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

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Fl LED 

United States Courc of Appeals 

Tenth Circuit 

UNITED STATES COURT OF APPEALS 

FOR THE TENTH CIRCUIT 

AUG 2 8 1990 

ROBERT L. HOECKER 

Clerk 

JOHN DILLON, 

Plaintiff-Appellant, 

v. 

) 

) 

) 

) 

) No. 89-2292 

) (D.C. No. 87-1480-M) 

SECRETARY OF HEALTH & HUMAN SERVICES, 

Defendant-Appellee. 

) (D. N.M.) 

) 

) 

ORDER AND JUDGMENT * 

Before SEYMOUR, BRORBY, and EBEL, Circuit Judges. 

After examining the briefs and appellate record, this panel 

has determined unanimously that oral argument would not materially 

assist the determination of this appeal. See Fed. R. App . P . 

34(a); 10th Cir. R. 34.1.9. The case is therefore ordered 

submitted without oral argument. 

Plaintiff-appellant appeals the district court's order of 

October 25, 1989, affirming the decision of defendant-appellee 

Secretary of Health and Human Services (Secretary) denying 

plaintiff's application for disability insurance benefits. On 

appeal, plaintiff asserts that the decision below was not 

* This order and judgment has no precedential value and shall 

not be cited, or used by any court within the Tenth Circuit, 

except for purposes of establishing the doctrines of the law of 

the case, res judicata, or collateral estoppel. 10th Cir. R. 

36.3. 

Appellate Case: 89-2292 Document: 010110041614 Date Filed: 08/28/1990 Page: 1 
supported by substantial evidence. Plaintiff also contends that 

the administrative law judge (A.L.J.) erred in failing to discuss 

fully the report of Dr. Schultz, and that the district court erred 

in concluding that the report of Dr. Schultz related only to 

plaintiff's condition after the last date on which he was insured 

for benefits. Further, plaintiff argues that both the A.L.J. and 

the district court misapplied the treating physician's rule. 

Plaintiff raised several other issues on appeal to the district 

court but did not raise them in his brief on appeal to this court. 

Therefore, we will deem those issues abandoned. 

Garcia, 742 F.2d 1237, 1244 (10th Cir. 1984). 

See Bledsoe v. 

The Secretary's decision must be upheld if it is supported by 

substantial evidence and if the correct legal standards were 

applied. See . Frey v. Bowen, 816 F.2d 508, 512· (10th Cir. 1987). 

Based upon our thorough review of the record, see Broadbent v. 

Harris, 698 F.2d 407, 414 (10th Cir. 1983), as well as the 

parties' briefs on appeal, we conclude that the district court 

properly affirmed the decision of the Secretary denying 

plaintiff's application for disability insurance benefits. 

Therefore, the judgment of the United States District Court for 

the District of New Mexico is AFFIRMED for substantially the 

reasons set forth in its memorandum opinion and order of 

October 25, 1989, a copy of which is attached hereto. 

ENTERED FOR THE COURT 

PER CURIAM 

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\ '· Q--. · .... __ 

... ) 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF NEW MEXICO 

JOHN DILLON, 

Plaintiff, 

·FILED 

AT Al.8UQI IPOUf 

JESSE °'51\uS 

a.ERK 

vs. Civ. No. 87-1480 M 

OTIS R. BOWEN, M.D., 

SECRETARY OF HEALTH 

AND HUMAN SERVICES, 

Defendant. 

MEMORANDUM OPINION AND ORDER 

· ENTERED ON DOCKET 

__ _ j_Q ~ ~6- ~Cj 

Plaintiff invokes this Court's jurisdiction under 42 U.S.C. 

§405(g) (1982), seeking judicial review of a final decision of 

the Secretary of Health and Human Services (Secretary). The 

Secretary determined that plainti_ff is not eligible for 

disability insurance benefits. Plaintiff moves this Court for an 

order reversing the Secretary's decision or remanding this matter 

for a rehearing. This Court reviews the Secretary's decision to 

determine whether the Secretary's findings are supported by 

substantial evidence and whether the Secretary applied correct 

legal standards in making his findings. Williams v. Bowen, 844 

F.2d 748 (10th Cir. 1988). 

Administrative History 

Plaintiff's application for disability insurance benefits 

was denied at the administrative level both initially and on 

reconsideration. Plaintiff requested and received a de novq 

review before an administrative law judge (ALJ). A hearing was 

held before the ALJ at which plaintiff and his attorney appeared. 

Appellate Case: 89-2292 Document: 010110041614 Date Filed: 08/28/1990 Page: 3 
( 

The ALJ found that plaintiff was not disabled within the meaning 

of the Social Security Act. 1 The Appeals Council denied 

plaintiff's request for review of the ALJ's decision. The 

decision of the ALJ therefore became the final decision of the 

Secretary for judicial review purposes. 

Statement of the Facts 

Plaintiff alleges disability since April 1976 due to 

arthritis. He also suffers from the adverse effects of 

medications, obesity, and hearing loss. Plaintiff was 40 years 

old in December 1983, when he was last insured under the Social 

Security Act. He h~s a high school education. His past relevant 

work was as a transport driver for the construction industry. 

Plaintiff has not worked since October 1983. 

A. Medical Evidence 

. 

Plaintiff was admitted to a hospital in January 1978 for a 

spinal fusion to relieve lower back pain. Tr. 58. s. Schultz, 

M.D., diagnosed plaintiff as having a mechanically unstable back 

and degenerative .disc disease. Id. Dr. Schultz previously noted 

that all of plaintiff's lumbar motions were limited, straight leg 

raisings were limited but he noted no reflex or sensory changes 

relative to either lower extremity, and plaintiff was "diffusely 

1

The Secretary found that as of May 1984 the medical 

evidence supported plaintiff's contention that he was disabled 

for purposes of receiving supplemental security income benefits. 

In this case, however, plaintiff must show that he was disabled 

prior to December 1983, the date he was last insured under the 

Social Security Act, in order to receive disability insurance 

benefits. 

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:) 

tender on pressure throughout the entire low back region." Tr .. 

59 . 

In May 1983, plaintiff was hospitalized for injuries which 

resulted from a motorcycle accident. Tr. 80. Plaintiff 

complained of a head injury, left shoulder pain, left wrist pain, 

neck pain, and left knee pain . Id. Plaintiff stated also that 

he was "otherwise healthy" and took no regular medications. Id. 

The attending physician's final assessment of plaintiff's 

injuries was that plaintiff had multiple abrasions, a single 

laceration, and a fractured left clavicle . Id . 

The remainder of the medical evidence relates to plaintiff's 

physical condition after the date he was last insured . In June 

1984, Dr. Schultz saw plaintiff whom he had not seen since 1979 . 

Dr. Schultz found ·that plaintiff had "degenerative arthritic 

changes above the level of his (spinal] fusion," "marked 

chondromalacia of both patellae,'' and "degenerative, arthritic 

changes in both knees." Tr. 91 . Dr. Schultz also opined that 

plaintiff was "totally and permanently disabled for a return to 

any type of employment, even that of a sedentary nature." Id . 

In September 1984, plaintiff had a left groin mass removed which 

was a lipoma. Tr. 75 , 78-79. In October 1984, plaintiff was 

admitted to a hospital for back pain with severe muscle spasm and 

strain, urinary tract infection, and possible nosocomial 

infection. Tr. 68. 

In July 1985, a consultative physician, Michael Kaufman, 

M.D., examined plaintiff. Dr. Kaufman found that plaintiff had 

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. ~ ·-·~ 

chronic low back pain with sciatica on the left, status postmultiple compression fractures, and status post-pulmonary emboli; 

osteoarthritis of the back and knees; and decreased hearing on 

the right. Tr. 93 . Dr. Kaufman also opined that plaintiff was 

"fully disabled." Tr. 94. 

B. Plaintiff's Testimony 

Plaintiff testified that he has used crutches and canes 

since the spinal fusion operation and that Dr. Schultz prescribed 

these devices. Tr. 33-34. Plaintiff also testified that he 

could sit for 20-30 minutes at a time if he was taking demerol. 

Tr. 34. Furthermore, plaintiff stated that he had always been on 

medication since the spinal fusion and that some of the 

medications made him hallucinate, hyperactive, nervous, and made 

his hands and feet swell . Tr. 35-36, 38. Plaintiff also stated 

that he was most comfortable when sitting in a recliner with his 

right foot propped up or lying on his side with a pillow behind 

him. Tr. 36. Next, plaintiff testified that he could only drive 

an automatic car provided that he kept his foot on the brake in 

case he had to react quickly. Tr. 38. Plaintiff also testified 

that he needed help with bathing, tying his shoes, and going to 

the bathroom. Id. He stated that he could not grocery shop or 

do housework, either. Id. Furthermore, plaintiff testified that 

his daily activities included watching television, reading, and 

listening to music and relaxation tapes. Tr. 39. 

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Issues 

Plaintiff contends that the Secretary did not base his 

decision on substantial evidence nor did he poperly apply legal 

standards in finding that the plaintiff was not disabled and has 

' 

the capacity to perform his past relevant work. 

Discussion 

A. The Standard of Review 

The function of this Court on review is not to· try the 

plaintiff's claim de novo, but to determine upon the whole record 

whether the Secretary's decision is supported by substantial 

evidence. Cagle v. Califano, 638 F.2d 219-21 (10th Cir. 1981). 

Substantial evidence is more than a scintilla but less than a 

preponderance of the evidence. Richardson v. Perales, 402 U.S. 

389, 401 (1971). It is such relevant evidence as reasonable 

minds might accept as adequate to support a conclusion. Id. It 

is·well settled that if there is substantial evidence to support 

the Secretary's decision then that decision must be upheld. 

Cagle, 638 F.2d at 220. However, the district court should not 

blindly affirm the Secretary's decision but must instead 

scrutinize the entire record to determine if the plaintiff's 

claim is supported by substantial evidence and the law has been 

correctly applied. Hogan v. Schweiker, 532 F.Supp. 639, 642 

(D.Colo. 1982). 

The plaintiff must first make a prima facie showing of an 

impairment which effectively precludes him from returning to his 

past work. once that showing is made, the burden shifts to the 

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\ 

Secretary to show: (1) that the plaintiff, considering his age, 

education, work experience and physical shortcomings, has the 

capacity to perform alternative jobs and (2) that these specific 

types of jobs exist in significant numbers in the economy. Hal~ 

v. Harris; 658 F.2d 260, 264 (4th Cir. 1981); Salas v. Califano, 

612 F.2d 480, 482-83 (10th Cir. 1979); Gardner v. Brian, 369 F.2d 

443, 446-47 (10th Cir. 1966). 

To regularize the adjudicative process, the Social Security 

Administration has promulgated regulations which establish a 

"sequential evaluation process" to determine whether a claimant 

is disabled. 20 C.F.R. §404.1520 (1986). 2 The first inquiry 

under the sequence is whether the claimant is currently engaged 

in substantial gainful employment. If he is so engaged, the 

claim is denied. The second inquiry is whether the claimant has 

a severe impairment. If the impairment is severe, the third 

inquiry is whether such an impairment meets or equals one of the 

impairments listed under 20 C.F.R. Part 404, Subpt. P, App. 1 

(1986). If it does meet or equal a listing, the claim is 

approved. If it does not, the fourth inquiry is whether the 

claimant's impairments prevent him from performing his past 

relevant work. If he is found to be capable of returning to his 

past relevant work, the claim is denied. By satisfying inquiry 

four, the claimant establishes a prima facie case of disability. 

2

The 1986 C.F.R. 's were in effect at the time of the 

plaintiff's filing for benefits. More current C.F.R. 's are 

presently available. 

6 

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.·.-.. ) 

Should he not be found capable of returning to his past relevant 

work, a fifth and final inquiry is asked. The burden of proof 

then shifts to the Secretary for the fifth inquiry. The fifth 

inquiry is whether the claimant is able to perform other forms of 

substantial gainful activity considering age, education, and 

prior work experience. If he cannot perform other forms of 

substantial gainful activity, his claim is approved. If a 

determination of disabled or not disabled is found at any step, 

fu·rther inquiry is not required. 20 C.F.R. §404.1520 (1986). 

Upon reaching the fifth step of the sequential evaluation 

process, the Medical-Vocational Guidelines (grids} are used in 

determining whether disability exists. 20 C.F . R. Part 404, 

Subpt. P, App. 2 (1986). These grids reflect the existence of 

jobs in the national economy at various residual functional 

levels by incorporating administrative·notice of some 

occupational publications and studies. 20 C.F.R. §404.1566(d} 

(1986}. This aids the Secretary in determining what specific job 

types exist in the national economy for the claimant. To apply 

the grids, the AIJ must make findings of fact as to age, 

education, work experience, and residual functional capacity. 20 

C.F.R. §§404.1545, 404.1563-.1565 (1986). These findings of fact 

are plugged into the grid to produce a factual conclusion of 

disabled or not disabled. 20 C.F.R. §404.1569 (1986}. The grids 

assume that the claimant's sole limitation is lack of strength, 

also known as an exertional impairment. 20 C.F.R. Part 404, 

Subpt. P, App. 2, §200.00(e} (2) (1986). 

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) 

Where a claimant presents evidence of both exertional and . 

nonexertional impairments (such as pain, respiratory problems, 

and diminished vision), the grids are not conclusive but merely 

form a framework for disability determination. Id. In that 

situation, the ALJ must make findings on how much a claimant's 

work ability is further diminished by the nonexertional 

limitations. Id. If the claimant's nonexertional limitations 

are significant enough to reduce further his or her work 

capacity, the ALJ may not rely upon the grids but instead must 

give full consideration to all relevant facts, including 

vocational expert testimony if necessary, in determining whether 

the claimant is disabled. Id.; Channel v. Heckler, 747 F.2d 577, 

583 (10th Cir. 1984). 

B. The Secretary's Decision 

1. Post-Last Date Insured Evidence 

Plaintiff argues that the Secretary should have fully 

discussed the opinions of Drs. Schultz (plaintiff's treating 

physician) and Kaufman (a consulting doctor) each of whom stated 

after plaintiff's last date of insurance, that plaintiff was 

disabled. Medical evidence produced subsequent to the last date 

insured should be reviewed by the Secretary in light of the whole 

record to determine whether it establishes the presence of a 

physical impairment before plaintiff's insured sta.tus expired. 

Basinger v. Heckler, 725 F.2d 1166, 1169 (8th Cir: 1984). The 

Secretary did not do this, although he stated in a conclusory 

fashion that he studied carefully all of the medical evidence. 

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• 

Tr. 12. Rather, he only discussed the medical evidence for the. 

period ending on December 31, 1983, the last date insured. 

Therefore, the Secretary erred by not discussing the medical 

opinions of Ors. Schultz and Kaufman. 

' 

However, had the Secretary examined the opinions of Ors. 

Shultz and Kaufman, the Secretary would have found that their 

opinions did not relate to plaintiff's impairments prior to the 

date last insured. Dr. Schultz wrote about plaintiff's "present 

physical incapacity" and that plaintiff's "present physical 

condition (was] permanent." Tr. 91. Dr. Kaufman also stated 

that plaintiff was "presently disabled". Tr. 92. These two 

medical opinions obviously do not relate back to the time in 

question for purposes of this case . Therefore, the opinions are 

irrelevant and the Secretry committed only harmless error by not 

discussing them. 

2. Adverse Reactions to Medications 

Plaintiff next argues that the Secretary failed to 

address the several alleged serious adverse effects of 

plaintiff's prescribed medications. "[I]f the Secretary chooses 

to disregard a claimant's testimony as to the subjective 

limitations of (medication] side effects, he must support that 

decision with specific findings similar to those required for 

excess pain (see pain discussion, infra] testimony, as long as 

the side effects are in fact associated with the claimant's 

medication(s)." Varney v. Secretary of Health and Human 

Services, 846 F.2d 581, 585 (9th Cir. 1988). In this case, the 

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) 

Secretary did not discuss plaintiff's adverse side effects 

because the objective medical evidence does not indicate that 

plaintiff had side effects. Tr. 13. In fact, plaintiff told Dr. 

Johnson that he took no regular medications, had no allergies, 

and was healthy. Tr. 80. Furthermore, after the spinal fusion 

operation, Dr. Schultz indicated that the discharge medications 

were vitamin c, vitamin E, Tylenol #3, and sodium fluoride. Tr. 

61. The above medication list contradicts plaintiff's testimony 

that he had an allergic reaction to the drug epherine. Moreover, 

there is no objective medical evidence in the record to 

collaborate plaintiff's allegation th~t his feet and hands 

swelled as a result of adverse side effects. Finally, although 

plaintiff did take an opium-derived drug (Tylenol #3) which he 

claimed irritated his intestines, the drug was prescribed to him 

post-operatively without any indicatioh that its use would be 

long term. Tr. 61. Furthermore, the record does not contain any 

objective medical evidence that plaintiff ever had an intestinal 

irritation. Since plaintiff has not shown that his alleged side 

effects were in fact associated with his medications, the 

Secretary did not have to discuss the plaintiff's alleged adverse 

side effects. 

3. Treating Physician's Rule 

Plaintiff also contends that the Secretary improperly 

disregarded the medical opinion of. plaintiff's treating 

physician, Dr. Schultz, who found that plaintiff was disabled. 

As already shown, Dr. Shultz's opinion does not relate to the 

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) 

relevant time period involved in this case. See post-last date 

insured evidence discussion, supra. Thus, the Secretary did not 

err by ignoring Dr. Schultz's opinion. 

4. Pain 

Plaintiff argues, next, that the Secretary did not 

properly discuss plaintiff's allegations of disabling pain. The 

Social Security Disability Reform Act of 1984, 42 u.s.c. 

§423(d) (1) (A) (Supp. III 1985) requires that a pain~producing 

impairment be proven by some objective medical evidence before 

pain can be found disabling. Luna v. Bowen, 834 F . 2d 161, 163 

(10th Cir. 1987); Nieto v. Heckler, 750 F.2d 59, 61-62 (10th Cir. 

1984. Once that has been proven, the plaintiff needs to show 

that there is a reasonable expectation that the impairment 

produces some pain. 42 u.s.c. §423(d) (5) (A); Luna, 834 F.2d at 

164; Howard v. Heckler, 782 F.2d 1484,'1488 n. 4 (9th Cir. 1986). 

If the pain is reasonably related to the impairment, the 

Secretary must then consider all the evidence presented to 

determine whether the pain is in fact disabling. 42 U.S.C. 

§423(d) (5) (A); Luna, 834 F.2d at 163. Only at this point does 

the ALJ decide whether he believes plaintiff's allegations of 

pain. Luna, 834 F.2d at 163. In making his decision on 

credibility, the ALJ should look at facts beyond objective 

medical evidence and the plaintiff's appearance. See id. at 165-

66; Turner v. Heckler, 754 F.2d 326, 331 (10th Cir. 1985); Nieto, 

750 F.2d at 62; Polaski v. Heckler, 751 F.2d 943, 948 (8th Cir. 

1984). On the issue of credibility, courts will defer to the 

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AI.J's judgment. Beavers v. Secretary of Health. Education and . 

Welfare, 577 F.2d 383, 387 (6th Cir. 1978). 

The Secretary implied that plaintiff's type of back problem 

could produce pain and reasonably could have been expected to 

cause pain in the plaintiff. The Secretary, however, did not 

think that plaintiff's allegations of disabling pain were 

credible. In coming to his credibility determination, the 

Secretary examined the facts that plaintiff worked with livestock 

from 1980 to May 1983 until he had a motorcycle accident, that 

the motorcycle accident produced injuries unrelated to 

plaintiff's back probl~ms, that there is no objective medical 

evidence that plaintiff had crutches or a cane prescribed to him 

as plaintiff had testified, and that being able to ride a 

motorcycle did not comport with plaintiff's testimony of 

restricted activity due to pain. The above reasons are 

substantial enough to support the Secretary's decision that 

plaintiff's allegations of disabling pain were not credible. 

Thus, the Court will defer to the Secretary's credibility 

determination. 

5. Combination of Impairments 

Plaintiff argues that the Secretary failed to consider the 

~ effect of the combination of plaintiff's impairments of adverse 

side effects of medication, obesity, and loss of hearing with his 

back problem. The . regulations require that the Secretary 

consider all impairments in combination when he is deciding the 

severity of plaintiff's impairments even if those impairments, if 

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· , I 

considered separately, would not be severe. 40 C.F.R. §404.1522 

(1984); Hudson v. Heckler, 755 F.2d 781, 785 (11th Cir. 1985); 

Houston v. Secretary of Health and Human Services, 736 F.2d 365, 

366-67 (6th Cir. 1984). The Secretary has a duty to make 

' 

specific and well articulated findings as to the effect of the 

combination of impairments. Hudson, 755 F.2d at 785; Purter v. 

Heckler, 711 F.2d 682, 699 (3rd Cir. 1985); Bowen v. Heckler, 748 

F.2d 629, 635 (11th Cir. 1984). 

In order for the Secretary to consider an impairment in 

combination with other impairments, the plaintiff must state that 

he has that impairment or produce evidence showing that 

impairment and its level of severity. 20 C.F.R. §404.1512(b) 

(1986). See also 20 C.F.R. §404.946 (1986) (notice required of 

new issues); Sheppeard v. Heckler, 760 F.2d 1253, 1254 (11th Cir. 

1985) (the ALJ can determine issues only if affirmatively 

raised). In this case, as already discussed, there is no 

objective evidence that plaintiff suffered from adverse side 

effects. Thus, the Secretary need not consider the plaintiff's 

. . 

allegations of adverse side effects in combination with 

plaintiff's back impairment. 

Next, plaintiff did not put the ALJ on notice that obesity 

was to be considered an impairment. Plaintiff's application for 

disability benefits does not list obesity as an impairment. Tr. 

102. Plaintiff also did not allege that obesity was an 

impairment at the administrative hearing. The hearing record 

indicated that plaintiff was five feet and eleven inches tall and 

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weighed two hundred and sixteen pounds. Tr. 27. However, no one 

at the hearing asserted that being this tall and heavy amounted 

to a claim based on obesity. The AL.J should not be required to 

second guess what impairments plaintiff suffers from. Thus, the 

AL.J was not obligated to consider plaintiff's obesity in 

combination with plaintiff's back impairment. 

Plaintiff has not shown that he had a hearing impairment 

prior to the date he was last insured. The only mention of a 

hearing loss was made in July 1985, more than - a year after the 

date last insured. Tr. 93. A health evaluation made by 

plaint~ff's treating physician in June 1984, six months past the 

date last insured, did not mention a hearing problem at that time 

or during past examinations in 1978 or 1979. Tr. 89-91. The 

above evidence tends to show that plaintiff probably developed a 

hearing loss after the date last insured. Thus, the hearing 

impairment is irrelevant to a discussion of this case and need 

not be considered in combination with plaintiff's back 

impairment. 

Conclusions 

First, the Secretary did not err by dismissing the medical 

evidence produced after the date plaintiff was last insured. 

Second, the Secretary was correct in dismissing plaintiff's 

allegations of adverse side effects in light of the lack of 

objective medical evidence to support those allegations. Third, 

the Secretary did not err by disregarding the medical opinion of 

plaintiff's treating physician without good cause. Fourth, the 

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• 

Secretary properly discussed plaintiff's allegations of disabling 

pain. Fifth, the Secretary was not obligated to discuss the 

combined effects of plaintiff's allegations of adverse medication 

side effects, obesity, and hearing less at the severity inquiry 

of the sequential evaluation process. For these reasons, the 

Secretary's decision shall be affirmed. 

WHEREFORE, 

IT IS ORDERED that plaintiff's motion to reverse or remand 

hereby be denied. 

UNITEO STATES DISTRICT JUDGE 

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