Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_10-cv-00095/USCOURTS-almd-2_10-cv-00095-0/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

SYLVIA ELLIS, o/b/o E.D.B., )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:10cv95-CSC

)

MICHAEL ASTRUE, )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION

Plaintiff Sylvia Ellis filed this lawsuit on behalf of her son, E.D.B., to review a final 1

judgment by defendant Michael J. Astrue, Commissioner of Social Security, in which he

determined that E.D.B. is not “disabled” and therefore, not entitled to supplemental security

income benefits. 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 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). See Chester v. Bowen, 792 F.2d 2

129, 131 (11 Cir. 1986). The parties have consented to the undersigned United States th

Pursuant to the E-Government Act of 2002, as amended on August 2, 2002, and M.D. Ala. General

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Order No. 2:04mc3228, the court hasredacted the plaintiff’s minor child’s name throughout this opinion and

refers to him only by his initials, E.D.B.

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

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 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 1 of 11
Magistrate Judge rendering a final judgment in this lawsuit pursuant to 28 U.S.C. § 636(c)(1)

and M.D. Ala. LR 73.1. The court has jurisdiction over this lawsuit pursuant to 42 U.S.C.

§§ 405(g) and 1383(c)(3). For the reasons that follow, the court concludes that the

Commissioner’s decision denying E.D.B. supplemental security income benefits should be

affirmed.

I. STANDARD OF REVIEW

An individual under 18 is considered disabled “if that individual has a medically

determinable physical or mental impairment, which results in marked and severe functional

limitations, and 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.” 42 U.S.C. §

1382c(a)(3)(C)(I) (1999). The sequential analysis for determining whether a child claimant

is disabled is as follows:

1. If the claimant is engaged in substantial gainful activity, he is not

disabled.

2. If the claimant is not engaged in substantial gainful activity, the

Commissioner determines whether the claimant has a physical or

mental impairment which, whether individually or in combination with

one or more other impairments, is a severe impairment. If the

claimant’s impairment is not severe, he is not disabled.

3. If the impairment is severe, the Commissioner determines whether the

impairment meets the durational requirement and meets, medically

equals, or functionally equals in severity an impairment listed in 20

C.F.R. Part 404, Subpart P, Appendix 1. If the impairment satisfies this

requirement, the claimant is presumed disabled.

See 20 C.F.R. § 416.924(a)-(d) (1997).

The Commissioner’s regulations provide that if a child’s impairment or impairments

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Case 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 2 of 11
are not medicallyequal, or functionallyequivalent in severityto a listed impairment, the child

is not disabled. See 20 C.F.R. § 416.924(d)(2) (1997). In determining whether a child's

impairment functionally equals a listed impairment, an ALJ must consider the extent to

which the impairment limits the child's ability to function in the following six “domains” of

life: (1) acquiring and using information; (2) attending and completing tasks; (3) interacting

and relating with others; (4) moving about and manipulating objects; (5) caring for oneself;

and (6) health and physical well-being. Shinn ex rel. Shinn v. Comm'r of Soc. Sec., 391 F.3d

1276, 1279 (11 Cir. 2004); 20 C.F.R. § 416.926a(b)(1). A child's impairment functionally th

equals a listed impairment, and thus constitutes a disability, if the child's limitations are

“marked” in two of the six life domains, or if the child's limitations are “extreme” in one of

the six domains. Shinn, 391 F.3d at 1279; 20 C.F.R. § 416.926a(d).

In reviewing the Commissioner’s decision, the court asks only whether his findings

concerning the steps are supported by substantial evidence. Dyer v. Barnhart, 395 F.3d

1206, 1210 (11 Cir. 2005). Substantial evidence is “more than a scintilla,” but less than a

th

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 (11th

Cir. 2004) (quotation marks 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 th

omitted). The court must, however, conduct an “exacting examination of the

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[Commissioner's] conclusions of law.” Martin v. Sullivan, 894 F.2d 1520, 1529 (11 Cir. th

1990).

II. ISSUES

As stated by the plaintiff, there are two issues in this case.

I. The Commissioner’s decision should be reversed because, the ALJ’s

functionality findings lack the support of substantial evidence and

contain no rationale or reference to any supporting evidence. 

II. The Commissioner’s decision should be reversed because, the ALJ

failed to evaluate the limitations imposed by the combinations of

E.D.B.’s impairments under the proper legal standard.

(Pl’s Br., doc. # 12 at 6).

III. DISCUSSION

The plaintiff raises two issues related to this court’s ultimate inquiry of whether the

Commissioner’s disabilitydecision is supported by the proper legal standards and substantial

evidence. See Bridges v. Bowen, 815 F.2d 622 (11 Cir. 1987). However, the court th

pretermits discussion of the plaintiff’s specific arguments because the court concludes the

ALJ’s determination is supported by substantial evidence, and even if the ALJ erred, any

error is harmless.

E.D.B. was born on January 24, 1998. He was eight (8) years old on the date the

application for benefits was filed. (R. 18). The ALJ concluded that E.D.B. is not disabled

and therefore denied his claim for supplemental security income. Under the first step, the

ALJ found that E.D.B. is not engaged in substantial gainful activity. At the second step, the

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ALJ found that E.D.B. suffers from severe impairments of “attention deficit hyperactivity

disorder, borderline intellectual functioning and encopresis.” (Id.) At step three, the ALJ 3

found that E.D.B. did not have an impairment or combination of impairments that met or

medically equaled a Listing in Appendix 1 of 20 C.F.R. Part 404, Subpart P. (R. 27). The

ALJ then considered whether E.D.B.’s impairments were “functionally equal” a level of

severity in a Listing. (R. 27-30). 

In order to functionally equal a listing, E.D.B.’s impairments must result in “marked”

limitations in two or more ofsix functional domains or “extreme” limitation in one functional

domain. 20 C.F.R. § 416.926a(a). These six functional domains are set forth in the

applicable regulations: Acquiring and using information; Attending and completing tasks;

Interacting and relating to others; Moving about and manipulating objects; Caring for

yourself; and Health and physical well-being. Id. at 416.926a(b). 

Encopresis is a problem that children develop due to constipation and possibly caused by stress. 3

Boys are six (6) times more likely to develop the condition that girls. 

Encopresis is a problem that children can develop due to chronic (long-term) constipation.

With constipation, children have fewer bowel movements than normal, and the bowel

movements they do have can be hard, dry, and difficult to pass. Once a child becomes

constipated, a vicious cycle can develop. The child may avoid using the bathroom to avoid

discomfort. Stool can become impacted (packed into the rectum and large intestine) and

unable to move forward. The rectum and intestine become enlarged due to the hard,

impacted stool. Eventually, the rectum and intestine have problems sensing the presence of

stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool

in) loses its strength. Liquid stool can start to leak around the hard, dry, impacted stool,

soiling a child's clothing

What is Encopresis? available at http://www.allkids.org/body.cfm?xyzpdqabc=0&id=412&action=detail

&AEProductID=Greystone%5Fpeds&AEArticleID=332&AEArticleType=Digestive%20%26%20Liver

%20Disorders (last visited on July 22, 2011)

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The ALJ concluded that E.D.B. has “less than marked limitation” in the domains of

acquiring and using information, attending and completing tasks, and interacting and relating

to others. (R. 28-30). He further concluded that E.D.B. has no limitation in the domains of

moving about and manipulating objects and health and well-being. (R. 31). However, the

ALJ concluded that E.D.B. has a marked limitation in his ability to care for himself. (R. 31). 

Finally, the ALJ concluded that E.D.B. does not have an extreme limitation in one area of

functioning, nor does he have marked limitations in two areas of functioning. (R. 31). 

Consequently, the ALJ concluded that E.D.B. was not disabled. (Id.) 

The crux of this case is the ALJ’s determination of the severity of E.D.B.’s functional

limitations. E.D.B. argues that the ALJ failed to properly evaluate his impairments and did

not properly state the reasons for finding that he was not disabled. The plaintiff complains

that the ALJ failed to state “with sufficient clarity the legal rules being applied and the

weight accorded the evidence considered.” (Pl’s Br., doc. # 12, at 7). The ALJ stated in his

opinion that he had considered all of the claimant’s symptoms and medical evidence. (R. at

27). Even thought the ALJ did not specifically state the weight assigned to each piece of

evidence, the ALJ recited all the applicable law and detailed all the medical evidence. The

ALJ specifically stated that he accepted the testimony of the medical expert, and he rejected

the statements of the claimant’s mother regarding the severity of E.D.B.’s limitations.

At the hearing, Dr. Durham testified that the claimant has a less than marked

limitation in acquiring and using information, a less than marked limitation in

attending and completing tasks, a less than marked limitation in interacting and

relating with others, no limitation in moving about and manipulating objects,

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Case 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 6 of 11
a marked limitation in caring for himself and no limitation in health and

physical well-being. The claimant has functioned at this level since 2006. I

accept the testimony of our medical expert because I find that the testimony is

credible (sic) makes sense and as an independent finder of facts believe the

testimony to be true, accurate and correct.

I find that the testimony and statements of record offered by the claimant’s

mother were sincere in presenting the problems of her child’s situation;

however, the limitations alleged are out of proportion to the objective medical

evidence of record.

(R. 27-28). Thus, the ALJ’s general comments about the evidence are sufficient to show that

he considered all the evidence. 

Moreover, even if it was error, it is harmless. The opinion of the ALJ shows that he

carefully considered the evidence in this case and was extremely familiar with it. A remand

is not required. In this case, the ALJ concluded that although E.D.B. has deficits in acquiring

and using information, only his ability to care for himself rises to the level of marked. None

of his limitations rise to the level of extreme. (R. 31). Substantial evidence supports the

ALJ’s determination. Although E.D.B.’s mother asserts that he suffers from ADHD, none

of E.D.B.’s physicians who evaluated E.D.B. diagnosed him as suffering from ADHD. In 4

fact, testing demonstrated that he does not suffer from ADHD. (R. 200-01, 210).

On August 31, 2004, E.D.B. underwent a psychological evaluation by Dr. Dorn

Majure, PhD. At that time, E.D.B.’s mother reported that E.D.B. was in special education

classes and his grades were poor. (R. 171). E.D.B.’s school records demonstrate that he is

Dr. Majure, a 2004 consultative psychologist, diagnosed E.D.B. as suffering from ADHD. 4

However, subsequent testing and evaluations do not support that diagnosis.

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Case 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 7 of 11
not in special education classes, and his grades are above average (B’s). (R. 119-120). Dr.

Majure opined that E.D.B.’s

... developmental status appeared to be within normal limits. He was

cooperative during this evaluation. His speech was at a normal rate. His

stream of thought appeared grossly normal and logical. Psychosis was denied

and not evident. His affect appeared to be appropriate to content of thought

and conversation. His mood appeared to be normal. The relationship between

the examiner and the claimant was appropriate. Symptoms of anxiety were

denied. Symptoms of depression were denied. His appetite was reported to

be good. [E.D.B.] reportedly experiences initial insomnia and is currently

prescribed Clonidine. Suicidal and homicidal ideation was denied. Recent

stressors were denied. His level of consciousness appeared to be alert. He was

oriented to person, place, time, and situation. His recent and remote memory

appeared to be good. His estimated level of intellectual functioning appears

to be in the borderline to low average range. His judgment, insight and

decision-making appeared to be intact. 

(R. 171-72). Dr. Majure concluded that E.D.B.

appears to be mildly impaired in his ability to function in an age-appropriate

manner cognitively, communicatively, socially, adaptively, behaviorally, and

in concentration, persistence and pace.

(R. 173)

On June 20, 2006, Dr. GuyRenfro, PhD, conducted another psychological evaluation

of E.D.B. (R. 184-86). At that time, E.D.B.’s mother reported that he was not in any special

education classes. (R. 185). She reported that he was prescribed Adderall but she took him

off the medication because he was not eating, and she did not see much change in his

behavior when he was on the medication. (Id.) Dr. Renfro opined that 

[a]lthough his mother complains of hyperactivity, he did not display any

excessive activitylevel, unusual impulsivity, or excessive distractibilityduring

this evaluation. His mother did describe episodes of encopresis.

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Case 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 8 of 11
(R. 186). Dr. Renfro diagnosed E.D.B. as suffering from encopresis (without incontinence

or constipation), and borderline intellectual functioning based on prior testing. (Id.) 

Finally, on September 8, 2006, Marnie Smith Dillon, a licensed clinical psychologist,

conducted an evaluation and testing on E.D.B. (R. 193-203). During this evaluation,

E.D.B.’s mother denied any “academic concerns.” (R. 194). E.D.B.’s test results were “not

suggestive of the presence of ADHD.” (R. 200-01). A ‘provisional diagnosis of ADHD,

Combined Type is also given based on clinical history.” (R. 201) (emphasis added). 

E.D.B. and his mother began therapy at Associate Psychologists in September 2006. 

Testing on October 3, 2006 was not suggestive of ADHD. (R. 210). Treatment notes

indicate that E.D.B. and his mother disagree about his “accidents” – E.D.B. denies accidents

at school but his mother insists that his pants are soiled when he comes home. (Id.) After

missing two appointments, E.D.B. and his mother presented for therapy on November 9,

2006. At that time, E.D.B.’s mother complained about his encopresis; she does not have a

medical explanation for his condition. (R. 209). On January 4, 2007, E.D.B. and his mother

appeared for therapy, but his mother was agitated and uncooperative. (R. 208). On March

21, 2007, she reported taking E.D.B. off his medication because it was “not doing any good.” 

(Id.).

On January 21, 2008, E.D.B.’s mother complained that he could not “stay focused.” 

(R. 207). E.D.B. was not on medication. On February 13, 2008, E.D.B.’s mother reported

that he had two ‘accidents’ in class. (Id.) On March 11, 2008, he was doing much better,

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Case 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 9 of 11
and was not on medication. (Id.) On April 14, 2008, treatment notes indicate that E.D.B.’s

mother ‘may be seeking secondarygain’ fromE.D.B.’s condition. On April 24, 2008, E.D.B.

denied that the encopresis was a problem but his mother insisted that it was. (R. 206).

On May8, 2008, E.D.B.’s mother reported that although E.D.B.’s medication dosages

were increased by their family physician, she was not giving him the medication. (R. 206). 

Treatment notes indicate that E.D.B.’s mother had “a litany of complaints” about him. (Id.) 

During family therapy on May 28, 2008, E.D.B. was not oppositional to his mother “but

rather resign[ed] . . . to the fact that [his mother] [wa]s going to complain about him no

matter what he does.” (R. 205). 

On July 27, 2007, E.D.B. was diagnosed with encopresis based on history provided

by his mother. (R. 221-22). 

At the administrative hearing, E.D.B.’s mother described her inability to keep him

focused on his homework, (R. 43), his inability to sit still (R. 45), and his inability to interact

socially. (R. 42). According to his mother, E.D.B. has no friends because they call him

names, he is “constantly” getting into fights, and he has accidents “four days out of a sevenday period.” (Id.) Even if E.D.B.’s mother’s testimony was taken as true, these limitations

are insufficient to support a finding that E.D.B. has extreme or marked limitations of

functioning in any of the six domains sufficient to meet, medically equal, or functionally

equal a Listing. Unquestionably, E.D.B. has some degree of limitation interacting and

relating to others and in his ability to care for himself. However, the evidence does not

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Case 2:10-cv-00095-CSC Document 15 Filed 07/27/11 Page 10 of 11
support a finding that E.D.B. has an “extreme” limitation in these or any other areas of

functioning, or “marked” limitations in two or more areas of functioning. 

CONCLUSION

In short, the court has carefully and independently reviewed the record, and concludes

that the ALJ’s conclusion that E.D.B. is not disabled is supported by substantial evidence.

Thus, the decision of the Commissioner should be affirmed.

A separate order will issue.

Done this 27 day of July, 2011. th

 /s/Charles S. Coody 

CHARLES S. COODY

UNITED STATES MAGISTRATE JUDGE

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