Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alsd-1_06-cv-00295/USCOURTS-alsd-1_06-cv-00295-0/pdf.json

Parties Involved:
Michael J. Astrue
Defendant
Shiquita L. Frieson
Plaintiff

Document Text:

IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF ALABAMA

SOUTHERN DIVISION

SHIQUITA L. FRIESON, *

 * 

Plaintiff, *

*

vs. * CIVIL ACTION 06-00295-WS-B

*

MICHAEL J. ASTRUE, *

Commissioner of Social Security, *

*

Defendant. *

REPORT AND RECOMMENDATION

Plaintiff Shiquita L. Frieson (“Plaintiff”), proceeding pro se, brings this action seeking

judicial review of a final decision of the Commissioner of Social Security denying her claim for

disability insurance benefits and supplemental security income under Titles II and XVI of the Social

Security Act, 42 U.S.C. §§ 401 et seq., and 1381 et seq. Oral argument was held on April 24, 2007.

Upon careful consideration of the administrative record, oral argument and the memoranda of the

parties, it is hereby RECOMMENDED that the decision of the Commissioner be AFFIRMED.

I. Procedural History

Plaintiff protectively filed applications for disability insurance benefits and supplemental

security income on March 17, 2000, alleging that she has been disabled since February 21, 2000 due

to cardiomyopathy, hypertension and asthma. (Tr. 21, 62-64, 368). The Social Security Agency

determined that Plaintiff met Listing 4.08 (cardiomyopathy) effective February 21, 2000. (Id.)

Thus, she was found disabled, and entitled to benefits. (Id.) Pursuant to the regulations, Plaintiff’s

health condition was reevaluated in 2003 for continued disability, and it was determined that her

disability ceased in September 2003. (Id. at 23-45, 368-371). Consequently, on September 23,

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2003, Plaintiff received initial notification of the cessation of benefits. (Id. at 25-28, 146-153).

Plaintiff requested and was denied reconsideration of the cessation decision. (Id. at 29-35). Plaintiff

then requested a hearing before an Administrative Law Judge (“ALJ”). (Tr. 46). On June 22, 2005,

ALJ William Ragland (“ALJ” or “ALJ Ragland”) held an administrative hearing, and on December

16, 2005, issued an unfavorable decision. (Id. at 9-20, 372-383). He found that Plaintiff’s disability

ceased as of September 30, 2003, and that she retains the residual functional capacity (“RFC”) to

perform a full range of light work. (Id. at 20). On March 16, 2006, the Appeals Council denied

Plaintiff’s request for review; thus, the ALJ’s decision became the final decision of the

Commissioner in accordance with 20 C.F.R. § 404.981. (Id. at 4-7). The parties agree that this case

is now ripe for judicial review and is properly before this Court pursuant to 42 U.S.C. §§ 405(g) and

1383(c)(3).

II. Issues on Appeal

A. Whether the ALJ erred by finding that Plaintiff had medical improvement such that

her disability ceased in September 2003? 

III. Factual Background

Plaintiff was born on September 8, 1975, and was 29 years old at the time of the

administrative hearing. (Tr. 375). She has an 11th grade education, and past work experience

(“PRW”) as a custodian, cashier, instructor’s aide and dietary aide. (Id. at 96, 101, 117-124, 376-

377). At the June 2005 hearing, Plaintiff, proceeding pro se, reported that she last worked in 2000,

that she was diagnosed with cardiomyopathy in 2000, and that she was unable to work because she

suffered shortness of breath and swollen ankles, hands and feet, and tired easily. (Id. at 377, 379-

382). Plaintiff also reported that she has asthma, hypertension, elevated blood pressure, left arm

problems from a prior injury; and psychosis, and suffered a “really bad” nervous breakdown in 2002

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This Court’s review of the Commissioner’s application of legal principles is plenary. Walker v. Bowen,

826 F.2d 996, 999 (11th Cir. 1987).

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or 2003 which resulted in her being diagnosed with schizophrenia and a bipolar disorder. (Id. at

379-380). According to Plaintiff, her mother helps her cook and care for her four children. (Id. at

381). Plaintiff indicated that she performs some household chores, reads the newspaper some, and

drives every so often. (Id. at 381-382). Her reported medications have included Coreg, Primidone,

Wellbutrin, Seroquel, Potassium, Lexapro, Lasix, Mysolin, Albuterol, Prozac, Altace, Tylenol PM

and Vasotec. (Tr. 90, 100, 160, 162).

IV. Analysis

A. Standard of Review

In reviewing claims brought under the Act, this Court’s role is a limited one. The Court’s

review is limited to determining 1) whether the decision of the Secretary is supported by substantial

evidence and 2) whether the correct legal standards were applied. Martin v. Sullivan, 894 F.2d

1520, 1529 (11th Cir. 1990).1 A court may not decide the facts anew, reweigh the evidence, or

substitute its judgment for that of the Commissioner. Sewell v. Bowen, 792 F.2d 1065, 1067 (11th

Cir. 1986). The Commissioner’s findings of fact must be affirmed if they are based upon substantial

evidence. Brown v. Sullivan, 921 F.2d 1233, 1235 (11th Cir. 1991); Bloodsworth v. Heckler, 703

F.2d 1233, 1239 (11th Cir. 1983) (holding substantial evidence is defined as “more than a scintilla

but less than a preponderance” and consists of “such relevant evidence as a reasonable person would

accept as adequate to support a conclusion[]”). In determining whether substantial evidence exists,

a court must view the record as a whole, taking into account evidence favorable, as well as

unfavorable, to the Commissioner’s decision. Chester v. Bowen, 792 F. 2d 129, 131 (11th Cir.

1986); Short v. Apfel, 1999 U.S. DIST. LEXIS 10163 (S.D. Ala. 1999).

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The claimant must first prove that he or she has not engaged in substantial gainful activity. The second

step requires the claimant to prove that he or she has a severe impairment or combination of impairments. If, at the

third step, the claimant proves that the impairment or combination of impairments meets or equals a listed

impairment, then the claimant is automatically found disabled regardless of age, education, or work experience. If

the claimant cannot prevail at the third step, he or she must proceed to the fourth step where the claimant must prove

an inability to perform their past relevant work. Jones v. Bowen, 810 F.2d 1001, 1005 (11th Cir. 1986). In

evaluating whether the claimant has met this burden, the examiner must consider the following four factors: (1)

objective medical facts and clinical findings; (2) diagnoses of examining physicians; (3) evidence of pain; (4) the

claimant’s age, education and work history. Id. at 1005. Once a claimant meets this burden, it becomes the

Commissioner’s burden to prove at the fifth step that the claimant is capable of engaging in another kind of

substantial gainful employment which exists in significant numbers in the national economy, given the claimant’s

residual functional capacity, age, education, and work history. Sryock v. Heckler, 764 F.2d 834 (11th Cir. 1985). If

the Commissioner can demonstrate that there are such jobs the claimant can perform, the claimant must prove

inability to perform those jobs in order to be found disabled. Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999). 

See also Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987) (citing Francis v. Heckler, 749 F.2d 1562, 1564 (11th

Cir. 1985)). 

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B. Discussion

An individual who applies for Social Security disability benefits must prove her disability.

20 C.F.R. §§ 404.1512, 416.912. Disability is defined as the “inability to do any substantial gainful

activity by reason of any medically determinable physical or mental impairment 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 twelve months.” 42 U.S.C. §§ 423(d)(1)(A), 404.1505(a), 416.905(a). The Social

Security regulations provide a five-step sequential evaluation process for determining if a claimant

has proven her disability. 20 C.F.R. §§ 404.1520, 416.920.2

After a claimant has been awarded disability benefits, the Commissioner is statutorily

required to periodically review whether entitlement to receive benefits continues. 20 C.F.R. §

404.1594(a). When a claimant presents evidence of continuing disability, a presumption attaches

that the disability continues, until proven otherwise. See, e.g., Williams v. Apfel, 73 F. Supp. 2d

1325, 1337 (M.D. Fla. 1999). Therefore, the burden is upon the Commissioner to present evidence

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“[O]nce the claimant has introduced evidence that his or her condition remains essentially the same as it

was at the time of the earlier determination, the claimant is entitled to the benefit of a presumption that his or her

condition remains disabling . . . . The presumption of a continuing disability does not affect the ultimate burden of

proof. It imposes on the [Commissioner] only the burden of going forward with evidence to rebut or meet the

presumption . . . . Once the burden to come forward has shifted to the SSA, the [Commissioner] must present

evidence that there has been sufficient improvement in the claimant's condition to allow the claimant to undertake

gainful activity.” Williams, 73 F. Supp 2d at 1337.

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to support the decision to terminate disability income benefits or supplemental security income.3

Id. In reviewing a decision to terminate benefits, the ALJ must compare the original medical

evidence to the new medical evidence used to make a finding of medical improvement. Id. The

comparison begins with the most recent favorable medical decision, that is, the latest final decision

involving consideration of the medical evidence and the issue of whether claimant was disabled or

continued to be disabled. Id. See also 20 C.F.R. §§ 404.1594(b)(7), 416.994(b)(1)(vii). Review of

the medical signs, the claimant’s statements of her symptoms and complaints, and laboratory

findings are all necessary to determine whether medical improvement has occurred. See, e.g.,

Williams, 73 F. Supp. 2d at 1337-1338. See also 20 C.F.R. §§ 404.1594(b)(1), 416.994(b)(1)(i). 

Medical improvement is defined as any decrease in the medical severity of the claimant’s

impairment(s) which was present at the time of the most recent favorable medical decision that the

claimant was disabled or continued to be disabled. 20 C.F.R. §§ 404.1594(b)(1), 416.994(b)(1)(i).

The medical improvement must be related to the claimant’s ability to work, which means that along

with the decrease in severity of the claimant’s medical impairment, there has been an increase in the

claimant’s residual functional capacity to do basic work activities. 20 C.F.R. §§ 404.1594(b)(3),

419.994(b)(1)(iii). There must also be a showing that the claimant is able to engage in substantial

gainful activity. 20 C.F.R. §§ 404.1594(b)(5), 419.994(b)(1)(v). The regulations state that when

new evidence showing a change in signs, symptoms and laboratory findings establishes that both

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There are exceptions to the requirement of a finding of medical improvement, which may also result in the

termination of disability benefits. 20 C.F.R. § 404.1594(d) and (e). Sub-section (d) refers to certain limited

situations where disability has ended without medical improvement. Specifically, (1) where medical technological

advances improve the claimant’s ability to perform substantial gainful employment, (2) where the claimant has had

vocational therapy which improves the ability to meet the vocational requirements of more jobs, (3) where the

claimant should never have been considered disabled because new or improved medical diagnostic or evaluative

techniques show that the claimant’s impairment is not as disabling as it was once considered, and (4) where

substantial evidence demonstrates that the prior decision was in error because (i) evidence was misread or an

adjudicative standard, such as a Listing, was misapplied, (ii) where missing evidence later supplied supports a

finding of not disabled, (iii) where new evidence relating to the prior determination refutes conclusions based upon

the prior evidence, (iv) or the claimant is working. Sub-section (e) refers to a second group of exceptions which

result in a decision without a determination of medical improvement or ability to engage in substantial gainful

activity. These are circumstances of (1) fraud in obtaining benefits, (2) failure to cooperate, (3) inability to find the

claimant, and (4) failure to follow prescribed treatments which would restore the claimant’s ability to work. See also

20 C.F.R. § 416.994(b)(3) and (4).

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 In cases wherein the plaintiff previously received supplemental security income benefits there is a sevenstep process. 20 C.F.R. § 416.994(b)(5). 

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medical improvement has occurred and a claimant’s functional capacity to perform basic work

activities, or residual functional capacity, has increased, medical improvement which is related to

your ability to work has thus occurred. 20 C.F.R. §§ 404.1594(b), 416.994(b).4

In a disability insurance benefits case, the regulations require the Commissioner to follow an

eight-step5 sequential evaluation process to determine whether a claimant has obtained medical

improvement: 1) the claimant must not be engaged in “substantial gainful activity;” 2) it must be

determined whether the claimant's severe impairment meets or equals the severity of a listed

impairment – if the claimant's condition meets or equals the level of severity of a listed impairment,

the claimant's disability continues; 3) if the severe impairment does not equal or meet the severity

of a listed impairment, the examiner proceeds to the third step – an assessment of whether there has

been medical improvement of the claimant's condition; 4) if there has been medical improvement,

it must be determined if that improvement is related to the claimant’s ability to do work, and if there

has not been medical improvement, the examiner proceeds to the fifth step; 5) to determine whether

any exceptions listed in 20 C.F.R.§ 404.1594(d) and (e) apply; 6) if there has been medical

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improvement shown to be related to a claimant’s ability to do work or one of the first group of

exceptions applies, it must then be determined whether all claimant’s current impairments in

combination are severe, and if severe, the examiner proceeds to the seventh step; 7) an assessment

of the claimant's ability to do substantial gainful activity – i.e., an assessment of a claimant’s RFC

based on all current impairments and a consideration as to whether a claimant can still perform her

PRW, and if the claimant is unable to perform PRW, the examiner proceeds to the eighth step; and

8) will determine whether, given her RFC, age, education and PRW, the claimant can perform other

work. 20 C.F.R. § 404.1594(f)(1)-(8). See, e.g, Whetstone v. Barnhart, 263 F. Supp. 2d 1318, 1337-

1338 (M.D. Ala. 2003); Chumbley v. Shalala, 1994 WL 774030, *2-3 (M.D. Ga. Nov. 22, 1994);

Cagle v. Shalala, 1994 WL 465824, *3-6 (N.D. Ala. May 10, 1994). This eight-step standard

subsumes the substantial evidence analysis such that this Court must review the Secretary's final

decision in terms of both the eight-step analysis and the substantial evidence standard. Whetstone,

263 F. Supp. 2d at 1321. “The appropriate inquiry is whether the Secretary's finding of improvement

to the point of no disability is supported by substantial evidence.” Id. 

In case sub judice, the ALJ determined that Plaintiff had not engaged in substantial gainful

activity since she was found to be disabled. (Tr. 19-20). The ALJ found that while Plaintiff has the

severe impairment of cardiomyopathy, it does not meet or equal the severity of a listed impairment.

(Id.) The ALJ concluded that there had been medical improvement of Plaintiff’s condition and that

said improvement was related to her ability to work. (Id.) The ALJ determined that while Plaintiff’s

cardiomyopathy impairment is severe, she retains the RFC to perform light work but is unable to

perform her past relevant work (“PRW”). (Id.) The ALJ then determined that due to Plaintiff’s

residual functional capacity (“RFC”) for light work, age, education and work history, a finding of

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The undersigned notes that while the ALJ cited to the correct rule, Rule 202.17 in the body of his decision,

he inadvertently cited to Rule 201.17 in his formal findings – a rule which is inapplicable to the present case as it

concerns sedentary work and here, Plaintiff was found to retain the RFC for light work. (Tr. 20).

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not disabled was directed by Rule 202.17 of the Medical-Vocational Guidelines.

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 (Id.) Thus, the

ALJ concluded that Plaintiff’s disability ceased on September 30, 2003. (Id.)

The undersigned’s review of the relevant medical evidence reveals that she was treated in

the Emergency Room at the Mobile Infirmary Medical Center (“Infirmary”) as follows (Tr. 169-

222):

• February 10-11, 2000: Plaintiff reported epigastric and upper mid back

discomfort and atypical chest pain. (Id. at 169-184, 216-222). Her heart

exams revealed a normal S1 and S2, no audible murmur, no gallop and no

rub. (Id.) She had atypical chest pain but no angina. (Id.) Her February

10th chest x-ray revealed cardiomegaly present with the cardiac to thoracic

ratio of 17/29; and echocardiographic studies were scheduled for February

21st and she was instructed to follow-up with Cardiology and her primary

care physician Dr. Carroll. (Id.)

• February 29, 2000: Plaintiff reported epigastric pain and discomfort; an upper

abdominal sonogram/ultrasound was conducted. (Id. at 185-189). 

• January 8, 2001: Plaintiff’s chest x-ray was normal and the enlarged cardiac

silhouette noted previously was no longer identified. (Tr. 215).

• August-September 2002: Plaintiff was hospitalized for paranoia/hearing

voices. (Id. at 190-214). She was assessed with psychosis nos and a history

of dilated cardiomyopathy, presumed peripartum (managed on beta blockers

and ACE inhibitors). (Id.) A cardiology consultant recommended that she

continue taking Coreg, Lasix and Casotec and obtain an echocardiogram.

(Id.) Plaintiff denied any dizziness, chest pain, shortness of breath, numbness

or weakness of her extremities. (Id.) 

• August 19, 2002: Plaintiff’s electrocardiogram revealed T inversions

anteriorly (sinus bradycardia with a rate of 50 with T inversions in V2 and

V3), which were less prominent than on prior electrocardiograms a year and

a half earlier. (Id. at 211-213). Plaintiff denied pain or shortness of breath.

(Tr. 211). She had a regular cardiovascular rate and rhythm without gallops

or murmurs, and her chest x-ray was normal. (Id.)

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Plaintiff was treated at Franklin Primary Health Center, Inc. (“Franklin”) from 2000 through

2003, during which time her history of dilated cardiomyopathy was noted. (Id. at 234-254). Her

examinations revealed that her heart had decreased tones and no murmurs. (Id.) 

Plaintiff was also treated by David M. Shaw, M.D. (“Dr. Shaw”) of The Heart Group, from

February 21, 2000 through November 18, 2003 (Id. at 308-342):

• 2000: Plaintiff had nine visits during 2000, and her echocardiogram revealed

a left ventricle dilated with severe global decrease in LV systolic function.

The records reflect an ejection fraction of 15-20% was repeatedly noted. (Id.

at 319-342). It was also noted that she had a history of gastroespohageal

reflux, mild obesity, tobacco use, and a history of palpitation. (Tr. 319-342).

An outpatient echo revealed significant cardiomyopathy, global in

dysfunction. (Id.) She was assessed with cardiomyopathy of unknown

etiology; obesity; tobacco abuse; and a history of gastroesophageal reflux

disease. (Id.) Her treatment plan included decreasing Altace to 1.25 mg q.d.,

increasing her blood pressure, continuing her on Lasix, weight reduction, and

discontinuing all tobacco products. (Id.) By October 2001, it was noted that

Plaintiff had decreased shortness of breath, no chest pain, and that her

exercise capacity and fatigue were markedly improved, although she reported

occasional dizziness when taking both of her medications at same time. (Id.

at 315). Her cardiac rate/rhythm was regular with distant heart tones, no

gallop was appreciated and no murmur was appreciated. (Id.) There was

trace edema bilaterally in her extremities. (Tr. 315). She was assessed with

dilated cardiomyopathy, compensated on Coreg and Vasotec b.i.d. regimen;

obesity, weight reduction as possible; hypertension in the past; and tobacco

abuse in the past. (Id.)

• 2001: Plaintiff had three visits with Dr. Shaw in 2001. (Id. at 315-318). The

records reflect that Plaintiff had dilated cardiomyopathy that had been pretty

well compensated on ACE inhibitors and beta blocker, no chest pain, no

significant shortness of breath, and no orthopnea or PND. (Id.) She did have

intermittent lower extremity swelling; however, no acute distress was noted.

(Id.) Her cardiac exam revealed a regular rate/rhythm with distant heart

tones, no gallop was appreciated, she had a faint systolic murmur along right

upper sternal border, and her extremities revealed trace edema. (Id.) She

was assessed with an impacted wisdom tooth and dilated cardiomyopathy,

compensated by increasing Coreg 25 mg twice a day. (Tr. 315-318). She

was strongly encouraged to lose weight. (Id.) In June 2001, Plaintiff

reported that she had done reasonably well since her last visit, that she was

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walking 5 laps on the track in the mornings, and that she had experienced one

episode of shortness of breath due to exercising too late in the day with heat,

but that otherwise she “feels overall okay.” (Id. at 316). She was assessed

with dilated cardiomyopathy, compensated on Coreg and Vasotec b.i.d.

regimen; obesity, weight reduction as possible; hypertension in the past;

tobacco abuse in the past. (Id. at 315-318).

• 2002: Plaintiff had one visit with Dr. Shaw in 2002. (Id. at 314). The

records note that Plaintiff had a history of dilated cardiomyopathy,

hypertension and mild lower extremity edema, and that since her last visit,

she had felt good and has had no significant shortness of breath or chest pain.

(Id.) Some dental problems were noted. (Tr. 314). Her exam revealed a

regular cardiac rate and rhythm with distant heart tones, no gallop was

appreciated, she had no murmur and her extremities revealed no edema. (Id.)

She was assessed with dilated cardiomyopathy, recently compensated on

Coreg and Vasotec; obesity, weight reduction with diet/exercise;

hypertension; being a former smoker; and dental disease. (Id.)

• 2003: Plaintiff had five visits with Dr. Shaw in 2003. (Id. at 308-313). In

February 2003, it was noted that Plaintiff missed her last 2 appointments, and

that one missed appointment due to being hospitalized for psychosis. (Id. at

313). She reported no chest pain, but some shortness of breath which was

attributed to her weight gain. (Id.) Her exam revealed a regular cardiac rate

and rhythm with distant heart tones, no gallop was appreciated, she had no

murmur and she had no edema in her extremities. (Tr. 308-313). In April

2003, she was assessed with dilated cardiomyopathy reasonably

compensated; history of noncompliance; obesity, weight reduction; being a

former smoker; and dental disease. (Id. at 312). An echocardiogram in

September 2003 revealed an ejection fraction of 42%. (Id. at 309). The

records reveal that two months later, Plaintiff’s left ventricular function had

improved with an echocardiogram revealing an ejection fraction of 40-45%.

(Id. at 308). Plaintiff reported that she was feeling better, had more energy

and had begun an exercise program. (Id.) Her cardiovascular exam revealed

that she had a regular rate and rhythm without murmurs and no gallop. (Id.)

She was assessed with dilated cardiomyopathy “with improvement recent

assessment, on ACE inhibitor and beta blockers[;]” hypertension, well

compensated; a history of noncompliance with compliance issues better

addressed; obesity, and weight reduction through diet/exercise. (Tr. 308).

On July 28, 2003, Michael A. Rihner, M.D. (“Dr. Rihner”) completed a cardiovascular

disability evaluation of Plaintiff, and concluded that she had a history of dilated cardiomyopathy,

presumably nonischemic, the exact etiology of which was unclear; that her last documented ejection

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fraction of June 2001 revealed 30-35%; that her symptoms were most consistent with Class II New

York Heart Association congestive heart failure. (Id. at 299). He noted that it might be helpful to

have a more recent echocardiogram to evaluate the true left ventricular systolic function as she

appeared to be on appropriate medical therapy. (Id.) Dr. Rihner found that clearly Plaintiff, if she

does have depressed LV systolic function, has Class II symptoms, and would not be able to pursue

vigorous physical labor, but may be able to do some limited form of work involving sedentary

activities. (Id.)

On September 5, 2003, a State Agency physician completed a Physical Residual Functional

Capacity Assessment on Plaintiff, and concluded that she can occasionally lift/carry 20 pounds;

frequently lift/carry 10 pounds; stand/walk for 6 hours per 8 hour workday; sit for 6 hours per 8 hour

workday; her push/pull abilities were unlimited; she had no postural, manipulative, visual or

communicative limitations; and was only limited from avoiding concentrated exposure to extreme

cold and heat. (Id. at 300-307). It was noted that she had an ejection fraction of 20-25% in May

2000; that a September 2003 echocardiogram indicated apparently normal to mildly increased LV

systolic with an ejection fraction of 40-45% and no other significant abnormality; that in July 2003,

her cardiovascular exam indicated her heart had a regular rhythm, her lungs were clear and her

musculoskeletal exam was normal, Class II symptoms were noted; and that in July 2003, her

treating physician concluded that her dilated cardiomyopathy had compensated. (Id. at 301-302).

 Plaintiff was treated at the Mobile Mental Health Center (“MMHC”) from November 21,

2000 through December 9, 2003. (Tr. 343-362). She was diagnosed with psychosis nos, depression

nos and cardiomyopathy. (Id.) During her visits, Plaintiff denied self-injurious behavior and

suicidal/homicidal thoughts. (Id.) Her memory was impaired and her thoughts were generally

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within normal limits. (Id.) She was prescribed Seroquel and Wellbutrin. (Id.) 

Plaintiff was evaluated by C.E. Smith, M.D. (“Dr. Smith”) in September 2005, at the request

of the Disability Office. (Id. at 363-367). Dr. Smith noted that Plaintiff had a brief psychiatric

hospitalization in 2002, and that she had received treatment at MMHC for depression and psychosis

NOS; however, she discontinued that treatment and reported that she had begun seeing Dr. Shepard

Fleet instead. (Tr. 364). Dr. Smith found that Plaintiff showed no thinking disorder and that she

gave no indication of hallucinations. (Id. at 363-365). She was euthymic, easy going in manner and

her affect was adequate and appropriate. (Id.) He diagnosed Plaintiff with major depressive

disorder, by history; and psychosis NOS, by history. (Id. at 365). He opined that both diagnoses

were now in remission. (Id.)

1. Whether the ALJ erred by finding that Plaintiff had medical

improvement such that her disability ceased in September 2003?

Plaintiff contends that the ALJ erred by finding that her previously disabling impairment of

dilated cardiomyopathy had medically improved, such that her disability ceased in September 2003.

In order to find that Plaintiff’s condition had improved, the ALJ was required to compare original

medical evidence and new medical evidence. See, e.g., Williams, 73 F. Supp. 2d at 1337.

Here, the ALJ found that there had been medical improvement in Plaintiff’s cardiomyopathy

impairment since the time of the most recent favorable decision. Section 4.04 of Appendix 1

references cardiac conditions and requires that the diagnosis be established by appropriate imaging

techniques with evaluation of the severity cross-referred to other cardiac listings. See 20 C.F.R. Pt.

404, Subpt. P, App. 1, § 4.04. Specifically, the cardiac “Listings of Impairments” at Appendix 1 to

Subpart P requires a ejection fraction (“EF”) measured at 30% or less to meet the listings at Section

4.02(B) (Congestive Heart Failure), Section 4.04(B) (Ischemic Heart Disease) or Section 4.08

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(Cardiomyopathies). Id. Listing 4.08 is the specific listing for cardiomyopathies in the Social

Security Regulations. Id.

In the case sub judice, the ALJ stated as follows with regard to Plaintiff’s medically

improved cardiomyopathy:

The record . . . establishes that the claimant was found disabled based upon a heart

condition that, by echocardiogram testing, resulted in an ejection fraction of 15-20

percent, a finding consistent with Section 4.08 of Appendix 1, with reference to

Section 4.04 and an ejection fraction of less than 30 per[cent]. Subsequent testing

clearly established much greater ejection fractions, and improvement of left

ventricular function, being reported by her attending cardiologist . . . . The claimant

does not have an impairment that meets or medically equals any impairment listed

in Appendix 1.

The reports from Dr. Shaw, the echocardiogram results, and the reports form all

other attending and examining sources show that substantial medical improvement

has occurred. The consulting cardiologist noted a Class II impairment, which is

consistent with light work as defined in the Social Security Administration

Regulations. The ability to sustain light work establishes that the improvement is

related to the ability to work.

No exceptions to the medical improvement standard apply.

The claimant continues to have cardiomyopathy which, although substantially

improved as compared to the onset date, is severe . . . .

The claimant . . . is found to be unable to return to any of her past jobs.

The record includes an assessment of the claimant’s residual functional capacity,

completed by the state agency, which assesses her as capable of a full range of light

work. That assessment is consistent with the medical record, and is hereby adopted

by the Administrative Law Judge . . . . the claimant has no nonexertional limitations

and no additional exertional limitations that would reduce her residual functional

capacity for light work.

. . . . she matches the criteria for Rule 202.17 . . . That Rule directs a finding that she

is not disabled. Consequently, the Administrative Law Judge finds that the claimant’s

disability ceased in September, 2003, and her entitlement to benefits terminated at

the end of November, 2003.

In concluding that the claimant is no longer disabled, the Administrative Law Judge

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carefully considered her subjective allegations . . . .

The claimant described daily activities that included doing her house work, taking

care of her children, attending school activities and driving on occasion, all activities

that are consistent with light work.

The claimant testified that she had shortness of breath and swelling of her hands,

feet, and ankles. However, the reports from her treating cardiologist show that she

reported no shortness of breath, and none of the evidence refers to significant

swelling.

No specific precipitating or aggravating factors were described, and the record is

void of reference to factors that precipitate or aggravate any symptoms in this case.

The claimant takes medications prescribe[d] for her various diagnoses, and the

record does not indicate any allegations of adverse effects of medications. The

claimant did not testify to any adverse effects of any medication.

The record does not reflect a history of any treatment, other than medication, used

to control any of her symptoms.

No other factors were described in the testimony, and none are apparent from the

record.

The claimant’s allegations of continuing disability are not supported by her history

of medical treatment and are not credible.

(Tr. 18-19). Thus, the ALJ concluded, through a comparison of the medical evidence, that there has

been improvement in her cardiomyopathy, and that the medical improvement is related to her ability

to work. (Id. at 19, Findings 5-6).

The evidence in the medical record supports the ALJ’s finding. See, e.g., Whetstone, 263

F. Supp. 2d at 1322-1323; Allen v. Sullivan, 1992 WL 443576, *2-4 (N.D. Ala. Oct. 30, 1992). The

relevant record reflects that while Plaintiff initially met the Listing 4.08 requirements, based on the

fact that her February 2000 echocardiogram revealed left atrial enlargement and a left ventricular

ejection fraction of 15-20%, Dr. Shaw’s subsequent treatment notes from June 2000-January 2001

revealed that she was doing well, and had no shortness of breath or chest pain. See supra. Her

Case 1:06-cv-00295-WS-B Document 13 Filed 04/26/07 Page 14 of 18
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January 8, 2001 chest x-ray revealed a normal size heart; and on January 26, 2001, it was noted that

her dilated cardiomyopathy had “pretty well compensated” on ACE inhibitors and beta blockers.

(Tr. 330-333). Additionally, a June 22, 2001 echocardiogram revealed that she had a left ventricular

ejection fraction of EF 30-35%, with a slight decrease in left ventricular size and slight improvement

in overall left ventricular function. (Id. at 316). From October 2001-July 2003, Plaintiff, again,

showed continued improvement, and had no chest pain, had decreased shortness of breath and had

no edema. (Id. at 310-315). Dr. Shaw also noted that Plaintiff had a regular heart rate and regular

heart rhythm, and that her dilated cardiomyopathy was “compensated.” (Id. at 310). Dr. Rinher

evaluated Plaintiff on July 28, 2003, at which time – after reviewing her June 22, 2001

echocardiogram – he concluded that her symptoms were consistent with Class II New York Heart

Association congestive heart failure and recommended an echocardiogram. (Id. at 299). He opined

that Plaintiff might be able to perform some sedentary work. (Id.) Plaintiff had an echocardiogram

on September 2, 2003, which demonstrated continued improvement in her cardiomyopathy, an

ejection fraction of EF 40-45%, and a normal or only mildly increased left ventricle size. (Tr. 309).

On September 5, 2003, a State Agency medical consultant completed a Residual Functional

Capacity Assessment, wherein he concluded that Plaintiff could occasionally lift 20 pounds; could

frequently lift 10 pounds; could stand/walk about 6 hours per 8 hour work day; and could sit about

6 hours per 8 hour work day. (Id. at 300-307). Furthermore, on November 18, 2003, Dr. Shaw

concluded that Plaintiff’s ventricular function had improved with an ejection fraction of 40-45%,

that she had more energy, that she had begun exercising, that she had good blood pressure readings

for her last assessment, and that her dilated cardiomyopathy was improved and well compensated.

(Id. at 308). In short, these records indicate that Plaintiff’s cardiomyopathy has steadily improved,

Case 1:06-cv-00295-WS-B Document 13 Filed 04/26/07 Page 15 of 18
16

such that she no longer meets the requirements of Listing 4.08 (requiring an EF 30% or less). 

Furthermore, Plaintiff’s additional claim, that the ALJ ignored her subjective symptoms and

pain allegations, fails. Not only did the ALJ specifically state in his decision that he had considered

Plaintiff’s subjective complaints, (Tr. 18), but the record also reveals that her statements and selfreporting do not dictate a different finding, particularly given that Listing 4.08 requires a clinical

ejection fraction finding as opposed to subjective allegations. Moreover, as noted by the ALJ in his

decision, Plaintiff described performing activities of daily living that were consistent with light

work, and her testimony was contradicted by her physical examinations. (Tr. 18-19). Additionally,

there was no evidence of precipitating or aggravating factors, nor did Plaintiff testify that she

suffered from any adverse side effects from her medication (which was the only treatment used to

control her symptoms). (Id.) Plus, her allegations were not supported by her history of medical

treatment. (Id.) Thus, they were not credible. (Id. at 19). Accordingly, the ALJ properly concluded

that Plaintiff’s cardiomyopathy, while a severe impairment, had reached “medical improvement,”

that such improvement was related to her ability to work, that she no longer met the relevant Listing,

and that as a result, she is not disabled. See, e.g., Williams, 73 F. Supp. 2d at 1325; Whetstone, 263

F. Supp. 2d at 1318.

V. Conclusion

For the reasons set forth, and upon careful consideration of the administrative record, oral

argument and memoranda of the parties, it is hereby RECOMMENDED that the decision of the

Commissioner of Social Security, denying Plaintiff’s claim for disability insurance benefits and

supplemental security income, be AFFIRMED. 

Case 1:06-cv-00295-WS-B Document 13 Filed 04/26/07 Page 16 of 18
The attached sheet contains important information regarding objections to this Report and

Recommendation.

DONE this 25th day of April, 2007.

 /s/SONJA F. BIVINS 

UNITED STATES MAGISTRATE JUDGE

Case 1:06-cv-00295-WS-B Document 13 Filed 04/26/07 Page 17 of 18
MAGISTRATE JUDGE’S EXPLANATION OF PROCEDURAL RIGHTS

AND RESPONSIBILITIES FOLLOWING RECOMMENDATION

AND FINDINGS CONCERNING NEED FOR TRANSCRIPT

1. Objection. Any party who objects to this recommendation or anything in it must, within ten

days of the date of service of this document, file specific written objections with the clerk of court.

Failure to do so will bar a de novo determination by the district judge of anything in the

recommendation and will bar an attack, on appeal, of the factual findings of the magistrate judge.

See 28 U.S.C. § 636(b)(1)(c); Lewis v. Smith, 855 F.2d 736, 738 (11th Cir. 1988). The procedure

for challenging the findings and recommendations of the magistrate judge is set out in more detail

in SD ALA LR 72.4 (June 1, 1997), which provides, in part, that:

A party may object to a recommendation entered by a magistrate judge in a

dispositive matter, that is, a matter excepted by 28 U.S.C. § 636(b)(1)(A), by filing

a “Statement of Objection to Magistrate Judge’s Recommendation” within ten days

after being served with a copy of the recommendation, unless a different time is

established by order. The statement of objection shall specify those portions of the

recommendation to which objection is made and the basis for the objection. The

objecting party shall submit to the district judge, at the time of filing the objection,

a brief setting forth the party’s arguments that the magistrate judge’s

recommendation should be reviewed de novo and a different disposition made. It is

insufficient to submit only a copy of the original brief submitted to the magistrate

judge, although a copy of the original brief may be submitted or referred to and

incorporated into the brief in support of the objection. Failure to submit a brief in

support of the objection may be deemed an abandonment of the objection.

A magistrate judge’s recommendation cannot be appealed to a Court of Appeals; only the

district judge’s order or judgment can be appealed.

2. Opposing party’s response to the objection. Any opposing party may submit a brief

opposing the objection within ten (10) days of being served with a copy of the statement of

objection. Fed. R. Civ. P. 72; SD ALA LR 72.4(b). 

3. Transcript (applicable where proceedings tape recorded). Pursuant to 28 U.S.C. § 1915

and Fed.R.Civ.P. 72(b), the magistrate judge finds that the tapes and original records in this action

are adequate for purposes of review. Any party planning to object to this recommendation, but

unable to pay the fee for a transcript, is advised that a judicial determination that transcription is

necessary is required before the United States will pay the cost of the transcript.

 /s/SONJA F. BIVINS 

UNITED STATES MAGISTRATE JUDGE

Case 1:06-cv-00295-WS-B Document 13 Filed 04/26/07 Page 18 of 18