Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-6_05-cv-06004/USCOURTS-arwd-6_05-cv-06004-0/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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1Plaintiff filed her appeal on January 4, 2005 (Doc. #1). The answer of the

Commissioner and the transcript of the administrative proceedings was filed of record and

provided to Plaintiff on February 28, 2005 (Doc. #2). 

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

HOT SPRINGS DIVISION

ANGELA R. FORD PLAINTIFF

vs. Civil No. 05-6004

JO ANNE B. BARNHART,

Commissioner, Social Security Administration DEFENDANT

MEMORANDUM OPINION

Factual and Procedural Background:

Angela R. Ford (hereinafter "Plaintiff"), has appealed the final decision of the

Commissioner of the Social Security Administration (hereinafter "Commissioner"), denying

her claim for 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. In this judicial review, the Court must determine whether

there is substantial evidence in the administrative record to support the Commissioner’s

decision. 42 U.S.C. § 405(g).

The Commissioner filed an appeal brief on April 25, 2005 (Doc. #4). Despite ample

time to do so1, Plaintiff has failed to file an appeal brief in this matter. The history of the

administrative proceedings is contained in the Commissioner’s appeal brief (Doc. #4, pp. 1-

2). and will not be recounted herein, except as is necessary. 

Plaintiff alleges that she is disabled due to: Systemic Lupus Erythematosus

(hereinafter, "SLE"); fatigue; swelling; joint pain; anemia; weakness and loss of strength;

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pain; inability to concentrate; inability to sleep; memory loss; blurred vision; renal vascular

hypertension; side effects of chemotherapy; hypertension; migraine headaches; seizure

disorder; loss of range of motion; polyserositis; mucositis; arthritis; loss of hair and other

side effects of chemotherapy; dysuria; hematuria; angioedema; chills and fever; synovitis;

SLE vasculitis/renal vascular hypertensive encephalopathy with diffuse areas of abnormal

increased signal intensity in the cortical and subcortical regions, perventricular regions, both

cerebellar hemispheres and the corpus callosum of her brain; and, shortness of breath. The

issue before this Court is whether the decision of the Commissioner is supported by

substantial record evidence. 

The Plaintiff’s administrative hearing was conducted on December 10, 2003 (T. 386-

408). The Administrative Law Judge (hereinafter "ALJ") issued his final written decision

denying Plaintiff’s applications for benefits on July 22, 2004 (T. 15-22). Plaintiff then

sought review by the Appeals Council (T. 10). The Appeals Council denied Plaintiff’s

request for review on November 8, 2004 (T. 7-9), thus making the decision of the ALJ the

final decision of the Commissioner.

From this adverse decision, the Plaintiff appeals (Doc. #1). This matter is before the

undersigned by consent of the parties (Doc. #2).

Relevant Law:

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

supported by substantial evidence on the record as a whole. See Prosch v. Apfel, 201 F.3d

1010, 1012 (8th Cir. 2000); see also Craig v. Apfel 212 F.3d 433, 435-436 (8th Cir. 2000). 

Substantial evidence is relevant evidence that a reasonable mind would accept as adequate to

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support the Commissioner's conclusion. See Haggard v. Apfel, 175 F.3d 591, 594 (8th Cir.

1999). In considering whether existing evidence is substantial, we consider evidence that

detracts from the Commissioner's decision as well as evidence that supports it. See Prosch,

201 F.3d at 1012. We may not reverse the Commissioner's decision merely because

substantial evidence exists in the record that would have supported a contrary outcome. See

id.; Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir. 1993). Even if this Court might have

weighed the evidence differently, the decision of the ALJ may not be reversed if there is

enough evidence in the record to support the decision. Browning v. Sullivan, 958 F.2d 817,

822 (8th Cir. 1992). 

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

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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.

Discussion:

The ALJ found that the medical evidence established that Plaintiff suffered from the

following severe impairments: "lupus, polyserositis, muscositis, arthritis, hair loss,

headaches, blurred vision dysuria, hematuria, angioedema, chills and fever; (sic) synovitis of

the hands, wrists, elbows, knees, ankles, and feet; (sic) and [,] seizures" (T. 17). 

Throughout his decision, the ALJ singularly considered some of Plaintiff’s alleged

impairments, with single sentences or paragraphs being devoted to the analysis of each

impairment (T. 15-22). In doing so, the ALJ singularly discussed Plaintiff’s treatment for

the alleged impairment at issue. However, he failed to consider or discuss the combined

effect of Plaintiff’s severe impairments. The ALJ also failed to consider the side effects of

Plaintiff’s chemotherapy treatments. In fact, the ALJ’s analysis of Plaintiff’s alleged

impairments, follows in its entirety:

The medical evidence indicates that the claimant has lupus, polyserositis,

mucositis, arthritis, hair loss, headaches, blurred vision, dysuria, hematuria,

angioedema, chills and fever; (sic) synovitis of the hands, wrists, elbows,

knees, ankles, and feet; and[,] seizures, impairments that are "severe" within

the meaning of the Regulations but not "severe" enough to meet or medically

equal, either singly or in combination to one of the impairments listed in

Appendix 1, Subpart P, Regulations No. 4. Specifically, the Administrtive

Law Judge has considered the criteria of listed impairments 2.04 (Visual

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Acuity), 11.03 (Epilepsy), and 14.02 (Systemic Lupus Erythematosus), and

14.09 (Inflammatory Arthritis), but finds that the objective medical records

do not substantiate findings consistent with listing level criteria. 

Claimant presented to the Hot Springs County Medical Center in Malvern,

Arkansas, on November 252, 2000, for complaints of sharp and stopping

(sic) right lower chest pain. She refused admission stating she needed to

breast feed her baby, and wanted IM Rocephin for two days, and Biaxin XL. 

Her current medications were Prednisone, and Ibuprophen. X-rays indicated 

large right pleural effusion with compression atelectasis of the adjacent lung. 

There was little change comparee to x-rays of November 25, 2000. The left

lung was clear. She received an injection ov Rocephin on November 26,

2000 (Exhbit 7-F(1-3)).

Claimant underwent an MRI of the brain with and without Gadolinium on

May 12, 2001. The impression was abnormal diffuse areas of increast T2-

weighted signal density of cortical and subcortical regions, periventricular

regions, corpus callosum, and both cerebellar hemispheres. Findings

reflected Systemic Lupus Erythematosus (SLE) vasculitis or renal vascular

hypertensive encephalopathy (Exhibit 10-F).

A medical record dated August 10, 2001, indicated claimant was a slender

female weighing 134 pounds, with blood pressure 124/80, SLE, hypertension

and seizure disorder. She had no skin rash, synovitis, or edema of lower

extremities. Her hair was growing back and she was "doing well." Her

current medications were Prevacid changing to Prilosec due to cost,

Plaquenil, Lasix, Prednisone, Dilantin changed to Tegretol, Toprol, PhosLo,

and Cytoxan. She had also taken Epogen for enemia of low erythopoietin

level. The impression was her SLE was doing well (Exhibit 14-F(3)). Lab

results indicated hemoglobin was 11 - improved from a low of 7; stable

creatinine at 1.8 - improved from 4.4; and the Lupus and renal failure were

improving. She was to receive a gram of Cytoxan on August 21, 2001, and

continue her Epogen monthly (Exhibit 16-F(7)). (Exhibits 14-F(3)) and 16-

F(7)).

On December 17, 2003, claimant was well developed an dwell nourished in

no acute distress. The heart had regular rhythm, no murmurs; all joints had

full range of motion; no active synovitis/synovial proliferation; and there was

"good grip and curl of the hands." Current medications were Prednisone, and

Plaquenil. She was currently attending cosmetology school 5 days per week,

8:00 A.M. to 4:30 P.M. She was divorced and raising to (sic) young children

ages 3 and 13 (Exhibit 18-F(1)).

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2Systemic lupus erythematosus is an inflammatory connective tissue disorder of

unknown etiology, which predominately occurs in young women. SLE involves symptoms

such as fever, malaise, manifestation in any organ, intermittent arthritis to acute

polyarthralgias, tendon contractures, joint deformity without evidence on x-ray of erosion,

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(T. 17-18).

The above quotation sets forth the entirety of the ALJ’s analysis of Plaintiff’s

impairments and treatment thereof. 

As evidenced above, the ALJ discussed the singular treatment for some of Plaintiff’s

severe impairments, but never considered the combined effect to the impairments he found

to be severe in conjunction with one another, or with the allegations of pain (T. 392, 393,

394), fatigue (T. 392, 393, 394, 231, 318, 319,65-69, 229-233), weakness/loss of strength (T.

393), inability to sleep (T. 394, 333), inability to concentrate (T. 401, 229), memory loss (T.

399, 401, 229), swelling (T. 393, 405, 303, 304, 332), shortness of breath (T. 399, 269),

anemia (T. 318), rash (T. 393) or decreased range of motion (T. 393).

20 C.F.R. § 423 (d)(2)(B) provides:

In determining whether an individual's physical or mental impairment or

impairments are of a sufficient medical severity that such impairment or

impairments could be the basis of eligibility under this section, the

Commissioner of Social Security 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. If the Commissioner of

Social Security does find a medically severe combination of impairments, the

combined impact of the impairments shall be considered throughout the

disability determination process.

The ALJ is required to consider all impairments he finds to be severe. Likewise, he

is required to consider the combined effect of all impairments he finds to be severe. See 42

U.S.C. § 1382c(a)(3)(F); See also 20 C.F.R. § 404.1523. In this instance, the ALJ found the

Plaintiff’s history, diagnoses and/or treatment for lupus2, polyserositis3, mucositis4, arthritis,

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butterfly pattern cutaneous lesions, recurrent pleurisy, pulmonary function abnormalities,

pericarditis, pulmonary hypertension, headaches, lesions of the spleen, epilepsy, personality

changes, psychoses, organic brain syndrome, and renal failure or disease. See The Merck

Manual, pp.1317-1319 (16th Edition 1992).

3Polyserositis involves the general inflammation of serous membranes with serous

effusion. Dorland’s Illustrated Medical Dictionary, p. 1335 (27th Edition 1988).

4Mucositis is the inflammation of mucous membranes. Dorland’s Illustrated Medical

Dictionary, p. 1059 (27th Edition 1988).

5Dysuria is the medical term used to describe painful or difficult urination. Dorland’s

Illustrated Medical Dictionary, p. 522 (27th Edition 1988).

6Hematuria is the term used to describe blood in the urine. Dorland’s Illustrated

Medical Dictionary, p. 743 (27th Edition 1988).

7Angioedema is the vascular reaction involving the deep dermis or subcutaneous or

submucosal tissues, representing localized edema caused by dilatation and increased

permeability of the capillaries and characterized by development of giant wheals. Dorland’s

Illustrated Medical Dictionary, pp. 82-83 (27th Edition 1988).

8Synovitis involves the inflammation of the synovial membrane. It is usually painful,

particularly on motion, and is characterized by a fluctuating swelling due to effusion within a

synovial sac. Dorland’s Illustrated Medical Dictionary, p. 1649 (27th Edition 1988).

9Namely, the side effects of the chemotherapy drugs were not discussed within the

ALJ’s decision, nor were Plaintiff’s extended hospitalizations during renal failure and

chemotherapy treatments (T. 278, 396, 397, 406, 404, 405, 406, 407).

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hair loss, headaches, blurred vision, dysuria5, hematuria6, angioedema7, chills and fever,

synotitis8 of the hands, wrists, elbows, knees ankles, and feet, and seizures, to be severe

impairments. Nonetheless, despite his solitary statement that these impairments represent

severe impairments, he failed to otherwise consider the issue of whether the combination of

these severe impairments, together with the alleged pain, fatigue, swelling, decreased range

of motion weakness/loss of strength, inability to sleep or concentrate, loss of memory,

shortness of breath or other medication side effects9 result in a finding of disability. The

apparent failure to consider these subjective allegations in relation to what he deemed to be

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severe impairments necessarily leads to the conclusion that the ALJ failed in his duty to

consider the combined effect of all of Plaintiff’s impairments, in making a disability

determination with respect to her application for benefits. 

The ALJ must consider the impairments in combination and not fragmentize them in

evaluating their effects. Delrosa v. Sullivan, 922 F.2d 480, 484 (8th Cir. 1991), citing

Johnson v. Secretary of Health & Human Servs., 872 F.2d 810, 812 (8th Cir. 1989). In the

present case, therefore, the ALJ was obligated to consider the combined effect of [Plaintiff]'s

physical impairments. Id. at 484, citing Reinhart v. Secretary of Health & Human Servs.,

733 F.2d 571, 573 (8th Cir. 1984) and Wroblewski v. Califano, 609 F.2d 908, 914 (8th Cir.

1979). As has been noted, the Plaintiff alleged numerous impairments. Under these

circumstances, the Social Security Act requires the Commissioner to consider all

impairments without regard to whether any such impairment, if considered separately, would

be of sufficient medical severity to be disabling. Cunningham v. Apfel, 222 F.3d 496, 501

(8th Cir. 2000). 

A thorough review of the record indicates that the ALJ failed to properly analyze

Plaintiff’s subjective allegations. In determining whether the ALJ properly disregarded

Plaintiff’s subjective complaints, such as 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

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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 or reject 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 v. Heckler, 739 F.2d at 1322 (emphasis in original).

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. 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). 

Further, in evaluating these factors, the ALJ must "discuss" these factors in the

hearing decision. Herbert v. Heckler, 783 F.2d 128, 131 (8th Cir.1986)(citing Polaski v.

Heckler, 751 F.2d 943, 9580-950 (8th Cir.1984)). 

"While the claimant has the burden of proving that the disability results from a

medically determinable physical or mental impairment, direct evidence of the cause and

effect relationship between the impairment and the degree of claimant's subjective

complaints need not be produced." Polaski v. Heckler, 739 F.2d at 1322. 

To determine whether the ALJ properly applied the factors listed in Polaski, we must

determine whether the ALJ took into account all the relevant evidence, and whether that

evidence contradicted the claimant's own testimony so that the ALJ could discount the

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testimony for lack of credibility. Benskin v. Bowen, 830 F.2d 878, 882 (8th Cir.1987). The

ALJ's credibility assessment must be based on substantial evidence. Rautio v. Bowen, 862

F.2d 176, 179 (8th Cir.1988). 

In this case, with respect to subjective allegations and nonexertional limitations, the

ALJ found plaintiff’s allegations not supported by credible facts (T. 23). Implicit in the

ALJ’s task of making a credibility determination is the requirement that he "discuss" the

Polaski factors. Herbert v. Heckler, 783 F.2d at 130 (the Polaski cases and the Social

Security Disability Reform Act of 1984 require that the Commissioner set forth the

inconsistencies in the objective medical evidence presented and discuss the factors set forth

in the Polaski settlement when making "credibility" determinations concerning claimant’s

subjective complaints of pain).

Here, the ALJ fails to meaningfully examine the Polaski factor of dosage and side

effects of medication, particularly the chemotherapy drugs at issue. See Polaski v. Heckler,

739 F.2d at 1321-22. The ALJ must discuss and point out the inconsistencies in the record,

in order to make a credibility determination. Cline v. Sullivan, 939 F.2d 560, 565 (8th

Cir.1991) ("it is not enough that inconsistencies may be said to exist, the ALJ must set forth

the inconsistencies in the evidence presented and discuss the factors set forth in Polaski

when making credibility determinations"); Herbert v. Heckler, 783 F.2d at 131 (even though

evidence with respect to Polaski factors is in the record, those factors must be discussed in

the decision). 

Likewise, the ALJ’s analysis must address the relevant time period of Plaintiff’s

pending application. Here, the relevant time period for Plaintiff’s application for DIB began

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10The original application for DIB benefits alleged an onset date of January 2, 2001

(T. 208). However, at hearing the onset date was amended to September 20, 1999, both

orally and in writing (T. 388, 212)

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on the alleged onset date of September 20, 199910, and ends with the date of the ALJ’s

decision, July 22, 2004 (T. 388, 208, 212, 15-22). For purposes of Plaintiff’s application for

SSI benefits, the relevant time period begins with the date the application was filed, May 2,

2002, and ends with the date of the ALJ’s decision, July 22, 2004 (T. 379, 15-22). Yet, the

ALJ failed to discuss any of the numerous medical records which exist prior to November

25, 2000, or after December 17, 2003 (T. 17-18). Rather than discussing the medical

evidence for the entire relevant time period(s), the ALJ began his discussion with records

beginning well after the DIB relevant time period began, and ceasing his discussion with

records of December 2003 (T. 18), which was seven months prior to the end of both the DIB

and SSI relevant time periods. The ALJ must consider the record as a whole when

discrediting subjective complaints. Ownbey v. Shalala, 5 F.3d at 344. Upon remand, the

ALJ should discuss and consider all evidence from the relevant time period. 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 Commissioner denying benefits to

the Plaintiff is not supported by substantial evidence and should be reversed. This matter

should be remanded to the Commissioner for further proceedings consistent with this

decision.

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ENTERED this 25th day of January, 2006.

/s/Bobby E. Shepherd 

Honorable Bobby E. Shepherd 

 United States Magistrate Judge 

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