Recommended Disposition
J. THOMAS RAY, Magistrate Judge.
Instructions
The following recommended disposition was prepared for U.S. District Judge Susan W. Wright. A party to this dispute may file written objections to this recommendation. An objection must be specific and state the factual and/or legal basis for the objection. An objection to a factual finding must identify the finding and the evidence supporting the objection. Objections must be filed with the clerk of the court no later than 14 days from the date of this recommendation.1 The objecting party must serve the opposing party with a copy of an objection. Failing to object within 14 days waives the right to appeal questions of fact.2 If no objections are filed, Judge Wright may adopt the recommended disposition without independently reviewing all of the record evidence.
Reasoning for Recommended Disposition
Lora D. Burchfield seeks judicial review of the denial of her application for disability benefits.3 Burchfield worked as a grill cook at a truck stop until October 9, 2009.4 Her reasons for no longer working have varied.5 She applied for disability benefits on June 14, 2010, and alleged disability since she stopped working. She based disability on extreme weight loss, fatigue, dehydration, swelling, low blood pressure, lack of balance, headaches, and breathing problems.6
The Commissioner's decision. Initially, the Commissioner's ALJ determined Burchfield could do some light work,7 identified available work, and denied the application.8 Burchfield asked the Commissioner's Appeals Council to review the decision.9 The Appeals Council reversed the decision, and remanded the case to the ALJ to consider whether polyneuropathy is a severe impairment and to address an opinion by Burchfield's psychiatrist.10
The remand order instructed the ALJ to obtain updated medical evidence, reconsider Burchfield's ability to work, and obtain updated vocational evidence. The remand order gave the ALJ authority to order examinations if needed and to offer Burchfield a second hearing. The remand order instructed the ALJ to address whether alcoholism was a contributing factor material to any determination of disability. The ALJ obtained updated medical evidence,11 conduced a second hearing,12 and issued a second unfavorable decision.
In the second decision — the challenged decision — the ALJ identified peripheral neuropathy, chronic obstructive pulmonary disease, hypertension, mood disorder, and addiction disorder-alcohol as severe impairments.13 The ALJ determined Burchfield can do some light work if she stops drinking alcohol,14 but if she doesn't, there is no work that she can do.15 In other words, the ALJ concluded that Burchfield was disabled after including the limiting effects of alcohol in the standard five-step analysis, and then proceeded to consider her remaining limitations absent alcohol abuse.16 The ALJ found that substance abuse disorder is a contributing factor material to the determination of disability.17 Because a person is ineligible for disability benefits if alcohol abuse is a contributing factor material to her disability,18 the ALJ denied the application.
Burchfield asked the Appeals Council to review the second decision.19 After the Appeals Council declined to review,20 the ALJ's decision became the Commissioner's final decision for the purpose of judicial review.21 Burchfield filed this case to challenge the decision.22 In reviewing the decision, the court must determine whether substantial evidence supports the decision and whether the ALJ made a legal error.23 This recommendation explains why substantial evidence supports the decision and why the ALJ made no legal error.
Burchfield's allegations. Burchfield challenges the factual findings underlying the determination that alcohol is a contributing factor material to the determination of disability; i.e., she would be late or miss work more that twice per month, and she needs frequent, unscheduled breaks, due to alcohol use. She contends no evidence indicates she used alcohol throughout the pendency of her application, or that continued alcohol use exacerbated her problems with neuropathy. She contends the ALJ failed to develop the record as to the effects of alcohol abuse. She maintains the ALJ should have addressed alcohol abuse during the second hearing. For these reasons, she maintains substantial evidence does not support the ALJ's decision.
Applicable legal principles. A disabled claimant is ineligible for disability benefits if alcohol abuse materially contributes to her disability.24 Under the regulations, the relevant question is whether the ALJ would find the claimant disabled if she stopped using alcohol.25 The claimant bears the burden of proving alcohol abuse is not a contributing factor material to her disability.26 For substantial evidence to support the ALJ's decision, a reasonable mind must accept the evidence as adequate to show alcohol abuse is a contributing factor material to Burchfield's disability.27
Substantial evidence shows alcohol abuse is a contributing factor. Burchfield's challenge implicates the ALJ's duty to fairly and fully develop the record,28 because she suggests the ALJ placed the issue of alcohol abuse at issue. The ALJ, however, placed no matter at issue. Her treatment records placed alcohol abuse at issue.
Burchfield attributed disability to extreme weight loss, fatigue, dehydration, swelling, low blood pressure, lack of balance, headaches, breathing problems, and neuropathy; by doing so, she placed those matters at issue. Burchfield's allegations were not enough to prove disability because a determination of disability must be supported by medical evidence.29
The ALJ obtained medical evidence in the form of treatment records and diagnostic testing from medical and mental health providers. There was no need for consultative exams because that evidence provided sufficient medical evidence to determine whether Burchfield is disabled.30 The following discussion explains why the medical evidence shows alcohol abuse is a contributing factor material to the determination of disability.
1. One month after she says she stopped working, Burchfield presented to an emergency room and reported that she passed out at work and hit her head.31 She was diagnosed with low magnesium in the blood, alcohol abuse, and temporary loss of consciousness.32 Low magnesium levels are often associated with chronic alcoholism. The treating physician instructed Burchfield to decrease her alcohol intake and to take magnesium supplement for 15 days. The diagnosis and prescribed treatment establishes a causal connection between alcohol addiction and the inability to work, because Burchfield reported that she fell at work, and because what caused her to fall is associated with chronic alcoholism.
2. Six months later, Burchfield returned to the emergency room and complained about shortness of breath, coughing, and general weakness.33 She was smoking two packs of cigarettes per day; she was still drinking.34 Her magnesium and electrolytes levels were low;35 low levels of magnesium and imbalances of electrolytes are associated with alcohol abuse.36
Burchfield had a urinary tract infection and sinusitis.37 Drinking alcohol aggravates the urinary tract and causes the sinus membranes to swell. The treating physician treated Burchfield with magnesium and electrolytes. The diagnosis and prescribed treatment establishes a causal connection between alcohol abuse and the inability to work, because Burchfield's symptoms are associated with alcoholism.
3. Three days later, Burchfield returned to the emergency room, and reported that she had fallen upon standing and hit her head on concrete.38 She was diagnosed with orthostatic hypotension,39 a form of low blood pressure that occurs when a person stands up. Drinking alcohol can increase the risk of orthostatic hypotension. The diagnosis establishes a causal connection between alcohol addiction and the inability to work, because Burchfield's symptoms are associated with alcoholism. Burchfield applied for disability two weeks later.
4. After applying for disability, Burchfield sought mental health treatment for depression.40 Her psychiatrist prescribed anti-depressant medication.41 Treatment notes for visits with the psychiatrist and a therapist show Burchfield's depressive symptoms improve with treatment, if she doesn't drink alcohol.42 Burchfield struggled with financial difficulties, homelessness, family problems, and matters from her past.43 At times, she reported that she no longer drank alcohol, but at other times, it was clear to medical providers that she drank alcohol. Seven weeks after the second hearing, her mental health was declining due to lacking medication and drinking.44 Her psychiatrist diagnosed alcohol dependence, major depressive disorder, alcohol induced mood disorder, and personality disorder.45 The diagnosis and treatment notes indicate alcohol abuse is a contributing factor material to the determination of disability.
5. After applying for disability, Burchfield established care with a primary care physician. Treatment notes and diagnostic tests confirmed the presence of neuropathy.46 Neuropathy affects the nerves supplying the arms and legs. "If sensory nerves are involved, numbness, tingling, and pain are prominent, and if motor nerves are involved, the patient experiences weakness."47 Burchfield complained about these symptoms.
People who drink heavily for many years often develop neuropathy.48 Other things can cause neuropathy,49 but doctors identified no other cause for Burchfield's neuropathy.50 Laboratory tests suggest heavy alcohol use.51 Treatment notes indicate Burchfield's neuropathy likely flowed from alcohol.52 Burchfield's history of heavy drinking and the presence of neuropathy indicate alcohol abuse is a contributing factor material to the determination of disability.
A reasonable mind would accept the evidence as adequate to support the decision because the evidence indicates alcohol abuse is a significant contributor to Burchfield's symptoms. Her mental and physical symptoms improve with treatment so long as she doesn't drink alcohol. The medical evidence supports the ALJ's factual findings that Burchfield would be late or miss work more that twice per month, and she needs frequent, unscheduled breaks, due to alcohol use.
Conclusion and Recommendation
Substantial evidence supports the ALJ's decision. The ALJ made no legal error. For these reasons, the undersigned magistrate judge recommends denying Burchfield's request for relief (docket entry # 2) and affirming the Commissioner's decision.
