Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-6_04-cv-06117/USCOURTS-arwd-6_04-cv-06117-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (DIWC)

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AO72A

(Rev. 8/82)

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

HOT SPRINGS DIVISION

KATHRYN TOMKINS PLAINTIFF

v. Civil No. 04-6117

JO ANNE B. BARNHART,

Commissioner, Social

Security Administration DEFENDANT

MEMORANDUM OPINION

 Kathryn Tomkins (hereinafter "Plaintiff"), appeals from the decision of the

Commissioner of the Social Security Administration (hereinafter “Commissioner”), denying her

applications for a period of disability and disability insurance benefits (hereinafter "DIB"),

pursuant to §§ 216(i) and 223 of Title II of the Social Security Act (hereinafter "the Act"), 42

U.S.C. §§ 416(i) and 423, and for supplemental security income (hereinafter "SSI") benefits

pursuant to § 1602 of Title XVI, 42 U.S.C. § 1381a. 

Plaintiff was 28 years of age at the time of the March 21, 2001 administrative hearing

and had a high school education, as well as 3 semesters of college (T. 29, 107, 116). She last

worked at the front desk of a Clarion hotel (T. 30, 31, 40, 98-103, 123-129). 

Plaintiff alleges an inability to work due to: history of juvenile rheumatoid arthritis;

polyarthralgias; fibromyalgias; myalgias; gastric ulcers; pain in all of her joints; a bulging

lumbar disc; a bulging cervical disc; anxiety; swelling; depression; mitral valve prolapse;

chronic fatigue, exhaustion and weakness; migraine headaches; and, numbness. She

protectively filed her application for benefits on November 4, 1999, alleging an onset of

disability from May 15, 1996 (T. 82-84). Additionally, Plaintiff protectively filed her

application for SSI benefits on September 27, 1999 (T. 288-293).

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 The Social Security Administration denied plaintiff’s current application initially and on

reconsideration. Plaintiff then requested and received a hearing before an Administrative Law

Judge (hereinafter “ALJ”), which hearing was held on March 21, 2001 before ALJ Henry

Ginger in Hot Springs, Arkansas (T. 26-58). The ALJ rendered a decision adverse to Plaintiff

on July 12, 2001 (T. 15-19).

The Plaintiff then petitioned the Appeals Council for review on July 16, 2001 (T. 11). 

On May 1, 2003, counsel for Plaintiff again wrote to the Appeals Counsel requesting action on

Plaintiff’s July 16, 2001, request for review (T. 9). The Appeals Council denied review on

August 19, 2004 (T. 6-8), thus making the ALJ’s decision the final decision of the

Commissioner. Plaintiff now seeks judicial review of that unfavorable decision (Doc. # 1, 4). 

This matter is before the undersigned by consent of the parties (Doc. # 3).

Applicable Law:

Our role on review is to determine whether the Commissioner’s findings are supported

by substantial evidence in the record as a whole. See Prosch v. Apfel, 201 F.3d 1010, 1012 (8th

Cir. 2000). Substantial evidence is less than a preponderance but is enough that a reasonable

mind would find it adequate to support the Commissioner’s decision. Id. In determining

whether existing evidence is substantial, we consider evidence that detracts from the

Commissioner's decision as well as evidence that supports it. See Craig v. Apfel, 212 F.3d 433,

436 (8th Cir.2000). As long as substantial evidence in the record supports the Commissioner's

decision, we may not reverse it because substantial evidence exists in the record that would

have supported a contrary outcome, see id., or because we would have decided the case

differently. See Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir.1993).

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The Commissioner has established, by regulation, a five-step sequential evaluation for

determining whether an individual is disabled.

The first step involves a determination of whether the claimant is involved in substantial

gainful activity. 20 C.F.R. § 416.920(b). If the claimant is so involved, benefits are denied; if

not, the evaluation goes to the next step.

Step two involves a determination, based solely on the medical evidence, of whether

claimant has a severe impairment or combination of impairments. Id., § 416.920(c); see 20

C.F.R. § 416.926. If not, benefits are denied; if so, the evaluation proceeds to the next step.

The third step involves a determination, again based solely on the medical evidence, of

whether the severe impairment(s) meets or equals a listed impairment which is presumed to be

disabling. Id., § 416.920(d). If so, benefits are awarded; if not, the evaluation continues.

Step four involves a determination of whether the claimant has sufficient residual

functional capacity, despite the impairment(s), to perform past work. Id., § 416.920(e). If so,

benefits are denied; if not, the evaluation continues.

The fifth step involves a determination of whether the claimant is able to perform other

substantial and gainful work within the economy, given the claimant’s age, education and work

experience. Id., § 404.920(f). If so, benefits are denied; if not, benefits are awarded.

In addition, whenever adult claimants allege mental impairment, the application of a

special technique must be followed at each level of the administrative review process. See 20

C.F.R. § 416.920a(a).

The Commissioner is then charged with rating the degree of functional limitation, and

applying the technique to evaluate mental impairments. See 20 C.F.R. § 416.920a(d). 

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1See Doc. #4, pp 2-6.

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Application of the technique must be documented by the Commissioner at the ALJ hearing and

Appeals Council levels. See 20 C.F.R. § 416.920a(e). Such documentation, as referred to

within the regulations, is referred to as the PRT factors, mentioned previously.

Discussion:

The ALJ evaluated the plaintiff’s claim according to the five-step sequential evaluation

analysis prescribed by the social security regulations. See 20 C.F.R. §§ 404.1520(a)-(f); see

also Bowen v. Yuckert, 482 U.S. 137, 140-42 (1987) (describing five-step analysis). At the first

step, the ALJ found the plaintiff had not engaged in substantial gainful activity since her alleged

onset date (T. 16). At the second step, the ALJ determined that the plaintiff had no severe,

medically determinable impairments, and no impairment or impairments that significantly

limited her ability to perform basic work-related activities (T. 17, 19). See 20 C.F.R. §

404.1521; Bowen v. Yuckert, supra.

Plaintiff makes several arguments1, however, the primary question before the

undersigned is whether the ALJ erred in determining that Plaintiff did not have a severe,

medically determinable impairment. In addition to this issue, it is noted that Plaintiff argues

that the ALJ: rendered a decision not supported by substantial evidence; erred in finding

Plaintiff’s allegations not fully credible; and, erred in finding Plaintiff could perform work in

the national economy (Doc. #4, p. 2). The sequential evaluation process may only be

terminated, as herein, at step two, when the impairment or combination of impairments would

have no more than a minimal effect on the plaintiff's ability to work. Nguyen v. Chater, 75 F.3d

429, 431 (8th Cir.1996), citing Henderson v. Sullivan, 930 F.2d 19, 21 (8th Cir.1991)

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The procedure of terminating the process at step two has been upheld by the United

States Supreme Court in Bowen v. Yuckert, 482 U.S. 137, 107 S.Ct. 2287, 96 L.Ed.2d 119

(1987). In Brown v. Bowen, 827 F.2d 311 (8th Cir.1987), the United States Court of Appeals

for the Eighth Circuit discussed the impact of Yuckert and noted: 

On June 8, 1987, the Supreme Court held that the second step of the sequential

evaluation process was not per se invalid. See Bowen v. Yuckert, 482 U.S. 137,

107 S.Ct. 2287, 96 L.Ed.2d 119 (1987). In regard to the application of that

standard, however, a majority of the Court adopted a standard which provides

that '[o]nly those claimants with slight abnormalities that do not significantly

limit any "basic work activity" can be denied benefits without undertaking' the

subsequent steps of the sequential evaluation process. Id. 482 U.S. at 158, 107

S.Ct. at 2299. 

Brown v. Bowen, 827 F.2d at 312. 

Alleged impairments may not be considered severe when they are stabilized by

treatment and otherwise are generally unsupported by medical record. Johnston v. Apfel, 210

F.3d 870, 875 (8th Cir. 2000); see also Mittlestedt v. Apfel, 204 F.3d 847, 852 (8th Cir. 2000)

(plaintiff bears the burden to establish severe impairments at step-two of the sequential

evaluation). Thus, the plaintiff did have the burden of showing a severe impairment that

significantly limited her physical or mental ability to perform basic work activities, but the

burden of a plaintiff at this stage of the analysis is not great. Caviness v. Massanari, 250 F.3d

603, 605 (8th Cir. 2001). 

Further, to establish entitlement to benefits, the plaintiff must show that she had been

unable to engage in any substantial gainful activity by reason of a medically determinable

impairment which had lasted or could have been expected to last for not less than 12 months. 

See 42 U.S.C. §§ 423(d)(1)(A) and 1382c(a)(3)(A).

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The administrative record herein discloses Plaintiff’s longstanding and recurrent

problems with pain (T. 34, 35, 38, 39, 41, 42, 43, 44, 49, 50, 51, 54, 55, 56, 105, 106, 107, 131,

133, 132, 134, 136, 144, 176, 191, 192), fatigue (T. 39, 41, 49, 50, 54, 56, 104, 106, 133, 134,

144, 193, 219), anxiety (T. 36, 37, 142, 143, 144, 145) and depression (T. 36, 37, 54, 88, 90,

103, 104, 142, 143, 144, 154, 164, 165, 166, 212). Plaintiff testified that she had experienced

the fatigue and weakness for a long time. Indeed, she reported her fatigue and exhaustion to her

treating physicians on a number of occasions. Likewise, Plaintiff sought counseling for her

anxiety and depression. During the relevant time period, Plaintiff was prescribed numerous

anti-depressant medications, including Zoloft, Effexor XR and Paxil (T. 114, 164, 142, 143, 90,

103, 164, 165, 167). Plaintiff was also prescribed Xanax in response to her complaints of

anxiety (T. 36, 49, 142, 143).

Yet, despite the above record cites to Plaintiff’s allegations of depression and anxiety,

the ALJ fails to mention these alleged impairments when rendering his decision (T. 13-17). 

Neither does the ALJ cause Plaintiff to undergo an updated psychiatric consultative

examination, nor does his decision include documentation of the PRT analysis, mentioned

previously. 

We question the adequacy of the ALJ’s analysis of Plaintiff’s mental impairments. No

PRT analysis or documentation was included within or attached to the ALJ’s decision. Under

Social Security regulations, completion of such analysis, and documentation thereof, is required

when evidence of a medically determinable mental impairment has been presented. See Pratt v.

Sullivan, 956 F.2d 830, 834 (8th Cir.1992).

Likewise, the undersigned questions the adequacy of the ALJ’s assessment of Plaintiff’s

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alleged physical impairments. The ALJ only finds that Plaintiff suffers from one impairment,

degenerative disc disease (T. 17). However, the ALJ finds that Plaintiff does not have a severe

impairment (T. 17, 19). The ALJ makes this determination without conducting any analysis of

Plaintiff’s diagnosis of fibromyalgia.

Dr. Melody St. John, a rheumatologist, diagnosed Plaintiff with fibromyalgia. The term

"myalgia" indicates muscular pain. Fibromyalgia involves pain in fibrous tissues, muscles,

tendons, ligaments and other "white" connective tissues. Any of the fibromuscular tissues may

be involved, but those of the occiput, low back, neck, shoulders, thorax, and thighs are

especially affected. Fibromyalgia occurs mainly in women. This condition may be induced or

exacerbated by physical or mental stress, poor sleep trauma, exposure to dampness or cold, and

occasional by a systemic, usually rheumatic disorder. A viral or other systemic infection may

precipitate the syndrome in a person who may be otherwise predisposed. 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. In localized forms, symptoms are more

often sudden and acute. The pain is aggravated by straining or overuse. Tenderness, tightness

and/or muscle spasms may occur. The onset of pain and stiffness can be gradual, diffuse and

achy. However, in localized forms, symptoms are more often sudden and acute. In milder

cases, fibromyalgia can remit spontaneously with decreased stress. Yet, the condition may

become chronic or recur at frequent intervals. See The Merck Manual, pp. 1369-1371 (16th

Edition, 1992). 

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2

 Fibromyalgia is also referred to as myofascial pain syndrome, fibrositis and

fibromyositis. The Merck Manual, p. 481 (17th Ed.1999). 

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Fibromyalgia2 is a group of common nonarticular disorders characterized by achy pain,

tenderness, and stiffness of muscles, areas of tendon insertions, and adjacent soft tissue

structures. See The Merck Manual, p. 481-482 (17th Ed. 1999). 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 18 fixed locations on the body (and the rule of

thumb is that the patient must have at least 11 of them to be diagnosed as having fibromyalgia)

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

Here, Dr. St. John determined Plaintiff suffered from 12 out of 18 fibromyalgic tender

points on August 1, 2000 (T. 206-207), and December 21, 1999 (T. 211-212). Dr. St. John also

found Plaintiff had 18 out of 18 fibromyalgic tender points on January 5, 2000 (T. 208-209). 

Despite these findings by Plaintiff’s treating and examining rheumatologist, the ALJ failed to

mention these findings or the significance thereof (T. 15-19).

After careful consideration of the administrative record, the undersigned finds that

substantial evidence does not support the ALJ’s termination of the sequential evaluation at step

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two. Substantial evidence does not support a finding that Plaintiff’s impairments had no more

than a minimal impact on her ability to work. Caviness v. Massanari, 250 F.3d at 605. 

Additionally, upon remand, the Court suggests that the Commissioner consider and

analyze the issue of Plaintiff’s alleged lack of financial means with which to obtain treatment

(T. 51, 137, 263). Plaintiff alleges that she experiences a lack of money to the point that she is

unable to obtain insurance or continue to see her rheumatologist, Dr. St. John. The record also

reflects that Plaintiff was the recipient of Medicaid benefits during only a portion of the relevant

time period (T. 137, 263). This issue may or may not impact upon the frequency of Plaintiff’s

medical treatment and/or use of prescription or over-the-counter medication. Upon remand, the

issue should be addressed by the parties. Such analysis is essential when, as here, the ALJ relied

upon a finding that Plaintiff’s subjective complaints are not entirely credible when halting the

sequential analysis at step two (T. 18). 

The undersigned acknowledges that the ALJ’s decision may be the same after proper

analysis. Nonetheless, proper analysis must occur. Groeper v. Sullivan, 932 F.2d 1234, 1239

(8th Cir. 1991).

Conclusion:

Accordingly, we conclude that the decision of the ALJ herein, denying benefits to the

Plaintiff, is not supported by substantial evidence of record, and should be reversed. This matter

should be remanded to the Commissioner for reconsideration consistent with this opinion.

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ENTERED this 7th day of September, 2005.

/s/Bobby E. Shepherd 

 Honorable Bobby E. Shepherd 

 United States Magistrate Judge 

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