Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-5_05-cv-05207/USCOURTS-arwd-5_05-cv-05207-1/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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Michael J. Astrue became the Social Security Commissioner on February 12, 2007, 1

and pursuant to F.R.C.P. 25(d)(1) has been substituted for Jo Anne B. Barnhart as the

defendant in this suit.

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

PAMELA J. JOHNSON PLAINTIFF

v. Civil No. 05-5207

MICHAEL J. ASTRUE, Commissioner, 1

Social Security Administration DEFENDANT

J U D G M E N T

Now on this 23rd day of March, 2007, the captioned matter

comes on for judicial review of the decision of the Commissioner

of the Social Security Administration, denying plaintiff Pamela

Johnson disability insurance benefits and supplemental security

income benefits under the Social Security Act.

1. The Court's role upon review of the decision of a Social

Security Administrative Law Judge ("ALJ") is to determine whether

the decision is supported by substantial evidence on the record as

a whole. Ramirez v. Barnhart, 292 F.3d 576 (8th Cir. 2002).

Substantial evidence is less than a preponderance but enough that

a reasonable mind would find it adequate to support a conclusion.

Id. The Court must consider not only the evidence supporting the

ALJ's decision, but also that which fairly detracts from it, and

must affirm if the record - viewed as a whole - contains

substantial evidence to support the decision. Id. The Court may

not reverse simply because the record also contains substantial

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evidence that would have supported a contrary decision. Haley v.

Massanari, 258 F.3d 742 (8th Cir. 2001). 

The burden rests on the claimant to prove that she has a

mental or physical disability that has lasted - or can be expected

to last - at least one year and that prevents her from engaging in

any substantial gainful activity. Pearsall v. Massanari, 274 F.3d

1211 (8th Cir. 2001).

2. Johnson alleged a disability onset date of March 26,

2003, due to carpal tunnel syndrome, arthritis of the hands,

shoulder, and hip, anxiety, pain, and a nervous disorder of her

legs.

Following a hearing on September 9, 2004, the ALJ found that

Johnson had major depression, osteoarthritis, carpal tunnel

syndrome, and spastic legs, and therefore had a severe

impairments, but further found that these conditions did not,

alone or in combination, meet or equal any impairment listed in

Appendix 1, Subpart P, Regulations No. 4.

The ALJ discounted Johnson's subjective complaints, finding

them inconsistent with both her own reported level of activity and

psychological symptoms, and with the reports of examining sources.

He found that Johnson had the residual functional capacity to

perform light work.

Based on evidence obtained from a Vocational Examiner

obtained by way of interrogatories, the ALJ concluded that Johnson

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The medical records from this fall are not in the administrative record. 2

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had certain transferrable skills, including the ability to follow

instructions carefully, to do the same thing repeatedly, to pay

attention to safety rules, to work around machinery, and to

exercise limited supervision. He found that she could do work as

a motel maid, fast food attendant, bus boy, or security guard, and

that such jobs existed in significant numbers in the regional and

national economy. The ALJ thus concluded that Johnson was not

disabled.

3. Johnson alleges that the ALJ erred in failing to

consider her impairments in combination, failing to properly

evaluate her credibility, and failing to develop the record with

respect to her medical condition. 

4. The relevant evidence from the administrative record may

be summarized as follows:

* On November 10, 1994, Dr. David Davis, a Neurologist,

saw Johnson for a two-month history of numbness in the

right hand, and two-week history of numbness in the left

hand. She gave a history of a hard fall on her right

side in 1993, with treatment by Dr. John Park, who told 2

her she had permanently damaged the shoulder. The level

of numbness was affecting her sleep. Dr. Davis planned

nerve conduction studies to evaluate the possibility of

carpal tunnel syndrome.

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Johnson testified that this surgery was never performed, and it appears that 3

funding was an impediment.

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* On December 16, 1994, Dr. Davis wrote a letter with

regard the denial of workers' compensation coverage for

Johnson, stating it as his opinion that "it seems likely

that the job precipitated or aggravated her carpal

tunnel syndrome."

* On December 29, 1994, Dr. Davis noted that Johnson "is

continuing to have numbness in her hands. She awakens

at least once a night and has to get up and walk around

to try to relieve the numbness. It is provoked in the

day by minimal activity such as washing dishes. Today

she had repeat median nerve conduction velocities which

continue to show abnormalities in both hands." Dr.

Davis referred Johnson to Dr. Heinzelmann for

consideration for surgery.3

* On February 24, 1995, Dr. Davis noted that Johnson was

under the care of Dr. Heinzelmann for carpal tunnel

syndrome, and that her job, as described to him, likely

"precipitated, aggravated or exacerbated" the condition.

* On July 17, 2003, Johnson completed a Disability Report.

She indicated that her ability to work was limited by

carpal tunnel syndrome in both wrists, arthritis of the

shoulder and hip, a "nervous disorder of legs," and

anxiety. She had left her job as an attendant in a dry

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cleaning establishment on March 26, 2003, because of

these conditions. In her work she stood 8 hours a day,

had to grip, pinch, and use foot controls, and

supervised two other people. She took only ibuprofen

("about 15 tabs a day") for her pain and muscle spasms.

She had an 8th grade education, and was 47 years old. 

* On July 25, 2003, Johnson completed a Disability

Supplemental Interview Outline. She indicated that she

could bathe and dress herself and care for her hair, but

did not shave because she would cut herself due to the

numbness in her fingers. She did laundry, changed

sheets, vacuumed, swept, took out the trash, and mowed

the lawn, but did not do dishes, iron, make home or car

repairs, wash the car, rake leaves, or do garden work,

because she could not "hold anything without dropping."

She shopped for groceries and clothes, cooked, drove and

use public transportation, but did not walk because of

the arthritis in her left hip. She spent her time

watching television, reading, and visiting. She

required a 30-45 minute nap daily. She described her

conditions as causing numbness in both hands, pain in

her elbows, pain in her right shoulder and left hip, and

spastic leg movements. The pain was said to exist all

the time, and be caused by repetitive movement. She

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A "sensation of tingling, or of 'pins and needles,' felt at the lesion site or 4

more distally along the course of a nerve when the latter is percussed; indicates a

partial lesion or early regeneration in the nerve." Stedman's Medical Dictionary, 28th

Ed.

A maneuver "in which the wrist is maintained in volar flexion; paresthesia 5

occurring in the distribution of the median nerve within 60 seconds may indicate carpal

tunnel syndrome." Stedman's Medical Dictionary, 28th Ed.

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took ibuprofen and used hot baths and heating pads to

relieve it.

* On September 19, 2003, Dr. Randy Conover conducted a

General Physical Examination of Johnson. Johnson gave

a history of carpal tunnel syndrome since 1994 and

arthritis of the neck and hips slowly worsening since

1998. She said that she could walk 50 yards before

sitting; could stand for 30 minutes but sit only for 15

minutes because of leg spasms and back discomfort. She

took only ibuprofen. On examination, she had normal

range of motion in all joints except her hips, which had

80 degrees of flexion out of a possible 100 degrees.

Her hands were enlarged, with swollen joints. She

exhibited positive Tinel sign and Phalen maneuver. 4 5

Dr. Conover estimated that Johnson's grip was 90% of

normal, and found that she could hold a pen and write,

touch fingertips to palm, oppose thumb to finger, pick

up a coin, walk without assistive devices, heel-to-toe

walk, squat and rise. X-ray showed a decreased joint

space in the hip. Dr. Conover diagnosed osteoarthritis,

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carpal tunnel syndrome, spastic legs, and anxiety, and

found mild limitation on Johnson's ability to sit, and

moderate limitations on her ability to walk, stand,

lift, carry, handle, and finger.

* On September 25, 2003, Dr. Virginia Krauft, a

Psychologist, conducted a mental status/adaptive

functioning evaluation of Johnson. Johnson described

her physical condition to Dr. Krauft as "numbness in her

hands and swelling in her hands that make it impossible

for her to work now," and legs that "are spastic and, at

night, they seem to jerk in the night," along with

shoulder and neck pain, causing a sharp pain when she

turned her head to the right. She was taking some

muscle relaxants that a friend had given her. Dr.

Krauft estimated Johnson's IQ to be "80 or greater," and

diagnosed Johnson with major depression,. She noted

that Johnson's prognosis was "poor as she appears to

live a very dysfunctional life and does not have a major

support system at this time." Dr. Krauft also found

that Johnson "may have adaptive functioning problems,

particularly in the social and personal areas," but not

such as to be consistent with a diagnosis of mental

retardation. Dr. Krauft found no evidence of

exaggerating or malingering. Johnson told Dr. Krauft

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that she was "able to perform household chores such as

doing dishes and cleaning around the house."

* On October 9, 2003, a reviewing source, Dr. Linda Green,

filled out a Residual Functional Capacity Assessment on

Johnson. She found Johnson capable of lifting 20 pounds

occasionally, and 10 pounds frequently; of standing,

walking, and sitting about 6 hours in a normal workday;

of limited capacity to use her arms and hands, with no

frequent repetitive flexion of the wrists due to carpal

tunnel syndrome. No other limitations were noted.

* On October 28, 2003, another reviewing source, Dr.

Kathryn Gale, filled out a Mental Residual Functional

Capacity Assessment form on Johnson. She found moderate

limitations on the ability to carry out detailed

instructions and maintain attention and concentration

for extended periods; the ability to complete a normal

workday and workweek without interruptions from

psychologically based symptoms and to perform at a

consistent pace without an unreasonable number and

length of rest periods; the ability to interact

appropriately with the general public; and the ability

to set realistic goals or make plans independently. She

opined that Johnson "is able to perform work where

interpersonal contact is incidental to work performed,

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e.g. assembly work; complexity of tasks is learned and

performed by rote, few variables, little judgment;

supervision required is simple, direct and concrete."

* On November 17, 2003, Johnson completed a

Reconsideration Disability Report. She indicated that

since she had initially filed, changes in the weather

made her pain worse, and that she did not drive much

because of the condition of her hands and the stress of

driving. She had a painful knot between thumb and wrist

on the left, and had developed stress incontinence. It

was difficult for her to "close buttons," and pull up

her pants. She had not seen a doctor because she could

not afford to do so.

* In an undated Claimant's Statement When Request For

Hearing Is Filed, which appears to have been completed

in March, 2004, Johnson indicated that the knot on her

left thumb had gotten bigger and more painful, and that

she could not grip with her left hand. Her restless leg

syndrome had worsened and interfered with sleep. Her

hand numbness was worse, and her hips hurt when she

walked. She had not seen a doctor due to lack of funds.

She had tried to be seen at a free clinic, but "cannot

get in." She took ibuprofen, "up to 8 at a time."

* On April 1, 2004, Johnson's attorney submitted a PreCase 5:05-cv-05207-JLH Document 12 Filed 03/23/07 Page 9 of 16 PageID #: <pageID>
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hearing Memorandum in which she listed Johnson's

impairments as arthritis of the hands and elbows;

bilateral carpal tunnel syndrome; restless leg syndrome;

hip pain with numbness; right shoulder pain; and

depression. Johnson's daily activities and condition

were narratively stated as follows: "I have a lot of

trouble with both hands. I cannot grip, and when I try

to hold on to something, I often drop it. I cannot open

jars or bottles. I cannot write more than a very small

amount and I cannot button my buttons. I cannot even

hold a book to read it. I cannot lift because of my

hands and my shoulder. I have had carpal tunnel

syndrome for many years. I have a difficult time

sleeping, because if I roll over onto my right shoulder,

it is extremely painful and wakes me up. My hands also

hurt at night. I have a hard time walking or sitting

because of my hip pain. I cannot sit for very long

because of my restless leg syndrome. I have a lot of

problems with my memory and concentration. I have a lot

of depression."

* On July 29, 2004, Johnson was seen in the emergency room

for complaints of right shoulder and neck pain for the

past four days, with intermittent spasms and tingling.

Johnson attributed this to pulling weeds, and said her

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symptoms were "typical of previous exacerbations." She

denied wrist pain, hand pain, and finger pain.

* At the hearing before the ALJ on September 9, 2004,

Johnson's attorney reiterated a request that Johnson be

sent for evaluation of her carpal tunnel syndrome, and

additionally sought orthopedic examination of the

shoulder. Johnson testified at the hearing that her

fingers were totally numb on the ends, and that her

right arm was numb almost up to the elbow and she could

not lift it above her waist without pain all the way up

to the neck. She said that her condition had been

worsening ever since she quit working. She had pain in

her left hip, causing leg spasms if she sat "too long."

The pain in her hands would wake her at night, and the

numbness caused her to drop things. She testified that

she had made the hospital visit because her arm was

"hurting so bad then that I couldn't stand it," and she

was not taking medications at the time of the hearing

because she had no money to pay for them. She tried to

alleviate her arm and neck pain by lying down, and by

using cold packs, and to alleviate her hip pain by

walking around. She would lie down four or five times a

day. She could not use a broom because her right arm

did not have the strength to pull it toward her, and she

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mostly just let the arm "hang." She could not button

her pants, and had to lay down and pull them up with her

left hand. She was depressed by her inability to work.

She spent her days walking a little, and talking to her

small dog. She could only walk 10 or 15 minutes before

her left leg started giving her trouble. She could sit

for 20-30 minutes. She shopped for groceries, but only

in 15-minute increments, and had trouble carrying her

groceries. She could not drive because of the condition

of her arm - she had trouble turning the steering wheel

and looking over her shoulder. She did not do any

lifting with her right arm, although she is righthanded. She could no longer crochet, or hold a book to

read. She testified that she never did have surgery for

carpal tunnel syndrome. She lived with a friend, and

was supposed to do yard work to pay her rent, but could

not do anything except pick up limbs. She could not

rake, pull weeds, or push a mower. She kept her dirty

clothes picked up, and could put her dirty dishes in the

sink but could not "seem to get them back out of there."

She used paper cups and plates often.

5. The Court is persuaded that this matter must be

remanded. The medical information in the file is not sufficient

to allow an informed decision about residual functional capacity

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to be made, given the lack of objective information about

Johnson's hand and arm condition, especially as it pertains to her

dominant right hand. 

Johnson sustained an injury to her right shoulder in 1993,

but the records of that injury and treatment were not obtained and

reviewed. From the time of her shoulder injury forward, Johnson

began to experience problems with her right shoulder, arm, wrist,

and hand. Abnormalities in the median nerve conduction velocities

of both hands were objectively demonstrated by Dr. Davis in

December, 1994. It appears that Johnson did not receive treatment

of the problem for financial reasons. She ultimately left work as

a result of her hand and arm condition, being unable to perform

the repetitive motions of her job.

In her paperwork and testimony, Johnson described progressive

numbness in her hands; dropping objects; pain going up her arm

into her shoulder; pain caused by repetitive movement; inability

to turn the steering wheel of a car, close buttons, pull up her

pants or hold a book while reading; and eventually even difficulty

in lifting her right arm above her waist. While the ALJ did not

fully credit this testimony, and it may represent an exaggeration

of her condition, these problems are all consistent with carpal

tunnel syndrome untreated over a ten-year period.

Dr. Conover observed Johnson's enlarged hands and swollen

joints, and diagnosed carpal tunnel syndrome, but the testing done

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during his examination was not sufficient - given the duration of

the condition and Johnson's subjective descriptions of her

condition - to determine whether Johnson could be gainfully

employed. Dr. Conover merely estimated Johnson's grip strength,

and asked her to hold a pen and write, touch fingertip to palm,

oppose thumb to finger, and pick up a coin. These actions could

have been performed in the space of two or three minutes, and do

not demonstrate that Johnson would be capable of performing "full

time competitive work," Ross v. Apfel, 218 F.3d 844, 849 (8th Cir.

2000). They are not an adequate substitute for nerve conduction

studies.

Carpel tunnel syndrome is not necessarily disabling, but its

effects must be appropriately evaluated. It

results from compression of the median nerve in the

volar aspect of the wrist," and "produces paresthesias

in the radial-palmar aspect of the hand plus pain in the

wrist, in the palm, or sometimes proximal to the

compression site in the forearm and shoulder. The pain

may be more severe at night. Sensory deficit in the

palmar aspect of the first 3 digits and/or weakness and

atrophy in muscles controlling thumb abduction and

apposition may follow. The syndrom is relatively common,

may be uni- or bilateral, and occurs more often in

women. It is particularly associated with occupations

that require repeated forceful wrist flexion. . . . If

symptoms continue or progress, surgical decompression of

the median nerve at the wrist is required.

The Merck Manual, 16th Ed.

The Court finds that nerve conduction studies and other

appropriate tests will be required to determine whether Johnson is

capable of working, given the severity of her condition as she

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describes it, the objective tests from 1994 which indicate that

nerve abnormalities existed then, and the length of time that the

condition has gone untreated. It may well be that at this point

irreversible damage has been done to the nerves of Johnson's

hands, with concomitant impact on her ability to perform work.

The Court also finds that the ALJ should obtain Johnson's

medical records from Dr. Park with regard to the 1983 shoulder

injury for assistance in determining the extent of her right upper

extremity problems.

6. The Court also agrees with Johnson that the ALJ erred in

failing to consider the combined impact of her impairments, and in

not giving sufficient emphasis to her complaints of numbness,

pain, and lack of sleep. In addition, Johnson must struggle with

a limited education, borderline intelligence, and major

depression. The ALJ is required to consider the combined effect

of all a claimant's impairments without regard to whether any

impairment, if considered separately, would be disabling. "The

ALJ must consider the impairments in combination and not

fragmentize them in evaluating their effects." Delrosa v.

Sullivan, 922 F.2d 480 (8th Cir. 1991). 

Accordingly, the Court reverses the decision of the

Commissioner, and remands this case to the Commissioner for

further consideration in accordance with this Judgment, pursuant

to sentence four of 42 U.S.C. §405(g).

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If plaintiff wishes to request an award of attorney's fees

and costs under the Equal Access to Justice Act, an application

may be filed up until thirty days after the judgment becomes "not

appealable," i.e., thirty days after the sixty-day time for appeal

has ended. Shalala v. Schaefer, 509 U.S. 292 (1993); 28 U.S.C. §§

2412(d)(1)(B) and (d)(2)(G).

IT IS SO ORDERED.

/s/Jimm Larry Hendren

JIMM LARRY HENDREN

UNITED STATES DISTRICT JUDGE

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