Opinion ID: 3059388
Heading Depth: 2
Heading Rank: 1

Heading: First ALJ Hearing and Appeals Council Remand

Text: In 2002, Flowers applied for benefits alleging that she was unable to work as of May 15, 2001 due to her lupus, rheumatoid arthritis and thyroid disease. Flowers claimed that her impairments made her tired, caused swelling, pain and numbness in her hands and feet and made it difficult for her to grasp and lift things. Flowers’s application was denied initially and upon reconsideration. After a September 2005 hearing, the ALJ issued a partially favorable decision, finding that Flowers was disabled as of May 11, 2005. In so doing, the ALJ gave “great weight” to the May 2005 opinion of Flowers’s family physician, Dr. Paul Raber, as to Flowers’s residual functional capacity (“RFC”).1 Dr. Raber 1 Residual functional capacity, or RFC, is a medical assessment of what the claimant can do in a work setting despite any mental, physical or environmental limitations caused by the claimant’s impairments and related symptoms. 20 C.F.R. §§ 404.1545(a), 416.945(a). As to 2 opined that Flowers could lift less than ten pounds, could sit, stand and walk less than two hours in an eight-hour workday and needed to alternate between sitting and standing at will. The Appeals Council vacated the ALJ’s decision and remanded for further proceedings. Among other things, the Appeals Council concluded (1) that “neither the clinical findings contained in the treatment record nor treatment history since the alleged onset date appears to support the debilitating limitations proposed by Dr. Raber,” and (2) that “Dr. Raber’s notes do not provide detailed clinical findings; his progress notes during the relevant period generally include only a check mark [and] clinical finding of tenderness and spasm of the back.” The Appeals Council remanded so that the ALJ, inter alia, could give further consideration to Dr. Raber’s opinions; request additional evidence or clarification from Dr. Raber; obtain additional evidence of Flowers’s impairments, including updated records from Flowers’s rheumatologist and a consultative exam from either a rheumatologist or internist; obtain other evidence from a medical expert to physical abilities, the RFC assesses the claimant’s ability to do things like sit, stand, walk, lift, carry, push or pull. Id. §§ 404.1545(b), 416.945(b). The ALJ uses the RFC finding to determine whether the claimant can do her past relevant work or any other work. Id. §§ 404.1520(a)(4), 404.1545(a)(5), 416.920(a)(4), 416.945(a)(5). 3 clarify the nature and severity of Flowers’s impairments; and to further consider Flowers’s RFC. B. Additional Evidence After Appeals Council Remand Upon remand, additional evidence was placed in the record, including, inter alia, (1) Dr. Raber’s May 2005 “Medical Opinion Re: Ability to Do Work-Related Activities (Physical),” which contained an RFC assessment; (2) Dr. Fritz Lubin’s May 2008 examination report and questionnaires, which also contained an RFC assessment; and (3) 2008 medical records from Dr. Cynthia Lawrence-Elliott, Flowers’s rheumatologist. Specifically, in May 2005, Dr. Raber, Flowers’s family physician, opined that Flowers could lift less than ten pounds occasionally, stand less than two hours in an eight-hour work day, would need to lie down every two to three hours at unpredictable intervals, could never twist, stoop, crouch or climb ladders and had unspecified limitations in reaching, handling, fingering, feeling and pushing/pulling. In June 2005, Dr. Raber further opined that Flowers was unable to lift, stoop, climb or use her fingers for fine manipulation. In May 2008, Dr. Lubin, a consulting internist who examined Flowers, opined that Flowers could occasionally lift and carry ten pounds, sit for six hours in an eight-hour work day, stand for twenty minutes without interruption and for a 4 total of two hours in an eight-hour work day, walk for thirty minutes without interruption and for a total of one hour in a work day and occasionally finger and feel in both hands. Dr. Lubin further opined that Flowers could occasionally balance, stoop, kneel, crouch and climb stairs and ramps, but could never climb ladders or crawl. Dr. Lawrence-Elliott, Flowers’s rheumatologist, did not offer a medical opinion as to Flowers’s RFC. However, in her 2008 treatment notes, Dr. Lawrence-Elliott indicated that Flowers should avoid activities that put excessive strain on her lower back, such as heavy lifting, bending at the waist or sitting for prolonged periods, and needed rest periods of between 45 and 60 minutes. C. Second ALJ Hearing At a second hearing in January 2009, Flowers and a friend, Kimberly Stevens, testified about the affects of Flowers’s impairments on her daily life. Flowers was experiencing a lot of pain and was becoming more immobile. Therefore, Dr. Raber referred her to Dr. Lawrence-Elliott, who prescribed medication for Flowers’s thyroid problems, inflammation, pain and arthritis. According to Flowers: (1) the medications made her drowsy and lethargic, and she had to lie down several times a day; (2) even while on the medication, Flowers could not dress herself because she could not raise her arms or bend over; (3) 5 because of swelling in her hands and feet, Flowers sat in a recliner with her feet elevated several times a day; (4) Flowers could not lift more the five pounds and could sit or stand for only fifteen to twenty minutes at a time. Flowers’s friend, Stevens, testified that: (1) Flowers was often tired and could not stand for long periods of time; (2) Flowers’s strength had deteriorated to the point that she needed help getting out of bed; (3) Stevens helped Flowers finish chores and went grocery shopping for Flowers because Flowers was not able to move or lift and carry most objects. Dr. Lina Caldwell, a consulting internist who reviewed Flowers’s medical records but did not examine Flowers, also testified. Dr. Caldwell disagreed with the RFC assessments of Drs. Raber and Lubin and opined that Flowers could perform at least light work. A vocational expert testified, inter alia, that a person capable of lifting and carrying ten pounds frequently and twenty pounds occasionally, and sitting, standing or walking for six hours in an eight-hour work day (i.e., light work) could perform Flowers’s past relevant work as a cashier, motel desk clerk or waitress. D. ALJ’s Second Decision On March 26, 2009, the ALJ denied Flowers’s application, finding that: (1) Flowers had not engaged in substantial gainful activity since May 15, 2001; (2) 6 Flowers had severe impairments of lupus, rheumatoid arthritis and degenerative joint disease of the cervical spine;2 (3) Flowers’s impairments or combination of impairments did not meet or equal a listed impairment; (4) Flowers had the RFC to perform work at the light exertional level, which included lifting and carrying twenty pounds occasionally and ten pounds frequently, sitting up to six hours in an eight-hour workday and standing and/or walking up to six hours in an eight-hour workday; and (5) Flowers could perform her past relevant work as a motel desk clerk, cashier/stock checker, waitress or mobile home sales person. In determining that Flowers retained the RFC to perform light work, the ALJ relied on the opinion of Dr. Caldwell, gave very little weight to the opinions of Drs. Raber, LawrenceElliott and Lubin and partially discredited the testimony of Flowers and her friend Stevens. E. Second Appeals Council Decision Flowers sought review with the Appeals Council and submitted additional medical evidence. Among other things, Flowers submitted: (1) Dr. LawrenceElliott’s treatment notes for examinations conducted in June 5, 2008, October 9, 2 The ALJ found that Flowers also had the non-severe mental impairment of mood disorder. Although Flowers challenged this finding before the Appeals Council, she did not raise it in the district court and does not raise it in this Court. Therefore, we do not address it. See Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999) (explaining that a claimant waives an argument that was not raised in the district court); Allstate Ins. Co. v. Swann, 27 F.3d 1539, 1542 (11th Cir. 1994) (explaining that issues not raised on appeal are abandoned). 7 2008 and April 8, 2009; (2) an April 8, 2009 “Medical Opinion Re: Ability to Do Work-Related Activities (Physical)” in which Dr. Lawrence-Elliott opined that Flowers, inter alia, could lift and carry ten pounds occasionally and less than ten pounds frequently, stand and walk less than one hour and sit less then two hours in an eight-hour work day, sit for fifteen minutes and stand for ten minutes before changing positions and occasionally twist, stoop and climb stairs, but that Flowers could never crouch or climb ladders and needed to lie down at unpredictable intervals with undetermined frequency; and (3) medical records indicating that Flowers received home health care between May 4, 2009 and June 30, 2009. The Appeals Council made this additional evidence part of the record. The Appeals Council stated that it had considered Flowers’s reasons for her disagreement with the ALJ’s decision and her additional evidence. The Appeals Council concluded “that this information does not provide a basis for changing the Administrative Law Judge’s decision.” The Appeals Council denied review, making the ALJ’s decision the final decision of the Commissioner. See Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). Flowers appealed to the district court. A magistrate judge entered a report (“R&R”) recommending that the district court affirm the Commissioner’s 8 decision. Over Flowers’s objections, the district court adopted the R&R and affirmed the Commissioner’s denial of benefits. Flowers filed this appeal.3