MADELINE HUGHES HAIKALA, District Judge.
Pursuant to 42 U.S.C. §§ 405(g) and 1383(c), plaintiff Jeanette Chandler seeks judicial review of a final adverse decision by the Commissioner of Social Security. The Commissioner denied Ms. Chandler's claims for disability insurance benefits and supplemental security income. After careful consideration of the record, the Court remands for additional proceedings.
Ms. Chandler applied for disability insurance benefits and supplemental security income. (Doc. 6-3, p. 15; Doc. 6-4, pp. 36, 37). Ms. Chandler alleges that her disability began on November 23, 2015. (Doc. 6-3, p. 15; Doc. 6-3, p. 37).
The scope of review in this matter is limited. "When, as in this case, the ALJ denies benefits and the Appeals Council denies review," the Court "review[s] the ALJ's `factual findings with deference' and [his] `legal conclusions with close scrutiny.'" Riggs v. Comm'r, Soc. Sec. Admin., 522 Fed. Appx. 509, 510-11 (11th Cir. 2013) (quoting Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001)).
The Court must determine whether there is substantial evidence in the record to support the ALJ's factual findings. "Substantial evidence is something more than a mere scintilla, but less than a preponderance. If the Commissioner's decision is supported by substantial evidence, this Court must affirm, even if the proof preponderates against it." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005) (internal quotation marks and citations omitted); see also Costigan v. Comm'r, Soc. Sec. Admin., 603 Fed. Appx. 783, 786 (11th Cir. 2015) (same). In evaluating the administrative record, the Court may not "decide the facts anew, reweigh the evidence," or substitute its judgment for that of the ALJ. Winschel v. Comm'r, Soc. Sec. Admin., 631 F.3d 1176, 1178 (11th Cir. 2011) (internal quotation marks and citation omitted).
With respect to the ALJ's legal conclusions, the Court must determine whether the ALJ applied the correct legal standards. If the Court finds an error in the ALJ's application of the law, or if the Court finds that the ALJ failed to provide sufficient reasoning to demonstrate that the ALJ conducted a proper legal analysis, then the Court ordinarily must reverse the ALJ's decision. Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir. 1991).
To determine whether a claimant has proven that she is disabled, an ALJ follows a five-step sequential evaluation process. The ALJ considers:
Winschel, 631 F.3d at 1178.
Here, the ALJ found that Ms. Chandler met the insured status requirements for disability insurance benefits through December 31, 2015. (Doc. 6-3, p. 17). Ms. Chandler had not engaged in substantial gainful activity since November 23, 2015, the alleged amended onset date. (Doc. 6-3, p. 18). The ALJ determined that Ms. Chandler suffered from five severe impairments: obesity, osteoarthritis, asthma, anxiety, and depression. (Doc. 6-3, p. 18). The ALJ determined that Ms. Chandler's hypertension and residual symptoms from a 2017 car accident were non-severe impairments. (Doc. 6-3, p. 18). Based on his review of the medical evidence, the ALJ concluded that Ms. Chandler did not have an impairment or a combination of impairments that met or medically equaled the severity of any of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Doc. 6-3, p. 18).
Given these impairments, the ALJ determined that Ms. Chandler had the RFC to "perform light work" with the following exceptions:
(Doc. 6-3, p. 21). Based on this RFC and vocational expert testimony, the ALJ concluded that Ms. Chandler could not perform her past relevant work as a fast food worker and house cleaner. (Doc. 6-3, p. 25). Relying on the Medical-Vocational Guidelines and expert testimony, the ALJ found that Ms. Chandler was capable of doing light jobs including cashier II, power screwdriver operator, and marker. (Doc. 6-3, p. 26). Accordingly, the ALJ determined that Ms. Chandler was not under a disability within the meaning of the Social Security Act. (Doc. 6-3, p. 27).
Ms. Chandler challenges the ALJ's RFC determination. (Doc. 8, p. 4). An RFC "is an assessment, based on all relevant medical and other evidence, of a claimant's remaining ability to work despite his impairment." Castle v. Colvin, 557 Fed. Appx. 849, 852 (11th Cir. 2014). The ALJ determined that despite her physical and mental impairments, Ms. Chandler could perform a reduced range of light work. Under the Social Security regulations, "light work":
20 C.F.R. § 404.1567(b). In the RFC for light work, the ALJ placed no limit on Ms. Chandler's ability to stand and walk or her need for breaks. See p. 5, above; (Doc. 6-3, p. 24).
At the administrative hearing, Ms. Chandler testified that she can stand for only ten minutes at a time. (Doc. 6-3, p. 45). Dr. Ashley Holdridge, a doctor of osteopathic medicine (DO) who Ms. Chandler saw in January 2015 for a consultative physical examination, limited Ms. Chandler's ability to stand and walk "to four hours with frequent breaks." (Doc. 6-11, pp. 95, 99).
With respect to Ms. Chandler's testimony about her limited ability to stand, the ALJ found that Ms. Chandler's "medically determinable impairments could reasonably be expected to cause some symptoms and functional limitations. However, the claimant's statements concerning the intensity, persistence, and limiting effects of these symptoms are not entirely consistent with the medical evidence and other evidence in the record." (Doc. 6-3, p. 23). With respect to Dr. Holdridge's opinion regarding Ms. Chandler's limited ability to stand and walk during a workday, the ALJ gave "some good weight" to Dr. Holdridge's assessment of Ms. Chandler's physical capabilities, but the ALJ found that Dr. Holdridge's "opinions are not based on the evidence in its entirety (Exhibit B10F)." (Doc. 6-3, p. 25). The ALJ determined that Dr. Holdridge's conclusion about Ms. Chandler's limited ability to stand and walk and Ms. Chandler's need for frequent breaks was inconsistent with Dr. Holdridge's "findings [and] the overall evidence of record." (Doc. 6-3, p. 25).
With respect to the "overall evidence of record" as it pertains to Ms. Chandler's ability to stand and walk, the ALJ stated:
(Doc. 6-3, p. 24). As part of his examination of Ms. Chandler's ability to stand and walk, the ALJ also considered a collection of treatment records from Dr. J. Walden Retan, a treating physician. (Doc. 6-3, pp. 22-23).
The Court must review Dr. Holdridge's findings and the "overall evidence of record" on which the ALJ relied, including Dr. Retan's treatment records, to determine whether substantial evidence supports the ALJ's decision to discount Dr. Holdridge's opinion about Ms. Chandler's limited ability to stand and walk and her need for frequent breaks in a workday.
As pertinent to Dr. Holdridge's stand/walk restrictions, when Ms. Chandler saw Dr. Holdridge, Ms. Chandler identified bilateral knee pain and low back pain as her chief complaints. (Doc. 6-11, p. 95).
Dr. Holdridge summarized Ms. Chandler's medical history concerning knee pain as follows:
(Doc. 6-11, p. 95).
Ms. Chandler told Dr. Holdridge that her lower back pain began after she gained weight in 2012. (Doc. 6-11, p. 96). Ms. Chandler indicated that the pain does not radiate, tingle, or cause numbness; "[i]t just hurts." (Doc. 6-11, p. 96). According to Ms. Chandler, sitting too long, standing, and walking beyond 15 feet exacerbates her back pain. (Doc. 6-11, p. 96).
Concerning daily activities, Ms. Chandler reported to Dr. Holdridge that she was cooking, washing dishes, and doing laundry. She could dress herself but sometimes needed help putting on socks. (Doc. 6-11, p. 96). Ms. Chandler reported that she did not vacuum or mop. (Doc. 6-11, p. 96). Ms. Chandler stated that she had no hobbies, and she spent her days watching TV or lying down. (Doc. 6-11, p. 96).
After examining Ms. Chandler, Dr. Holdridge described Ms. Chandler's gait as antalgic and "slightly wide-based." (Doc. 6-11, p. 97). Ms. Chandler "was unable to walk on her toes, . . . heels, or heel-to-toe[,]" and she did not attempt squatting. (Doc. 6-11, p. 97). Dr. Holdridge reported that Ms. Chandler "was able to get onto the [examining] table, but [that she] did have difficulty getting from a supine to a sitting position and needed assistance." (Doc. 6-11, p. 97). Dr. Holdridge found that Ms. Chandler had:
(Doc. 6-11, pp. 98-99).
On January 29, 2015, Dr. Holdridge diagnosed Ms. Chandler with probable osteoarthritis in both knees, lower back hyperlordosis and probable arthritic changes with sacroilitis on the right, hypertension, asthma, and morbid obesity. (Doc. 6-11, p. 99).
In Ms. Chandler's RFC, the ALJ accounted for the latter limit on climbing, crouching, kneeling, and crawling but not the former limit on standing and walking. (Doc. 6-3, p. 21) ("The claimant can occasionally climb ramps or stairs, stoop, kneel, crouch, or crawl."). The ALJ discounted Dr. Holdridge's limit on walking and standing at least in part because the ALJ believed that Dr. Holdridge's finding that Ms. Chandler had an antalgic gait was an outlier. Antalgic means "marked by or being an unnatural position or movement assumed by someone to minimize or alleviate pain or discomfort (as in the leg or back)[.]" https://www.merriam-webster.com/medical/antalgic (last visited Aug. 7, 2019). Citing Exhibits B10F, B11F, and B15F, the ALJ stated that Ms. Chandler generally exhibited a normal gait. (Doc. 6-3, p. 24).
Exhibit B10F is the report in which Dr. Holdridge observed that Ms. Chandler walked with an antalgic gait in January 2015. (Doc. 6-11, pp. 95-100). Exhibit B11F is the report that Dr. Sally Gordon, a licensed psychologist, prepared after evaluating Ms. Chandler's mental health in February 2015. (Doc. 6-12, pp. 2-4). Dr. Gordon stated that on the day she saw Ms. Chandler, Ms. Chandler's "posture, balance, gait, and spontaneous use of both upper extremities were normal, with no gross or fine motor impairments evident." (Doc. 6-12, p. 3).
Exhibit B15F consists of Ms. Chandler's records from two visits to St. Vincent's Hospital's emergency room. (Doc. 6-12, pp. 13-44). During a visit for back pain in June 2015, a nurse noted that Birmingham Fire & Rescue Service transferred Ms. Chandler from the ambulance stretcher to a bed. (Doc. 6-12, p. 19; 6-12, p. 28). When he examined her about 35 minutes later, the emergency room doctor reported that Ms. Chandler had "[n]o trouble walking." (Doc. 6-12, p. 20). Records from a December 2014 emergency room visit do not describe Ms. Chandler's gait. (See, e.g., Doc. 6-12, p. 40) (listing some physical findings, but not Ms. Chandler's gait); (see also Doc. 6-12, p. 39) ("Ambulatory in ED — placed in bed").
Thus, the records that the ALJ cited establish two dates on which Ms. Chandler's gait was recorded as normal. These snapshots do not provide substantial evidence to support the ALJ's finding that Ms. Chandler's gait generally was normal, especially when her treating physician, in 2016, prescribed a cane to steady her as she walked. See pp. 15-16, below; (Doc. 6-12, p. 50).
In May 2013, Dr. Retan described Ms. Chandler's bilateral knee pain as "years in the making with old trauma [and] increasing knee pain that has caused her to be unable to work. This seems to be related to a past treatment of the problem with daily use of Lortab." (Doc. 6-11, p. 39; Doc. 6-12, p. 48). Dr. Retan assessed Ms. Chandler as suffering from "morbid obesity with complic[a]ting patellofemoral pain, non[-]operative disease." (Doc. 6-11, p. 39; Doc. 6-12, p. 48).
In 2014, Ms. Chandler told Dr. Retan that her knees "hurt, but tolerable." (Doc. 6-12, p. 49). Ms. Chandler asked "for letter saying she can't do community service. Given probable COPD, obesity, she probably can't." (Doc. 6-12, p. 49).
Dr. Retan's notes from early 2015 state, "Norco makes knee pain sorta tolerable." (Doc. 6-12, p. 49). Later in the year when Ms. Chandler complained of knee pain, Dr. Retan increased her dosage of Norco, and Ms. Chandler reported "better pain relief." (Doc. 6-12, pp. 49-50).
In 2016, Dr. Retan wrote in his notes:
(Doc. 6-12, p. 50). Dr. Retan did not offer an opinion concerning restrictions on Ms. Chandler's ability to walk or stand. The ALJ reported that he gave "good weight to the objective medical evidence from the claimant's treating medical sources in the relevant period." (Doc. 6-3, p. 23).
The ALJ believed that Dr. Retan's treatment record supported the RFC for light work because Dr. Retan "advised [Ms. Chandler] to exercise, which indicates that her body habitus may exacerbate her pain but does not itself limit her movement (Exhibits B12F and B16F)." (Doc. 6, p. 24). It is true that in 2013, Dr. Retan advised Ms. Chandler to exercise, but in 2014, Dr. Retan reported that Ms. Chandler could not perform community service because of her weight, and in 2016, Dr. Retan reported that Ms. Chandler's knees gave way, that he prescribed a cane, and that Ms. Chandler's weight was a "problem, but not coming off." In addition, in 2015, Dr. Retan increased the dosage of Ms. Chandler's pain medication to address her reports of worsening pain. Thus, substantial evidence does not support the ALJ's finding, based on Dr. Retan's records, that Ms. Chandler's pain does not limit her movement.
In discussing some of the other "overall evidence of record," the ALJ stated that Ms. Chandler "alleged severely limited activities," but the "activity level she reported at the consultative examinations" was inconsistent with her allegations. (Doc. 6-3, p. 24). The medical record contradicts the ALJ's assessment.
Dr. Gordon, Ms. Chandler's consultative psychologist, described Ms. Chandler's daily activities as follows:
(Doc. 6-12, p. 3). Dr. Gordon stated that "[t]here was no evidence" that Ms. Chandler attempted to "embellish her symptoms or otherwise provide misleading information." (Doc. 6-12, p. 4). As indicated, Ms. Chandler reported to Dr. Holdridge, a consulting physician, that she could cook, wash dishes, and do laundry, but she could not vacuum or mop. Ms. Chandler told Dr. Holdridge that she had no hobbies and that she spent her days watching TV or lying down. (Doc. 6-11, p. 96).
While Ms. Chandler's report of her activities to Dr. Holdridge indicates slightly more activity than her report of activities to Dr. Gordon, overall Ms. Chandler consistently reported limited daily activities. The fact that she was able to help prepare her meals and wash dishes does not undermine Dr. Holdridge's opinion that Ms. Chandler could stand and walk for only four hours with frequent breaks.
Thus, substantial evidence does not support the ALJ's conclusion that Dr. Holdridge's stand/walk restriction was inconsistent with the "overall evidence of record," and substantial evidence does not support the ALJ's exclusion from Ms. Chandler's RFC of Dr. Holdridge's four-hour restriction on walking and standing with frequent breaks. (Doc. 6-11, p. 99). The ALJ's opinion that Ms. Chandler could perform the light jobs of cashier II, power screwdriver operator, and marker, (Doc. 6-3, p. 26), is not supported by substantial evidence.
The Commissioner argues that Ms. Chandler "can show no harm" in the ALJ's failure to include a four-hour restriction on walking or standing with frequent breaks in Ms. Chandler's RFC "because the [vocational expert] testified [that] a person with Plaintiff's limitations could perform jobs existing in significant numbers in the national economy, even with those limitations." (Doc. 11, p. 9); see Timmons v. Comm'r, Soc. Sec. Admin., 522 Fed. Appx. 897, 906 (11th Cir. 2013) ("[T]he omission of a squatting restriction from the RFC assessment was harmless error" because the jobs the claimant could perform did not require squatting.). The Commissioner points out that in response to the ALJ's second hypothetical question that the VE mistakenly thought included the four-hour restriction, the VE testified that Ms. Chandler could work as an addresser, document preparer, and call out operator. (Doc. 11, p. 9). Each of those jobs is sedentary work. (Doc. 6-3, pp. 60-61). The VE explained:
(Doc. 6-3, pp. 60-61).
The testimony on which the Commissioner relies is part of the fifth step in the sequential evaluation process. At step five, the Commissioner bears the burden of determining "if there is other work available in significant numbers in the national economy that the claimant is able to perform." Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir. 1999). To carry this burden, an ALJ "must articulate specific jobs that the claimant is able to perform, and this finding must be supported by substantial evidence, not mere intuition or conjecture." Wilson v. Barnhart, 284 F.3d 1219, 1227 (11th Cir. 2002). "[F]or a vocational expert's testimony to constitute substantial evidence, the ALJ must pose a hypothetical question which comprises all of the claimant's impairments." Wilson, 284 F.3d at 1227.
The Court is not persuaded that the ALJ's analysis at the fifth stage of the sequential evaluation process rests on substantial evidence because the ALJ struggled to articulate a hypothetical that encompassed all of Ms. Chandler's limitations. The transcript of the conversation between the ALJ and the VE reveals a string of successive statements in which the ALJ adjusted his hypothetical questions to address miscommunications and misunderstandings between himself and the VE. The following exchange concerning the first of four hypotheticals illustrates the point:
(Doc. 6-3, pp. 56-59).
The conversation between the ALJ and the VE concerning the meaning of the term "frequent breaks" reveals flaws in the ALJ's analysis of the medical evidence for several reasons. First, the ALJ attributed the requirement of frequent breaks only to Dr. Holdridge's functional assessment and indicated that the breaks related only to obesity, probable osteoarthritis, and back pain. But Dr. Holdridge was not alone in recommending breaks for Ms. Chandler. Dr. Williams completed a mental assessment of Ms. Chandler without examining her. (Doc. 6-4, pp. 2-17). Dr. Williams stated that Ms. Chandler "would benefit from regular rest breaks and a slowed pace" because of limits on Ms. Chandler's concentration and persistence. (Doc. 6-4, p. 13). Dr. Williams explained:
(Doc. 6-4, p. 13). The ALJ assigned significant weight to Dr. Williams's report as "the only comprehensive assessment of [Ms. Chandler's] mental functioning." (Doc. 6-3, p. 24).
Second, an ALJ has not only a duty at step five to pose a comprehensive hypothetical but also a general obligation "to develop the record where appropriate." Robinson v. Astrue, 365 Fed. Appx. 993, 999 (11th Cir. 2010) (internal citation omitted). Under Social Security Ruling 96-5p, "an ALJ should recontact a claimant's treating physician if the evidence in the record is otherwise inadequate to determine whether the claimant is disabled." Robinson, 365 Fed. Appx. at 999. Ruling 96-5p states that if "the adjudicator cannot ascertain the basis of the opinion from the case record, the adjudicator must make `every reasonable effort' to recontact the source for clarification of the reasons for the opinion." Robinson, 365 Fed. Appx. at 999 (quoting Ruling 96-5p). When the failure to do so produces "unfairness or clear prejudice," the error is not harmless. Here, the VE did not understand what the ALJ meant by "frequent breaks," and the ALJ acknowledged the need for clarification from Dr. Holdridge, but the ALJ did not attempt to consult Dr. Holdridge. The ALJ defaulted to advising the VE: "frequent is going to mean something different to everyone and I'll just ask you to try to read all of these limitations together." (Doc. 6-3, p. 58). Ultimately, in expressing opinions about both the first and second hypotheticals, the VE did not mention frequent breaks but instead discussed only the four hour walk/stand limitation. (Doc. 6-3, pp. 60-64).
Because the hypothetical questions on which the Commissioner relied were confusing and incomplete, and because the ALJ's failure to recontact Dr. Holdridge or even consider Dr. Williams's opinion regarding Ms. Chandler's need for breaks rendered the hypotheticals unfair and unreliable, the VE's testimony concerning available work does not constitute substantial evidence, and the ALJ's errors are not harmless.
For the reasons discussed above, the Court remands the Commissioner's decision for additional proceedings consistent with this opinion. The Court will enter a separate final judgment consistent with this memorandum opinion.
"Sacroiliitis (say-kroe-il-e-I-tis) is an inflammation of one or both of your sacroiliac joints — situated where your lower spine and pelvis connect. Sacroiliitis can cause pain in [a person's] buttocks or lower back, and can extend down one or both legs. Prolonged standing or stair climbing can worsen the pain." https://www.mayoclinic.org/diseases-conditions/sacroiliitis/symptoms-causes/syc-20350747 (last visited Sept. 21, 2019).
