Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-5_09-cv-02021/USCOURTS-alnd-5_09-cv-02021-0/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 UNITED STATES DISTRICT COURT 

FOR THE NORTHERN DISTRICT OF ALABAMA

NORTHEASTERN DIVISION

TOSHIA HANSON,

Plaintiff,

v.

MICHAEL J. ASTRUE, 

Commissioner of Social Security,

Defendant.

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CIVIL ACTION NO. 09-G-2021-NE

MEMORANDUM OPINION

The plaintiff, Toshia Hanson, brings this action pursuant to the provisions

of section 205(g) of the Social Security Act (the Act), 42 U.S.C. § 405(g), seeking

judicial review of a final adverse decision of the Commissioner of the Social Security

Administration (the Commissioner) denying her application for Social Security Benefits. 

Plaintiff timely pursued and exhausted her administrative remedies available before the

Commissioner. Accordingly, this case is now ripe for judicial review under 205(g) of the

Social Security Act (the Act), 42 U.S.C. §405(g).

STANDARD OF REVIEW

The sole function of this court is to determine whether the decision of the

Commissioner is supported by substantial evidence and whether proper legal standards

were applied. Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). To that

end this court “must scrutinize the record as a whole to determine if the decision reached

FILED

 2010 Aug-23 PM 01:41

U.S. DISTRICT COURT

N.D. OF ALABAMA

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is reasonable and supported by substantial evidence.” Bloodsworth, at 1239 (citations

omitted). Substantial evidence is “such relevant evidence as a reasonable person would

accept as adequate to support a conclusion.” Bloodsworth, at 1239.

STATUTORY AND REGULATORY FRAMEWORK

In order to qualify for disability benefits and to establish her entitlement for

a period of disability, a claimant must be disabled. The Act defines disabled as the

“inability 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 twelve

months . . . .” 42 U.S.C. § 423(d)(1)(A); 42 U.S.C. § 416(I). For the purposes of

establishing entitlement to disability benefits, physical or mental impairment is defined 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).

In determining whether a claimant is disabled, Social Security regulations

outline a five-step sequential process. 20 C.F.R.§ 404.1520(a)-(f). The Commissioner

must determine in sequence:

(1) whether the claimant is currently employed; 

(2) whether she has a severe impairment; 

(3) whether her impairment meets or equals one listed by the Secretary; 

(4) whether the claimant can perform her past work; and 

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(5) whether the claimant is capable of performing any work in the national

economy.

 

Pope v. Shalala, 998 F.2d 473, 477 (7th Cir.1993); accord McDaniel v. Bowen, 800 F.2d

1026, 1030 (11th Cir. 1986). “Once the claimant has satisfied Steps One and Two, she

will automatically be found disabled if she suffers from a listed impairment. If the

claimant does not have a listed impairment but cannot perform her past work, the burden

shifts to the Secretary to show that the claimant can perform some other job.” Pope at

477; accord Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir. 1995). The Commissioner

further bears the burden of showing that such work exists in the national economy in

significant numbers. Id. 

THE STANDARD FOR REJECTING

THE TESTIMONY OF A TREATING PHYSICIAN

As the Sixth Circuit has noted: “It is firmly established that the medical

opinion of a treating physician must be accorded greater weight than those of physicians

employed by the government to defend against a disability claim.” Hall v. Bowen, 837

F.2d 272, 276 (6 Cir. 1988). “The testimony of a treating physician must ordinarily be th

given substantial or considerable weight unless good cause is shown to the contrary.” 

McGregor v. Bowen, 786 F.2d 1050, 1053 (11th Cir. 1986); accord Elam v. Railroad

Retirement Bd., 921 F.2d 1210, 1216 (11th Cir. 1991). In addition, the Commissioner

“must specify what weight is given to a treating physician’s opinion and any reason for

giving it no weight ....” McGregor, 786 F.2d at 1053. If the Commissioner ignores or

fails to properly refute a treating physician’s testimony, as a matter of law that testimony

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must be accepted as true. McGregor, 786 F.2d at 1053; Elam, 921 F.2d at 1216. The

Commissioner’s reasons for refusing to credit a claimant’s treating physician must be

supported by substantial evidence. See McGregor, 786 F.2d at 1054; cf. Hale v. Bowen,

831 F.2d 1007, 1012 (11th Cir. 1987)(articulation of reasons for not crediting a

claimant’s subjective pain testimony must be supported by substantial evidence).

THE STANDARD WHEN THE CLAIMANT TESTIFIES 

SHE SUFFERS FROM DISABLING PAIN

In this circuit, “a three part ‘pain standard’ [is applied] when a claimant

seeks to establish disability through his or her own testimony of pain or other subjective

symptoms.” Foote, at 1560.

The pain standard requires (1) evidence of an underlying medical condition

and either (2) objective medical evidence that confirms the severity of the

alleged pain arising from that condition or (3) that the objectively

determined medical condition is of such a severity that it can be reasonably

expected to give rise to the alleged pain.

Foote, at 1560 (quoting Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991). In this

circuit medical evidence of pain itself, or of its intensity, is not required.

While both the regulations and the Hand standard require objective

medical evidence of a condition that could reasonably be expected to cause

the pain alleged, neither requires objective proof of the pain itself. Thus

under both the regulations and the first (objectively identifiable condition)

and third (reasonably expected to cause pain alleged) parts of the Hand

standard a claimant who can show that his condition could reasonably be

expected to give rise to the pain he alleges has established a claim of

disability and is not required to produce additional, objective proof of the

pain itself. See 20 CFR §§ 404.1529 and 416.929; Hale at 1011.

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Elam v. Railroad Retirement Bd., 921 F.2d 1210, 1215 (11th Cir. 1991)(parenthetical

information omitted)(emphasis added). Furthermore, it must be kept in mind that “[a]

claimant’s subjective testimony supported by medical evidence that satisfies the pain

standard is itself sufficient to support a finding of disability.” Foote at 1561. Therefore,

if a claimant testifies to disabling pain and satisfies the three part pain standard, he must

be found disabled unless that testimony is properly discredited.

When the Commissioner fails to credit a claimant’s pain testimony, he must

articulate reasons for that decision.

It is established in this circuit that if the Secretary fails to articulate reasons

for refusing to credit a claimant’s subjective pain testimony, then the

Secretary, as a matter of law, has accepted that testimony as true. Implicit

in this rule is the requirement that such articulation of reasons by the

Secretary be supported by substantial evidence.

Hale v. Bowen, 831 F.2d 1007, 1012 (11th Cir. 1987). Therefore, if the ALJ either fails

to articulate reasons for refusing to credit the plaintiff’s pain testimony, or if his reasons

are not supported by substantial evidence, the pain testimony of the plaintiff must be

accepted as true.

THE IMPACT OF A VOCATIONAL EXPERT’S TESTIMONY 

It is common for a vocational expert (“VE”) to testify at a claimant’s

hearing before an ALJ, and in many cases such testimony is required. The VE is typically

asked whether the claimant can perform his past relevant work or other jobs that exist in

significant numbers withing the national economy based upon hypothetical questions

about the claimant’s abilities in spite of his impairments. “In order for a vocational

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expert’s testimony to constitute substantial evidence, the ALJ must pose a hypothetical

question which comprises all of the claimant’s impairments.” Jones v. Apfel, 190 F.3d

1224, 1229 (11 Cir. 1999). th

If the claimant is unable to perform his prior relevant work the burden shifts

to the Commissioner to establish that he can perform other work. In such cases, if the

vocational expert testimony upon which the ALJ relies is based upon a hypothetical

question that does not take into account all of the claimant’s impairments, the

Commissioner has not met that burden, and the action should be reversed with

instructions that the plaintiff be awarded the benefits claimed. This is so even if no other

hypothetical question is posed to the VE. See Gamer v. Secretary of Health and Human

Services, 815 F.2d 1275, 1280 (9 Cir. 1987)(noting that when the burden is on the th

Commissioner to show the claimant can do other work, the claimant is not obligated to

pose hypothetical questions in order to prevail). However, it is desirable for the VE to be

asked whether the claimant can perform any jobs if his subjective testimony or the

testimony of his doctors is credited. Such a hypothetical question would allow disability

claims to be expedited in cases in which the ALJ’s refusal to credit that testimony is

found not to be supported by substantial evidence.

In Varney v. Secretary of Health and Human Services, 859 F.2d 1396 (9th

Cir. 1987), the Ninth Circuit adopted the Eleventh Circuit rule which holds that if the

articulated reasons for rejecting the plaintiff’s pain testimony are not supported by

substantial evidence, that testimony is accepted as true as a matter of law. Id at 1401. 

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The court noted that “[a]mong the most persuasive arguments supporting the rule is the

need to expedite disability claims.” Id. If the VE is asked whether the claimant could

perform other jobs if his testimony of pain or other subjective symptoms is accepted as

true, the case might be in a posture that would avoid the necessity of a remand. As

Varney recognized, if the VE testifies the claimant can perform no jobs if his pain

testimony is accepted as true, the only relevant issue would be whether that testimony was

properly discredited. Id. This also holds true for the opinions of treating physicians.

DISCUSSION

The plaintiff was 19 years old at the time of ALJ Earl Cates’s decision, but

was still in high school (12 grade) after failing kindergarten and fourth grade. She was th

in special education classes and reported earning As and Bs, although to obtain a

certificate of attendance. [R. 57, 58]. The ALJ found the following severe impairments: 

borderline intellectual functioning, degenerative disc disease of her back, and a history of

headaches. [R. 18]. 

On December 5, 2003, when the plaintiff was 15 years and 9 months, she

obtained a Verbal IQ of 76, Performance IQ of 52, and a Full Scale IQ of 62 on the

Wechsler Intelligence Scale for Children - III. [R. 160]. John G. Hovater, Psy.D., stated,

“It is the examiner’s impression that these results represent Toshia’s level of intellectual

functioning at the time of testing.” [R. 164]. These scores are presumed valid for two

years.

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On June 1, 2006, the plaintiff was seen by John R. Haney, Ph.D., at the

request of the Commissioner. Dr. Haney administered the WAIS-III IQ test, and her

results were Verbal IQ 78, Performance IQ 72, and Full Scale IQ 73. [R. 243]. Dr.

Haney said:

These scores placed the patient in the borderline range of intellectual

functioning, and corresponded to the fourth percentile. This is seen as a

recently accurate estimate of the patient’s current level of intellectual

functioning. The patient was fairly cooperative and seemed to put forth her

best effort. Most of the patient’s subtest scores were significantly below

average, no particular strengths were noted. The current performance is

similar to previous evaluations conducted on 12-5-03 when she earned a

full scale IQ score of 62 with a WISC-III, and 11-4-97 when the full scale

IQ score was 73 with the same instrument.

[R. 243]. Dr. Haney stated, “The patient’s ability to function in most jobs appeared

impaired due to the patient’s combination of physical problems and intellectual

limitation.” [R. 244]. Dr. Haney regarded the statements of the plaintiff and her mother

as truthful. [Id.].

As for her physical condition, a treating physician, F. Calame Sammons,

M.D., on December 6, 2005, opined that the plaintiff suffers from adolescent disc disease

with annular tears. [R. 283]. The annulus is part of the intervertebral disc:

Intervertebral discs are composed of

an annulus fibrosus and a nucleus

pulposus.

The annulus fibrosus is a strong radial

tire–like structure made up of

lamellae; concentric sheets of

collagen fibers connected to the

vertebral end plates. The sheets are

Case 5:09-cv-02021-JFG Document 9 Filed 08/23/10 Page 8 of 14
 “We generally give more weight to the opinion of a specialist about medical 1

issues related to his or her area of specialty than to the opinion of a source who is not a

medical specialist.” 20 C.F.R. § 404.1527(d)5) 

9

orientated at various angles. The annulus fibrosus encloses the nucleus

pulposus.

http://www.spineuniverse.com/displayarticle.php/article1267.html Dr. Sammons wrote:

Ms. Hanson has been seen my [sic] me for problems related to her back. 

The patient has adolescent disk disease with annular tears and radicular

pain. She is only 16 years of age. She is having considerable problems

performing her tasks at school because of pain with sitting, bending, and

twisting. Our typical treatment for this in adults would be lumbar interbody

fusion. However, at her age we do not want to do this type of procedure on

such a young individual. Additionally, we did not want this patient to

become addicted to chronic pain medicine to help cope with her pain. The

transcutaneous electrical nerve stimulator [TENS unit] has provided an

alternative for this patient.

Please reconsider this treatment modality for this patient. She has tried

epidural steriods, physical therapy, and activity modification all without

relief of pain.

[R. 283].(emphasis added) 

Because Dr. Sammons is a specialist in the field of pediatric orthopedics

and spinal surgery, his opinion is entitled to more weight in this area. In his decision, the 1

ALJ makes no mention of the opinion of Dr. Sammons. Instead, the ALJ refers to a May

30, 2006, consultative physical examination by Robert A. Sparks, III, M.D. Dr. Sparks

referred to a September 30, 2004, MRI of the lumbar spine which showed “minimal

annular bulges at L4-5 and L5-S1.” [R. 245]. Dr. Sparks noted her medications:

Miss Hanson has a TENS unit and uses that 2-3 times a day for pain relief. 

Her present medications are: Protonix 40mg once daily; Bentyl 25mg once

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daily; Neurontin 100mg in the morning, 100mg at noon and 200mg at

bedtime; Naprosyn 500mg twice a day; and multi-vitamins.

[Id.]. However, Dr. Sparks opined:

There is no objective sign of any abnormality on physical examination of

this woman. She has full spine mobility. She can reach to within 6 inches

of her toes when I asked her to bend forward while keeping her knees

straight. Lateral bending and extension are completely normal. There is no

paravertebral muscle spasm as the range of motion exam is carried out. 

There is no neurologic abnormality. Knee jerks and ankle jerks are

symmetrical and are of normal amplitude. She can walk on her tiptoes and

on her heels without apparent weakness. Straight leg raising does not cause

sciatic stretch pain. Hip rotation does not duplicate her pain. She can squat

and arising [sic] from a squat without any difficulty.

***

Based on the lack of physical findings I must conclude that Miss Hanson is

physically able to do work related activities such as sitting, standing,

walking, lifting, carrying, and handling objects.

[R. 245-246]. The opinion of this one-time examiner is at odds with the opinion of the

plaintiff’s treating physician, Dr. Sammons. In ignoring the opinion of Dr. Sammons, the

Commissioner failed to properly refute a treating physician’s testimony, and as a matter

of law that testimony must be accepted as true.

At the hearing, the plaintiff testified that her back hurts constantly and she

cannot sit or stand for more than 15 minutes at one time. [R. 63]. At school she has to

shift positions at her desk because of pain. [R. 65]. She also testified that she gets

headaches every couple of weeks, accompanied by nausea, with photophobia, which hurt

so much that she has to stay in a dark, quiet room. [R. 66]. Her medication for the

headaches sometimes helps and sometimes does not. [Id.]. 

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The ALJ stated that “the claimant’s statements concerning the intensity,

persistence and limiting effects of [her] symptoms are not entirely credible.” [R. 20]:

The claimant alleges significant limitations due to her impairments. 

However, when completing her Daily Activities Questionnaire in April

2006, she reported numerous activities. She reported she goes to school,

shops occasionally, and does household chores including dusting and

folding laundry. In her spare time, she reported she reads, watches

television, and plays on the computer. The undersigned finds the claimant

has not reported activities which are significantly limiting or consistent with

the disabling limitations she alleges. Furthermore, she is a full-time student

and the undersigned finds her ability to attend school on a full time basis is

also inconsistent with significant limitations in her functioning.

[R. 20].

The ALJ spoke further as to her credibility:

The claimant’s testimony did not appear credible, it seemed rehearsed. The

claimant is currently a senior in her final year of high school and her

attendance is good. She is not available to work because she is going to

school. If she were not going to school, she would be capable of working.

[R. 23].

 The activities of daily living recited by the ALJ do not support a finding

that the plaintiff’s pain testimony is not true. The ability to perform the limited activities

noted by the ALJ does not rule out the presence of disabling pain. The ability to watch

television, do occasional shopping, or perform other sporadic activities does not mean the

plaintiff is not disabled. In this circuit it has been recognized that “participation in

everyday activities of short duration, such as housework or fishing” does not disqualify a

claimant from disability. Lewis v. Callahan, 125 F.3d 1346, 1441 (11 Cir. 1997). As th

has been noted:

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[S]tatutory disability does not mean that a claimant must be a quadriplegic

or an amputee. Similarly, shopping for the necessities of life is not a

negation of disability and even two sporadic occurrences such as hunting

might indicate merely that the claimant was partially functional on two

days. Disability does not mean that a claimant must vegetate in a dark room

excluded from all forms of human and social activity. . . . It is well

established that sporadic or transitory activity does not disprove disability.

Smith v. Califano, 637 F.2d 968, 971-72 (3 Cir. 1981)(emphasis added). It is the ability rd

to engage in gainful employment that is the key, not whether a plaintiff can perform

minor household chores or drive short distances. In Easter v. Bowen, the court observed

as follows:

Moreover, an applicant need not be completely bedridden or unable to

perform any household chores to be considered disabled. See Yawitz v.

Weinberger, 498 F.2d 956, 960 (8th Cir.1974). What counts is the ability to

perform as required on a daily basis in the "sometimes competitive and

stressful" environment of the working world. Douglas v. Bowen, 836 F.2d

392, 396 (8th Cir.1987) (quoting McCoy v. Schweiker, 683 F.2d 1138,

1147 (8th Cir.1982) (en banc)).

867 F.2d 1128, 1130 (8th Cir. 1989). The Easter court further noted that "[e]mployers are

concerned with substantial capacity, psychological stability, and steady attendance . . . .” 

867 F.2d at 1130 (quoting Rhines v. Harris, 634 F.2d 1076, 1079 (8th Cir.1980)). As

Judge Allgood observed in Lamb v. Bowen: “[T]he record is replete with evidence of a

medical condition that could reasonably be expected to produce the alleged pain. No

examining physician ever questioned the existence of appellant’s pain. They simply

found themselves unable to cure the pain.” 847 F.2d 698 (11th Cir. 1988).

With this standard in mind, it is clear that the ALJ’s articulated reasons for

rejecting the plaintiff’s pain testimony are not supported by substantial evidence. 

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Therefore, the ALJ failed to satisfy the requirements of Hale. The conclusion of that

court is equally appropriate in the instant case. “[T]he Secretary has articulated reasons

for refusing to credit the claimant’s pain testimony, but none of these reasons is supported

by substantial evidence. It follows, therefore, that claimant’s pain testimony has been

accepted as true.” Hale, at 1012.

At the hearing, the vocational expert testified:

Q: If there was a problem, assuming a person had a problem with

attention, and let’s say it was less than two hours they could maintain

attention, would that change any of the factors with the, these [sic]

work, this employment here?

A: Yes, sir. That would generally be indicative of a greater than

moderate impairment in a person’s ability to maintain attention and

concentration, and if they’re having a greater than moderate

impairment in those areas, then that would generally preclude them

from doing any type of employment.

ALJ: Okay. If someone had a, migraine headaches, let’s say, every two 

weeks unexpectedly, and the claimant had to take off work for three 

or four hours, I mean, how would that impact on ability to perform 

these jobs?

A: Well, assuming that they’d have to miss work during those periods

of time, you know, you’d be missing more than two days a month,

and that would generally result in excessive absenteeism and

inability to maintain employment.

[R. 73-74]. Taking the testimony of the plaintiff and the plaintiff’s treating physician as

true, in conjunction with the vocational expert’s testimony, the plaintiff is unable to work.

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CONCLUSION

This is a case where “the [Commissioner] has already considered the

essential evidence and it is clear that the cumulative effect of the evidence establishes

disability without any doubt.” Davis v. Shalala, 985 F.2d 528, 534 (11 Cir. 1993). In th

such a case the action should be reversed and remanded with instructions that the plaintiff

be awarded the benefits claimed. Id. 

DONE and ORDERED 23 August 2010.

 

UNITED STATES DISTRICT JUDGE

J. FOY GUIN, JR.

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