Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alsd-1_14-cv-00191/USCOURTS-alsd-1_14-cv-00191-0/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)

---

1

IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF ALABAMA

SOUTHERN DIVISION

APRIL M. LUCAS, :

 :

Plaintiff, :

 :

vs. : CIVIL ACTION 14-0191-CB-M

 :

CAROLYN W. COLVIN, :

Commissioner of Social Security, :

 :

Defendant. :

REPORT AND RECOMMENDATION

In this action under 42 U.S.C. § 405(g), Plaintiff seeks 

judicial review of an adverse social security ruling which 

denied a claim for disability insurance benefits. The action 

was referred for report and recommendation pursuant to 28 U.S.C. 

§ 636(b)(1)(B). Oral argument was waived in this action (Doc. 

17). Upon consideration of the administrative record and the 

memoranda of the parties, it is recommended that the decision of 

the Commissioner be affirmed, that this action be dismissed, and 

that judgment be entered in favor of Defendant Michael J. Astrue 

and against April M. Lucas.

This Court is not free to reweigh the evidence or 

substitute its judgment for that of the Secretary of Health and 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 1 of 23
2

Human Services, Bloodsworth v. Heckler, 703 F.2d 1233, 1239 

(11th Cir. 1983), which must be supported by substantial 

evidence. Richardson v. Perales, 402 U.S. 389, 401 (1971). The 

substantial evidence test requires "that the decision under 

review be supported by evidence sufficient to justify a 

reasoning mind in accepting it; it is more than a scintilla, but 

less than a preponderance." Brady v. Heckler, 724 F.2d 914, 918 

(11th Cir. 1984), quoting Jones v. Schweiker, 551 F.Supp. 205 

(D. Md. 1982).

At the time of the administrative hearing, Plaintiff was 

thirty-five years old, had completed a college education (Tr. 

39), and had previous work experience as an ultrasound 

technologist, data entry clerk, office manager, and secretary 

(see Tr. 51). In claiming benefits, Lucas alleges disability 

due to fibromyalgia, migraine headaches, and major depressive 

disorder (Doc. 13 Fact Sheet).

The Plaintiff filed a protective application for disability 

benefits on April 23, 2012 (Tr. 140-46; see Tr. 19). Benefits 

were denied following a hearing by an Administrative Law Judge 

(ALJ) who determined that although she could not return to her 

past relevant work, there were light work jobs that she could 

perform (Tr. 19-29). Plaintiff requested review of the hearing 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 2 of 23
3

decision (Tr. 14) by the Appeals Council, but it was denied (Tr. 

1-5).

Plaintiff claims that the opinion of the ALJ is not 

supported by substantial evidence. Specifically, Lucas alleges 

that: (1) The ALJ did not properly consider the opinions and 

conclusions of her treating physician; (2) the ALJ improperly 

discounted her testimony of pain and limitation; and (3) the ALJ 

failed to re-contact the consultative examiner for questions 

about the opinion rendered (Doc. 13). Defendant has responded 

to—and denies—these claims (Doc. 14). The Court’s review of the 

relevant evidence follows.1

On August 10, 2011, Dr. Mark Robinson saw Lucas for a 

migraine headache and nausea; he prescribed Stadol,2 Phenergan,3

and Topomax4 (Tr. 304).5 On September 9, Robinson again saw 

Plaintiff for a three-day headache; Lucas indicated that 

 1

Plaintiff’s asserted date of disability is October 30, 2011 (Tr. 

140), so the Court will not review the evidence preceding that date by

more than several months.

2

Stadol is a synthetic opioid, administered by injection or nasal 

spray, used to relieve pain. See http://www.drugs.com/pro/stadol.html 3

Error! Main Document Only.Error! Main Document Only.Phenergan is used 

as a sedative or sleep aid or to treat nausea, vomiting, or pain. 

http://www.drugs.com/phenergan.html 4

Topomax is used in the treatment of migraine headaches. Error! 

Main Document Only.Physician's Desk Reference 2378-79 (62nd ed. 2008).

5

The Court notes that drug therapy is the primary treatment for 

Lucas’s headaches throughout this record. The Court will report new

drugs as they are prescribed, but will not keep a “scorecard” of all 

drugs in use at any particular time.

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 3 of 23
4

although she got no relief from her home medications, the 

Topomax helped with the frequency of the headaches (Tr. 303). 

On September 26, 2011, Dr. Elizabeth J. Low, a General 

Practitioner, examined Plaintiff for a dull, throbbing, 

continuing headache with photophobia, nausea, and vomiting; Low 

noted that Lucas was in no distress, continued her former 

medications, and prescribed Savella,6 Amitriptyline,7 Maxalt,8

and Ultram9 (Tr. 298-301, 513). On October 10, Plaintiff’s 

migraine resulted in injections of Phenergan and Demerol10 as 

well as a prescription for Demerol (Tr. 296-97). The next day, 

Lucas was seen for a three-day headache; the doctor noted no 

acute distress, diagnosed a migraine, and continued the Demerol 

prescription (Tr. 292-94). On November 7, Dr. Low examined 

Plaintiff for a three-day headache (Tr. 282-85). On December 

15, Lucas complained of a headache, nausea, and blurred vision 

 6

Savella is used in the treatment of fibromyalgia. See 

http://www.drugs.com/savella.html

7

Error! Main Document Only.Amitriptyline, marketed as Elavil, is 

used to treat the symptoms of depression. Physician's Desk Reference

3163 (52nd ed. 1998). 

8

Maxalt is used for the acute treatment of migraine attacks. 

Error! Main Document Only.Physician's Desk Reference 1904-1905 (66th ed. 

2012).

9

Error! Main Document Only.Ultram is an analgesic “indicated for 

the management of moderate to moderately severe pain.” Physician's 

Desk Reference 2218 (54th ed. 2000). 

10Error! Main Document Only.Demerol is a narcotic analgesic used for 

the relief of moderate to severe pain. Physician's Desk Reference

2570-72 (52nd ed. 1998).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 4 of 23
5

for which Dr. Low continued the Stadol prescription (Tr. 274-

76). A throbbing two-day headache on December 26 led to represcribing of Stadol and Phenergan (Tr. 270-73).

On October 3, 2011, Dr. Ellen W. McKnight, Rheumatologist,

examined Lucas for an inability to stay asleep, fatigue, 

weakness, muscular pain, stiffness, headaches, and poor memory; 

Plaintiff rated her pain as five on a ten-point scale (Tr. 323-

27; see also Tr. 25; Doc. 13, p. 3). The Doctor noted that she 

was in no acute distress and the physical exam was normal; 

McKnight’s impression was fibromyalgia, fatigue, chronic 

debilitating migraine headaches, severe depression, restless 

legs syndrome, osteoarthritis, possible inflammatory 

polyarthritis, and vitamin D deficiency for which she prescribed 

Mobic11 and Vitamin D and continued her Prozac,12 Topamax, and 

Maxalt. On March 13, 2012, McKnight’s examination reported 

everything to be within normal limits; she prescribed Cymbalta13

and decreased the Prozac daily dose (Tr. 319-22).

 11Error! Main Document Only.Mobic is a nonsteroidal anti-inflammatory 

drug used for the relief of signs and symptoms of osteoarthritis and 

rheumatoid arthritis. Physician's Desk Reference 855-57 (62nd ed. 

2008). 

12Error! Main Document Only.Prozac is used for the treatment of 

depression. Physician's Desk Reference 859-60 (52nd ed. 1998).

13Cymbalta is used in the treatment of major depressive disorder. 

Error! Main Document Only.Physician's Desk Reference 1791-93 (62nd ed. 

2008).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 5 of 23
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On February 14, 2012, Dr. Badr Sultan examined Plaintiff 

for her headaches (Tr. 315-17). His neurological exam was as 

follows:

The patient was alert and oriented x 3. 

Her speech and language were intact. 

Cranial nerve examination showed full visual 

field and intact extraocular muscles. 

Facial sensations were intact. Facial 

muscles were symmetric. Motor examination 

showed 5/5 muscle strength throughout. 

Coordination examination showed finger-tonose without dysemetria. Deep tendon 

reflexes showed symmetric response 

throughout. Plantar was downgoing 

bilaterally.

(Tr. 316). Dr. Sultan discontinued one drug and prescribed 

Lyrica14 and Fioricet;15 he also discussed some treatment options 

that could be used in the future.

Records from Dr. Low indicate that she examined Lucas five 

times between February 28 and April 2, 2012 for complaints of 

headache (Tr. 332-53). Though four exams noted that Plaintiff 

was in no acute distress, the March 19 record indicates that she 

was in obvious distress (Tr. 343). 

On March 30, Dr. Mark E. Larkins, of the West Florida 

 14Lyrica is used for the management of neuropathic pain. Error! 

Main Document Only.Physician's Desk Reference 2517 (62nd ed. 2008).

15Fioricet contains a barbiturate and relaxes muscle contractions 

involved in tension headaches. http://www.drugs.com/fioricet.html

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 6 of 23
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Medical Center, examined Lucas for neck pain and headaches (Tr. 

361-63). On exam, the Doctor noted discomfort on extension of 

the cervical spine indicating possible cervical facet loading 

with some tenderness to palpation over the paracervical 

musculature at the splenius cervicis and capilis regions, into 

the facets and trapezius bilaterally. X-rays showed a normal 

cervical spine (Tr. 364). Indocin16 was prescribed (Tr. 362). 

On April 6, 2012, Dr. Kristin L. Davis examined Lucas and noted 

that she had “significant analgesic overuse with overuse of 

stadol, maxalt, fioricet, Excedrin migraine and Indocin” before 

prescribing Depakote17 and Verapamil18 (Tr. 360; see generally Tr. 

359-61). Dr. Davis saw Plaintiff again four days later and 

noted that she had quit taking most of the drugs the Doctor had 

indicated were being overused; Lucas presented with a headache 

and reported having been fired from her job because she had 

missed too much work (Tr. 356-57). The examination was normal 

though Plaintiff was reported to be in mild distress; Davis 

 16Error! Main Document Only.Indocin is a non-steroidal drug found to 

be effective in the treatment of moderate to severe rheumatoid 

arthritis, moderate to severe ankylosing spondylitis, moderate to 

severe osteoarthritis, acute painful shoulder (bursitis and/or 

tendinitis), and acute gouty arthritis. Physician's Desk Reference

1676 (52nd ed. 1998).

17Error! Main Document Only.Depakote is used for the treatment of 

seizures. Physician's Desk Reference 428-34 (52nd ed. 1998). 

18Verapamil is used for the treatment of hypertension. Error! 

Main Document Only.Physician's Desk Reference 3070-71 (62nd ed. 2008).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 7 of 23
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indicated a desire to try Botox injections for the headaches. 

On April 16, Dr. Larkins determined that Botox injections were 

inappropriate at that time (Tr. 355).

On June 4, Plaintiff went to the D. W. McMillan Memorial 

Hospital Emergency Room for a migraine headache for which she 

was given Phenergan, Toradol, and Morphine; she was discharged 

in fair, but improved condition (Tr. 367-84).

On June 12, 2012, Lucas returned to the McMillan Hospital 

ER for a migraine and was given Phenergan and Decadron19 (Tr. 

385-97). She was discharged home in stable, improved condition 

with prescriptions for Compazine20 and Fioricet. Two days later 

though, Plaintiff was admitted to the hospital overnight for an 

intractable headache, gastroenteritis with dehydration, and noncardiac chest pain (Tr. 399-407). Lucas was treated with 

Morphine, and Toradol; Cymbalta and Toradol doses were 

decreased, Prozac was discontinued, and Zoloft21 was prescribed.

On July 5, Plaintiff went to PRI Med Wetumpka for a 

migraine; though she was in no apparent distress, she was 

 19Error! Main Document Only.Decadron is used for, among other things, 

the treatment of rheumatic disorders. Physician's Desk Reference

1635-38 (52nd ed. 1998).

20Compazine is an anti-psychotic drug used to treat psychotic 

disorders, anxiety, and to control severe nausea and vomiting. 

http://www.drugs.com/mtm/compazine.html 

21Error! Main Document Only.Zoloft is “indicated for the treatment of 

depression.” Physician's Desk Reference 2229-34 (52nd ed. 1998).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 8 of 23
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treated with Demerol and Phenergan (Tr. 409-11).

On August 5, Lucas returned to the McMillan Hospital ER for 

a migraine and was treated with Vistaril,22 Decadron, and Toradol 

(Tr. 412-20). 

On August 31, 2012 Forensic Psychologist Robert A. 

DeFrancisco examined Lucas at the request of the Social Security 

Administration (Tr. 421-23). He noted that her affect was 

appropriate to her mood: “Her mood is one of frustration and 

some anger, some depression as well as obvious pain” (Tr. 422). 

Her memory was grossly intact for both short- and long-term 

memory. “She [was] preoccupied with her depression and her 

pain” (Tr. 422). Insight was fair. DeFrancisco noted that she 

could “understand and remember instructions [though] carrying 

them out appear to be a major issue for her” (Tr. 423). 

“Restriction of activities/constriction of interest seem [] to 

be primarily a result of pain issues and depression issues which 

probably are now secondary to her pain problem” (Tr. 423).

On August 15, 2012, Dr. McKnight examined Lucas who rated 

her pain as eight; the Doctor noted that she “has had a very 

difficult course recently with a very significant worsening of 

her migraine headaches which has considerably flared her 

 22Vistaril is used to treat anxiety and tension and may be used to 

control nausea and vomiting. http://www.drugs.com/vistaril.html

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 9 of 23
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fibromyalgia” (Tr. 432; see generally Tr. 429-32). McKnight 

adjusted her medications, adding Tramadol23 and Temazepam24 to her 

regimen. On September 25, 2012, Plaintiff again saw McKnight 

for deep aching in her arms, neck, and shoulders as well as 

severe fatigue; she rated her pain as eight (Tr. 425-28). Lucas 

noted that she was having some difficulty with dressing herself, 

getting in and out of bed, walking outdoors on flat ground, and 

washing/drying herself. McKnight’s examination was within 

normal limits; medications were continued and Plaintiff was to 

return in four months.

Lucas was examined by Dr. Low or Dr. Maria I. Villarreal

seven times between May 4 and December 3, 2012, primarily—though 

not exclusively—for headaches (Tr. 454-92). Low’s examinations 

were, generally, essentially normal; medications were continued 

or new ones prescribed. On June 14, the Doctor noted Lucas to 

be in acute distress because of non-radiating chest discomfort, 

accompanied by fatigue, nausea, vomiting, and diarrhea; 

Plaintiff did not specifically complain of a migraine (Tr. 480-

83). A non-contrast CT brain scan was negative; chest x-rays 

 23 Tramadol “is indicated for the management of moderate to moderately 

severe chronic pain in adults who require around-the-clock treatment of 

their pain for an extended period of time.” Error! Main Document 

Only.Physician's Desk Reference 2520 (66th ed. 2012).

24Temazepam is used to treat insomnia symptoms, such as falling—or 

staying—asleep. http://www.drugs.com/temazepam.html

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 10 of 23
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were normal (Tr. 485-86). On July 13, Lucas received an 

injection of promethazine25 (Tr. 479). On August 10, Plaintiff 

was noted to be in obvious distress though the doctor noted that 

there were “no special circumstances for examination;” 

promethazine was ordered for nausea as needed (Tr. 474; see 

generally Tr. 473-76). On September 20, 2012, Lucas was found 

to be in acute distress though, again, there were “no special 

circumstances for examination” (Tr. 471; see generally Tr. 470-

72). On October 8, Dr. Low found Plaintiff to be in acute 

distress; Lucas reported that her pain got worse with movement 

(Tr. 462-66). A report from Dr. Davis on November 16 indicated 

that Plaintiff had had Botox injections two months earlier; she 

indicated that she was having three-to-four headaches per week, 

down from the four-to-five she had been experiencing (Tr. 458-

60). Davis found her in no acute distress and suggested that 

more injections a month later may be in order. On December 3, 

Lucas complained of depression and insomnia; Dr. Low found her 

to be in no acute distress but prescribed Ambien26 (Tr. 454-57). 

On December 18, a Pain Assessment form was completed by Dr. 

 25Promethazine is used to treat nausea and vomiting or used as a 

sedative or sleep aid. http://www.drugs.com/promethazine.html

26AmbienError! Main Document Only. is a class four narcotic used 

for the short-term treatment of insomnia. Physician's Desk Reference

2799 (62nd ed. 2008).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 11 of 23
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Ellen McKnight, indicating that Plaintiff experienced pain that 

was intractable and virtually incapacitating; physical exercise 

would increase her pain to the extent that she would have to 

have bed rest or medication (Tr. 494). McKnight also indicated 

that drug side effects would be severe and would limit Lucas’s 

effectiveness due to distraction, inattention, and drowsiness. 

On the same date, the Doctor also completed a Physical 

Capacities Evaluation (hereinafter PCE) in which she found

Plaintiff capable of lifting and carrying one pound frequently 

and five pounds occasionally; Lucas was capable of sitting for 

two hours and standing or walking for less than one hour during 

an eight-hour day (Tr. 495). McKnight indicated that Plaintiff 

could perform fine manipulation occasionally, pushing and 

pulling of arm or leg controls, gross manipulation, reaching, 

and operating motor vehicles only rarely, and that she could 

never climb, bend, stoop, or work around hazardous machinery; 

the Doctor indicated that Plaintiff would miss more than four 

days a month from work because of her impairments or treatment. 

On December 31, 2012, Dr. Villarreal examined Lucas for a 

two-day headache; she was noted to be in some distress (Tr. 504-

08). On January 16, 2013, Dr. Low saw Plaintiff for upper 

respiratory tract symptoms and a headache, finding her in no 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 12 of 23
13

acute distress (Tr. 497-503). On April 16, Low again examined 

Lucas for upper respiratory tract symptoms, a headache and 

sunburn; Plaintiff was in no acute distress and the exam was 

normal (Tr. 516-19). On April 26, Lucas received Phenergan and 

Toradol injections (Tr. 515). On June 3, Plaintiff complained 

of depression and feelings of sadness, hopelessness, and 

excessive tearfulness; Low noted that she was in no acute 

distress and prescribed Trazodone27 (Tr. 521-27). On July 24, 

2013, Plaintiff again had upper respiratory tract symptoms and a 

headache; the Doctor diagnosed bronchitis, rhinitis, sinusitis, 

depressive disorder, fibromyalgia, and insomnia (Tr. 528-31).

On July 8, Psychologist DeFrancisco noted that Lucas’s 

affect was flat, her mood dysphoric, and she was in obvious 

pain; her symptoms were consistent with pain and depression 

secondary to pain (Tr. 533-34). The Psychologist adjusted 

Plaintiff’s medications and indicated that she needed chronic 

pain management.

On August 13, Dr. Ellen W. McKnight examined Lucas for 

complaints of severe depression and muscle pain in her 

shoulders, rated as eight; the Doctor’s exam found her to be in 

no acute distress and within normal limits (Tr. 539-44). 

 27Error! Main Document Only.Trazodone is used for the treatment of 

depression. Physician's Desk Reference 518 (52nd ed. 1998).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 13 of 23
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McKnight prescribed Neurontin,28 and set out the following 

statement:

This patient has a very severe 

fibromyalgia and fatigue issues. She has 

had severe depression and anxiety. It is my 

opinion that she is not able to work on 

either a full or part-time position. I do 

not feel her medical condition allows for 

this and she is on numerous medications that 

interfere with her ability to concentrate 

and decrease her cognitive function. I feel 

that this is a permanent condition.

(Tr. 542). The Doctor indicated that Lucas should return in 

four months.

At the evidentiary hearing before the ALJ, Plaintiff 

testified that she sought disability benefits at the urging of 

Dr. McKnight (Tr. 40; see generally Tr. 38-50). Lucas had 

worked after that date, but her boss let her go because she was 

missing work two days a week due to her migraines, fibromyalgia,

or the treatment of them (Tr. 40-41). She also suffered from 

migraines, accompanied by an aura, nausea, and throbbing pain; 

the headaches occurred twelve-to-fifteen days a month and lasted

all day, requiring bed rest and medication (Tr. 44). Prescribed 

medications did not work on the migraines as well as the 

 28Error! Main Document Only.Neurontin is used in the treatment of 

partial seizures. Physician's Desk Reference 2110-13 (52nd ed. 1998).

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 14 of 23
15

injections of Toradol and Phenergan (Tr. 45). Lucas also 

suffered from depression and chronic fatigue (Tr. 45). 

Plaintiff estimated that she could walk for about fifteen 

minutes, stand about thirty minutes, and sit for about fortyfive minutes before experiencing a total loss of energy or pain 

(Tr. 45-46). She also had some joint pain in her fingers 

reported to be osteoarthritis (Tr. 46). On a lot of days, 

Plaintiff did not have the energy to drive (Tr. 46). Lucas had

problems with concentration; her mother took care of the 

laundry, meal preparation, and making sure that the children 

completed their homework (Tr. 47). Plaintiff spent about 

fifteen hours a day in bed, though she only got about five-tosix hours of sleep a day; she spent the rest of her time reading 

(Tr. 48). This concludes the summarized evidence of record.

In bringing this action, Lucas first claims that the ALJ 

did not properly consider the opinions and conclusions of her 

treating physician, Dr. McKnight (Doc. 13, pp. 3-8). It should 

be noted that "although the opinion of an examining physician is 

generally entitled to more weight than the opinion of a nonexamining physician, the ALJ is free to reject the opinion of 

any physician when the evidence supports a contrary conclusion." 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 15 of 23
16

Oldham v. Schweiker, 660 F.2d 1078, 1084 (5th Cir. 1981);29 see 

also 20 C.F.R. § 404.1527 (2014). 

In her determination, after summarizing the medical 

evidence, the ALJ made the following findings regarding Dr. 

McKnight’s opinions:

Dr. McKnight has opined that the 

claimant experiences disabling pain and is 

unable to perform even sedentary work 

activities on a regular and continuing basis 

(Exhibits 17F and 24F). Although Dr. 

McKnight is a treating medical source, I 

give her overly restrictive opinion little 

weight. There is little in the way of 

abnormal objective findings in the medical 

evidence of record, and Dr. McKnight is 

basing a good portion of her opinion on the 

claimant’s subjective complaints.

(Tr. 28). The ALJ also found that there was “nothing in Dr. 

McKnight’s records indicating that fibromyalgia tender points 

were identified, and the claimant acknowledged at the hearing 

that there were no blood test results or other clinical findings 

for chronic fatigue” (Tr. 27).

The Court finds the ALJ’s conclusions are supported by 

substantial evidence. The Court notes that although McKnight’s 

 29The Eleventh Circuit, in the en banc decision Bonner v. City of 

Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981), adopted as precedent 

decisions of the former Fifth Circuit rendered prior to October 1, 

1981.

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 16 of 23
17

evidence of record covers nearly two years (October 3, 2011

through August 13, 2013), there are only five examinations 

during the period considered by the Court; that amounts to an 

exam approximately every six months. While that fact does not 

disprove her conclusions, the Court also notes that the Doctor’s 

evidence reveals no real substance from McKnight’s exams 

themselves. Lucas’s subjective claims figure largely throughout 

each report while the Doctor’s own objective findings barely 

make an appearance; McKnight’s notations are generally limited 

to findings that Plaintiff is in no acute distress and the exam 

was within normal limits (Tr. 321, 326, 426, 430, 541). The 

Court further notes that the Pain Assessment and PCE forms 

completed by McKnight on December 18, 2012 (Tr. 494-95) were 

without benefit of a recent exam as the Doctor had last seen 

Lucas three months earlier on September 2, 2012 (Tr. 425-28). 

The Rheumatologist’s final exam came almost a year later, on 

August 13, 2013, and even though she ventured the opinion that 

Plaintiff was totally disabled and unable to perform any work, 

the examination notes indicate nothing to support the conclusion

(Tr. 539-44). Finally, the Court notes that no other evidence 

of record supports McKnight’s findings of extreme limitation. 

Lucas’s claim that the ALJ did not properly consider Dr. 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 17 of 23
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McKnight’s opinions is without merit.

Plaintiff next claims that the ALJ improperly discounted

her testimony of pain and limitation (Doc. 13, pp. 8-13). The 

standard by which Lucas's complaints of pain are to be evaluated 

requires "(1) evidence of an underlying medical condition and 

either (2) objective medical evidence that confirms the severity 

of the alleged pain arising from that condition or (3) that the 

objectively determined medical condition is of such a severity 

that it can be reasonably expected to give rise to the alleged 

pain." Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991) 

(citing Landry v. Heckler, 782 F.2d 1551, 1553 (11th Cir. 

1986)). The Eleventh Circuit Court of Appeals has also held 

that the determination of whether objective medical impairments 

could reasonably be expected to produce the pain was a factual 

question to be made by the Secretary and, therefore, "subject 

only to limited review in the courts to ensure that the finding 

is supported by substantial evidence." Hand v. Heckler, 761 

F.2d 1545, 1549 (11th Cir.), vacated for rehearing en banc, 774 

F.2d 428 (1985), reinstated sub nom. Hand v. Bowen, 793 F.2d 275 

(11th Cir. 1986). Furthermore, the Social Security regulations 

specifically state the following:

statements about your pain or other symptoms 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 18 of 23
19

will not alone establish that you are 

disabled; there must be medical signs and 

laboratory findings which show that you have 

a medical impairment(s) which could 

reasonably be expected to produce the pain 

or other symptoms alleged and which, when 

considered with all of the other evidence 

(including statements about the intensity 

and persistence of your pain or other 

symptoms which may reasonably be accepted as 

consistent with the medical signs and 

laboratory findings), would lead to a 

conclusion that you are disabled.

20 C.F.R. § 404.1529(a) (2014).

In her determination, the ALJ found that Plaintiff’s 

testimony was not credible; specifically, “the claimant’s 

statements concerning the intensity, persistence, and limiting 

effects of these symptoms are not entirely credible for the 

reasons explained in this decision” (Tr. 25). Regarding Lucas’s 

fibromyalgia and osteoarthritis, the ALJ noted that although 

there were some indications of “neck tenderness and obvious 

pain,” there were other musculoskeletal examinations that were 

normal; additionally, x-ray results had all been normal (Tr. 

25). In spite of the multitude of medications taken, the ALJ 

noted Plaintiff’s claim “that she does not get much relief from 

her pain” (Tr. 25). The ALJ further noted, with regard to 

Lucas’s migraines, that although pain and distress have been 

noted by physicians at times, no objective testing confirmed any 

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 19 of 23
20

abnormal findings; again, Plaintiff generally claimed that she 

received no relief from treatment (Tr. 26). Similar findings 

and claims were made regarding Lucas’s assertions of depression.

The ALJ went on to question Lucas’s credibility, noting 

that she engaged in a range of activities that cast doubt on her 

testimony (Tr. 27). The ALJ also noted that her Doctor’s 

medical records did not support the claims she made of extreme 

limitations; those records also failed to provide objective 

evidence of disability (Tr. 27). 

The Court finds substantial support for the ALJ’s decision. 

Lucas’s claims of extreme pain and limitation are supported by 

the medical records only in that the Doctors repeat Plaintiff’s 

claims; the exams, however, regularly report normal findings. 

The Court agrees with the ALJ’s conclusion that McKnight’s 

opinions are based, in large part, on Lucas’s subjective 

complaints (Tr. 28). Even Dr. Low, who examined Plaintiff the 

most often and prescribed many different medications to 

alleviate her claims of intractable headaches, generally always 

reported that Lucas was in no acute distress and reported normal 

examinations. While Plaintiff certainly suffers some pain and 

limitation, this medical record does not support the extreme 

claims made.

Case 1:14-cv-00191-CB-M Document 18 Filed 01/15/15 Page 20 of 23
21

Finally, Lucas asserts that the ALJ failed to re-contact 

the consultative examiner for questions about the opinion 

rendered (Doc. 13). More specifically, Plaintiff refers to the 

report of Psychologist DeFrancisco in which he states the 

following: “She can understand and remember instructions, [sic] 

carrying them out appear to be a major issue for her” (Tr. 423). 

In reviewing this evidence, the ALJ gave some weight to 

DeFrancisco’s opinion overall, but gave little weight to his 

opinion that carrying out instructions would be a major issue 

for Lucas, finding that conclusion vague (Tr. 27-28). 

Plaintiff urges the Court to find the ALJ in error for not 

fully developing the record (Doc. 13, pp. 13-15). The Eleventh 

Circuit Court of Appeals has required that "a full and fair 

record" be developed by the Administrative Law Judge even if the 

claimant is represented by counsel. Cowart v. Schweiker, 662 

F.2d 731, 735 (11th Cir. 1981). 

The Court notes that the Psychologist’s report indicates 

that Lucas’s problems are two-fold: “1) pain disorder 

associated by general medical condition 2) major depression as a 

result of problem number one” (Tr. 423). The Government has 

argued that because DeFrancisco found Plaintiff’s problems to be 

more physical than mental, she has not sustained her burden of 

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demonstrating disabling mental limitations (Doc. 14, pp. 13-14). 

The Court notes that the burden is on the claimant to prove that 

she is disabled. See 20 C.F.R. § 404.1512(a) (2014); see also 

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

Psychologist’s conclusions, considered in a light most favorable 

to Lucas, do not support a finding of disability on the basis of 

depression. His conclusions on examination ten months later 

confirm this finding (Tr. 533-34). The Court further finds that 

the balance of the record also fails to support such a finding. 

Plaintiff’s claim otherwise is without merit.

Lucas has raised three different claims in bringing this 

action. All are without merit. Upon consideration of the 

entire record, the Court finds "such relevant evidence as a 

reasonable mind might accept as adequate to support a 

conclusion." Perales, 402 U.S. at 401. Therefore, it is 

recommended that the Secretary's decision be affirmed, see 

Fortenberry v. Harris, 612 F.2d 947, 950 (5th Cir. 1980), that 

this action be dismissed, and that judgment be entered in favor 

of Defendant Carolyn W. Colvin and against Plaintiff April M. 

Lucas.

NOTICE OF RIGHT TO FILE OBJECTIONS

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A copy of this report and recommendation shall be served on 

all parties in the manner provided by law. Any party who 

objects to this recommendation or anything in it must, within 

fourteen (14) days of the date of service of this document, file 

specific written objections with the Clerk of this Court. See

28 U.S.C. § 636(b)(1); FED.R.CIV.P. 72(B); S.D. ALA. L.R.72.4. 

In order to be specific, an objection must identify the specific 

finding or recommendation to which objection is made, state the 

basis for the objection, and specify the place in the Magistrate 

Judge’s report and recommendation where the disputed 

determination is found. An objection that merely incorporates 

by reference or refers to the briefing before the Magistrate 

Judge is not specific.

DONE this 15th day of January, 2015.

s/BERT W. MILLING, JR. 

UNITED STATES MAGISTRATE JUDGE

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