Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_10-cv-00165/USCOURTS-almd-2_10-cv-00165-0/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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IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

AUDREY EDWARD o/b/o J.P., )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:10cv165-CSC

) (WO)

MICHAEL J. ASTRUE, )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION

I. Introduction

This is a child impairment case. On January 31, 2007, the plaintiff filed, pursuant to

Title XVI of the Social Security Act, 42 U.S.C. §§ 1381 et seq., an application for

supplemental security income on behalf of J.P., her minor son. The application was denied 1

at the administrative levels of review, and the plaintiff requested a hearing before an

Administrative Law Judge (ALJ) which was held on May 7, 2009. The ALJ denied the

application for benefits, and the Appeals Council denied review. Thus, the ALJ’s decision

is the final decision of the Commissioner now properly before the court for review. 

The parties have consented to the undersigned United States Magistrate Judge

rendering a final judgment in this lawsuit pursuant to 28 U.S.C. § 636(c)(1) and M.D. Ala.

LR 73.1. The court has jurisdiction over this lawsuit pursuant to 42 U.S.C. §§ 405(g) and

 Pursuant to the E-Government Act of 2002, as amended on August 2, 2002, and M.D. Ala.

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General Order No. 2:04mc3228, the court has redacted the plaintiff’s minor child’s name throughout this

opinion and refers to him only by his initials, J.P.

Case 2:10-cv-00165-CSC Document 18 Filed 08/12/11 Page 1 of 8
1383(c)(3). After careful consideration of the briefs of the parties and the record of the

administrative proceedings, the court concludes that the decision ofthe Commissioner should

be reversed and remanded for further proceedings.

II. Child Disability

An individual under 18 is considered disabled “if that individual has a medically

determinable physical or mental impairment, which results in marked and severe functional

limitations, and which can be expected to result in death or which has lasted or can be

expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §

1382c(a)(3)(C)(I) (1999). The sequential analysis for determining whether a child claimant

is disabled is as follows:

1. If the claimant is engaged in substantial gainful activity, she is not

disabled.

2. If the claimant is not engaged in substantial gainful activity, the

Commissioner determines whether the claimant has a physical or

mental impairment which, whether individually or in combination with

one or more other impairments, is a severe impairment. If the

claimant’s impairment is not severe, she is not disabled.

3. If the impairment is severe, the Commissioner determines whether the

impairment meets the durational requirement and meets, medically

equals, or functionally equals in severity an impairment listed in 20

C.F.R. Part 404, Subpart P, Appendix 1. If the impairment satisfies this

requirement, the claimant is presumed disabled.

See 20 C.F.R. § 416.924(a)-(d) (1997).

The Commissioner’s regulations provide that if a child’s impairment or impairments

are not medicallyequal, or functionallyequivalent in severityto a listed impairment, the child

is not disabled. See 20 C.F.R. § 416.924(d)(2) (1997). In determining whether a child's

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impairment functionally equals a listed impairment, an ALJ must consider the extent to

which the impairment limits the child's ability to function in the following six “domains” of

life: (1) acquiring and using information; (2) attending and completing tasks; (3) interacting

and relating with others; (4) moving about and manipulating objects; (5) caring for oneself;

and (6) health and physical well-being. Shinn ex rel. Shinn v. Comm'r of Soc. Sec., 391 F.3d

1276, 1279 (11 Cir. 2004); 20 C.F.R. § 416.926a(b)(1). A child's impairment functionally th

equals a listed impairment, and thus constitutes a disability, if the child's limitations are

“marked” in two of the six life domains, or if the child's limitations are “extreme” in one of

the six domains. Shinn, 391 F.3d at 1279; 20 C.F.R. § 416.926a(d).

In reviewing the Commissioner’s decision, the court asks only whether his findings

concerning the steps are supported by substantial evidence. Dyer v. Barnhart, 395 F.3d

1206, 1210 (11 Cir. 2005). Substantial evidence is “more than a scintilla,” but less than a

th

preponderance: it “is such relevant evidence as a reasonable person would accept as adequate

to support a conclusion.” Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158–59 (11th

Cir. 2004) (quotation marks omitted). The court “may not decide the facts anew, reweigh

the evidence, or substitute . . . [its] judgment for that of the [Commissioner].” Phillips v.

Barnhart, 357 F.3d 1232, 1240 n. 8 (11 Cir. 2004) (alteration in original) (quotation marks th

omitted). The court must, however, conduct an “exacting examination of the

[Commissioner's] conclusions of law.” Martin v. Sullivan, 894 F.2d 1520, 1529 (11 Cir. th

1990).

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III. The Issues

As presented by the plaintiff, the issues before the court are as follows. 2

(1) The Commissioner’s decision should be reversed, because the ALJ’s

administrative finding of non-disability lacks the support of substantial

evidence. 

(2) The Commissioner’s decision should be reversed, because the ALJ

committed legal error at step three of the evaluation process. The court

pretermits discussion of the plaintiff's specific arguments because the court

concludes that the ALJ erred as a matter of law, and, thus, this case is due to

be remanded for further proceedings. 

(Pl.’s Br., doc. # 13, at 6).

III. Discussion and Conclusion

The ALJ found that J.P. had severe impairments of attention deficit disorder with

hyperactivity (ADHD), oppositional defiant disorder (ODD) and learning disability with a

reading emphasis. (R. at 12) The ALJ further found that J.P. did not have an impairment or

combination of impairments that met or medically equaled an impairment in the Listing of

Impairments in 20 C.F.R. Part 404, Subpt. P, App. 1(Appendix 1). Id. The ALJ then found

that J.P.’s impairments also did not functionally equal a listing. Consequently, the ALJ found

J.P. was not disabled. In reaching these conclusions, the ALJ relied heavily on the opinion

 In the order of procedure entered in this case, the court ordered as follows: “The plaintiff’s

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brief shall contain a section titled ‘Statement of the Issues.’ In this section in numbered paragraphs, the

plaintiff shall state in a concise, specific manner each issue which the plaintiff presents to the court for

resolution. Issues not presented in the Statement of the Issues will not be considered.” (doc. # 4) In a

footnote, the court warned that “general statements of issues such as ‘the ALJ’s decision is not supported

by substantial evidence’ will not be considered by the court.” On this basis alone, the court could affirm

the Commissioner’s decision in this case because the plaintiff’s brief most certainly is in violation of

these proscriptions. In this instance, the court will not take that drastic action but counsel for the plaintiff

should take heed in the future.

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of the medical expert who testified at the hearing.

J.P. argues that the ALJ erred when he based his findings “upon the medical opinions

received by the non-examining testifying expert of record.” (Pl. Br. at 6) The plaintiff

contends that under the law of this circuit the opinion of a non-examining physician cannot

constitute substantial evidence to support an administrative decision. 

The Commissioner's regulations require that "more weight [be given] to the opinion

of a source who has examined [the claimant] than to the opinion of a source who has not

examined [the claimant]." 20 C.F.R. § 404.1527(d)(1); accord Broughton v. Heckler, 776

F.2d 960, 962 (11 Cir. 1985); Swindle v. Sullivan, 914 F.2d 222, 226 n. 3 (11 Cir. 1990). th th

Moreover, "[t]he opinions of nonexamining, reviewing physicians, ... when contraryto those

of the examining physicians, are entitled to little weight, and standing alone do not constitute

substantial evidence." Lamb v. Bowen, 847 F.2d 698 (11 Cir. 1988); Sharfarz v. Bowen, th

825 F.2d 278, 280 (11 Cir. 1987); accord Spencer on Behalf of Spencer v. Heckler, 765 th

F.2d 1090, 1094 (11 Cir. 1985) (“‘[t]o attempt to evaluate disability without personal th

examination of the individual and without evaluation of the disability as it relates to the

particular person is medical sophistry at best’”). In Edwards v. Sullivan, 937 F.2d 580, 584-

85 (11 Cir. 1991), the court found that the ALJ did not err in relying on the opinion of a

th

nonexamining physician where the physician's opinion was consistent with the opinions of

examining physicians.

One of the interpretive difficulties with this seemingly straightforward principle of

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law arises from cases such as Swindle v. Sullivan, 914 F.2d 222, 226 n. 3 (11 Cir. 1990), in th

which the court stated, albeit in a footnote, that the opinion of a nonexamining physician “is

entitled to little weight and taken alone does not constitute substantial evidence to support

an administrative decision.” In isolation, Swindle seems to suggest that the opinion of a

nonexamining physician cannot be substantial evidence under any circumstances. Swindle

cites Broughton as authority, but that case “held that the opinion of a nonexamining

physician is entitled to little weight if it is contrary to the opinion of the claimant's treating

physician.” Broughton, 776 F.2d at 962 (emphasis added). That formulation of the law is

consistent with Lamb and Sharfarz. Thus, the court concludes that the opinion of a

nonexamining physician who has reviewed medical records may be substantial evidence if

it is consistent with the well-supported opinions of examining physicians or other medical

evidence in the record.

The problem in this case is that the ALJ ignored what the medical expert said about

other medical evidence that he needed in order to proffer an opinion. During the hearing

which was held on May 7, 2009, the medical expert asked J.P.’s mother when J.P. last saw

Dr. Palmer, the treating psychiatrist. (R. at 34) The mother replied that her son saw Dr.

Palmer every two months, “frequently and regularly.” Id. The medical expert then stated,

“Then his [Dr. Palmer’s] records are outdated, judge.” Id. After a discussion about obtaining

those records, the medical expert interjected this.

If I may add, judge. Those records would be very helpful because there is an

inconsistency in the last exhibit, which is Dr. Palmer's overall MRFC

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evaluation and the treating records that we have thus far from him. The

treating records we have thus far as a year, we're missing the most current year

of treatment. Teacher questionnaires would also certainly be very helpful.

Unless I'm missing that, I don’t see any in the file.

(R. at 34)

Near the conclusion of the hearing, the ALJ asked the medical expert whether based

on his review of the record the claimant's impairments individually or in combination meet

or medically equal the requirements of a listing. In response, the medical expert said

Based on the record as it stands, in my opinion they would not meet or

equal. It would not meet or equal 112.11 for the ADHD. Dr. Palmer's

indications in his records indicate that the claimant has a very positive

response to the Concerta. He notes that when the claimant is taking his

medication his mood is stable and that he has improved concentration. That

is up until the records we have, again, that end May 2008. The record would

indicate that there is some significant behavioral problems in my opinion,

judge, that would cause marked impairments in his interacting and relating

with others. With the record as is at this point I would say less than marked

impairments acquiring and using information, less than marked impairments

attending and completing tasks when adequatelymedication, less than marked

impairments caring for self, no impairments manipulating objects, no

impairments with health and physical well -being.

(R. at 36)

It is painfully obvious that the medical expert carefully qualified his opinion based on

the record before him while again noting that the records were not current. An ALJ plays a

“crucial role in the disability review process” and has a duty to “develop a full and fair

record” and to “carefully weigh the evidence, giving individualized consideration to each

claim.” Miles v. Chater, 84 F.3d 1397, 1401 (11 Cir. 1996) (per curiam). As already noted, th

the ALJ heavily relied on the medical expert but remarkably ignored that expert’s entreaties

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about needing updated records. The ALJ’s failure to secure the updated medical records and

provide them to the medical expert for his review and opinion was error.

The Commissioner argues that reliance on the medical expert was not error because

his opinion was congruent with other medical evidence. This argument is beside the point. 

The medical expert noted several times that he needed updated information to form a

reasoned opinion. The ALJ failed to get that information, and on remand, this error must be

cured.

The court will enter a final judgment reversing and remanding this case to the

Commissioner for further proceedings consistent with this opinion.

Done this 12 day of August, 2011. th

 /s/Charles S. Coody 

CHARLES S. COODY

UNITED STATES MAGISTRATE JUDGE

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