soc. Sec. Admin., 496 F.3d 1253, 1269 (11 Cir. 2007) (citing Doughty v. Apfel, 245 F.3d

th

1274, 1281 (11 Cir. 2001)). See also Holladay v. Bowen, 848 F.2d 1206, 1209 (11 Cir. th th

1988). This the plaintiff has failed to do.

that may develop in association with chronic substance use.” DIAGNOSTIC AND STATISTICAL MANUAL

OF MENTAL DISORDERS (FOURTH) § 301.83, p. 424. (emphasis in original). In this instance, neither the

DSM-IV nor the court limits Sanchez’s substance use to marijuana. The record is clear that for many years,

she has been prescribed numerous prescription medications including Xanax, Effexor, and Soma.

8

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 8 of 10
Even if the error was not harmless, it is clear that the ALJ considered Dr. Kirkland’s

opinions regarding Sanchez’s mental impairments including borderline personality disorder.

When determining the medical evidence, the ALJ gave greater weight to the opinion of Dr.

McKeown, the non-examining medical expert who testified at the administrative hearing,

that Sanchez’s substance abuse is a contributing and material factor to the severity of her

moods disorders. The ALJ also considered the opinion of Dr. Kirkland, an examining

psychologist, that she suffers froma personality disorder. The ALJ described Dr. Kirkland’s

diagnoses from his second evaluation of Sanchez. “Following a thorough evaluation, Dr.

Kirkland diagnosed bipolar disorder, history of panic disorder with agoraphobia, borderline

personality disorder, 8 grade reading level, and chronic back pain by self-report.” (Id.) th

After considering Dr. Kirkland’s reports, the ALJ considered Dr. Kirkland’s opinions as

follows:

The undersigned has considered the opinion of Dr. Kirkland in accordance

with 20 CFR 404.1527 (Exhibit 3F). As it relates to the listed impairments,

this opinion merits significant weight. However, the claimant appears to have

misled the examiner concerning her substance use. Consequently, the

omission of substance abuse from the diagnoses merits no substantial weight.

* * *

The undersigned has also considered the second opinion of Dr. Kirkland,

obtained by the claimant’s attorney (Exhibit 11F). After reviewing this

evaluation, it is noted that it was based, in part, on the notion that the claimant

“last worked in 2006" for Lee High School. However, the record indicates

that the claimant worked for four to five months in 2006 and 2007 for

Martin’s Restaurant and worked for a period beginning November 2008 for

Aspire Staffing (Exhibits 3D & 5D). In addition, Dr. Kirkland indicated that

the claimant “does not use drugs or alcohol,” which suggests that the claimant

again misled the examiner regarding her substance use. Accordingly, as it

9

Case 2:11-cv-00118-CSC Document 16 Filed 02/10/12 Page 9 of 10
relates to the listed impairments, the opinion merits significant weight but the

omission of substance abuse merits no significant weight.7

(R. 24). 

Thus, it is clear that the ALJ considered Dr. Kirkland’s opinions while giving greater

weight to the opinion of Dr. McKeown. This he was entitled to do, especially since Dr.

Kirkland’s opinion was based, at least in part, on the plaintiff’s patent misrepresentations

about her drug use. 

IV. Conclusion

The court has carefully and independently reviewed the record and concludes that

substantial evidence supports the ALJ’s conclusion that plaintiff is not disabled. Thus, the

court concludes that the decision of the Commissioner is supported by substantial evidence

and is due to be affirmed.

A separate order will be entered.

Done this 10 day of February 2012.

th

 /s/Charles S. Coody 

CHARLES S. COODY

UNITED STATES MAGISTRATE JUDGE

This statement by the ALJ is at best ambiguous and at worst nonsensical. However, the medical 7

expert was asked about Dr. Kirkland’s opinion and stated that the fact that Sanchez apparently lied to Dr.

Kirkland about her drug use “limits the significance of the consultative opinion.” (R. 109).

10

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