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Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 

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1

Michael J. Astrue has been appointed to serve as Commissioner of Social

Security and is substituted as appellee pursuant to Rule 43(c)(2) of the Federal Rules

of Appellate Procedure.

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 06-3474

___________

Derone Combs, *

*

Plaintiff - Appellant, *

* Appeal from the United States

v. * District Court for the Southern

* District of Iowa.

Michael J. Astrue,1

 Commissioner *

of Social Security, * [UNPUBLISHED]

* 

Defendant - Appellee. *

___________

Submitted: April 13, 2007

Filed: July 30, 2007

___________

Before LOKEN, Chief Judge, BYE and RILEY, Circuit Judges.

___________

PER CURIAM.

Derone Combs filed applications for disability insurance benefits and

supplemental security income (SSI) benefits, which were denied by the Social

Security Administration (SSA). Combs sought review before two administrative law

judges (ALJs), who each conducted a hearing; the second ruled Combs was not

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 The Honorable Robert W. Pratt, Chief Judge, United States District Court for

the Southern District of Iowa.

3

 RSD is a “series of changes caused by the sympathetic nervous system,

marked by pallor or rubor, pain, sweating, edema, or osteoporosis, following muscle

sprain, bone fracture, or injury to nerves or blood vessels.” Dorland’s Illustrated

Medical Dictionary 560 (29th ed. 2000).

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entitled to benefits. The SSA Appeals Council denied review, rendering the ALJ’s

decision final. Combs sought review in district court,2

 which affirmed the decision of

the agency. Combs appeals, and we affirm.

I

On July 24, 2000, Combs was burned by steam while working as a dishwasher.

He was seen three times for physical therapy. After the burn healed, he continued to

feel pain consistent with reflex sympathetic dystrophy3

 (RSD), so his physical

therapist referred him to a physician. 

Two medical reports from August 2000 state that although Combs’s burn had

healed, he continued to complain of sharp pain over the area of the burn, swelling and

cold feelings in his hand and increased pain with changes in the ambient temperature.

The doctor diagnosed possible RSD of the right upper extremity and tried several

treatments. There is no record of his receiving medical care for his condition between

this time and late 2003, when he was seen for forty minutes by a physician. He

reported attacks of pain two to three times per week, during which his arm was

swollen and extremely tender. On physical examination, no abnormalities were noted.

The doctor was not able to verify his complaints of episodic pain, and recommended

he be limited to lifting no more than twenty-five pounds. No other limitations were

noted. He was seen by another doctor on December 23, 2003, requesting medication

for RSD. He appeared uncomfortable on physical examination, and both arms were

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tender to the touch. His doctor prescribed Elavil (a prescription antidepressant) and

ibuprofen. The doctor also recommended a referral to a pain clinic. 

Combs was seen at a pain clinic on January 19, 2004. After an examination the

doctor wrote there was no clear diagnosis: “I cannot certainly make a diagnosis of

reflex sympathetic dystrophy or complex regional pain syndrome.” The doctor noted

a flat affect and possible depression. On April 21, 2004, he again saw the pain clinic

doctor, who noted Combs’s symptoms and signs were consistent with complex

regional pain syndrome (type I) (another term for RSD) and depression. 

Combs was seen for an intake evaluation at a community mental health center

on March 16, 2004. He had no prior psychiatric care or counseling and referred

himself to the center. He indicated being restless all night, was tired, and it became

difficult for him to get up in the morning. His appetite declined and his energy level

was low. He indicated his concentration and memory were poor. He was scheduled

for individual therapy and for an appointment with a psychiatrist. On June 23, 2004,

a doctor described him as still symptomatic with “major depressive disorder,” with no

additional detail, and prescribed Zoloft. 

An undated medical source statement from an unidentified health-care provider

was found in Combs’s record. The statement reflects diagnoses of major depressive

disorder and RSD, and a global assessment of functioning (GAF) of 60. This provider

indicated he had a “medical issue that affects ability to work/function.” He had

“marked” limitations in completing a normal workday and working at a consistent

pace. He had slight limitations in working with others “due to pain.” He had

“moderate” limitations in the ability to be aware of hazards. 

Combs filed applications for benefits on October 2, 2003. After his applications

were denied, he requested a hearing. He also appeared and testified before ALJ

Thomas Gaye on August 12, 2004. When Judge Gaye learned Combs was claiming

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a mental as well as a physical impairment, he adjourned the hearing and said a mental

status examination would be ordered. Judge Gaye also recommended Combs obtain

the services of an attorney.

Combs was hospitalized for depression August 13-15, 2004. As part of his

application for Social Security benefits, Combs was seen for a functional capacity

evaluation at the Genesis Valley Fair rehabilitation clinic in Davenport, Iowa, on

August 16, 2004. During the evaluation, he was able to lift sixty-five pounds and

showed no limitations in his ability to sit, stand, crawl, kneel, crouch, or squat. He

displayed noted muscle definition in his arms without any apparent disuse atrophy.

On a thirteen-point consistency checklist, part of the evaluation, Combs produced

results inconsistent with his giving maximum effort on nine of the points, when just

three inconsistencies are ordinarily enough to indicate overall the subject is providing

non-maximum or inconsistent effort on the evaluation. He was scheduled to complete

the evaluation on the 17th, but did not show up. It was noted he was uncooperative in

complying with test requirements. His pain behaviors indicated to the tester that while

pain may be present, his behavior was the greatest limitation. Based upon his

performance during the portions of the evaluation he attended, the physical therapist

described his limitations as self-imposed. Throughout the period of claimed

disability, Combs was able to care for a small child, clean the house, and occasionally

cut the lawn with a self-propelled mower. 

Combs appeared on October 21, 2004, before ALJ John Sandbothe. He told the

ALJ he had not been able to find an attorney to represent him, so the hearing

proceeded pro se. The ALJ concluded Combs was not credible when he claimed his

pain was so severe he could not work: “[C]laimant’s allegations of disability are not

consistent with the medical signs and findings or treating and examining physician

reports and are therefore not credible, as the medical evidence of record demonstrates

that his reflex sympathetic dystrophy is largely under control, as shown by treatment

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 The residual functional capacity is the most an individual can do despite the

combined effect of all of their credible limitations. 20 C.F.R. §§ 404.1545, 416.945

(2006). The residual functional capacity is based on all of the relevant evidence in the

case record, and is assessed at step four of the sequential evaluation. Id.

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notes showing only very occasional acute exacerbation of symptoms.” The ALJ noted

his RSD was controlled with medications and required only occasional treatment.

In his decision, the ALJ found Combs has the residual functional capacity

(RFC)4

to lift and carry ten pounds frequently and twenty pounds occasionally,

and he can sit, stand and/or walk at least six hours of a work day. He can

occasionally balance, stoop, crouch, kneel, crawl, and climb. Mentally

and emotionally, due to low academic achievement, he is limited to

simple, routine, repetitive work, and is limited to a regular work pace.

He has no other significant limitations. 

At the last step of the five-step sequential evaluation, the ALJ found Combs

able to perform a significant number of light and sedentary jobs existing in the

national economy. At the hearing, a vocational expert testified his limitations would

allow for wide range of unskilled light and sedentary occupations.

Combs appealed. The district court upheld the decision, finding no fault with

the ALJ’s credibility finding. “Although the evidence in this case establishes the

existence of impairments severe enough to advance the case beyond the second step

of the sequential evaluation, the impairments are not severe enough to prevent the

performance of all substantial gainful activity . . . . In this case, the ALJ found that

Combs’s pain limits him to the performance of light and sedentary work as defined

in the regulations.” The district court found the Commissioner’s decision supported

by substantial evidence on the record as a whole, and held the ALJ’s findings to have

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been “well within the zone of reasonable choices that this Court will not disturb.”

This appeal followed. 

II

To establish entitlement to benefits, a claimant must show he is unable to

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

impairment 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). In Barnhart v. Walton, 535 U.S.

212, 215 (2002), the Supreme Court upheld the Social Security Commissioner’s

interpretation of this statutory definition, which requires the disability, and not only

the impairment, to have existed or be expected to exist for twelve months.

We review de novo the decision of the district court affirming the agency’s

denial of benefits. Nicola v. Astrue, 480 F.3d 885, 886 (8th Cir. 2007). Our task is

to determine whether the ALJ’s findings are supported by substantial evidence on the

record as a whole. Id. Substantial evidence is evidence a reasonable person would

consider adequate to support the ALJ’s conclusion. Id. If the record contains

insufficient evidence to support the outcome, we will reverse the ALJ’s decision, but

we will not reverse merely because we may have reached a different conclusion. Id.

If, after reviewing the record, we find it possible to draw two inconsistent

positions from the evidence and one of those positions represents the Commissioner’s

findings, we must affirm the decision of the Commissioner. Young v. Apfel, 221 F.3d

1065, 1068 (8th Cir. 2000).

The evaluation of disability in a Social Security claim is a five-step process.

SSR 86-8, 20 C.F.R. §§ 404.1520, 416.920. The claimant must show he is not

engaging in substantial gainful activity and that he has a severe impairment. Those

are steps one and two. Id. Consideration must then be given, at step three, to whether

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the claimant meets or equals a listing. Id. Step four concerns whether the claimant

can perform his past relevant work; if not, at step five, the ALJ determines whether

jobs the claimant can perform exist in significant numbers.

Combs argues the ALJ failed to fully develop the record, erred in following set

rules in the evaluation of RSD, and erred in his posing of a hypothetical to a

vocational expert. The ALJ did find he suffered from RSD and depression at step

three; the dispute here centers on steps four and five: whether he suffers from them

to a sufficient degree to keep him from working at most jobs. 

A. Developing the Record

Combs argues the ALJ failed to develop the record as to his depression and

physical limitations, a duty particularly important because he was appearing pro se.

But Combs bears a heavy burden in showing the record has been inadequately

developed. He must show both a failure to develop necessary evidence and unfairness

or prejudice from that failure. Haley v. Massanari, 258 F.3d 742, 749-750 (8th Cir.

2001) (holding “reversal due to failure to develop the record is only warranted where

such failure is unfair or prejudicial”; ALJ may issue decision without obtaining

additional evidence if existing evidence provides sufficient basis for decision (internal

quotes and citations omitted)).

 The Commissioner notes all of Combs’s medical records – including those

related to the small number of times he received psychiatric evaluation – were in the

record, and treated as accurate. The Commissioner argues his record is complete – as

he has identified no missing documents – and asserts failure to show any prejudice

from any missing records. 

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The Commissioner acknowledges the psychiatric examination requested by the

first ALJ was not completed. But while the record of Combs’s psychiatric history was

thin when the exam was requested, the Commissioner argues it was subsequently

supplemented with records from the community mental health center, and the second

ALJ felt comfortable making his decision on that record. The ALJ is required to order

medical examinations and tests only if the medical records presented to him do not

give sufficient medical evidence to determine whether the claimant is disabled. Barrett

v. Shalala, 38 F.3d 1019, 1023 (8th Cir. 1994); 20 C.F.R. §§ 404.1519a(b) and

416.919a(b) (2006). 

Combs argues the record is “replete” with references to his depression. The

record does mention it several times, but described him as “sad” or with “flat affect.”

While the record may show he was depressed – and the ALJ did find he was –

nowhere does the record indicate he is suffering from depression to the extent he

cannot work. The mild treatments he was prescribed also argue against a finding of

such severe depression. 

B. Following Set Rules in the Evaluation of RSD

Combs argues Social Security Ruling (SSR) 03-2p requires ALJs to follow set

procedures in evaluating RSD claims. But he does not identify anything in particular

the ALJ did wrong under SSR 03-2p, other than proceed on the basis of a record he

claims was inadequate. His objections also seem to imply the ALJ either did not find

he suffered from RSD, or found his RSD was not severe. In fact, the ALJ did make

those findings; he just did not find the evidence in the record sufficient to deem him

unable to work. Once a diagnosis of RSD is found, the determination of whether

someone is disabled is made the same way it is for any other condition, and the ALJ

is fully authorized to make credibility determinations on the record before him.

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Factoring into the ALJ’s assessment of Combs’s credibility was a) he reported

no pain to a doctor in September 2000; b) he was not treated for the condition between

September 2000 and November 2003; c) he did not cooperate with, nor complete, a

functional capacity evaluation; and d) what he did complete of the functional capacity

evaluation led the physical therapist to conclude he was exaggerating his symptoms.

Combs testified he only took non-prescription pain medications for the majority

of the relevant period. The lack of strong prescription pain medication supports the

ALJ’s findings. Rankin v. Apfel, 195 F.3d 427, 430 (8th Cir. 1999). Over-the-counter

medications are inconsistent with complaints of disabling pain. Loving v. Dep’t. of

Health & Human Serv., 16 F.3d 967, 971 (8th Cir. 1994). Moreover, when he did take

the medications, his doctor noted they resolved his complaints of pain. Patrick v.

Barnhart, 323 F.3d 592, 596 (8th Cir. 2003) (holding if an impairment can be

controlled by treatment or medication, it cannot be considered disabling). 

C. The Posing of the Hypothetical

At the second hearing, the ALJ proposed a hypothetical to the vocational expert

(VE): “If I have a person who is basically limited to lifting 20 pounds occasionally,

10 pounds frequently, and can only occasionally balance, stoop, crouch, kneel, crawl,

or climb; simple, routine, repetitive work, no more than a regular pace, are there any

jobs he’d be capable of doing?” “Yes, there are, in my opinion,” the VE replied.

The VE testified Combs could perform almost all sedentary and light work.

The limitation on simple, routine work would limit the numbers of jobs available, but

a wide range of light and sedentary jobs would still be available. 

The ALJ then asked a second hypothetical, adding that the person would require

two or more absences per month and when he is working, would require a slower pace

for a third of that day. The VE replied that in his opinion, that second person would

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not be competitively employable. Based on this – and after finding Combs not fully

credible as to the extent of his impairments – the ALJ found the first hypothetical best

described his residual functional capacity. 

Combs argues the ALJ erred when he posed his first hypothetical question to

the VE, as it had no medical basis. This assertion is premised on the argument that the

record was undeveloped, and ignores that the ALJ found some of his reporting of

subjective symptoms to be not credible.

The Commissioner notes it is Combs’s – and not the Commissioner’s – burden

to prove his RFC at step four of the sequential evaluation, and it is the ALJ’s

responsibility to determine the RFC based on all relevant evidence, including medical

records, observations of treating physicians and others, and the claimant’s own

description of his limitations. Young, 221 F.3d at 1069 n.5.

Having determined Combs’s RFC, the ALJ found he did not have any past

relevant work to which he could return. Therefore, at step five of the sequential

evaluation process, the burden of production shifted to the Commissioner to

demonstrate there was other work found in significant numbers in the national

economy he could perform given his age, education, and residual functional capacity.

Id. See also 20 C.F.R. §§ 404.1520(f); 416.920(f) (2006). The VE indicated to the

ALJ that he could perform all but 10% of the sedentary jobs in the national economy,

and the ALJ accepted that analysis.

III

The district court correctly upheld the Commissioner’s decision in this matter.

The ALJ did not fail to fully develop the record, and Combs did fail to show how he

might have been prejudiced by any omission. The ALJ properly applied the rules in

the evaluation of RSD. The ALJ’s posing of a hypothetical to a vocational expert was

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proper. In the end, the ALJ’s decision was supported by substantial evidence on the

record as a whole, and its findings were within the “zone of reasonable choices”

within its discretion. We affirm.

______________________________

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