Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_15-cv-00380/USCOURTS-almd-2_15-cv-00380-0/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)

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IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

DESMOND KELLY, )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:15cv380-CSC

) (WO)

CAROLYN W. COLVIN, )

Acting Commissioner of Social Security,

1

)

)

Defendant. )

MEMORANDUM OPINION and ORDER

I. Introduction

Plaintiff Desmond Kelly (“Kelly”) applied for supplemental security income benefits

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

unable to work because of a disability. His 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 also denied the claim. 

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”).2See Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). The case

is now before the court for review pursuant to 42 U.S.C. §§ 405 (g) and 1383(c)(3). Pursuant

1

 Carolyn W. Colvin became the Acting Commissioner of Social Security on February 14, 2013.

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

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 2:15-cv-00380-CSC Document 16 Filed 05/23/16 Page 1 of 12
to 28 U.S.C. § 636(c)(1) and M.D. Ala. LR 73.1, the parties have consented to the United

States Magistrate Judge conducting all proceedings in this case and ordering the entryoffinal

judgment. 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 reversed and this case

remanded to the Commissioner for further proceedings.

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,3

 the Commissioner employs a five-step, sequential 

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.”

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

psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory

diagnostic techniques.

2

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McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986).4

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); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997). “Substantial

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.” Richardson v.

Perales, 402 U.S. 389, 401 (1971). A reviewing court may not look only to those parts of

the record which support the decision of the ALJ but instead must view the record in its

entirety and take account of evidence which detracts from the evidence relied on by the ALJ. 

Hillsman v. Bowen, 804 F.2d 1179 (11th Cir. 1986). 

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

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

presumption of validityattaches to 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 (11th Cir. 1987).

III. The Issues

A. Introduction. Kelly was 52 years old5

on the date of alleged onset of disability,

and has a limited education. (R. 20). His prior work experience includes work as a tire

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

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 (5th Cir. 1981) (Unit A).

5

In her opinion, the ALJ makes the following finding. “The claimant was born on October 19, 1960

and was 52 years old, which is defined as a younger individual age 18-49, on the date the application was

filed.” (R. 20). The error in this statement is apparent.

3

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changer. (Id.). Following the administrative hearing, the ALJ concluded that Kelly has

severe impairments of “moderate degenerative osteoarthritis of the right knee, osteoarthritis

of the left knee, and obesity.” (R. 15). The ALJ found that Kelly was unable to perform his

past relevant work but concluded that he 

has the residual functional capacity to perform a medium work as defined in

20 CFR 416.967(c) he is limited to occasional operation of foot controls with

the right lower extremity; no climbing of ladders, ropes, or scaffolds; no

kneeling, crouching, or crawling; and no unprotected heights, hazardous

machinery, or excessive vibration.

(R. 16).

Using the Medical-Vocational Guidelines, 20 C.F.R. Pt. 404, Subpt. P., App. 2, as a

framework and relying on the testimony of a vocational expert, the ALJ concluded that there

were significant number of jobs in the national economy that the plaintiff could perform. (R.

20-21). Accordingly, the ALJ concluded that the plaintiff was not disabled. (R. 21). 

B. Plaintiff’s Claim. As stated by Kelly, the issue for the court’s review is whether 

“[t]heCommissioner’s decision should be reversed because in issuing her negative credibility

finding the ALJ failed to apply the proper legal standard and improperly took judicial notice

of facts not in evidence.” (Doc. # 13, Pl’s Br. at 3). 

IV. Discussion

After reciting the law, the ALJ detailed the medical evidence and found that the

plaintiff’s testimony “as to his limitations not fully credible and that he is not precluded from

performing the demands of all work.” (R. 18). The ALJ repeatedly discredits the plaintiff’s

pain testimony because “he has received minimal, conservative treatment for his allegedly

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disabling pain and the objective findings do not indicate that he is as limited as alleged.” (R.

17-20). The ALJ then says this:

Additionally, the undersigned recognizes the claimant’s financial situation is

not optimal and that this has been a factor in his having been unable to afford

additional healthcare. However, on this record, the undersigned is unable to

make a finding that the claimant has exhausted all resources available to

individuals who cannot afford medical treatment or medication such as

hospitals, clinics, or community agencies. In fact, the claimant presented with

reports of pain on only three occasions since the application date, and only to

the emergency room on one of those occasions. Accordingly, the undersigned

finds that the claimant’s testimony is not credible with respect to the intensity

and persistence of his pain and other symptoms.

(R. 18-19) (emphasis added). 

The ALJ discredited the plaintiff because he failed to seek medical care. In this

regard, she erred as a matter of law. The record is replete with references to Kelly’s inability

to afford treatment. (R. 8, 49, 50, 225-26, 279 & 281). The ALJ did not conduct a searching

inquiry into the plaintiff's financial condition as it related to his medical treatment, even

though he testified to his inability to support himself financially. (R. 30-31). The record

reveals that the plaintiff has not been gainfully employed for many years; he lives in an

abandoned house with no heat or gas; and he subsists on food stamps. (R. 7, 49, & 225-26). 

The colloquy between the ALJ and the plaintiff is telling. 

Q: Have you worked at all since December of 2012?

A: No.

Q: Have you applied for any jobs?

A: No.

Q: And how are you supporting yourself?

A: I’m really not, I’m living in a house with somebody, and then getting

Food Stamps. I’m really not, really supporting myself. The fact that

like, you know, just really doing anything, it’s still probably mostly

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homeless still like I be.

* * *

Q: And who do you live with?

A: Me and a, the other person maybe come by, mostly just by myself

really. Peoples just really just let me live in there since I don’t have

anywhere to go.

(R. 30-31)

The ALJ then questioned Kelly about his pain but she did not ask about his treatment.

Q: And that’s the level of pain you’re in right now, is that correct?

A: No, I, I took some pain pills. This was a little – is – 

Q: What kind of pain pills did you take today?

A: I had some Tylenol and Tramadol.

Q: Who prescribed the Tramadol?

A: A doctor at River Regions, I forgot his name.

Q: How often do you take the Tramadol?

A: Mostly I take them as needed. When I’m – 

Q: How often do you take the Tramadol?

A: Mostly when I try to sleep or during the day, if I try to get up and do

something, to move around.

Q: How often do you take the Tramadol?

A: About maybe, as needed, yeah. 

Q: How often do you take the Tramadol?

A: Like two or three times a day, as, well, as needed, well when I eat with

meals – 

Q: Do, do you take it two to three times a day everyday?

A: With meals, I take it mostly with meals. 

Q: Do you take it – Mr. Kelly, we’re going round and round. Listen to my

questions.

A: Yes. 

Q: I know it’s been prescribed, take as needed. I know you can probably

take up to two to three per day.

A: Yeah. 

Q: What I want to know is how often you take the Tramadol.

A: About three times a day. 

Q: Three times a day.

A: Yeah. 

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Q: For how long, how long have you been taking Tramadol three times a

day?

A: Probably, I’ve been changing up on it, so I take Tramadol then I take

Tylenol. 

Q: Mr. Kelly, how long have you been taking Tramadol three times a day?

A: For about, ever since I’ve been going to the doctor really.

Q: Mr. Kelly, how long have you been taking Tramadol three times a day?

A: It’s hard to say, because I’ve been taking it for a while.

(R. 34-35).

The plaintiff further testified that he could not get a new ID card because he didn’t

have the money to pay for one. (R. 37). At no point during the administrative hearing did

the ALJ ask about Kelly’s efforts to secure treatment and she did not delve into Kelly’s

financial condition at all. The ALJ did not inquire into the availability of free or subsidized

sources of treatment. The ALJ simply assumes that these resources are available, and she

assumes that these resources could provide the medical treatment required by the plaintiff. 

Interestingly, the record contains two applications for charity care from UAB Medicine in

Birmingham. See R. 50, 279. The ALJ does not mention this evidence. 

When discounting the plaintiff’s testimony for non-compliance, the ALJ is obligated

to follow Social Security Ruling 82-59. A review of Social Security Ruling 82-59 clearly

demonstrates that the ALJ failed to meet her burdens as set forth in the Ruling. 

The claimant or beneficiary should be given an opportunity to fully express the

specific reason(s) for not following the prescribed treatment. Detailed

questioning may be needed to identify and clarify the essential factors of

refusal. . . . Individuals should be asked to describe whether they understand

the nature of the treatment and the probable course of the medical condition

(prognosis) with and without the treatment prescribed. . . . They should be

made aware that the information supplied will be used in deciding the

disability claim and that, because of the requirements of the law, continued

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failure to follow prescribed treatment without good reason can result in denial

or termination of benefits.

Social Security Ruling, 82-59 (Aug. 20, 1980). 

While failure to seek treatment is a legitimate basis to discredit the testimony of a

claimant, it is the law in this circuit that poverty excuses noncompliance with prescribed

medical treatment or the failure to seek treatment. Dawkins v. Bowen, 848 F.2d 1211 (11th

Cir. 1988). The ALJ concluded that, on this record, she could not make a finding that Kelly

had exhausted his community resources but then she discredited his testimony based on his

failure to seek medical care. The ALJ retains the responsibility of fully and fairly developing

the record. The ALJ erred as a matter of law when she failed to develop the record with

regard to whether relevant free community resources exist as required under SSR 82-59, and

when she discredited the plaintiff’s testimony for failing to secure treatment without first

inquiring into whether good cause exists to justify Kelly’s alleged failure to seek more

treatment. Consequently, the court concludes that the ALJ erred as a matter of law when she

failed to develop the record regarding the plaintiff’s financial situation as it relates to his

failure to seek treatment, and thus, her credibility determination is thus wholly inadequate

in light of the facts. 

The court is compelled to address one other aspect of this case that it finds troubling.

It is patently obvious from reading the transcript that Kelly was having difficulty answering

the ALJ’s questions during the administrative hearing. At one point, Kelly told the ALJ that

he was getting confused. (R. 37). Moreover, Kelly testified that dropped out of school in

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the eighth or ninth grade. (R. 41-42). 

Q: Besides sleeping and watching TV, do you do any, anything else during

the day?

A: No I can’t because my leg won’t let me do nothing.

Q: So if you’re watching TV for 12 hours a day, are you sleeping for 12

hours a day?

A: Sometime, it, it, it varies from sleeping to watching TV, sleeping and

up watching TV.

Q: All right, so how long have you been doing nothing but sleeping and

watching TV all day?

A: Ever since the pain started getting worser. It’s the only thing I could

do.

Q: How long have you been sleeping and watching TV all day?

A: That’s the only thing I’m able to do. Can’t go nowhere.

Q: How long – 

A: For about, it’s a long time, maybe about a year ago, six months or more,

a long time. 

Q: All right, now, you look really strong. You look very strong. Your

arms look very strong from doing nothing but sleeping and watching

TV.

A: That’s all I have been able to do.

Q: All right. I’m having a hard time believing that. Counsel, do you have

any questions?

BY ATTORNEY:

Q: How far did you go in school, Mr. Kelly?

A: Eighth grade, ninth grade.

BY ADMINISTRATIVE LAW JUDGE:

Q: Now there is a note in there that says you have a high school education?

A: No, I never did finish high school.

Q: Do you have a GED?

A: No.

Q: Or an eleventh grade, I see one part it says eleventh grade. When you

filled out your disability report in 2E, you said you completed the

eleventh grade in 1979 and did not attend special education.6

A: No, no special education.

Q: I’m – I had, I had it written down. It shows the eleventh grade and not

the twelfth.

6 The court notes that Kelly’s disability report was completed by a disability specialist during an inperson interview in the Social Security office. (R. 195)

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A: No. I didn’t finish high school.

Q: Did you complete the eleventh grade?

A: Eleventh grade.

Q: Yes.

A: Yeah.

Q: All right.

A: None, nine to eleventh. I dropped out. I was going through a lot of changes

then. I dropped out in ninth or the tenth grade, something like that. I didn’t

finish the whole semester.

* * *

ATY: That’s all I have.

ALJ: All right.

CLT: I don’t know, ma’am, but get on nerves, maybe nerves. I can’t even think

straight.

(R. 40-43).

There is sufficient evidence in the record from which the ALJ should have concluded

that it was necessary to secure additional evidence regarding the plaintiff’s intellectual

functioning before rendering a decision regarding his disability. Kelly’s testimony, coupled

with his confusion during colloquies with the ALJ during the administrative hearing, should

have led the ALJ to conclude that additional information was needed to properly evaluate his

intellectual limitations. It is clear that Kelly suffers fromsome intellectual or mental deficits. 

What is not clear is the extent or effect of any intellectual limitation on his ability to work.

The ALJ’s failure to develop the record regarding Kelly’s intellectual capabilities is contrary

to the evidence, and erroneous as a matter of law. 

Where a consultative evaluation is needed to make an informed decision, it is error

for an ALJ not to order such an evaluation. Reeves v. Heckler, 734 F.2d 519 (11th Cir.

1984). Under the circumstances of this case, the court concludes that there was sufficient

information before the ALJ to require her to obtain a psychiatric or psychological evaluation

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about Kelly’s mental impairments so she could make an informed decision. “[I]n any case

where there is evidence which indicates the existence of a mental impairment the . . .

[Commissioner] may determine that the claimant is not disabled only if the . . .

[Commissioner] has made every reasonable effort to obtain the opinion of a qualified

psychiatrist or psychologist.” McCall v. Bowen, 846 F.2d 1317, 1320 (11th Cir. 1988). 

While the ALJ is entitled to make credibility determinations, the ALJ may not substitute her

judgment for the judgments of experts in their field of expertise. “‘Even a “mild” mental

impairment may “prevent [a] claimant from engaging in the full range of jobs contemplated

by the exertional category for which the claimant otherwise qualifies.’” Allen v. Sullivan,

880 F.2d 1200, at 1202 (11th Cir. 1989). 

By failing to refer Kelly for a consultative psychological examination, the ALJ

improperly substituted her judgment for that of a psychologist with respect to the question

of whether the plaintiff has a mental impairment. The court concludes that the case should

be remanded to further develop the record by ordering a psychological evaluation so that the

next ALJ will have a full and complete picture of the extent of the plaintiff’s intellectual

functioning and its effects on his ability to work.

V. Conclusion

“Social Security proceedings are inquisitorial rather than adversarial. It is the ALJ’s

duty to investigate the facts and develop the arguments both for and against granting

benefits.” Sims v. Apfel, 530 U.S. 103, 110-111 (2000). In this regard, the ALJ failed in her

duty to develop the record.

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The SSA is perhaps the best example of an agency that is not based to a

significant extent on the judicial model of decisionmaking. It has replaced

normal adversary procedure with an investigatory model, where it is the duty

of the ALJ to investigate the facts and develop the arguments both for and

against granting benefits; review by the Appeals Council is similarly broad. 

Id. The regulations also make the nature of the SSA proceedings quite clear. 

They expressly provide that the SSA “conducts the administrative review

process in an informal, nonadversary manner.” 20 C.F.R. § 404.900(b).

Crawford & Co. v. Apfel, 235 F.3d 1298, 1304 (11th Cir. 2000). Based on the inadequate

credibility determination, the court cannot determine whether the ALJ’s conclusion that the

plaintiff is not disabled is based on substantial evidence. Accordingly, the decision of the

Commissioner will be reversed and this case remanded to the Commissioner for further

proceedings consistent with this opinion. 

A separate final judgment will be entered. 

It is further

ORDERED that, in accordance with Bergen v. Comm’r of Soc. Sec., 454 F.3d 1273,

1278 fn. 2 (11th Cir. 2006), the plaintiff shall have sixty (60) days after he receives notice

of any amount of past due benefits awarded to seek attorney’s fees under 42 U.S.C. § 406(b). 

See also Blitch v. Astrue, 261 Fed. Appx. 241, 242 fn.1 (11th Cir. 2008). 

Done this 23rd day of May, 2016.

 /s/Charles S. Coody 

CHARLES S. COODY

UNITED STATES MAGISTRATE JUDGE

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