Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-6_05-cv-06075/USCOURTS-arwd-6_05-cv-06075-0/pdf.json

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

---

Michael J. Astrue became the Social Security Commissioner on February 12, 2007, 1

and pursuant to F.R.C.P. 25(d)(1), he has been substituted for Jo Anne B. Barnhart as

the defendant in this suit.

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

HOT SPRINGS DIVISION

LAURA PARTEE PLAINTIFF

v. Civil No. 05-6075

MICHAEL J. ASTRUE , Commissioner, 1

Social Security Administration

of the United States of America DEFENDANT

J U D G M E N T

Now on this 27th day of March, 2007, comes on for

consideration the Complaint of Laura Partee for judicial review of

the denial of Social Security benefits by the Commissioner. This

Court's review is conducted pursuant to 42 U.S.C. §405(g). 

1. The Court's role upon review of the decision of a Social

Security Administrative Law Judge ("ALJ") is to determine whether

the decision is supported by substantial evidence on the record as

a whole. Ramirez v. Barnhart, 292 F.3d 576 (8th Cir. 2002).

Substantial evidence is less than a preponderance but enough that

a reasonable mind would find it adequate to support a conclusion.

Id. The Court must consider not only the evidence supporting the

ALJ's decision, but also that which fairly detracts from it, and

must affirm if the record -- viewed as a whole -- contains

substantial evidence to support it. Id. The Court may not

reverse simply because the record also contains substantial

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evidence that would have supported a contrary decision. Haley v.

Massanari, 258 F.3d 742 (8th Cir. 2001). 

The burden rests on the claimant to prove that she has a

disability, mental or physical, that has lasted -- or can be

expected to last -- at least one year and that prevents her from

engaging in any substantial gainful activity. Pearsall v.

Massanari, 274 F.3d 1211 (8th Cir. 2001).

2. Partee alleges a disability onset date of December 3,

2001. At the time of her administrative hearing, she was 46 years

old, and had a high school education. Her past work experience was

as a fast food worker and waitress. 

The ALJ found that Partee had fibromyalgia, depression,

residuals of remote bilateral shoulder adhesive capsulitis, and

gastroesophageal reflux disease controlled with medication. He

found this combination of impairments severe, but not severe

enough to meet or medically equal any of the impairments listed in

Appendix 1, Subpart P, Regulations No. 4.

The ALJ found Partee's testimony about her limitations not

fully credible, and ultimately determined that Partee had the

residual functional capacity to perform a significant range of

sedentary work, so long as she did not have to perform work above

waist level or be subjected to too much stress. Based on the

testimony of a Vocational Expert that jobs with such restrictions

existed in significant numbers in the economy, the ALJ concluded

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Medical records pertaining to conditions not relevant to the claim of disability 2

are not included. In addition, the record contains office visit notes dated January 30,

2003, and May 16, 2003, from a practitioner who cannot be identified. These documents

are illegible, and so are not included.

Indicated for relief of mild to moderate pain. Physicians' Desk Reference, 1995 3

Ed.

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that Partee was not disabled.

3. The Administrative Record reflects the following

relevant facts: 2

* On April 29, 1998, Partee was seen by Dr. Dale Kincheloe

for pain in her shoulders. She had some limitation in

the range of motion of her shoulders. Dr. Kincheloe

diagnosed bilateral adhesive capsulitis. He prescribed

Advil and physical therapy to regain motions and

increase strength.

* On June 10, 1998, Partee saw Dr. Kincheloe again. He

noted that she had been going to physical therapy three

times a week, and had experienced pain with the

exercises. He added Darvocet to the Advil, and 3

continued physical therapy with some modification in the

types of exercises. His diagnosis remained the same.

* On July 22, 1998, the physical therapist wrote Dr.

Kincheloe, noting that Partee had made modest gains in

range of motion, and had been trained in a home physical

therapy program.

* On December 29, 1998, Partee saw Dr. Verser with a

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Indicated for the relief of symptoms of depression. Physicians' Desk Reference, 4

1995 Ed.

Indicated for acute or long-terms use in the treatment of osteoarthritis, 5

rheumatoid arthritis, ankylosing spondylitis, acute painful shoulder, and acute gouty

arthritis. Physicians' Desk Reference, 1995 Ed.

Used to treat osteoarthritis, rheumatoid arthritis, ankylos9ng spondylitis, and 6

acute pain, among other conditions. Physicians' Desk Reference, 2007 Ed.

Used to treat a wide variety of rheumatic disorders, among other conditions. 7

Physicians' Desk Reference, 1995 Ed.

Sold under the brand name Elavil, this drug is an antidepressant with sedative 8

effects. Physicians' Desk Reference, 1995 Ed.

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complaint that "both shoulders are frozen." She gave

Dr. Verser a history of seeing "numerous doctors," and

having "50 sessions of physical therapy prior to August,

1998." He diagnosed bilateral shoulder pain, and

prescribed Pamelor and Clinoril .

4 5

* On June 19, 1999, Partee saw Dr. Verser for complaints

of right shoulder pain. She told him she had been

unable to tolerate the Clinoril because of stomach

problems. He injected her shoulder with Decadron, and

prescribed Celebrex .

6

* On November 1, 1999, Partee saw Dr. Verser for

complaints of unresolved shoulder pain. His diagnosis

was fibromyalgia and right shoulder inflammatory pain.

He prescribed Vioxx, Celestone , and Amitriptyline .

7 8

* On November 9, 1999, Partee saw Dr. Verser for a twisted

right foot. He prescribed an ACE wrap, Vioxx and

Tylenol.

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Used to treat major depressive disorder, among other conditions. Physicians' Desk 9

Reference, 2007 Ed.

Used in the treatment of muscle spasm associated with acute painful 10

musculoskeletal conditions. Physicians' Desk Reference, 1995 Ed.

-5-

* On July 18, 2000, Partee was seen by Dr. Verser with a

complaint of a swollen painful foot. He noted a history

of "frozen shoulder" and neck and shoulder pain. Vioxx

was prescribed.

* On October 5, 2000, Partee was seen by Dr. Mike Verser

for a refill of her medication. The diagnosis was

fibromyalgia and shoulder pain, and prescriptions were

written for Vioxx and Amitriptyline.

* On January 3, 2001, Partee saw Dr. Melody St. John, a

Rheumatologist, with complaints of a frozen shoulder,

pain in her back, hands, feet and neck, stiffness,

"charley horses" and leg cramps at night, difficulty

sleeping, diarrhea and constipation, a feeling "like she

has a fever all over," and painful breathing. At that

time, Partee was taking BC powders, Vioxx, Elavil,

vitamin C, magnesium, calcium, Aluna, and Exlax. Dr.

St. John diagnosed arthralgias, myalgias, frozen

shoulder, headaches, peptic ulcer, and depression. She

prescribed Prozac , Steri-Pred dose pack, Flexeril ,

9 10

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An analgesic used to treat moderate to moderately severe chronic pain when around- 11

the-clock treatment is needed for an extended period of time. Physicians' Desk

Reference, 2007 Ed.

A non-steroidal anti-inflammatory drug. Physicians' Desk Reference, 2007 Ed. 12

Used in the treatment of acute and chronic osteoarthritis and rheumatoid 13

arthritis. Physicians' Desk Reference, 1995 Ed.

-6-

Ultram , and Mobic . She sent Partee for laboratory 11 12

tests, and told her to return in two weeks.

* On January 17, 2001, Partee returned to Dr. St. John.

Her lab tests had all been normal. Partee was sleeping

better on the medication regimen Dr. St. John had

prescribed. She had some pain and limitation with range

of motion testing in her shoulders, but good range of

motion in her elbows, wrists, hips, knees, and ankles.

Dr. St. John renewed the Ultram prescription and gave

her some samples of Relafen . She was to return in two 13

months to be reevaluated for "possible seronegative

rheumatoid arthritis."

* On January 30, 2001, Dr. Jerry Thomas did a Functional

Capacity Assessment of Partee, without benefit of a

treating source statement. He indicated that Partee

could occasionally lift 10 pounds, and frequently lift

or carry less than 10 pounds; that she could stand or

walk 2 hours in an 8-hour workday, and sit, with normal

breaks, for about 6 hours in a workday. He opined that

she should be restricted from work requiring the ability

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Used in the treatment of seizure and panic disorders. Physicians' Desk Reference, 14

2007 Ed.

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to push or pull with her upper extremities above waist

level. No other limitations were reported. This RFC

was affirmed by Dr. Ronald Crow on May 31, 2002.

* On March 19, 2001, Partee returned to see Dr. St. John.

She complained of swelling in her legs, and jerking of

her legs at night, with trouble standing in the

mornings. She had decreased range of motion in her

shoulders, but otherwise good range of motion. Dr. St.

John took Partee off Relafen and Ultram, put her back on

Prozac, increased her Elavil, and gave her samples of

Day Pro. She was to return to the clinic in three or

four months.

* On July 11, 2001, Partee returned to see Dr. St. John.

She complained of pain in her hands, occasional trouble

turning the pages of a book, leg spasms, being stiff in

the mornings, difficulty walking, and constipation. She

was taking Flexeril, Ultram, BC powders, vitamin C,

magnesium, calcium, Aluna, Exlax, and Relafen. Dr. St.

John prescribed Klonopin , discontinued Elavil, and 14

told Partee to return in one year.

* On December 18, 2001, Partee contacted Dr. St. John's

office with complaint of a charley horse that made her

unable to stand, and then left her leg sore. She was

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told that "this is normal."

* On December 26, 2001, Partee completed a Disability

Report - Adult. She indicated that her ability to work

was limited by fibromyalgia, which made it hard to use

her hands and to walk, and caused spasms. She had

stopped working on February 1, 1998, because of this

condition. Her medications at that time were Flexeril,

Prozac, Elavil, and Klonopin.

* On January 4, 2002, Partee completed a Disability

Supplemental Interview Outline. She indicated that she

could not bathe, dress, shave, or care for her hair

without assistance, because it was hard to hold her

shoulders and arms up, and hard to stand on her right

leg. She could wash dishes, but not do laundry, change

sheets, iron, vacuum or sweep, take out the trash, rake

leaves, do garden work, or drive long distances. If she

did do something like vacuum or sweep, she would not be

able to walk the next day "for pain." She did some

grocery shopping, but did not shop for clothes or do

banking. She said that her fingers were usually

"frozen" and on such days she could not write or do

other things using her fingers. She cooked, but it took

longer than before her disability began. She had a

"terrible short term memory." She used a cane. She

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Used in the acute and long-term treatment of osteoarthritis and rheumatoid 15

arthritis. Physicians' Desk Reference, 1995 Ed.

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spent her time attending church, watching television,

listening to the radio, and reading, although it was

hard to turn pages. Her disability had interfered with

her work when her shoulder became "frozen," and she

could not "lift anything or move my hand and arms." She

suffered from unusual fatigue and required naps. She

had to be helped out of bed because tendons would "stick

out of right leg and that makes me sick." The pain,

located in both legs and feet, and on her right side,

interfered with her sleep. She also noted "terrible"

diarrhea about once a week. She did stretching and

stepping exercise, and took Elavil, Prozac, Klonopin,

and Daypro . She had discontinued Vioxx because of 15

side effects. She noted that she had taken "so many

steroids at first" that she gained 60 pounds in two

months. She gave the following narrative statement:

"My life has changed. I am only 44 & can't hardly stand

the pain. I am up all night for leg spasms. I used to

love bingo, swimming, shopping, & driving my car & now

I can't even wash & dry my hair or lift laundry out & in

dryer or turn pages in bible at church. The pain &

stiffing [sic] of my body has changed not only my life,

but my family's. I feel I am turning into stone."

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* On January 11, 2002, Partee saw Dr. William Wright with

complaints of fibromyalgia and a history of hurting her

shoulder while working as a waitress. She had decreased

range of motion in her right shoulder, and decreased

sensation in her finger tips and toes. Dr. Wright

recorded that Partee was "unreceptive to treatment

suggestion about diet and exercise," and appeared

depressed, with a flat affect. His diagnosis was

fibromyalgia and irritable bowel syndrome. He made no

changes to her medication regimen, which at that time

included Elavil, Klonopin, Prozac, and Flexeril.

* On January 14, 2002, Partee completed another Disability

Supplemental Interview Outline. She indicated that she

could wash dishes and iron, shop for groceries, and do

her banking and post office errands, but could not

bathe, dress or care for her hair without assistance, do

the laundry, change the sheets, vacuum, sweep, take out

the trash, or shop for clothes. She explained that her

arms would not "go back that far" to bathe or dress

herself, and that she had trouble holding her arms up to

wash her hair. Vacuuming hurt her back, and while she

could put clothes in the washing machine, lifting them

from the washer to the dryer caused "terrible pain."

She did prepare meals daily, although it took longer

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than before, and she drove short distances only. She

walked for exercise or errands, but used a cane. She

attended church, watched television, listened to the

radio and read. Her impairments had forced her to quit

work because she could not lift the weight that was

required. She suffered from unusual fatigue, chronic

pain in her hands, forearms, and legs, mainly of the

right side but also in her left hand and foot. She had

pain every day, which interfered with her sleep.

"Simple chores" like mopping or trying to bathe would

make her pain worse. She was taking Elavil, Prozac,

Klonopin, and Flexeril, and noted that she had had to

discontinue taking Vioxx, Clinoril, Daypro, and

hydrocodone because of side effects. She concluded with

the statement "I don't know how to explain what it is

like living with this horrible pain. I am so stiff all

the time I feel as if I am turning to stone. I also

can't afford my medicine. I also have terrible

diarr[hea]."

* On April 1, 2002, Partee completed a Reconsideration

Disability Report. She indicated that her pain had

increased, her fingertips were always numb, and that she

had difficulty writing or using her fingers to turn

pages or pick things up because of numbness and

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swelling. She noted that filling out the form had

caused her right hand to "really hurt[]." Cooking had

become difficult. Her arms were "frozen" at the rotary

cuff, and would only go back "even with my side." Her

left foot also swelled. She stated that she usually had

either diarrhea or constipation, and had gained 50

pounds since she first got sick. Leg spasms sometimes

left her legs sore to the touch for weeks. She had

trouble bathing, and her husband had to help her shower

and wash her hair. She could not drive very far, due to

pain, or hold a book and turn the pages. She did

stretches and yoga daily "to keep from freezing more,"

and had had 50 ultrasound treatments.

* In a Vocational Analysis written on January 30, 2002,and

affirmed on the basis of current medical records on May

31, 2002, Vocational Analyst Sondra Stone opined that

Partee retained the capacity to perform a wide range of

sedentary work, including surveillance-system monitor,

school bus monitor, and airline security representative,

all described as "sedentary to light level exertion jobs

that do not require bilateral hand usage."

* In an undated Claimant's Statement When Request For

Hearing Is Filed And The Issue Is Disability, which

appears to have been prepared about July 15, 2002,

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Useful in the treatment of anxiety disorders as well as for the relief of skeletal 16

muscle spasm due to inflammation of the muscles or joints. Physicians' Desk Reference,

2007 Ed.

-13-

Partee indicated that her hands were experiencing more

pain, for longer periods of time; that her right forearm

and calf hurt; that she was having "[m]ore problems with

running low grade fever and speech difficulty recently."

She had stopped attending church due to pain and

stiffness, and used a cane for about 20 minutes when she

got out of bed in the mornings. She was taking Elavil,

Klonopin, Prozac, and magnesium.

* On August 2, 2002, Partee saw Dr. Brenda Ketcher with a

complaint of a large volume of rectal bleeding,

associated abdominal pain, and alternating diarrhea and

constipation. She was anemic. Dr. Ketcher planned a

colonoscopy. Partee was taking BC Powder, Valium ,

16

Flexeril, Elavil, Ultram, Fiber Choice, and Klonopin. 

* On August 16, 2002, Partee had an EMG and nerve

conduction study at the request of Dr. St. John. Both

studies were reported as normal.

* On August 20, 2002, Partee had a flexible sigmoidoscopy

with polypectomy. The procedure could not be completed

because of adhesions and looping in the pelvic area.

Diagnosis for the areas that could be viewed included

polyps, irritable bowel syndrome and hemorrhoids (the

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The active ingredient in Klonopin. Physicians' Desk Reference, 2007 Ed. 17

Used to treat irritable bowel syndrome. Physicians' Desk Reference, 2007 Ed. 18

-14-

cause of the bleeding).

* On December 2, 2002, Partee saw Dr. William Beebe with

complaints of shortness of breath, congestion, and

cough. Dr. Beebe treated Partee for an upper

respiratory infection, but noted in the process that

"she seemed very weak standing from a seated position,"

and that she reported "having trouble with weakness of

her legs and arms over the last 1-2 years." Dr. Beebe

decided to refer Partee to a neurologist to evaluate

this weakness.

* On August 15, 2003, Partee saw Dr. Ross Bandy for

evaluation of her musculoskeletal symptoms. She told

Dr. Bandy that she had been diagnosed with fibromyalgia,

and reported numbness in her fingertips; discomfort and

swelling in her fingers, worse with flexion; swelling

and discomfort of her right forearm; discomfort in the

right scapular area; fullness and tenderness in the

right calf; occasional left foot swelling; poor sleep;

confused thinking; depression; and headaches. She noted

that Flexeril caused her to be groggy, and Daypro, Vioxx

and Celebrex made her nauseated. She was currently

taking clonazepam , Hyoscyamine , Fiber Choice, Coral 17 18

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This term refers to the finger joints closest to the palm of the hand. Stedman's 19

Medical Dictionary, 28th Ed.

-15-

Calcium, Magnesium, Flexeril (about every two weeks),

and glucosamine/chondroitin. Dr. Bandy observed that

Partee became "teary-eyed intermittently when discussing

her mood." His impressions included polyarthalgias and

questionable polyarthritis of the proximal

interphalangeal joints ; right scapular muscle 19

discomfort; swelling and tenderness of the right

forearm; sleep disturbance, probably secondary to mood;

depression; and decreased internal rotation of the

shoulders. Dr. Bandy made Partee an appointment with

Dr. Charles Lane, a Psychiatrist, and planned to discuss

Partee's physical problems with her primary care doctor,

as well as ordering a variety of tests.

* On August 27, 2003, Dr. Charles Lane conducted a

psychiatric evaluation of Partee. Partee told Dr. Lane

that "her fibromyalgia has completely altered her

lifestyle," that she was reclusive and lacked confidence

around people, and that "she has had great difficulty

convincing physicians of the severity of her pain and

the degree of restriction that it causes." Dr. Lane

opined that Partee's "[c]ontent of thought" was

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"Relating to the soma or trunk, the wall of the body cavity, or the body in 20

general." Stedman's Medical Dictionary, 28th Ed.

A GAF between 41 and 50 indicates "[s]erious symptoms (e.g., suicidal ideation, 21

severe obsessional rituals, frequent shoplifting) OR any serious impairment in social,

occupational, or school functioning (e.g., no friends unable to keep a job). Diagnostic

And Statistical Manual Of Mental Disorders, 4th Ed.

Indicated for the treatment of major depressive disorder. Physicians' Desk 22

Reference, 2007 Ed.

Indicated for treatment of depression. Physicians' Desk Reference, 1995 Ed. 23

This term refers to the finger joints closest to the ends of the fingers. 24

Stedman's Medical Dictionary, 28th Ed.

-16-

"strongly positive for somatic focus." He diagnosed 20

major depression, and assigned Partee a Global

Assessment of Functioning ("GAF") score of 45. He 21

increased her dosage of Lexapro , instructed her to 22

taper off and discontinue Klonopin, added Trazodone ,

23

and "strongly encouraged" Partee to get regular physical

exercise, eat a high protein diet, and "try to increase

her involvement in routine outside activities." She was

to return for a medication check on October 13.

* On September 5, 2003, Partee returned for a follow-up

with Dr. Bandy. Based on his additional exam, and the

results of various tests, Dr. Bandy diagnosed

polyarthralgias and questionable polyarthritis of the

proximal interphalangeal joints; slight osteoarthritis

of distal phalangeal joints ; fibromyalgia; right 24

scapular muscle discomfort; swelling and tenderness of

right forearm; elevated C-reactive protein; sleep

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disturbance, probably secondary to mood; depression; and

decreased internal rotation of shoulders. He advised

Partee to take Flexeril daily at 9 p.m., rather than

every two weeks, and started her on a trial of Bextra.

* In a letter dated September 23, 2003, Shannon Hale,

Partee's daughter, stated that she helped Partee with

mopping and dusting, cleaning the bathroom, changing

sheets, driving if the trip was one which would last

over 20 minutes, cooking, and ironing. She noted that

her mother's hands had deteriorated, and that he

handwriting "has become very bad." She also described

depression that caused Partee to not want to leave the

house, talk on the phone, or even get out of bed.

* Partee testified at a hearing before the ALJ on

September 24, 2003. She said that her main problem was

her hands, which had gotten numb starting about three

years earlier. She said she had fibromyalgia,

osteoarthritis, polymyalgia, irritable bowel syndrome,

a painful lump on her right leg, swelling of her left

foot that made it impossible to wear shoes, and

depression. The numbness in her fingers made it

difficult to write. She testified that Dr. Bandy was

the first doctor who had really "given me some care,"

and would listen to her and help her. She was taking

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Klonopin, Flexeril, Trazodone, and Lexapro. At Dr.

Bandy's recommendation, she exercised by walking in the

lake or pool, by light stretching, and by squeezing

balls to work her hands. She testified that she could

not hold her arms up very long, drive long distances, or

wash her hair, because "[t]hey just won't cooperate."

The areas most affected by fibromyalgia were her arms,

the right side of her back, her lower right leg, and the

top of her left foot. She described pain worsening

since she had filed her application for benefits, and

said that when she opened her eyes in the morning she

would be "just shocked with, with pain." She slept with

pillows under her arms to keep her shoulder blades from

going down, which felt like "a tearing motion."

Sometimes an arm would get "frozen" in the night, and

she would have to have help moving it. She was able to

sleep through the night on her new medication regimen,

however, and was not groggy when she awoke. She did

"very light housekeeping" such as dusting and some

cooking (which really was mostly just heating things

up), but testified that she could not peel a potato or

"anything turning in my hands very well." Her daughter

and husband did the housework, laundry and most of the

cooking. In describing her problem doing laundry, she

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explained that she could put laundry in, but could not

take it out, of the dryer, saying "I can't seem to pick

up anything if I extend my arms out." She could lift a

gallon of milk if she used both hands. She went grocery

shopping every two weeks, in a store about 20 minutes

away, usually with her son driving. Sometimes she would

send her son shopping with a list. On a good day she

could get up and move around, did not feel "like I need

to cry," and could do things like color with her

granddaughter. On a bad day, she would wake up "with a

terrible fever," not be able to move around, have

constipation or nausea, and be "crying all day." She

said she had about three good days a week. On days when

she had a lot of pain, she had trouble speaking,

"trouble getting my words out." She used a three-prong

cane in the mornings to get up. Her arms would not "go

past my body backwards." Her husband helped her shower

and fix her hair. She testified that she was sick of

"living like this," and was "very depressed" and

isolated. 

* On November 22, 2003, Dr. Michael Inman conducted a

mental status exam of Partee for the Commissioner. She

had driven herself to the appointment, an hour away from

her home, and noted that she had had to stop and stretch

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A corticosteroid useful for treating a variety of rheumatic disorders. 25

Physicians' Desk Reference, 1995 Ed.

-20-

and walk midway of the trip. Dr. Inman observed no

problems with Partee's standing or walking, and observed

that she "had no difficulty remaining seated for 4 1⁄2

hours, nor evidenced any obvious pain behaviors such as

grimacing or moaning." Partee gave a history of

"working in the kitchen at the Fish Ne[]t [restaurant]

and hurt my shoulder, my rotary cuff froze. I had 50

physical therapy appointments, and cortisone injections

in my shoulder and hip. Dr. Verser said it was

Fibromyalgia. Now, I see Dr. Bandy and he has changed

my medications, and is looking for why my arthritis is

spreading." Partee described her physical problems as

feeling like she had a "tennis ball size lump" in her

right calf; feeling wobbly when walking; using a walking

stick upon arising; inability to lift anything; writing

hurting her arm "terribly"; chest spasms, and "spastic

bowels." She was currently taking Flexeril, Trazodone,

Clonazepam, Lexapro, Valium, and prednisone . Partee 25

was anxious, tense and trembling during the exam. She

reported sleeping only 3-4 hours a night, due to pain,

and having gained 60 pounds in the past six months. She

told Dr. Inman that she was "getting to where I can't

stand the thought of living with this pain the rest of

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my life." She reported that her husband helped her

shower and wash and dry her hair and dress; that she did

not drive out of town by herself; that her husband did

the shopping; that her husband did the laundry and her

daughter did the "hard cleaning," but she did dishes and

"fast cooking." Testing showed Partee to have a Full

Scale IQ of 86 - in the low average range - and Dr.

Inman considered her responses to be candid, with no

evidence of exaggeration or malingering. He diagnosed

her with pain disorder associated with both

psychological factors and general medical condition;

major depression, recurrent, moderate; generalized

anxiety disorder; and personality disorder, not

otherwise specified, with dependent traits. He did not

assign a GAF score. He opined that her prognosis, with

treatment, "would be guarded."

* On November 26, 2003, Dr. Inman completed a Medical

Source Statement Of Ability To Do Work-Related

Activities (Mental). He indicated that Partee had

moderate impairment in her ability to respond

appropriately to work pressures in a usual work setting,

but found no other impairments.

* On June 4, 2004, Dr. Bandy hospitalized Partee for

depression. She arrived agitated and crying, stating

Case 6:05-cv-06075-BAB Document 10 Filed 03/27/07 Page 21 of 29 PageID #: <pageID>
A GAF between 21 and 30 indicates "[b]ehavior is considerably influenced by 26

delusions or hallucinations OR serious impairment in communication or judgment (e.g.,

sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability

to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).

Diagnostic And Statistical Manual Of Mental Disorders, 4th Ed.

Indicated in the treatment of major depressive disorder. Physicians' Desk 27

Reference, 2007 Ed.

A hypnotic agent used in the treatment of insomnia. Physicians' Desk Reference, 28

2007 Ed.

-22-

that she was in "too much pain" and could not "deal with

it anymore." She gave a history of stomach problems,

spasm in chest and abdomen, diarrhea, and polyarthritis.

She was taking Prozac, Elavil and Flexeril, but said

that she had stopped taking Klonopin and Lexapro for

financial reasons. Dr. Alfred Brem diagnosed major

depression; chronic pain disorder with physical and

psychological components; fibromyalgia; polyarthritis;

and probable irritable bowel syndrome. He estimated her

GAF on admission at 30. In sizing up the cause of 26

Partee's problems, Dr. Brem noted "[n]o doubt, she has

very serious depression that is complicating her pain

and the pain is also making her more depressed." He

prescribed Effexor , Darvocet, prednisone, Zanaflex 27

(for "some very unusual muscle tightness in her

forearms), and Ambien .

28

4. Partee contends that the ALJ's decision is not supported

by substantial evidence, and that he erred in concluding that she

retained the residual functional capacity to perform a full range

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of sedentary work. The second of these contentions is of no

merit, inasmuch as the ALJ did not find that Partee could perform

a full range of sedentary work. The first contention, however,

calls for further analysis, which in turn leads to the conclusion

that several findings of the ALJ are not supported by substantial

evidence, and that the case must be remanded with instructions, as

outlined below.

5. The ALJ found that Partee "has sought no significant

treatment for her shoulder condition since 1999." The record

reflects visits which include consultation about shoulder pain to

Dr. Verser (October 5, 2000); Dr. St. John (January 3, 2001;

January 17, 2001; March 19, 2001); Dr. Wright (January 11, 2002);

and Dr. Bandy (August 15, 2003; September 5, 2003). While this is

not a steady stream of consultations, it appears that Partee

returned for follow-up as advised and took the medications

prescribed. The record also reflects other visits to these same

physicians for complaints other than shoulder pain, but consistent

with the diagnosis of fibromyalgia, as outlined in paragraph 9,

infra. Consistent with the instructions contained in that

paragraph, upon remand the ALJ is directed to consider Partee's

medical consultations as part of a continuum of seeking treatment

for fibromyalgia symptoms, rather than isolating the shoulder

complaints from other physical complaints. "The ALJ must consider

the impairments in combination and not fragmentize them in

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evaluating their effects." Delrosa v. Sullivan, 922 F.2d 480 (8th

Cir. 1991). 

6. The ALJ found that Partee "has generally fair to good

control of her depression when she seeks treatment for symptoms or

a life stressor precipitates reoccurrence or aggravates her

depression," and noted that impairments that can be controlled

with medication are not disabling, Roth v. Shalala, 45 F.3d 279

(8th Cir. 1995). This conclusion is not supported by substantial

evidence. The record reflects that Partee was on Elavil when she

first consulted Dr. St. John in January, 2001, and that Dr. St.

John either added Prozac, or switched her to Prozac. From that

time forward, Partee was prescribed a varying regimen of antidepressants, including Elavil, Prozac, Trazodone, and Lexapro. In

addition, she was placed on several anti-anxiety medications,

including Klonopin and Valium. When Dr. Lane diagnosed Partee

with major depression in August, 2003, she was taking Lexapro and

Klonopin. When Dr. Inman diagnosed Partee with "major depression,

recurrent, moderate" in November, 2003, she was taking Trazodone,

clonazepam, Lexapro, and Valium. When Partee was hospitalized for

major depression in June, 2004, she was taking Prozac and Elavil.

The ALJ is directed, upon remand, to consider what effect Partee's

depression and anxiety -- treated by appropriate medications --

will have on her ability to work, and to obtain medical

consultations appropriate to this inquiry.

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7. The AlJ found Partee's level of activity inconsistent

with her alleged impairments, noting that she could do light

housework; cook breakfast and fix her husband's lunch; shop for

groceries and drive a car short distances; do exercises consisting

of "water walking," stretching, and squeezing balls with her

hands; color with her grandchild; attend church; read, watch

television, and listen to the radio; and use a checkbook. This

activity list may well be an overstatement of Partee's

capabilities. The record reflects that by mid-2002 Partee had

started using a cane to assist her with getting around in the

mornings, and stopped attending church because of her pain and

stiffness. In August, 2003, Dr. Lane found that Partee was

reclusive and lacked confidence around people. In September,

2003, Partee's daughter indicated that Partee's hands had

"deteriorated" and her handwriting had become very bad, and that

Partee did not want to leave the house, talk on the phone, or even

get out of bed. At the hearing, Partee testified that she did

"very light housekeeping" such as dusting, and that her cooking

consisted mainly of heating up foods prepared by others. Her

daughter and husband did most of the housework, laundry and

cooking. Partee also noted that she had good days and bad days,

and that on a bad day she would wake up with a fever, cry all day,

and have trouble speaking. Neither the level of activity

described by Partee, nor that parsed out by the ALJ, is

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necessarily consistent with the ability to work. The Eighth

Circuit has "repeatedly stated that the ability to do activities

such as light housework and visiting with friends provides little

or no support for the finding that a claimant can perform fulltime competitive work." Hogg v. Shalala, 45 F.3d 276, 278 (8th

Cir. 1995). On remand, the ALJ is directed to determine which of

Partee's activities indicate an ability to do work, and which --

such as coloring or watching television -- in actuality have

little or no bearing on the issue. 

8. The ALJ found that Partee's credibility was "seriously

undermined" by her failure to seek consistent medical care. The

record shows that between her alleged onset date (December 3,

2001) and the hearing before the ALJ (September 24, 2003), Partee

sought care or underwent testing for her musculoskeletal problems

on December 18, 2001; January 11, 2002; August 2, 2002; August 16,

2002; August 20, 2002; December 2, 2002; August 15, 2003; and

September 5, 2003. The medications recorded at these visits

indicate that Partee was taking medications for depression and

musculoskeletal pain and stiffness throughout this period. On

remand, Partee's pharmaceutical records should be obtained in

order to determine whether Partee was refilling her medications

during periods when she did not see doctors for several months.

The effect of depression on the willingness and/or ability to seek

out medical care should also be evaluated.

Case 6:05-cv-06075-BAB Document 10 Filed 03/27/07 Page 26 of 29 PageID #: <pageID>
"A spontaneous abnormal usually nonpainful sensation (e.g. burning, pricking)." 29

Stedman's Medical Dictionary, 28th Ed.

-27-

9. The ALJ found that the objective clinical and laboratory

findings did not support the level of impairment asserted by

Partee, because there was no evidence of muscle weakness or

atrophy, reflex abnormality, or "demonstrated degenerative or

other type of arthritis." This analysis ignores the close

correlation of Partee's symptoms with those of fibromyalgia.

Stedman's Medical Dictionary, 28th Ed. (published in 2006), gives

the following information on fibromyalgia:

Fibromyalgia is a disorder of unknown cause

characterized by chronic widespread aching and

stiffness, involving particularly the neck, shoulders,

back, and hips, which is aggravated by use of the

affected muscles. . . . Usually associated fatigue, a

sense of weakness or inability to perform certain

movements, paresthesia , difficulty sleeping, and 29

headaches are found. . . . Fibromyalgia frequently

occurs in conjunction with migraine headaches,

temporomandibular joint dysfunction, irritable bowel

syndrome, restless legs syndrome, chronic fatigue, and

depression; symptoms are typically exacerbated by

emotional stress. . . . Most patients (90%) are adult

women. . . . Most patients experience moderate to severe

disability, but symptoms can usually be mitigated by

treatment. Effective treatment programs include

education, a regular program of low-impact aerobic

exercise, and physical therapy as needed.

Fibromyalgia has only recently begun to be recognized as a

"real" medical condition, and many doctors are still either

unaware of it, or unwilling to consider it as a diagnosis.

Indeed, the 26th edition of Stedman's Medical Dictionary

(published in 1995) did not even contain a listing for the term.

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Thus it is not surprising that Partee reported difficulty

"convincing physicians of the severity of her pain and the degree

of restriction that it causes," as she explained to Dr. Lane in

August, 2003. It would be quite surprising if a woman with an IQ

of 86 could effectively mimic the symptoms of this mysterious

condition. Yet the record contains a 41⁄2 year history of pain and

stiffness in the shoulders, back, legs and neck; "frozen

shoulders" and a feeling of "turning to stone"; inability to

perform certain movements such as putting her arms behind her;

numbness of the fingers; sleep disturbances; fatigue; irritable

bowel syndrome; jerking legs; and depression. This combination of

symptoms is entirely consistent with what is now known about

fibromyalgia. The ALJ failed to consider whether Partee met the

parameters of this condition, and what effect the condition might

have on her ability to work, focusing instead on the shoulder pain

in isolation.

10. The ALJ also failed to consider the synergistic effects

of pain and depression on Partee's ability to work, and in fact,

it appears that neither Partee nor her medical care providers were

thinking along these lines until Dr. Beebe referred Partee to Dr.

Bandy, who recognized the seriousness of Partee's complaints,

including her depression, and referred her to Dr. Lane for

psychiatric evaluation. Dr. Bandy recognized that Partee was in

a dangerous tailspin: she had "very serious depression that is

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complicating her pain and the pain is also making her more

depressed." Upon remand, the ALJ is directed to recontact Dr.

Bandy to obtain Dr. Bandy's opinion on the effect of Partee's pain

on her depression; the effect of her depression on her pain; and

the combined effect of pain and depression on her ability to do

mental work-related activities.

IT IS THEREFORE ORDERED that the decision of the Commissioner

is reversed, and this matter is remanded to the Commissioner for

further consideration pursuant to sentence four of 42 U.S.C.

§405(g). Upon remand, the Commissioner is directed to conduct the

inquiries and take into consideration the matters outlined in this

Judgment.

If plaintiff wishes to request an award of attorney's fees

and costs under the Equal Access to Justice Act, an application

may be filed up until thirty days after the judgment becomes "not

appealable," i.e., thirty days after the sixty-day time for appeal

has ended. Shalala v. Schaefer, 509 U.S. 292 (1993); 28 U.S.C. §§

2412(d)(1)(B) and (d)(2)(G).

IT IS SO ORDERED.

 /s/ Jimm Larry Hendren 

JIMM LARRY HENDREN

UNITED STATES DISTRICT COURT

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