Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-6_18-cv-01149/USCOURTS-alnd-6_18-cv-01149-0/pdf.json

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

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UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

JASPER DIVISION

BRENT STEEPLES,

Plaintiff,

v.

ANDREW SAUL, Commissioner of 

the Social Security Administration,1

Defendant.

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Case No.: 6:18-cv-1149-MHH

MEMORANDUM OPINION 

Pursuant to 42 U.S.C. § 405(g), Brent Steeples seeks judicial review of a final 

adverse decision of the Commissioner of Social Security. After this Court in 6:15-

cv-01861-SGC remanded Mr. Steeples’s claims for disability insurance benefits and 

supplemental security income for further proceedings, the ALJ denied Mr. Steeples’s

disability insurance benefits claim, and Mr. Steeples appealed. For the reasons 

stated below, the Court remands the Commissioner’s decision. 

1 The Court asks the Clerk to please substitute Andrew Saul for Nancy A. Berryhill as the defendant 

pursuant to Rule 25(d) of the Federal Rules of Civil Procedure. See Fed. R. Civ. P. 25(d) (When 

a public officer ceases holding office, that “officer’s successor is automatically substituted as a 

party.”); see also 42 U.S.C. § 405(g) (“Any action instituted in accordance with this subsection 

shall survive notwithstanding any change in the person occupying the office of Commissioner of 

Social Security or any vacancy in such office.”).

FILED

 2020 Mar-30 AM 08:31

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 1 of 37
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I. PROCEDURAL HISTORY

In January 2012, Mr. Steeples applied for disability insurance benefits. (Doc. 

6-11, p. 15). Mr. Steeples alleged that his disability began on August 15, 2011. On 

March 16, 2012, the Commissioner denied Mr. Steeples’s application. (Doc. 6-4, p. 

5). 

In 2013, Mr. Steeples applied for disability, disability insurance benefits, and 

supplemental security income. (Doc. 6-4, pp. 6, 7). Mr. Steeples alleged again that 

his disability began on August 15, 2011. (Doc. 6-4, pp. 6, 7). The Commissioner 

initially denied Mr. Steeples’s application. (Doc. 6-4, pp. 6, 7). Mr. Steeples

requested a hearing before an Administrative Law Judge (ALJ). (Doc. 6-3, p. 8).

The ALJ issued an unfavorable decision, and the Appeals Council declined Mr. 

Steeples’s request for review. (Doc. 6-3, pp. 1, 14-22). 

Mr. Steeples appealed, and on February 24, 2017, this Court remanded Mr. 

Steeples’s application to the Commissioner for consideration of “new, noncumulative, [and] temporally relevant evidence” from Mr. Steeples’s osteopathic

physician, Dr. Ragland. (Doc. 6-12, pp. 24-34).2

 The Appeals Council vacated the 

adverse decision and remanded Mr. Steeples’s claims to the same ALJ. (Doc. 6-3, 

2 Dr. Ragland holds a D.O. (Doc. 6-20, p. 2). “A doctor of osteopathic medicine (D.O.) is a fully 

trained and licensed doctor who has attended and graduated from a U.S. osteopathic medical 

school. . . . The major difference between osteopathic and [other] doctors is that some osteopathic 

doctors provide manual medicine therapies, such as spinal manipulation or massage therapy, as 

part of their treatment.” https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expertanswers/osteopathic-medicine/faq-20058168 (last visited Mar. 10, 2020).

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 2 of 37
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p. 22; Doc. 6-12, pp. 34, 37). By that time, Mr. Steeples had filed a new application 

for benefits, so the ALJ consolidated Mr. Steeples’s old and new claims into one 

administrative action. (Doc. 6-12, p. 43; Doc. 6-14, pp. 2, 6). On March 27, 2018, 

the ALJ approved Mr. Steeples’s application for supplemental security income and 

denied his application for disability insurance benefits. (Doc. 6-11, pp. 11-27). 

On May 30, 2018, Mr. Steeples asked the Appeals Council to review the 

ALJ’s March 2018 decision, (Doc. 6-11, p. 7), and he requested additional time to 

prepare his appeal (Doc. 6-11, p. 8). The Appeals Council explained to Mr. Steeples 

that it appeared that he waited too long to request additional time. (Doc. 6-11, p. 3). 

The Appeals Council gave Mr. Steeples the opportunity to demonstrate that he had 

requested additional time within 30 days of the ALJ’s decision. (Doc. 6-11, pp. 3-

4). Mr. Steeples did not respond to the Appeals Council’s notice. Instead, he filed 

this action in this Court on July 25, 2018, within 120 days of the ALJ’s decision. 

See 42 U.S.C. § 405(g) (“Any individual, after any final decision of the 

Commissioner of Social Security made after a hearing to which he was a party, 

irrespective of the amount in controversy, may obtain a review of such decision by 

a civil action commenced within sixty days after the mailing to him of notice of such 

decision or within such further time as the Commissioner of Social Security may 

allow.”); (Doc. 6-11, p. 11) (ALJ’s decision stating: “If you think my decision is 

wrong, you should file your exceptions [with the Appeals Council] within 30 days 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 3 of 37
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or file a new civil action [in federal district court] between the 61st and 121st day 

after the date of this notice.”). Consequently, this action is properly before the Court.

II. STANDARD OF REVIEW

The scope of review in this matter is limited. “When, as in this case, the ALJ

denies benefits and the Appeals Council denies review,” the Court “review[s] the 

ALJ’s ‘factual findings with deference’ and [his] ‘legal conclusions with close 

scrutiny.’” Riggs v. Comm’r, Soc. Sec. Admin., 522 Fed. Appx. 509, 510-11 (11th 

Cir. 2013) (quoting Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001)). 

The Court must determine whether there is substantial evidence in the record 

to support the ALJ’s findings. “Substantial evidence is more than a scintilla and is 

such relevant evidence as a reasonable person would accept as adequate to support 

a conclusion.” Crawford v. Comm’r, Soc. Sec. Admin., 363 F.3d 1155, 1158 (11th 

Cir. 2004). In making this evaluation, the Court may not “decide the facts anew, 

reweigh the evidence” or substitute its judgment for that of the ALJ. Winschel v. 

Comm’r, Soc. Sec. Admin., 631 F.3d 1176, 1178 (11th Cir. 2011) (internal quotations 

and citation omitted). If the ALJ’s decision is supported by substantial evidence,

then the Court “must affirm even if the evidence preponderates against the 

Commissioner’s findings.” Costigan v. Comm’r, Soc. Sec. Admin., 603 Fed. Appx. 

783, 786 (11th Cir. 2015) (citing Crawford, 363 F.3d at 1158).

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 4 of 37
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With respect to the ALJ’s legal conclusions, the Court must determine 

whether the ALJ applied the correct legal standards. If the Court finds an error in 

the ALJ’s application of the law, or if the Court finds that the ALJ failed to provide 

sufficient reasoning to demonstrate that the ALJ conducted a proper legal analysis, 

then the Court must reverse the ALJ’s decision. Cornelius v. Sullivan, 936 F.2d 

1143, 1145-46 (11th Cir. 1991). 

III. SUMMARY OF THE ALJ’S DECISION

To determine whether a claimant has proven that he is disabled, an ALJ 

follows a five-step sequential evaluation process. The ALJ considers:

(1) whether the claimant is currently engaged in substantial gainful 

activity; (2) whether the claimant has a severe impairment or 

combination of impairments; (3) whether the impairment meets or 

equals the severity of the specified impairments in the Listing of 

Impairments; (4) based on a residual functional capacity (“RFC”) 

assessment, whether the claimant can perform any of his or her past 

relevant work despite the impairment; and (5) whether there are 

significant numbers of jobs in the national economy that the claimant

can perform given the claimant’s RFC, age, education, and work 

experience.

Winschel, 631 F.3d at 1178. In this case, because Mr. Steeples seeks disability 

insurance benefits, the ALJ also had to determine whether Mr. Steeples was insured 

when he became disabled. (Doc. 6-11, p. 16).

The ALJ found that Mr. Steeples met the insured status requirements for 

disability insurance benefits through December 31, 2016. (Doc. 6-11, pp. 16, 18). 

The ALJ also found that Mr. Steeples had not engaged in substantial gainful activity 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 5 of 37
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since March 17, 2012, the day following the adverse administrative determination

on his 2012 application for benefits. (Doc. 6-11, p. 18). The ALJ determined that 

Mr. Steeples suffered from the following severe impairments from March 17, 2012, 

through February 27, 2017: hypertensive cardiovascular and peripheral vascular 

diseases, allergic rhinitis, obesity, and a seizure disorder. (Doc. 6-11, p. 18). The 

ALJ found that Mr. Steeples’s degenerative joint disease became severe effective 

February 27, 2017. (Doc. 6-11, p. 18).3

 Mr. Steeples suffered from the non-severe 

impairments of chronic obstructive pulmonary disease, diabetes mellitus with 

neuropathy, degenerative joint disease (pre-February 27, 2017), and ulcerative 

colitis. (Doc. 6-11, p. 18).4

 

The ALJ determined that Mr. Steeples became disabled on February 27, 2017. 

(Doc. 6-11, pp. 20, 26). The ALJ held that before February 27, 2017, Mr. Steeples

had the RFC to perform medium work as defined in 20 C.F.R. §§ 404.1567(c) and

416.967(c) subject to the following limitations: 

occasional postural maneuvers with the exception of no climbing of 

ropes, ladders, or scaffolds. [Mr. Steeples] would need to avoid 

3 “Degenerative joint disease, which is also referred to as osteoarthritis (OA), is a common ‘wear 

and tear’ disease that occurs when the cartilage that serves as a cushion in the joints deteriorates. 

This condition can affect any joint but is most common in knees, hands, hips, and spine.” 

https://www.aapmr.org/about-physiatry/conditions-treatments/pain-neuromuscular-medicinerehabilitation/degenerative-joint-disease (last visited Mar. 11, 2020).

4 “Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord 

(peripheral nerves), often causes weakness, numbness and pain, usually in [a person’s] hands and 

feet. . . . One of the most common causes is diabetes.” https://www.mayoclinic.org/diseasesconditions/peripheral-neuropathy/symptoms-causes/syc-20352061 (last visited Mar. 13, 2020). 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 6 of 37
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dangerous moving unguarded machinery, unprotected heights, large 

bodies of water, and uneven terrain. 

(Doc. 6-11, p. 20). “Medium work involves lifting no more than 50 pounds at a time 

with frequent lifting or carrying of objects weighing up to 25 pounds.” 20 C.F.R. § 

404.1567(c); 20 C.F.R. § 416.967(c). “If someone can do medium work, . . . he . . .

can also do sedentary and light work.” 20 C.F.R. § 404.1567(c); 20 C.F.R. § 

416.967(c). The ALJ relied on testimony from a vocational expert and concluded

that before February 27, 2017, Mr. Steeples could perform his past relevant work as 

a poultry boner. (Doc. 6-11, pp. 25-26). 

Because the ALJ determined that Mr. Steeples was not under a disability 

within the meaning of the Social Security Act until February 27, 2017, and because

December 31, 2016, was Mr. Steeples’s date last insured, (Doc. 6-1 p. 27), the ALJ 

concluded that disability insurance benefits were not available to Mr. Steeples. 

IV. ANALYSIS

Mr. Steeples argues that he is entitled to relief from the ALJ’s decision 

because the ALJ did not properly evaluate his RFC or his reasons for not complying

with treatment. (Doc. 11, p. 4). Mr. Steeples also contends that the ALJ committed 

error when she treated March 17, 2012 as his onset date based on his unsuccessful 

application for benefits in 2012. (Doc. 11, p. 4). The Court finds that the ALJ 

properly identified March 17, 2012 as Mr. Steeples’s effective onset date, but the 

Court remands because substantial evidence does not support the ALJ’s finding that 

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Mr. Steeples did not become disabled until February 27, 2017, and because 

substantial evidence does not support her decision to discount Mr. Steeples’s pain 

testimony.

5

 

Res Judicata

In this action, Mr. Steeples challenges the ALJ’s denial of his January 2013

application for disability insurance benefits. (Doc. 6-4, p. 6). In that application, 

Mr. Steeples asserted that his disability began on August 15, 2011. (Doc. 6-4, p. 6). 

As discussed above, Mr. Steeples also applied for disability insurance benefits in 

January 2012. (Doc. 6-11, p. 15). Mr. Steeples states that he asserted an onset date 

of August 15, 2011, in his 2012 application for disability insurance benefits. (Doc. 

11, p. 24).6 

On March 16, 2012, the Commissioner denied Mr. Steeples’s January 2012 

application for disability insurance benefits. (Doc. 6-4, p. 5). In September 2012, 

at Mr. Steeples’s request, the ALJ dismissed Mr. Steeples’s request for an 

administrative hearing on the 2012 application. (Doc. 6-4, pp. 2, 5). In the 

September 2012 order, the ALJ found that Mr. Steeples understood that because he 

was withdrawing his request for a hearing, the initial March 16, 2012 denial of his 

request for disability insurance benefits would remain in effect. (Doc. 6-4, p. 5).

5 The Court does not decide the RFC issues.

6 The Court has not located Mr. Steeples’s 2012 application in the administrative record.

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The ALJ found that res judicata precluded Mr. Steeples from using August 

2011 as his asserted onset date for his 2013 application for disability insurance 

benefits. The ALJ stated that “res judicata applie[d] through” March 16, 2012, the 

date of the Commissioner’s 2012 adverse decision, so the ALJ would “consider only 

if [Mr. Steeples] ha[d] been under a disability beginning March 17, 2012.” (Doc. 6-

11, p. 16). 

An ALJ may base a finding on the principle of res judicata if the 

Commissioner has “made a previous determination or decision . . . on the same facts 

and on the same issue or issues, and th[e] previous determination or decision has 

become final by either administrative or judicial action.” 20 C.F.R. § 404.957(c)(1). 

Mr. Steeples argues that “the current [2013] application [does] not involve the same 

facts and issues as the prior [2012] application” because “this Court remanded the 

case to the Commissioner, holding that the Appeals Council erred in denying review 

of new, material, and chronologically [relevant] evidence Steeples submitted to the 

Council.” (Doc. 11, pp. 24-25). But in its February 24, 2017 opinion remanding 

Mr. Steeples’s 2013 application for additional proceedings, this Court accepted the 

ALJ’s res judicata analysis and her finding of a March 17, 2012 onset date. (Doc. 

6-12, p. 24, n. 2). That finding became the law of the case. See Musacchio v. United 

States, 136 S. Ct. 709, 716 (2016) (Under the law-of-the-case doctrine, an appellate 

court declines “to depart from a ruling that it made in a prior appeal in the same 

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case.”); see also Piambino v. Bailey, 757 F.2d 1112, 1120 (11th Cir.1985) (“The law 

of the case doctrine is not an inexorable command, but rather a salutary rule of 

practice designed to bring an end to litigation, discourage panel [or district court 

judge] shopping, and ensure the obedience of lower courts.”) (internal quotation 

marks and citations omitted); United States v. Hall, 628 Fed. Appx. 681, 684 (11th 

Cir. 2015) (per curiam) (“The law-of-the-case doctrine is a rule of practice selfimposed by the court and operates to create efficiency, finality, and obedience within 

the justice system.”). 

Moreover, the 2017 remand concerned medical records from 2014 that Mr. 

Steeples presented to the Appeals Council after the ALJ initially denied his 2013 

application. The Court’s opinion requiring further examination of Mr. Steeples’s 

2013 application in light of the new medical evidence did not require reassessment 

of the March 2012 onset date. As Mr. Steeples argues in his reply brief (Doc. 15, p. 

10), the Court did note that the new medical evidence “relate[d] to long-standing 

conditions addressed by the ALJ,” (Doc. 6-12, p. 31), but that observation pertained 

to the Court’s finding that the new evidence “relate[d] to the period of time before 

the ALJ’s decision,” (Doc. 6-12, p. 31). The finding did not alter the relevant period 

of time before the ALJ’s decision, which the ALJ properly found began on March 

17, 2012 because of the res judicata effect of the March 16, 2012 adverse decision 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 10 of 37
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concerning Mr. Steeples’s 2012 application for benefits. Consequently, the Court 

affirms the ALJ’s use of an onset date of March 17, 2012.

The ALJ’s Finding that Mr. Steeples Became Disabled in February 2017

In determining that Mr. Steeples first became disabled in February 2017, the 

ALJ found that Dr. Ragland’s February 2017 treatment notes “corroborate [Mr. 

Steeples’s] allegations of knee pain and dysfunction.” (Doc. 6-11, p. 25). The ALJ 

stated:

This orthopaedic impairment combined with [Mr. Steeples’s] [sic]

contributes to his inability to perform routine movement and necessary 

physical activity [in] a medium work environment and [substantiates a 

need to] miss[] two or more days of work per month.

(Doc. 6-11, p. 25).7

 The ALJ discounted Mr. Steeples’s pre-February 2017 

subjective pain testimony partially because she found that Mr. Steeples “chose to 

allot money to tobacco over his medical need for treatment.” (Doc. 6-11, p. 23). 

Mr. Steeples contends that the ALJ erred because his evidence establishes that 

he became disabled before December 31, 2016, his date last insured. To evaluate 

Mr. Steeples’s argument, the Court must examine Ms. Steeples’s evidence. The 

Court has reviewed the entire record, but the Court has focused on the medical 

information relevant to Mr. Steeples’s osteoarthritis and knee impairment. 

The Medical Evidence

7 It appears the ALJ omitted the word “obesity” from this sentence. (Doc. 11, pp. 10, 12; Doc. 12, 

p. 7 n.3).

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In August, September, three times in October, and November 2011, Mr. 

Steeples visited Dr. Naidu, a physician with the Cardiovascular Institute of the 

Shoals based on a referral from Dr. Long, a primary care doctor with Family Medical 

Associates. (Doc. 6-8, pp. 63, 71, 75, 80, 86, 95; Doc. 6-9, p. 3; Doc. 6-9, p. 97). 

Mr. Steeples denied joint pain, stiffness, and swelling, muscle cramps, weakness, 

and aches, loss of strength, arthritis, and limb pain. (Doc. 6-8, pp. 65, 73, 77, 82, 

88, 97). After examining Mr. Steeples, Dr. Naidu noted that Mr. Steeples had full 

extremity strength. (Doc. 6-8, pp. 66, 74, 78, 83, 8, 98). The record of Mr. Steeples’s

March 2012 visit with Dr. Naidu contains similar information. (Doc. 6-8, pp. 101, 

103, 104). 

In September 2011, Dr. Naidu referred Mr. Steeples to Dr. Boorgu, a doctor 

with Shoals Kidney and Hypertension. (Doc. 6-8, p. 110). After examining Mr. 

Steeples, Dr. Boorgu noted minimal edema in Mr. Steeples’s lower extremities but 

reported no other musculoskeletal abnormalities. (Doc. 6-8, p. 111). Mr. Steeples 

did not complain of osteoarthritis or knee problems during this visit. (Doc. 6-8, pp. 

110, 111).

At the Commissioner’s request, Dr. Auxier, a general physician with Auxier 

Medical Center, examined Mr. Steeples in March 2012. (Doc. 6-9, pp. 59-62). 

During the evaluation with Dr. Auxier, Mr. Steeples complained of seizure disorders 

which caused Mr. Steeples to stop working at Pilgrim’s Pride as a chicken deboner 

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in 2011. (Doc. 6-9, p. 59). Mr. Steeples reported taking medication unrelated to 

pain. (Doc. 6-9, p. 59). Mr. Steeples denied “generalized joint pain or swelling.” 

(Doc. 6-9, p. 60). Dr. Auxier noted that Mr. Steeples’s range of motion in the knees, 

gait, station, squatting ability, heel to toe walking, and leg raising tests were normal. 

(Doc. 6-9, pp. 60-61). Dr. Auxier opined that Mr. Steeples was temporarily disabled 

from seizure activity and hypertension. (Doc. 6-9, p. 62).

In July 2012, Mr. Steeples saw Dr. Shukla, a gastroenterologist with 

Gastrointestinal Specialists, P.C. (Doc. 6-9, p. 3). Dr. Shukla noted that Mr. 

Steeples had a normal gait and no muscle weakness. (Doc. 6-9, p. 4).

In March 2013, Mr. Steeples visited a nurse practitioner with Family Care 

First and complained of blacking out, lower stomach pain, and uncontrolled high 

blood pressure. (Doc. 6-9, pp. 8-9). The nurse practitioner noted that Mr. Steeples 

had a normal gait and no edema or ataxia. (Doc. 6-9, p. 9). 8

At the Commissioner’s request, Dr. Harrison, a general physician with Boyde 

Jerome Harrison MDPC, completed an examination of Mr. Steeples in late March 

2013. (Doc. 6-9, pp. 10, 11, 14). Mr. Steeples complained of seizures, headaches, 

8 “Ataxia is typically defined as the presence of abnormal, uncoordinated movements. This usage 

describes signs [and] symptoms without reference to specific disease. An unsteady, staggering gait 

is described as an ataxic gait because walking is uncoordinated and appears to be ‘not ordered.’” 

https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/ataxia/conditions/

(last visited Mar. 3, 2020).

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and tinnitus. (Doc. 6-9, pp. 11, 12).9 Dr. Harrison noted that Mr. Steeples had a 

history of hypertension and possible ulcerative colitis. (Doc. 6-9, p. 11). Based on 

his examination, Dr. Harrison reported that Mr. Steeples had a normal range of 

motion in the knees. (Doc. 6-9, p. 13). Dr. Harrison opined that Mr. Steeples could 

“probably perform work related activities if his motivation were adequate.” (Doc. 

6-9, p. 14).

In July 2013, Mr. Steeples visited Dr. Ragland, an osteopathic doctor with 

Family Medical Associates. (Doc. 6-9, p. 24). Mr. Steeples told Dr. Ragland that

one year had passed since Dr. Long (also with Family Medical Associates as noted 

above) had treated him. (Doc. 6-9, p. 24). Mr. Steeples complained of colitis,

abdominal pain, and burning sensations in his back when bending. (Doc. 6-9, p. 24). 

Dr. Ragland’s diagnoses included colitis, hypertension, seizure disorder, and low 

back pain. (Doc. 6-9, p. 24). Dr. Ragland prescribed Mobic (one 7.5 mg tablet daily) 

for Mr. Steeples’s back symptoms. (Doc. 6-9, p. 24). Mobic (meloxicam) is an 

NSAID “used to treat pain or inflammation caused by . . . osteoarthritis.” 

https://www.drugs.com/search.php?searchterm=mobic&sources%5B%5D= (last 

visited Mar. 9, 2020).

9 “Tinnitus is the perception of noise or ringing in the ears.” https://www.mayoclinic.org/diseasesconditions/tinnitus/symptoms-causes/syc-20350156 (last visited Mar. 5, 2020).

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In September 2013, Mr. Steeples returned to Dr. Ragland and complained of 

eight months of back and stomach pain. (Doc. 6-16, p. 34). Mr. Steeples stated that 

he had not picked up the Mobic that Dr. Ragland had prescribed on his last visit. 

(Doc. 6-16, p. 34). Dr. Ragland’s diagnoses included benign hypertension, seizure 

disorder, back pain, and diabetes. (Doc. 6-16, p. 34). 

In March 2014, Mr. Steeples saw Dr. Ragland for medication refills. He 

complained of pain from a hernia on his abdomen. (Doc. 6-16, p. 30). Dr. Ragland 

diagnosed benign hypertension, diabetes, a hernia, hyperlipidemia, and abdominal 

pain. (Doc. 6-16, p. 30). Mr. Steeples’s medication list did not include Mobic or 

other pain relievers. (Doc. 6-16, p. 32).

In May 2014, Mr. Steeples visited Dr. Ragland for medication refills. He also 

asked her to complete forms for his disability claims. (Doc. 6-16, p. 25). During 

this visit, Dr. Ragland’s diagnoses were benign hypertension, diabetes, 

hyperlipidemia, seizure disorder, abnormal EKG, and acute COPD. (Doc. 6-16, p. 

25). Mr. Steeples’s medication list did not include Mobic or other pain relievers. 

(Doc. 6-16, pp. 25, 26). 

Mr. Steeples returned one day later to pick up the mental and physical

disability forms that Dr. Ragland had completed. (Doc. 6-16, p. 24; Doc. 6-9, p. 97; 

Doc. 6-10, pp. 2-3, 5-6; Doc. 6-16, p. 24). According to this May 2014 treatment 

record, Dr. Ragland’s diagnoses of Mr. Steeples included benign hypertension, Type 

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II diabetes, acute COPD, and joint pain. (Doc. 6-16, p. 24). Dr. Ragland noted in 

an accompanying cover letter that Mr. Steeples had been a patient of Family Medical 

Associates for many years. (Doc. 6-9, p. 97). Dr. Ragland reported that Mr. Steeples

had left his work as a chicken deboner because he had had two seizures while 

working on the assembly line, and he “recognized the danger of him handling sharp 

instruments with him having seizures.” (Doc. 6-9, p. 97). Dr. Ragland stated that 

Mr. Steeples had “a myriad of significant [uncontrolled] medical problems which 

ma[d]e it impossible for him to hold gainful employment,” including breathing and 

heart problems, hypertension, seizure disorder, obesity, and poor stamina. (Doc. 6-

9, p. 97). Dr. Ragland stated that Mr. Steeples could not see specialists or buy 

medication because of his uninsured status and lack of income, so his medical 

conditions were not controlled. (Doc. 6-9, p. 97). 

In the May 2014 physical functional statement, Dr. Ragland included several 

narrative clinical findings to supplement her answers to the check-boxes on the form. 

She reported that Mr. Steeples had back, neck, and hearing problems, poor 

circulation, leg swelling, dizziness, seizures, “numbness and sharp pain shooting to 

[the] fingertips,” and COPD. (Doc. 6-10, pp. 5-6). Dr. Ragland restricted Mr. 

Steeples to 20 minutes of standing, 20 yards of walking, and one hour of sitting. 

(Doc. 6-10, p. 5). Dr. Ragland limited Mr. Steeples to lifting 20 and carrying 10 

pounds occasionally. (Doc. 6-10, p. 5). Dr. Ragland stated that she completed the 

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form based “partly” on Mr. Steeples’s subjective complaints and “largely” on her 

objective examination of Mr. Steeples. (Doc. 6-10, p. 5). Dr. Ragland did not 

discuss osteoarthritis or knee pain in her letter or physical assessment. (Doc. 6-9, p. 

97; Doc. 6-10, pp. 5-6).

In August and December 2014, Mr. Steeples saw Dr. Ragland for medication 

refills. (Doc. 6-10, pp. 8, 15). Dr. Ragland’s diagnoses of Mr. Steeples included 

hypertension, diabetes, hyperlipidemia, colitis, seizure disorder, and obesity. (Doc. 

6-10, pp. 8, 15). During the August 2014 visit, Dr. Ragland noted that Mr. Steeples 

could not take tramadol for pain because of his seizure disorder, so she prescribed 

Norco (5-235 mg). (Doc. 6-10, pp. 8-9).10 Dr. Ragland did not note osteoarthritis 

or knee pain in these 2014 treatment records. (Doc. 6-10, pp. 8-10, 15-19).

In 2015, Mr. Steeples visited Dr. Ragland or Ms. Burleson, a certified 

registered nurse practitioner at Family Medical Associates, primarily for medication 

refills. (Doc. 6-17, pp. 35, 38, 48, 53, 59, 63). During a September 2015 visit, Mr. 

Steeples complained of pain from a knot on his right knee that began one month 

earlier. (Doc. 6-17, p. 48). Dr. Ragland diagnosed Mr. Steeples with, among other 

10 “Tramadol is a narcotic-like pain reliever. . . . used to treat moderate to severe pain.” 

https://www.drugs.com/tramadol.html last visited Mar. 12, 2020.

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 17 of 37
18

things, right knee pain and obesity. (Doc. 6-17, p. 48).

11 Dr. Ragland took x-rays 

of Mr. Steeples’s right knee. (Doc. 6-17, pp. 48-52). 

Dr. Ragland noted during the October 2015 visit that she would follow up on 

the results of Mr. Steeples’s right knee x-ray from September. (Doc. 6-17, p. 39). 

Dr. Sanders, a radiologist, provided the following x-ray impressions later in October 

2015:

1. Patellar spurring anteriorly.

2. Equivocal for suprapatellar bursal effusion.

3. Minimal thinning of the weight-bearing cartilage medially.

(Doc. 6-17, p. 52).12

For most of 2015, Mr. Steeples was taking Norco to manage his pain. (Doc. 

6-17, pp. 35, 37, 38, 44, 57, 59, 62, 64). Mr. Steeples denied painful joints or

musculoskeletal weakness during several 2015 visits. (Doc. 6-17, pp. 36, 39, 49, 

54).

11 The other diagnoses of Mr. Steeples in 2015 included back and chronic pain, neuropathy, and 

arthritis. (Doc. 6-17, pp. 35, 38, 53, 59). As Mr. Steeples told Ms. Burleson in July 2015, he 

attributed his back pain to a slipped disc injury. (Doc. 6-17, p. 59). 

12 “Bone spurs are bony projections that develop along bone edges. . . . The main cause of bone 

spurs is the joint damage associated with osteoarthritis. . . . Bone spurs in [the] knee can make it 

painful to extend and bend [the] leg.” https://www.mayoclinic.org/diseases-conditions/bonespurs/symptoms-causes/syc-20370212 (last visited Mar. 12, 2020).

“[A] knee effusion is an abnormal amount of fluid in the knee joint.” 

https://www.medicinenet.com/script/main/art.asp?articlekey=7016 (last visited Mar. 12, 2020).

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 18 of 37
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In January, February, and March 2016, Mr. Steeples visited Dr. Ragland for 

medication refills. (Doc. 6-17, p. 28; Doc. 6-20, pp. 43, 48). Dr. Ragland diagnosed 

Mr. Steeples with chronic pain. (Doc. 6-17, p. 28; Doc. 6-20, pp. 43, 48). Mr. 

Steeples denied painful joints or musculoskeletal weakness. (Doc. 6-17, pp. 13, 22,

29). During the January 2016 visit, Mr. Steeples reported that he was out of blood 

pressure medication. (Doc. 6-17, p. 28). Dr. Ragland noted her belief that Mr. 

Steeples was not “attempting real medical compliance” and recommended to Mr. 

Steeples that he inquire about Medicaid or a program for indigent patients that would 

enable him “to get his meds and possibly become more compliant.” (Doc. 6-17, p. 

29). Dr. Ragland refilled Mr. Steeples’s Norco prescription. (Doc. 6-17, p. 32; Doc. 

6-20, pp. 47, 51). Dr. Ragland did not note osteoarthritis or knee pain in these 2016 

treatment records. (Doc. 6-17, pp. 12-15, 21-23, 28-31).

During an April 2016 visit with Dr. Ragland, Mr. Steeples complained of 

“very bad” right knee pain. (Doc. 6-20, pp. 40, 41). Mr. Steeples told Dr. Ragland 

that his knee was “lock[ing] up.” (Doc. 6-20, p. 41). Dr. Ragland’s diagnoses 

included chronic pain and right knee pain. (Doc. 6-20, p. 40). Dr. Ragland observed 

Mr. Steeples rubbing the inside of his right knee, but she did not detect fluid or heat 

in that area. (Doc. 6-20, p. 41). 

In June 2016, Mr. Steeples visited Dr. Ragland for prescriptions and lab work. 

(Doc. 6-20, p. 36). Dr. Ragland’s diagnoses of Mr. Steeples included chronic pain. 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 19 of 37
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(Doc. 6-20, p. 36). Mr. Steeples received a Toradol injection on the right gluteus. 

(Doc. 6-20, pp. 36, 37).13 Dr. Ragland refilled Mr. Steeples’s Norco prescription

and recommended that Mr. Steeple restart Mobic for pain management. (Doc. 6-20, 

pp. 36, 37, 39). 

In July 2016, Mr. Steeples visited Dr. Ragland to refill his Norco prescription. 

(Doc. 6-20, pp. 33, 35). After examining Mr. Steeples, Dr. Ragland reported that he 

had no gross physical changes. (Doc. 6-20, p. 34). Dr. Ragland’s diagnoses included 

pain management and obesity. (Doc. 6-20, p. 33).

In June 2016, Dr. Ragland completed a medical source statement for Mr. 

Steeples. (Doc. 6-16, pp. 2-3).14 Dr. Ragland stated that she was a family 

practitioner who began treating Mr. Steeples in July 2013 and saw him three to five 

visits yearly. (Doc. 6-16, p. 2). Dr. Ragland’s diagnoses of Mr. Steeples included 

seizure disorder, COPD, diabetes, high blood pressure, neuropathy, arthritis, and 

chronic pain. (Doc. 6-16, p. 2). Dr. Ragland reported that Mr. Steeples’s neuropathy 

and back pain prevented him from standing or sitting for long periods. (Doc. 6-16, 

p. 3). Dr. Ragland opined that Mr. Steeples’s conditions precluded him from gainful 

employment and would cause him to miss two or more days of work monthly. (Doc. 

13 “Toradol (ketorolac) is a nonsteroidal anti-inflammatory drug (NSAID). . . . used . . . to treat 

moderate to severe pain.” https://www.drugs.com/toradol.html (last visited Mar. 9, 2020). 

14 As the ALJ noted in her decision, the handwriting on Dr. Ragland’s two medical source 

statements is different. (Doc. 6-11, p. 23; compare Doc. 6-16, pp. 2-3, with Doc. 6-10, pp. 5-6).

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 20 of 37
21

6-16, pp. 2, 3). Dr. Ragland affirmed that the severity of Mr. Ragland’s conditions 

had existed since Mr. Steeples’s alleged onset date, but the form does not specify a 

date and includes a handwritten question of “What is this?” by the onset date 

question. (Doc. 6-16, p. 3). 

In July 2016, Mr. Steeples visited Dr. Ragland for a Norco refill. (Doc. 6-20, 

pp. 33, 35). Mr. Steeples denied painful joints or musculoskeletal weakness. (Doc. 

6-20, p. 34). He was taking Norco and Mobic for pain. (Doc. 6-20, p. 33).

Mr. Steeples returned to Dr. Ragland in August 2016, complained of right 

knee pain, and requested an injection. (Doc. 6-20, pp. 27, 28). Dr. Ragland’s 

diagnoses of Mr. Steeples’s included chronic pain and right knee pain. (Doc. 6-20, 

p. 27). Dr. Ragland administered a trigger point injection into Mr. Steeples’s right 

knee. (Doc. 6-20, pp. 28-29).15 Dr. Ragland refilled Mr. Steeples’s Norco 

prescription. (Doc. 6-20, p. 31).

At the Commissioner’s request, Dr. Harrison completed a functional 

evaluation of Mr. Steeples in September 2016. (Doc. 6-18, pp. 2-6). Mr. Steeples 

stated that his knee and back prevented him from working. (Doc. 6-18, p. 3). Mr. 

Steeples showed Dr. Harrison the deformity on his (Mr. Steeples’s) kneecap, which

15 A trigger point injection “is a procedure used to treat painful areas of muscle that contain trigger 

points, or knots of muscle that form when muscles do not relax.” https://www.webmd.com/painmanagement/guide/trigger-point-injection (last visited Mar. 9, 2020). “Trigger points are often 

associated with chronic musculoskeletal disorders, including myofascial pain.” 

https://arapc.com/physician-consultation/joint-injection-therapy/ (last visited Mar. 9, 2020). 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 21 of 37
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Dr. Harrison described as “mild.” (Doc. 6-18, p. 3). Mr. Steeples reported his other 

diagnoses, including hypertension, COPD, seizures, colitis, and diabetes. Mr. 

Steeples’s medication list included Norco (3.25 mg twice daily) and meloxicam (7.5 

mg daily). (Doc. 6-18, p. 4).

Dr. Harrison made the following musculoskeletal findings:

There is normal [range of motion] in the shoulders, elbows and wrists, 

hips, knees and ankles. Patient can anteriorly flex to 90 degrees without 

difficulty. He squat and arose without difficulty. There is a very mild 

hyperostosis on the medial right patella that I do not think should be 

painful or involved in his joint. Joint has full [range of motion] without 

crepitation or instability. Left knee also has full [range of motion] 

without crepitation or instability. Patient could squat and arise without 

difficulty. He could stand on his toes and his heels. Lumbar spine has 

normal extension, side bending and rotation. Cervical spine has normal 

flexion, extension, side bending and rotation.

(Doc. 6-18, p. 5).16 Dr. Harrison noted that an x-ray of Mr. Steeples’s right knee 

“reveal[ed] minimal arthritic changes.” (Doc. 6-18, p. 5).17 Dr. Harrison reported 

that an x-ray of Mr. Steeples’s spine showed: “The preservation of the lumbar 

lordosis. Interspaces are well maintained. There is a mild narrowing at L-4, 5, but 

otherwise his lumbar spine is [within normal limits].” (Doc. 6-18, p. 6). Dr. 

16 Hyperostosis is an “excessive growth or thickening of bone tissue.” https://www.merriamwebster.com/dictionary/hyperostosis (last visited Mar. 13, 2020).

17 Dr. Harrison did not identify the date of the knee and back x-rays that he reviewed, state in his 

report that he took x-rays, or attach x-rays results to his report. The ALJ stated in her decision that 

a September 2016 x-ray of Mr. Steeples’s right knee showed “minimal degenerative changes.” 

(Doc. 6-11, p. 18). The ALJ based this objective finding on Dr. Harrison’s September 2016 

consultative report.

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 22 of 37
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Harrison concluded that the examination and x-ray of Mr. Steeples’s right knee did 

not corroborate Mr. Steeples’s complaint of osteoarthritis. (Doc. 6-18, p. 6). Dr. 

Harrison opined that Mr. Steeples “would be able to perform work related activities.” 

(Doc. 6-18, p. 6).

Mr. Steeples saw Dr. Ragland in late September 2016 for a Norco refill. (Doc. 

6-20, pp. 23, 26). Dr. Ragland’s diagnoses included chronic pain and obesity. (Doc. 

6-20, p. 23). Dr. Ragland reported that Mr. Steeples had “no gross physical changes” 

and no musculoskeletal abnormalities. (Doc. 6-20, p. 24). Mr. Steeples denied 

painful joints or musculoskeletal weakness. (Doc. 6-20, p. 25). 

During an October 2016 visit with Dr. Ragland, Mr. Steeples complained of 

COPD symptoms. (Doc. 6-20, p. 18). Dr. Ragland’s diagnoses included chronic 

pain and right knee pain. (Doc. 6-20, p. 18). Dr. Ragland’s structural examination 

of Mr. Steeples revealed no abnormalities. (Doc. 6-20, p. 19).18 Mr. Steeples denied 

painful joints or musculoskeletal weakness. (Doc. 6-20, p. 20). During a drug 

screen, Mr. Steeples told a clinic representative that he had run out of Norco during 

the previous week. (Doc. 6-20, p. 22). Dr. Ragland refilled Mr. Steeples’s Norco

prescription. (Doc. 6-20, p. 21).

18 A structural examination of a patient’s musculoskeletal system generally includes a “[v]isual 

assessment of posture, spine, muscles, balance, and gait,” a “[p]hysical palpation of the back, legs, 

and arms to assess the quality and motion of tissues and structural make-up,” and “[movement of 

the back, legs, and arms, checking for joint restriction and/or pain.” https://www.spinehealth.com/treatment/spine-specialists/osteopathic-medical-visit (last visited Mar. 9, 2020).

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 23 of 37
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In December 2016, Mr. Steeples visited Dr. Ragland for medication refills. 

(Doc. 6-20, p. 15). Dr. Ragland’s diagnoses included chronic pain. (Doc. 6-20, p. 

15). Dr. Ragland’s structural examination of Mr. Steeples revealed no 

abnormalities. (Doc. 6-20, p. 16). Mr. Steeples denied painful joints or

musculoskeletal weakness. (Doc. 6-20, p. 17).

In January 2017, Mr. Steeples visited Dr. Ragland for medication refills. 

(Doc. 6-20, p. 11). Mr. Steeples denied musculoskeletal weakness and painful joints. 

(Doc. 6-20, p. 13). Dr. Ragland’s diagnoses included chronic pain and arthritis

described as “painful spurs of knees.” (Doc. 6-20, p. 11). Dr. Ragland noted that 

Mr. Steeples was not in acute distress and that he exhibited “no gross physical 

changes.” (Doc. 6-20, p. 12). Dr. Ragland reported that Mr. Steeples had normal 

bilateral extremity motor strength and structural findings. (Doc. 6-20, p. 12).

In February 2017, Mr. Steeples visited Dr. Ragland and complained of 

bilateral knee pain. (Doc. 6-20, p. 6). During a drug screen, Mr. Steeples told a 

clinic representative that “he had to take extra [medication] due to increased pain.” 

(Doc. 6-20, p. 10). After examining Mr. Steeples, Dr. Ragland noted that his right 

knee was tender “but not hot or red.” (Doc. 6-20, p. 7) (emphasis omitted). Dr. 

Ragland detected crepitus in the right knee. (Doc. 6-20, p. 7).19 Dr. Ragland 

19 Crepitus is “[a] clinical sign in medicine that is characterized by a peculiar crackling, crinkly, or 

grating feeling . . . in the joints. . . . Crepitus in a joint can indicate cartilage wear in the joint 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 24 of 37
25

diagnosed Mr. Steeples with right knee pain and noted that the condition was an 

“acute exacerbation” and “chronic.” (Doc. 6-20, p. 6).20 Dr. Ragland’s other 

diagnoses included chronic pain and osteoarthritis. (Doc. 6-20, p. 6). Dr. Ragland 

reported that Mr. Steeples had a normal structural examination. (Doc. 6-20, p. 7). 

Mr. Steeples received a Toradol (60 mg) injection to alleviate pain. (Doc. 6-20, p. 

6). Dr. Ragland renewed Mr. Steeples’s prescription for Norco (one 5-325 mg tablet 

twice daily), prescribed Mobic (one 7.5 mg tablet daily), and provided Flector 

patches for him to apply twice daily. (Doc. 6-20, pp. 6, 9).21

Analysis

Mr. Steeples challenges the ALJ’s onset finding as contrary to the medical 

evidence and an improper inference without “a legitimate medical basis” under SSR 

83-20. (Doc. 11, pp. 10-15); SSR 83-20, 1983 WL 31249, at *3. Citing Klawinski 

space.” https://www.medicinenet.com/script/main/art.asp?articlekey=12061 (last visited Mar. 9, 

2020).

20 Acute means “[o]f abrupt onset, in reference to a disease. Acute often also connotes an illness 

that is of short duration, rapidly progressive, and in need of urgent care. ‘Acute’ is a measure of 

the time scale of a disease and is in contrast to ‘subacute’ and ‘chronic.’ . . . ‘Chronic’ indicates 

[an] indefinite duration or virtually no change.’” 

https://www.medicinenet.com/script/main/art.asp?articlekey=2133 (last visited Mar. 9, 2020).

21 “Norco 5/325 (hydrocodone acetaminophen and bitartrate) is an opioid analgesic . . . and pain 

reliever . . . used to treat moderate to fairly severe pain.” https://www.rxlist.com/norco-5-325-sideeffects-drug-center.htm (last visited Mar. 9, 2020). 

“Flector [transdermal] patches contain diclofenac epolamine, a nonsteroidal anti-inflammatory 

drug . . . . [and] are used to treat pain caused by minor sprains, strains, or bruising” 

https://www.drugs.com/flector.html (last visited Mar. 9, 2020). 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 25 of 37
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v. Comm’r of Soc. Sec., 391 Fed. Appx. 772 (11th Cir. 2010), the Commissioner 

maintains that SSR 83-20 does not apply because “[t]he record contain[s] precise 

evidence showing when [Mr. Steeple’s] condition caused limitations that resulted in 

an RFC that precluded work.” (Doc. 12, p. 10). 

The plaintiff in Klawinski had a “slowly progressive” knee disorder and 

argued that the ALJ should have relied on a medical advisor because the ALJ had to 

determine disability retroactively and “the onset date was ambiguous.” Klawinski,

391 Fed. Appx. at 775. The Eleventh Circuit Court of Appeals identified two 

instances in which SSR 83-20 suggests that an ALJ may rely on a medical advisor:

(1) where it may be possible, based on medical evidence, to “reasonably 

infer that the onset of a disabling impairment(s) occurred some time 

prior to the date of the first recorded medical examination”; and (2) in 

terms of a malignant neoplastic disease, “[t]o establish onset of 

disability prior to the time a malignancy is first demonstrated to be 

inoperable or beyond control by other modes of therapy.”

Klawinski, 391 Fed. Appx. at 776. The Court of Appeals concluded that “the ALJ 

did not contravene SSR 83–20 because the ALJ ultimately found that Klawinski was 

not disabled, and SSR 83–20 only required the ALJ to obtain a medical expert in 

certain instances to determine a disability onset date after a finding of disability.” 

Klawinski, 391 Fed. Appx. at 775.

This Court considered SSR 83-20 in Santiago v. Berryhill, No. 4:17-CV00209-MHH, 2018 WL 3208076 (N.D. Ala. June 29, 2018) and explained:

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 26 of 37
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Citing SSR 83-20, Mr. Santiago contends that if the ALJ was 

going to reject Ms. Portillo’s alleged onset date and identify a different 

onset date, then the ALJ was required to consult a medical advisor. (See

Doc. 9, p. 25). The Court disagrees.

Under SSR 83-20, an ALJ “should” consult a medical advisor if 

the ALJ must infer the disability onset date, and the medical evidence 

is inadequate. The ALJ has no such obligation if the medical evidence 

in the administrative record is adequate. SSR 83-20 provides:

In some cases, it may be possible, based on the medical 

evidence to reasonably infer that the onset of a disabling 

impairment(s) occurred some time prior to the date of the 

first recorded medical examination, e.g., the date the 

claimant stopped working. How long the disease may be 

determined to have existed at a disabling level of severity 

depends on an informed judgment of the facts in the 

particular case. This judgment, however, must have a 

legitimate medical basis. At the hearing, the administrative 

law judge (ALJ) should call on the services of a medical 

advisor when onset must be inferred. If there is 

information in the file indicating that additional medical 

evidence concerning onset is available, such evidence 

should be secured before inferences are made.

SSR 83-20, 1983 WL 31249, at *3.

The Commissioner recently clarified that SSR 83-20 does not 

require an ALJ to consult a medical expert even if the ALJ must infer a 

disability onset date. In an emergency message, the Commissioner 

explained that “SSR 83-20 does not impose a mandatory requirement 

on an ALJ to call on the services of a medical expert when onset must 

be inferred. Instead, the decision to call on the services of a medical 

expert when onset must be inferred is always at the ALJ’s discretion.” 

Emergency Message: Clarification of [SSR] 83–20—Titles II and XVI: 

Onset of Disability, 

TTPS://secure.ssa.gov/apps10/reference.nsf/links/10172016104408A

M, last visited May 25, 2018; see also Doc. 10-1.

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 27 of 37
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In any event, the Court finds that this is not a case where the ALJ 

had “to reasonably infer that the onset of a disabling impairment(s)

occurred some time prior to the date of the first recorded medical 

examination.” SSR 83-20, 1983 WL 31249, at *3. Rather, the medical 

records demonstrate that Ms. Portillo’s onset date was after her date last 

insured. The record contains numerous medical examinations from 

both before and after Ms. Portillo’s date last insured, but as the ALJ 

found, none of the records that pre-date Ms. Portillo’s date last insured 

established that Ms. Portillo had disabling impairments. Accordingly, 

the ALJ did not err by failing to consult a medical advisor. See O’Neal 

v. Comm’r of Soc. Sec., ––– Fed. Appx. ––––, 2018 WL 2111067 (11th 

Cir. May 8, 2018).

Santiago, 2018 WL 3208076, at *4-5.22 Consistent with Santiago, Mr. Steeples’s 

case does not trigger the application of SSR 83-20 because the ALJ based her 

disability onset finding on existing medical records. 

Substantial evidence still must support the ALJ’s reasons for selecting an 

onset date. Under the circumstances of Mr. Steeples’s case, remand is appropriate 

because of gaps in the ALJ’s analysis. The ALJ found that Mr. Steeples’s

22 After this Court decided Santiago, the Commissioner replaced SSR 83-20 with SSR 18-01p.

This replacement ruling states in relevant part:

At the hearing level of our administrative review process, if the ALJ needs to infer 

the date that the claimant first met the statutory definition of disability, he or she 

may call on the services of an ME by soliciting testimony or requesting responses 

to written interrogatories (i.e., written questions to be answered under oath or 

penalty of perjury). The decision to call on the services of an ME is always at the 

ALJ’s discretion. Neither the claimant nor his or her representative can require an 

ALJ to call on the services of an ME to assist in inferring the date that the claimant 

first met the statutory definition of disability.

SSR 18-01p, 2018 WL 4945639, at *6. SSR 18-01p pertains to applications filed on or after the 

effective date of October 2, 2018. 2018 WL 4945639, at *7. Consequently, SSR 83-20 applies to 

Mr. Steeples’s disability insurance claim.

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 28 of 37
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osteoarthritis was not severe until Dr. Ragland noted “an acute exacerbation of right 

knee pain” in February 2017. (Doc. 6-11, p. 18). During this February 2017 visit, 

Dr. Ragland detected crepitus in Mr. Steeples’s right knee and administered a

Toradol injection. (Doc. 6-20, pp. 6-7). The ALJ stated that Dr. Ragland’s treatment 

notes predating February 2017 showed “completely normal examinations” with 

respect to Mr. Steeples’s knee. (Doc. 6-11, pp. 22-23). Dr. Ragland’s treatment 

notes do reflect normal musculoskeletal examinations. But as the medical record

summary reveals, Dr. Ragland took x-rays of Mr. Steeples’s right knee after he 

reported a knot in September 2015. (Doc. 6-17, pp. 48-52). Dr. Ragland diagnosed 

Mr. Steeples with right knee pain in September 2015, (Doc. 6-17, p. 48), and arthritis 

in October 2015, (Doc. 6-17, p. 38). Dr. Ragland received x-ray results from Dr. 

Sanders later in October 2015 which confirmed spurring on Mr. Steeples’s right

kneecap and minimal thinning of the cartilage on the medial side of Mr. Steeples’s 

right knee. (Doc. 6-17, p. 52). Dr. Sanders could not confirm whether Mr. Steeples 

had fluid on his right knee joint. (Doc. 6-17, p. 52). 

In August 2016, Dr. Ragland gave Mr. Steeples a trigger point injection in the 

right knee. (Doc. 6-20, pp. 28-29). Dr. Ragland noted in January 2017 that “painful 

spurs of [the] knees” were responsible for Mr. Steeples’s arthritis. (Doc. 6-20, p. 

11); see SSR 02-1p, 2002 WL 34686281, at *3 (“[Obesity] commonly leads to, and 

often complicates, chronic diseases of the . . . musculoskeletal body system[, 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 29 of 37
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including] osteoarthritis.”). These pre-February 2017 treatment records are 

consistent with Mr. Steeples’s reports of knee pain and with his obesity. See SSR02-

01p, 2002 WL 34686281, at *6 (“The combined effects of obesity with other 

impairments may be greater than might be expected without obesity. For example, 

someone with obesity and arthritis affecting a weight-bearing joint may have more 

pain and limitation than might be expected from the arthritis alone.”).23

The ALJ found that Dr. Ragland’s treatment notes from October 2017 

“show[ed] that [Mr. Steeples] had palpable bony [callus] deposition in the knees and 

that [Mr. Steeples] was having some difficulty arising from a seated position.” (Doc. 

6-11, p. 23; 6-19, p. 21).24 The ALJ stated that these notes came “well after the 

established onset date.” (Doc. 6-11, p. 23). In finding that Mr. Steeples did not have

a severe knee condition before February 27, 2017, the ALJ relied on Dr. Harrison’s

2016 impression that an x-ray of Mr. Steeples’s knee showed minimal arthritic 

changes. (Doc. 6-11, p. 18; Doc. 6-18, p. 5). Given Mr. Steeples’s level II obesity 

from 2014 to 2017 and the degenerative nature of osteoporosis, the date of the x23 As mentioned above, the ALJ found that Mr. Steeples’s obesity was a severe impairment as of 

March 2012. (Doc. 6-11, p. 18). 

24 A bony callus is “[t]he hard new bone substance that forms in an area of bone fracture. Bony 

callus is part of the bone repair process.” 

https://www.medicinenet.com/script/main/art.asp?articlekey=2579 (last visited Mar. 20, 2020). 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 30 of 37
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rays that Dr. Harrison reviewed in 2016 is critical information.

25 The Court cannot 

tell if Dr. Harrison took new knee x-rays in September 2016 or if Dr. Harrison simply 

reviewed Dr. Sanders’s October 2015 radiological report. Because that date is 

uncertain, because medical records pre-dating February 27, 2017, corroborate Mr. 

Steeples’s knee pain, and because Mr. Steeples’s obesity impacts his knee pain and 

the related limitations, the Court cannot determine whether substantial evidence 

supports the ALJ’s onset date finding.

Mr. Steeples contends that the ALJ’s reliance on evidence of medical noncompliance to determine his severe conditions and to discount his subjective pain 

testimony is contrary to this Court’s remand decision. (Doc. 11, pp. 18, 20). The 

Eleventh Circuit pain standard “applies when a disability claimant attempts to 

establish disability through his own testimony of pain or other subjective 

symptoms.” Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991); Coley v. 

Comm’r, Soc. Sec. Admin., 771 Fed. Appx. 913, 917 (11th Cir. 2019). When relying 

on subjective symptoms to establish disability, “the claimant must satisfy two parts 

of a three-part test showing: (1) evidence of an underlying medical condition; and 

(2) either (a) objective medical evidence confirming the severity of the alleged 

25 Mr. Steeples’s body mass index (BMI) was 36.12 in December 2014, (Doc. 6-10, pp. 15, 18), 

35.01 in April 2016, (Doc. 6-20, p. 40), 36.01 in August 2016, (Doc. 6-20, pp. 27, 29), and 35.29 

in February 2017, (Doc. 6-20, pp. 6, 7). “Level II [obesity] includes BMIs of 35.0-39.9.” SSR 

02-01p, 2002 WL 34686281, at *2.

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 31 of 37
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[symptoms]; or (b) that the objectively determined medical condition can reasonably 

be expected to give rise to the claimed [symptoms].” Wilson v. Barnhart, 284 F.3d 

1219, 1225 (11th Cir. 2002) (citing Holt, 921 F.2d at 1223); Chatham v. Comm’r,

Soc. Sec. Admin., 764 Fed. Appx. 864, 868 (11th Cir. Apr. 18, 2019) (citing Wilson). 

If the ALJ does not demonstrate “proper application of the three-part standard[,]” 

reversal is appropriate. McLain v. Comm’r, Soc. Sec. Admin., 676 Fed. Appx. 935, 

937 (11th Cir. 2017) (citing Holt).

A claimant’s credible testimony coupled with medical evidence of an 

impairing condition “is itself sufficient to support a finding of disability.” Holt, 921 

F.2d at 1223; see Gombash v. Comm’r, Soc. Sec. Admin., 566 Fed. Appx. 857, 859 

(11th Cir. 2014) (“A claimant may establish that he has a disability ‘through his own 

testimony of pain or other subjective symptoms.’”) (quoting Dyer v. Barnhart, 395 

F.3d 1206, 1210 (11th Cir. 2005)). If an ALJ rejects a claimant’s subjective 

testimony, then the ALJ “must articulate explicit and adequate reasons for doing so.” 

Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002); Coley, 771 Fed. Appx. at 

918. The district court must accept the claimant’s testimony, as a matter of law, if 

the ALJ inadequately discredits it. Cannon v. Bowen, 858 F.2d 1541, 1545 (11th 

Cir. 1988); Kalishek v. Comm’r, Soc. Sec. Admin., 470 Fed. Appx. 868, 871 (11th 

Cir. 2012) (citing Cannon).

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When credibility is at issue, the provisions of Social Security Regulation 16-

3p apply. SSR 16-3p provides:

[W]e recognize that some individuals may experience symptoms 

differently and may be limited by symptoms to a greater or lesser extent 

than other individuals with the same medical impairments, the same 

objective medical evidence, and the same non-medical evidence. In 

considering the intensity, persistence, and limiting effects of an 

individual’s symptoms, we examine the entire case record, including 

the objective medical evidence; an individual’s statements about the 

intensity, persistence, and limiting effects of symptoms; statements and 

other information provided by medical sources and other persons; and 

any other relevant evidence in the individual’s case record.

SSR 16-3p, 2016 WL 1119029, at *4. Concerning the ALJ’s analysis when 

discrediting a claimant’s subjective symptoms, SSR 16-3p states:

[I]t is not sufficient . . . to make a single, conclusory statement that “the 

individual’s statements about his or her symptoms have been 

considered” or that “the statements about the individual’s symptoms are 

(or are not) supported or consistent.” It is also not enough . . . simply 

to recite the factors described in the regulations for evaluating 

symptoms. The determination or decision must contain specific reasons 

for the weight given to the individual’s symptoms, be consistent with 

and supported by the evidence, and be clearly articulated so the 

individual and any subsequent reviewer can assess how the adjudicator 

evaluated the individual’s symptoms.

SSR 16-3p, 2016 WL 1119029, at *10. 

In evaluating a claimant’s reported symptoms, an ALJ must consider: 

(i) [the claimant’s] daily activities; 

(ii) [t]he location, duration, frequency, and intensity of [the 

claimant’s] pain or other symptoms; 

(iii) [p]recipitating and aggravating factors; 

Case 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 33 of 37
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(iv) [t]he type, dosage, effectiveness, and side effects of any 

medication [the claimant] take[s] or ha[s] taken to alleviate . . . pain or 

other symptoms; 

(v) [t]reatment, other than medication, [the claimant] receive[s] or 

ha[s] received for relief of . . . pain or other symptoms; 

(vi) [a]ny measures [the claimant] use[s] or ha[s] used to relieve . . .

pain or other symptoms (e.g., lying flat on your back, standing for 15 

to 20 minutes every hour, sleeping on a board, etc.); and

(vii) [o]ther factors concerning [the claimant’s] functional limitations 

and restrictions due to pain or other symptoms.

 

20 C.F.R. §§ 404.1529(c)(3), 416.929(c)(3); Leiter v. Comm’r, Soc. Sec. Admin., 

377 Fed. Appx. 944, 947 (11th Cir. 2010).

The ALJ discounted Mr. Steeples’s subjective reports of knee limitations that 

predated February 27, 2017. (Doc. 6-11, pp. 18, 21-22). The ALJ found that Mr. 

Steeples’s medical records showed “no more than minimal work-related limitations” 

and “fail[ed] to document a sufficient objective basis to accept [his] allegations 

resulting in functional limitations before February 27, 2017.” (Doc. 6-11, pp. 18, 

22). The ALJ relied on evidence of Mr. Steeples’s non-compliance with treatment 

to support her pain assessment. (Doc. 6-11, pp. 23-24).

The ALJ’s reliance on Mr. Steeples’s non-compliance with medical treatment 

is inadequate to discount his knee pain. In her first decision, the ALJ found that Mr. 

Steeples did not take his diabetes and seizure medication as prescribed and continued

to smoke. (Doc. 6-3, pp. 17, 19, 20). The ALJ relied on Mr. Steeples’s medical nonCase 6:18-cv-01149-MHH Document 17 Filed 03/30/20 Page 34 of 37
35

compliance when she formulated his RFC. (Doc. 6-3, p. 20). The Court remanded 

Mr. Steeples’s case because the ALJ did not investigate the possible reasons for his 

non-compliance, and one of Dr. Ragland’s treatment records corroborated Mr. 

Steeples’s testimony that he could not afford medical treatment. (Doc. 6-12, pp. 33-

34). Because the record lacked evidence of willfulness, the Court found that the ALJ 

could not rely Mr. Steeples’s failure to quit smoking as evidence of medical noncompliance. (Doc. 6-12, p. 33 n.4).

The ALJ acknowledged the Court’s points in her second decision. (Doc. 6-

11, p. 23). Still, the ALJ found that:

[Mr. Steeples’s] continuing to smoke is a factor when assessing the 

effect of poverty on compliance with medical treatment and the 

consistency of [his] contention that he does not have funds for medical 

treatment. Because [Mr. Steeples] continues to choose to spend money 

on tobacco, albeit he asserts that this is money from friends and he has 

been trying to quit smoking, the claimant has shown that he has chosen 

to allot money to tobacco over his medical need for treatment.

(Doc. 6-11, p. 24). Concerning medical non-compliance, the ALJ also stated that: 

[Mr. Steeples’s] testimony that he does not know . . . about “charity 

care” is not consistent with a statement of Dr. Ragland of February 7, 

2018, when she reported: “With the assistance of indigent programs 

from pharmaceutical companies and ‘gratis’ medical care we have been 

able to get [Mr. Steeples’s] chronic disorders better controlled.” 

(Doc. 6-11, p. 24). For the purpose of this opinion, the Court finds that the ALJ’s 

reasons for discounting Mr. Steeples’s limitations caused by diabetes and seizures 

due to his medical non-compliance are adequate. 

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But the ALJ did not appropriately rely on that evidence to discount Mr. 

Steeples’s pain which, as the ALJ acknowledged, Mr. Steeples’s level II obesity 

exacerbated. Dr. Ragland diagnosed Mr. Steeples with chronic pain, refilled his 

Norco prescription regularly, and prescribed Mobic periodically before February 27, 

2017. Mr. Steeples received a Toradol injection and a right-knee trigger point 

injection before February 27, 2017. (Doc. 6-20, pp. 36, 37; Doc. 6-20, pp. 28-29). 

This evidence undermines the ALJ’s finding that the record lacked corroborating 

evidence of Mr. Steeples’s degenerative pain before February 27, 2017. (Doc. 6-11, 

p. 25). Therefore, the ALJ’s reliance on Mr. Steeples’s non-compliance with 

recommended diabetes and seizure treatment to discount his knee and osteoarthritis

pain at steps two and four is not supported by substantial evidence. 

V. CONCLUSION

The Court remands the Commissioner’s decision for further development of 

Mr. Steeples’s onset date. 

The recent General Order Regarding Court Operations During the Public 

Health Emergency Caused by the COVID-19 Virus (N.D. Ala. Mar. 17, 2020) does 

not affect the deadline to challenge a final order or judgment on appeal. See

https://www.alnd.uscourts.gov/general-order-regarding-court-operations-duringpublic-health-emergency-caused-covid-19-virus, p. 2, ¶ 7. The parties are reminded 

that under Rule 4(a)(5) of the Federal Rules of Appellate Procedure, a party may 

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request an extension of time for a notice of appeal. In addition, pursuant to Rule 

4(a)(6), a party may ask a district court to reopen the time to file a notice of appeal 

for 14 days. Parties are advised to study these rules carefully if exigent 

circumstances created by the COVID-19 Public Health Emergency require motions 

under FRAP 4(a)(5) or 4(a)(6).

DONE this 30th day of March 2020.

 _________________________________

 MADELINE HUGHES HAIKALA

 UNITED STATES DISTRICT JUDGE

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