Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-3_04-cv-03043/USCOURTS-arwd-3_04-cv-03043-0/pdf.json

Nature of Suit Code: 865
Nature of Suit: Social Security - RSI (405(g))
Cause of Action: 42:405g Review of HHS Decision (RSI)

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Torticollis is defined as a contracted state of the cervical muscles producing twisting of the neck and an unnatural 1

 position of the head. See Dorland's Illustrated Medication, Dictionary at 1853, 29th Edition (2000).

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

HARRISON DIVISION

ELIZABETH A. MORRISON PLAINTIFF

v. CIVIL NO. 04-3043

JO ANNE B. BARNHART, Commissioner

Social Security Administration DEFENDANT

MEMORANDUM OPINION

Plaintiff Elizabeth A. Morrison brings this action pursuant to 42 U.S.C. § 405(g), seeking

judicial review of a decision of the Commissioner of the Social Security Administration

(Commissioner) denying her claim for period of disability and disability insurance benefits (DIB)

under the provisions of Title II of the Social Security Act (Act). 

Procedural Background:

The application for DIB presently before this court was filed on January 15, 1999,

alleging an inability to work since January 6, 1999, due spasmodic torticollis, diffuse myofascial 1

pain syndrome and fibromyalgia. (Tr. 115-117). An administrative hearing was held on March

29, 2000. (Tr. 371-407). Plaintiff was present and represented by counsel. On May 19, 2000, the

ALJ issued an unfavorable decision finding plaintiff capable of performing a significant range

of light level work. (Tr. 34-45). Plaintiff appealed this decision and on September 14, 2001, the

Appeals Council remanded plaintiff’s claim for further consideration of plaintiff’s testimony and

to obtain vocational expert testimony. (Tr. 78-81). 

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A second hearing before an ALJ was held on March 20, 2002. (Tr. 408-424). Plaintiff

and two witnesses testified. On May 21, 2002, the ALJissued an unfavorable decision. Plaintiff

appealed this decision and on June 5, 2003, the Appeals Council remanded plaintiff’s claim and

instructed the ALJ to consider the testimony of plaintiff’s witnesses. (Tr. 100-102).

A third hearing before an ALJ was held on December 5, 2003. (Tr. 425-483). Present

and testifying were plaintiff, a witness and a vocational expert. By written decision dated

February 17, 2004, the ALJ found that plaintiff has an impairment or combination of

impairments that are severe. (Tr. 23). However, after reviewing all of the evidence presented,

he determined that plaintiff’s impairments do not meet or equal the level of severity of any

impairment listed in the Listing of Impairments found in Appendix I, Subpart P, Regulation No.

4. (Tr. 23). The ALJ found plaintiff retained the residual functional capacity (RFC) to perform

a full range of light work. (Tr. 23). With the help of vocational expert testimony, the ALJ found

plaintiff would be able to perform her past relevant work as a corrections clerk and an accounts

payable clerk. (Tr. 23).

Plaintiff appealed the decision of the ALJ to the Appeals Council. Plaintiff's request for

review of the hearing decision was denied. (Tr. 6-9). When the Appeals Council declined review,

the ALJ’s decision became the final action of the Commissioner. Plaintiff now seeks judicial

review of that decision. (Doc. #1). Both parties have submitted appeal briefs and this case is

before the undersigned pursuant to the consent of the parties. (Doc. #’s 5,6).

Applicable Law:

This court's role is to determine whether the Commissioner's findings are supported by

substantial evidence on the record as a whole. Ramirez v. Barnhart, 292 F.3d 576, 583 (8th Cir.

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2002). Substantial evidence is less than a preponderance but it is enough that a reasonable mind

would find it adequate to support the Commissioner's decision. The ALJ's decision must be

affirmed if the record contains substantial evidence to support it. Edwards v. Barnhart, 314 F.3d

964, 966 (8th Cir. 2003). As long as there is substantial evidence in the record that supports the

Commissioner's decision, the court may not reverse it simply because substantial evidence exists

in the record that would have supported a contrary outcome, or because the court would have

decided the case differently. Haley v. Massanari, 258 F.3d 742, 747 (8th Cir. 2001). In other

words, if after reviewing the record it is possible to draw two inconsistent positions from the

evidence and one of those positions represents the findings of the ALJ, the decision of the ALJ

must be affirmed. Young v. Apfel, 221 F.3d 1065, 1068 (8th Cir. 2000).

It is well-established that a claimant for Social Security disability benefits has the burden

of proving her disability by establishing a physical or mental disability that has lasted at least one

year and that prevents her from engaging in any substantial gainful activity. Pearsall v.

Massanari, 274 F.3d 1211, 1217 (8th Cir.2001); see also 42 U.S.C. § § 423(d)(1)(A),

1382c(a)(3)(A). The Act defines “physical ormental impairment” as “an impairment that results

from anatomical, physiological, or psychological abnormalities which are demonstrable by

medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C. § § 423(d)(3),

1382(3)©. A plaintiff must show that her disability, not simply her impairment, has lasted for

at least twelve consecutive months.

The Commissioner's regulations require her to apply a five-step sequential evaluation

process to each claim for disability benefits: (1) whether the claimant has engaged in substantial

gainful activity since filing her claim; (2) whether the claimant has a severe physical and/or

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mental impairment or combination of impairments; (3) whether the impairment(s) meet or equal

an impairment in the listings; (4) whether the impairment(s) prevent the claimant from doing past

relevant work; and, (5) whether the claimant is able to perform other work in the national

economy given her age, education, and experience. See 20 C.F.R. § 404.1520. Only if the final

stage is reached does the fact finder consider the plaintiff's age, education, and work experience

in light of her residual functional capacity. See McCoy v. Schwieker, 683 F.2d 1138, 1141-42

(8th Cir. 1982); 20 C .F.R. § 404.1520.

Discussion:

In determining whether the ALJ properly disregarded plaintiff’s subjective complaints

of 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 orreject 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, 739 F.2d at 1322 (emphasis in original).

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A significant number of people with fibromyalgia (FM) have a neuromuscular condition known as myofascial pain 2

 syndrome (MPS) in which very painful spots (trigger points) form in taut bands in muscles or other connective tissue,

 often as a result of repetitive motion injury, prolonged poor posture, or illness. Not only are these spots very painful

 but they also refer pain to other parts of the body in very predictable ways. Unlike FM which affects the entire body,

 MPS is a localized condition which occurs in very specific areas, typically the neck, shoulders, or lower back. TMJ is

 considered a form of MPS. National Fibromyalgia Partnership, Inc., Fibromyalgia: Symptoms, Diagnosis, Treatment

 & Research (2005), at http://www.fmpartnership.org. 

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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 and other witnesses.

Nelson v. Sullivan, 966 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). 

In his opinion, the ALJ found plaintiff’s spasmodic torticollis and myofascial pain

syndrome were severe impairments. (Tr. 19). He did not, however, discuss plaintiff’s

fibromyalgia.2

Fibromyalgia involves pain in fibrous tissues, muscles, tendons, ligaments and other

“white” connective tissues. Diagnosis is recognized by a typical pattern of diffuse fibromyalgia

and nonrheumatic symptoms, such as poor sleep, trauma, anxiety, fatigue, irritable bowel

symptoms, exposure to dampness and cold, and by exclusion of contributory or underlying

diseases. See The Merck Manual, pp. 1369-1371 (16th Edition, 1992). Its cause or causes are

unknown, there is no cure, and, perhaps of greatest importance to disability law, its symptoms

are entirely subjective. There are no laboratory tests for the presence or severity of fibromyalgia.

The principal symptoms are “pain all over,” fatigue, disturbed sleep, stiffness, and—the only

symptom that discriminates between it and other diseases of a rheumatic character— multiple

tender spots, more precisely eighteen fixed locations on the body (and the rule of thumb is that

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the patient must have at least eleven of them to be diagnosed as having fibromyalgia) that when

pressed firmly cause the patient who really has fibromyalgia to flinch. 

We recognize that it is difficult to determine the severity of plaintiff’s condition because

of the unavailability of objective clinical tests. Some people may have such a severe case of

fibromyalgia as to be totally disabled from working, but most do not. Michael Doherty & Adrian

Jones, Fibromyalgia Syndrome (ABC of Rheumatology), 310 BRITISH MED.J. 386 (1995). The

question is whether the plaintiff is one of the minority, or not.

The medical evidence clearly indicates that plaintiff had been diagnosed with

fibromyalgia. (Tr. 258, 295, 328, 331, 355-358). Physicians have documented plaintiff’s

complaints of pain, irritable bowel syndrome, sleep disturbance, fatigue and stiffness, all

symptoms reasonably expected to be produced by plaintiff’s fibromyalgia. Dr. Ronald Rubio

also noted plaintiff exhibited tenderness in eighteen of the eighteen fibromyalgia tender points.

(Tr. 356-357). However, it appears the ALJ gave little weight to the diagnosis of fibromyalgia

or its debilitating effect. Rather, he focused his attention of plaintiff’s reported ability to perform

household chores, care for her personal needs, grocery shop, drive short distances and visit with

her grandchildren. (Tr. 19). Contrary to the ALJ’s assertion, the Eighth Circuit has held, in the

context of fibromyalgia cases, that the ability to engage in activities such as cooking, cleaning,

and hobbies, does not constitute substantial evidence of the ability to engage in substantial

gainful activity. Brosnahan v. Barnhart, 336 F.3d 671, 677 (8th Cir. 2003); See Kelley v.

Callahan, 133 F.3d 583, 588-89 (8th Cir. 1998). Accordingly, plaintiff’s ability to perform these

tasks does not automatically render her capable of performing work. 

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Therefore, because the ALJ improperly discredited plaintiff’s subjective complaints of

pain without considering the impact of her fibromyalgia, we find that his conclusion that plaintiff

is not disabled is not supported by substantial evidence in the record as a whole. Accordingly,

we believe remand is necessary in order to allow the ALJ to further develop the record regarding

plaintiff’s fibromyalgia and for a reevaluation of plaintiff’s subjective complaints in light of this

diagnosis. On remand the ALJshould re-evaluate plaintiff's subjective allegations in accordance

with Polaski, 739 F.2d at 1322, specifically discussing each Polaski factor in the context of

plaintiff's particular case.

The ALJ’s RFC assessment is also of some concern to undersigned. “The ALJ determines

a claimant’s RFC based on all relevant evidence in the record, including medical records,

observations of treating physicians and others, and the claimant’s own descriptions of his or her

limitations.” Eichelberger v. Barnhart, 390 F.3d 584, 591 (8th Cir. 2004). This includes

medical records, observations of treating physicians and others, and the claimant’s own

descriptions of her limitations. Guilliams v. Barnhart, 393 F.3d 798, 801 (8th Cir. 2005).

Limitations resulting from symptoms such as pain are also factored into the assessment. 20

C.F.R. § 404.1545(a)(3). The United States Court of Appeals for the Eighth Circuit has held that

a “claimant’s residual functional capacity is a medical question.” Lauer v. Apfel, 245 F.3d 700,

704 (8th Cir. 2001). Therefore, an ALJ’s determination concerning a claimant’s RFC must be

supported by medical evidence that addresses the claimant’s ability to function in the

workplace.” Lewis v. Barnhart, 353 F.3d 642, 646 (8th Cir. 2003). 

Given the fact that plaintiff was diagnosed with fibromyalgia, we cannot say that the

ALJ’s RFC assessment is supported by substantial evidence. The ALJ, in concluding that

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plaintiff could perform the exertional and non-exertional requirements of a full range of light

work, relied on an RFC assessment completed by non-examining, medical consultant, indicating

plaintiff’s ability to perform this level of work. (Tr. 234). We note, that the opinion of a

consulting physician who examined the plaintiff once or not at all does not generally constitute

substantial evidence. See Jenkins v. Apfel, 196 F.3d 922, 925 (8th Cir. 1999). It is also

significant to note that the RFC assessment relied upon was completed in February of 1999, and

affirmed in June of 1999, prior to many of the medical records currently of recorded including

Dr.Rubio’s findings in support of his diagnosing plaintiff with fibromyalgia. As such, the

examiner did not have the benefit of reviewing all of the medical evidence contained in the file.

Therefore, on remand, the ALJ is directed to address interrogatories to plaintiff’s treating

physicians, including Dr. Rubio, asking them to review plaintiff’s medical records, complete an

RFC assessment regarding plaintiff’s capabilities during the time period in question, and to give

the objective basis for their opinions so that an informed decision can be made regarding

plaintiff’s ability to perform basic work activities on a sustained basis during the relevant time

period in question. Chitwood v. Bowen, 788 F.2d 1376, 1378 n.1 (8th Cir. 1986); Dozier v.

Heckler, 754 F.2d 274, 276 (8th Cir. 1985). The ALJ should also specifically request that the

above physicians discuss what, if any, limitations are caused plaintiff’s torticollis. The ALJ may

also order a consultative exam, in which, the consultative examiner should be asked to review

the medical evidence of record, perform a physical examination and appropriate testing needed

to properly diagnosis plaintiff's condition and level of pain, and complete a medical assessment

of plaintiff's ability to perform work related activities. See 20 C.F.R. §§ 404.1517. With this

evidence, the ALJ should then re-evaluate plaintiff's RFC and specifically list in a hypothetical

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to a vocational expert any limitations that are indicated in the RFC assessments and supported

by the evidence. If after proper review of an adequately developed record, the ALJ finds that

plaintiff cannot return to her past relevant work, the burden will shift to the Commissioner to

prove the existence of other jobs in the national economy that plaintiff can perform. Sells v.

Shalala, 48 F.3d 1044 (8th Cir. 1995). 

Conclusion:

Based on the foregoing, we hereby reverse the decision of the ALJ and remand this case

for further consideration pursuant to sentence four of 42 U.S.C. § 405(g).

DATED this 31 day of August 2005. st

/s/ Beverly Stites Jones 

HON. BEVERLY STITES JONES

UNITED STATES MAGISTRATE JUDGE

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