Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alsd-2_16-cv-00021/USCOURTS-alsd-2_16-cv-00021-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (DIWC)

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IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF ALABAMA

NORTHERN DIVISION

LAVETRIS HUNT, :

 :

Plaintiff, :

 :

vs. :

 : CIVIL ACTION 16-0021-M

CAROLYN W. COLVIN, :

Social Security Commissioner, :

 :

Defendant. :

MEMORANDUM OPINION AND ORDER

In this action under 42 U.S.C. § 1383(c)(3), Plaintiff 

seeks judicial review of an adverse social security ruling 

denying a claim for Supplemental Security Income (hereinafter 

SSI) (Docs. 1, 15). The parties filed written consent and this 

action has been referred to the undersigned Magistrate Judge to 

conduct all proceedings and order judgment in accordance with 28 

U.S.C. § 636(c), Fed.R.Civ.P. 73, and S.D.Ala. Gen.L.R. 73(b)

(see Doc. 21). Oral argument was waived (Doc. 20). After 

considering the administrative record and the memoranda of the 

parties, it is ORDERED that the decision of the Commissioner be 

AFFIRMED and that this action be DISMISSED.

This Court is not free to reweigh the evidence or 

substitute its judgment for that of the Secretary of Health and 

Human Services, Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th

Cir. 1983), which must be supported by substantial evidence. 

Richardson v. Perales, 402 U.S. 389, 401 (1971). Substantial 

Case 2:16-cv-00021-M Document 22 Filed 08/29/16 Page 1 of 12
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evidence requires “that the decision under review be supported 

by evidence sufficient to justify a reasoning mind in accepting 

it; it is more than a scintilla, but less than a preponderance.” 

Brady v. Heckler, 724 F.2d 914, 918 (11th Cir. 1984), quoting 

Jones v. Schweiker, 551 F.Supp. 205 (D. Md. 1982).

At the time of the administrative hearing, Hunt was thirtysix years old, had completed a high school education (Tr. 80), 

and had previous work experience as a detention officer, an 

account clerk, and an inventory clerk (Tr. 75). Plaintiff 

alleges disability due to a thyroid condition, a heart murmur, 

obesity, fatigue, shortness of breath, chronic pain, and 

paresthesias (Doc. 14 Fact Sheet).

Hunt applied for SSI on February 14, 2012, asserting

disability as of August 15, 2010 (Tr. 107, 190-95). An 

Administrative Law Judge (hereinafter ALJ) denied benefits, 

determining that Hunt was capable of performing her past 

relevant work as an inventory clerk and a custody officer (Tr. 

107-13). Plaintiff requested review of the hearing decision 

(Tr. 95-97), but the Appeals Council denied it (Tr. 1-6).

Plaintiff claims that the opinion of the ALJ is not 

supported by substantial evidence. Specifically, Hunt alleges 

that: (1) The ALJ’s finding regarding her residual functional 

capacity (hereinafter RFC) is not supported by the evidence; (2) 

the ALJ did not consider her poverty in reaching her decision; 

Case 2:16-cv-00021-M Document 22 Filed 08/29/16 Page 2 of 12
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and (3) the Appeals Council did not properly consider newlysubmitted evidence (Doc. 15). Defendant has responded to—and 

denies—these claims (Doc. 16).

The Court will now summarize the evidence of record.

On September 10, 2007, records from Hale County Hospital 

Clinic (hereinafter HCHC) show that Hunt was treated for a 

urinary tract infection; she had been experiencing back pain for 

several days (Tr. 277).

On April 24, 2010, Plaintiff went to HCHC for shortness of 

breath and pain in the right side of her neck because of a 

goiter (Tr. 279-87). Lortab1 was prescribed and Hunt was 

encouraged to meet with an endocrinologist the next week.

On April 10, 2012, Dr. Ronnie T. Chu examined Plaintiff for 

shortness of breath, occurring nightly; Hunt reported no pain 

(Tr. 271-73; see, generally, Tr. 263-71). The Doctor performed 

a full examination, including a comprehensive range of motion 

analysis (hereinafter ROM), before diagnosing her to have a 

goiter, and sharing his impression: 

A goiter is a condition, not a 

disability. Her thyroid function is normal. 

Patient stated she actually has gained 

weight, not lost weight. She also stated 

she has trouble swallowing. She has worked 

three different jobs since being diagnosed 

with the goiter. She does not meet the 

qualifications for disability.

																																																							 1

Error! Main Document Only.Lortab is a semisynthetic narcotic 

analgesic used for “the relief of moderate to moderately severe pain.” 

Physician's Desk Reference 2926-27 (52nd ed. 1998).

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(Tr. 273).

On October 27, 2013, Hunt went to Hale County Hospital, 

stating that her goiter was worse, causing her to have rightsided neck pain, difficulty breathing, and numbness in her right 

arm; she stated that she had not had surgery on the goiter 

because of money (Tr. 296-310). Plaintiff rated her pain as 

four on a ten-point scale. A chest CT scan demonstrated a 

single large nodule in the thyroid gland, causing flattening and 

mild narrowing of the trachea (Tr. 303-04). Hunt was given a 

Decadron2 injection; at discharge, she was encouraged to call and 

make an “urgent appointment” with Dr. Bilton who “would work 

something out with” her (Tr. 301, 310). 

On November 4, 2013, Plaintiff went to the HCHC for right 

arm pain; she reported being on no medications (Tr. 290-93). 

The exam record was to be forwarded to a thyroid surgeon at Good 

Samaritan Clinic;3 Lortab was prescribed. 

On April 4, 2014, Hunt returned to HCHC for pain and 

paresthesias into both arms; she reported taking no medications 

(Tr. 312-13). On examination, a huge thyroid was noted, though 

Plaintiff easily had full ROM of her neck; she exhibited a 

																																																							 2

Error! Main Document Only.Decadron is a corticosteroid used for, 

among other things, the treatment of rheumatic disorders. Physician's 

Desk Reference 1635-38 (52nd ed. 1998). 3

The Good Samaritan Clinic provides free primary health care, 

medication, and health information, among other things to those who do 

not have health insurance. See http://gscclinic.org/

Case 2:16-cv-00021-M Document 22 Filed 08/29/16 Page 4 of 12
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creaking noise in breathing, both inspiratory and expiratory, 

because of the goiter pressing on her trachea. Hunt was sent to 

Good Samaritan Clinic for various tests and to see a surgeon.

This concludes the Court’s summary of the evidence.

Hunt first claims that the ALJ’s RFC finding is not 

supported by the record. More specifically, she asserts the ALJ 

did not consider the combination of all of her impairments, 

listing fatigue, pain, and paresthesias (Doc. 15, pp. 3-4).

“The RFC assessment is a function-by-function assessment 

based upon all of the relevant evidence of an individual’s 

ability to do work-related activities.” Social Security Ruling 

96-8p, Titles II and XVI: Assessing Residual Functional 

Capacity in Initial Claims, 1996 WL 374184, *3. The ALJ is 

responsible for determining a claimant’s RFC. 20 C.F.R. § 

404.1546 (2016). That decision cannot be based on “sit and 

squirm” jurisprudence. Wilson v. Heckler, 734 F.2d 513, 518 

(11th Cir. 1984). However, security regulations state that 

Plaintiff is responsible for providing evidence from which the 

ALJ can make an RFC determination. 20 C.F.R. § 404.1545(a)(3). 

The ALJ found that Hunt had two severe impairments, her 

goiter and obesity (Tr. 109). The ALJ also found that Plaintiff

had the RFC “to perform light work as defined in 20 C.F.R. 

416.967(b)4 except the claimant would need a temperature-

																																																							 4

“Light work involves lifting no more than 20 pounds at a time 

with frequent lifting or carrying of objects weighing up to 10 pounds. 

Case 2:16-cv-00021-M Document 22 Filed 08/29/16 Page 5 of 12
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controlled environment without concentrated exposure to fumes, 

odors, etc.” (Tr. 110). The ALJ then summarized the medical 

evidence and found that Hunt’s statements regarding her 

impairments and their symptoms were not credible (Tr. 111).

One facet of Plaintiff’s argument is that the ALJ did not 

properly consider the combination of her impairments. It is 

true that "the Secretary shall consider the combined effect of 

all of the individual's impairments without regard to whether 

any such impairment, if considered separately, would be of such 

severity." 42 U.S.C. § 1382c(a)(3)(G). The Eleventh Circuit 

Court of Appeals noted this instruction and found that "[i]t is 

the duty of the [ALJ] to make specific and well-articulated 

findings as to the effect of the combination of impairments and 

to decide whether the combined impairments cause the claimant to 

be disabled." Bowen v. Heckler, 748 F.2d 629, 635 (11th Cir. 

1984); see also Reeves v. Heckler, 734 F.2d 519 (11th Cir. 

1984); Wiggins v. Schweiker, 679 F.2d 1387 (11th Cir. 1982).

The ALJ lists Hunt’s impairments and concludes that she

“does not have an impairment or combination of impairments that 

																																																																																																																																																																				

Even though the weight lifted may be very little, a job is in this 

category when it requires a good deal of walking or standing, or when 

it involves sitting most of the time with some pushing and pulling of 

arm or leg controls. To be considered capable of performing a full or 

wide range of light work, you must have the ability to do 

substantially all of these activities. If someone can do light work, 

we determine that he or she can also do sedentary work, unless there 

are additional limiting factors such as loss of fine dexterity or 

inability to sit for long periods of time.”

Case 2:16-cv-00021-M Document 22 Filed 08/29/16 Page 6 of 12
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meets or medically equals the severity of one of the listed 

impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1” (Tr. 

109). This language has been upheld by the Eleventh Circuit 

Court of Appeals as sufficient consideration of the effects of 

the combinations of a claimant's impairments. Jones v. 

Department of Health and Human Services, 941 F.2d 1529, 1533 

(11th Cir. 1991) (the claimant does not have “an impairment or 

combination of impairments listed in, or medically equal to one 

listed in Appendix 1, Subpart P, Regulations No. 4"). 

Hunt also asserts the ALJ did not consider her fatigue, 

pain, and paresthesias. She specifically argues that the ALJ 

did not evaluate her pain under the appropriate Eleventh Circuit 

measures of review.

The standard by which pain complaints are to be evaluated 

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." Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991) 

(citing Landry v. Heckler, 782 F.2d 1551, 1553 (11th Cir. 

1986)). The Eleventh Circuit Court of Appeals also held that 

the determination of whether objective medical impairments could 

reasonably be expected to produce the pain was a factual 

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question to be made by the Secretary and, therefore, "subject 

only to limited review in the courts to ensure that the finding

is supported by substantial evidence." Hand v. Heckler, 761 

F.2d 1545, 1549 (11th Cir.), vacated for rehearing en banc, 774 

F.2d 428 (1985), reinstated sub nom. Hand v. Bowen, 793 F.2d 275 

(11th Cir. 1986). The Social Security regulations specifically 

say that 

statements about your pain or other symptoms 

will not alone establish that you are 

disabled; there must be medical signs and 

laboratory findings which show that you have 

a medical impairment(s) which could 

reasonably be expected to produce the pain 

or other symptoms alleged and which, when 

considered with all of the other evidence 

(including statements about the intensity 

and persistence of your pain or other 

symptoms which may reasonably be accepted as 

consistent with the medical signs and 

laboratory findings), would lead to a 

conclusion that you are disabled.

20 C.F.R. 404.1529(a).

 The ALJ found that Hunt’s statements of her impairments, and 

the symptoms thereof, were not credible. The ALJ found that the 

objective medical evidence did not support her complaints, that

her hearing testimony about her medication use was inconsistent

with what she told her treating sources, and that her hearing 

testimony regarding her activities widely diverged from a form 

completed when she first applied for disability (Tr. 111-12). 

The ALJ pointed out that Hunt sought treatment infrequently (Tr. 

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111) and that, in an emergency room visit on October 27, 2013, 

she rated her pain as only four; the examination revealed normal 

breathing. The ALJ found that Plaintiff’s “allegations of low 

energy, difficulty breathing, and persistent arm pain [were] not 

supported by the objective evidence of record” (Tr. 111). 

 The Court finds the ALJ’s RFC determination supported by 

substantial evidence; the ALJ properly considered her pain and 

combination of impairments in determining that Hunt could return 

to her past work. Plaintiff’s claim otherwise is without merit.5

Hunt next claims the ALJ did not consider her poverty in 

reaching her determination (Doc. 15, pp. 2-3). Social Security 

regulations state that refusing to follow prescribed medical 

treatment will preclude disability if done so without a good 

reason. 20 C.F.R. § 416.930(b). However, the Eleventh Circuit 

Court of Appeals has held that poverty excuses noncompliance 

with medical treatment. Dawkins v. Bowen, 848 F.2d 1211, 1213 

(11th Cir. 1988). 

The ALJ discussed Plaintiff’s lack of treatment, noting 

that she had not taken opportunities to receive treatment that 

would accommodate her lacks of funds (Tr. 111). The ALJ 

specifically pointed out that Hunt had not contacted a surgeon, 

Dr. Bilton, who would work something out with her regarding her 

																																																							 5

Hunt also asserted the ALJ committed error in not including her 

symptoms in a hypothetical question to the Vocational Expert. As it 

is based on a claim the Court found meritless, this claim, too, must 

fail.

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goiter; instead, Plaintiff returned to the clinic (Tr. 111; cf.

Tr. 301). In another instance, Hunt was referred to Good 

Samaritan Clinic for treatment, but she testified that she did 

not go because she could not get a ride (Tr. 111; cf. Tr. 80, 

291). The Court cannot find that the ALJ was remiss in 

considering Plaintiff’s poverty in light of Plaintiff’s failure 

to follow-through with less expensive or free options that might

have provided necessary treatment. As noted by our sister 

Court, “a claim of financial inability to obtain prescribed 

treatment is only a justifiable cause for failure to follow the 

prescribed treatment when free community resources are 

unavailable.” Bulger v. Colvin, 2014 WL 4495220, *10 (M.D. Ala. 

September 12, 2014). This claim is without merit.

Hunt’s final claim is that the Appeals Council did not 

properly consider evidence newly-submitted to it. Though more 

evidence was considered by the Appeals Council, Plaintiff only 

references that found at Transcript pages 43-47, and 57 (Doc. 15, 

pp. 6-7); the Court will limit its review to those pages.

The Appeals Council considers additional evidence submitted 

by a claimant if it is new, material, and chronologically 

relevant. 20 C.F.R. § 404.970(b). The Appeals Council must 

then decide if the new evidence renders the ALJ’s “action, 

findings, or conclusion [] contrary to the weight of the 

evidence currently of record.” Id. The Eleventh Circuit Court 

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of Appeals held that “when a claimant properly presents new 

evidence to the Appeals Council, a reviewing court must consider 

whether that new evidence renders the denial of benefits 

erroneous.” Ingram v. Commissioner of Social Security 

Administration, 496 F.3d 1253, 1262 (11th Cir. 2007). The newlypresented evidence was as follows.

On January 7, 2015, Plaintiff underwent a CT of the soft 

tissues in the neck, after experiencing right-sided neck 

swelling and difficulty with breathing and swallowing; the exam 

showed a “[m]assive enlargement of the right thyroid lobe 

producing significant appearing compression and displacement of 

the trachea and esophagus” (Tr. 57). On July 23, 2015, Hunt

underwent a right thyroid lobectomy, plus isthmusectomy, 

removing the massive enlargement (Tr. 42-47). Hunt tolerated 

the procedure well with no complications (Tr. 44). 

In its decision, the Appeals Council found no reason to 

review the ALJ’s decision (Tr. 1). The Council considered the 

new evidence, but determined it post-dated the ALJ’s decision 

and would not affect it (Tr. 2).

The Court notes that the Appeals Council is not required 

“to give a detailed rationale for why each piece of new evidence 

submitted to it does not change the ALJ’s decision.” Mitchell 

v. Commissioner of Social Security Administration, 771 F.3d 780, 

784 (11th Cir. 2014). However, the Council is required “to apply 

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the correct legal standards in performing its duties.” Id. 

The Court finds no error in the Appeals Council’s decision 

to not remand this action as the evidence post-dated the ALJ’s 

determination of April 28, 2014. The last examination of 

record, predating the ALJ’s determination by three weeks, showed 

Plaintiff had full ROM in her neck, though there was creaking in 

her breathing; the examining physician noted no pain (Tr. 312-

13). Though Hunt referred for further treatment at a free 

clinic, she did not seek it out. The evidence of record at that 

time did not establish disability, as found by the ALJ. Though 

the newly-submitted evidence demonstrated treatment of the 

impairment, it does not establish disability. Plaintiff’s claim 

otherwise is without merit.

Hunt raises three claims in this action; all three are 

without merit. Upon considering the entire record, the Court 

finds "such relevant evidence as a reasonable mind might accept 

as adequate to support a conclusion." Perales, 402 U.S. at 401. 

Therefore, it is ORDERED that the Secretary's decision be 

AFFIRMED, see Fortenberry v. Harris, 612 F.2d 947, 950 (5th Cir. 

1980), and that this action be DISMISSED. Judgment will be 

entered by separate Order.

DONE this 29th day of August, 2016.

s/BERT W. MILLING, JR. 

UNITED STATES MAGISTRATE JUDGE

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