GREGORY J. KELLY, Magistrate Judge.
Angieannia K. Clarke (the "Claimant") appeals to the District Court from a final decision of the Commissioner of Social Security (the "Commissioner") denying her application for disability insurance benefits. Doc. No. 1; R. 312. Claimant alleges an onset of disability date as of August 1, 2010, primarily due to headaches. R. 147, 156, 312. On December 15, 2011, an Administrative Law Judge ("ALJ") issued a decision finding Claimant not disabled. See generally R. 188 (Appeals Council's Remand Order).
On May 12, 2012, the Appeals Council remanded the matter back to the ALJ, in part, for the following reason:
R. 188. Thus, the case was remanded to the ALJ, in part, because the ALJ made no particular findings regarding the credibility of Claimant's subjective complaints of headaches. R. 188. However, in its remand order, the Appeals Council did not direct the ALJ to take any particular action on remand with respect to Claimant's subjective complaints of headaches. R. 189-90.
On November 15, 2012, the ALJ issued a decision finding Claimant not disabled. R. 81-93. At the outset of the decision, despite having received no such directive from the Appeals Council (see R. 189-90), the ALJ notes that the "[ALJ] was also instructed to address the claimant's credibility in regards to her headaches. . . ." R. 81. In this appeal, Claimant argues that the ALJ erred by failing to articulate explicit reasons, supported by substantial evidence for finding Claimant subjective statements not credible, including failing to comply with the Appeals Council's order on remand. Doc. No. 27 at 11-17. For the reasons set forth below, the Commissioner's final decision is
The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla — i.e., the evidence must do more than merely create a suspicion of the existence of a fact, and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion. Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995) (citing Walden v. Schweiker, 672 F.2d 835, 838 (11th Cir. 1982) and Richardson v. Perales, 402 U.S. 389, 401 (1971)); accord Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991).
Where the Commissioner's decision is supported by substantial evidence, the District Court will affirm, even if the reviewer would have reached a contrary result as finder of fact, and even if the reviewer finds that the evidence preponderates against the Commissioner's decision. Edwards, 937 F.2d at 584 n.3; Barnes v. Sullivan, 932 F.2d 1356, 1358 (11th Cir. 1991). The District Court "`may not decide the facts anew, reweigh the evidence, or substitute [its] judgment for that of the [Commissioner].'" See Phillips v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004) (quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)).
In the Eleventh Circuit, subjective complaints of pain are governed by a three-part "pain standard" that applies when a claimant attempts to establish disability through subjective symptoms. By this standard, there must be: 1) evidence of an underlying medical condition and either 2) objective medical evidence that confirms the severity of the alleged symptom arising from the condition or 3) evidence that the objectively determined medical condition is of such severity that it can be reasonably expected to give rise to the alleged pain. See Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991) (citing Landry v. Heckler, 782 F.2d 1551, 1553 (11th Cir. 1986)). "20 C.F.R. § 404.1529 provides that once such an impairment is established, all evidence about the intensity, persistence, and functionally limiting effects of pain or other symptoms must be considered in addition to the medical signs and laboratory findings in deciding the issue of disability." Foote, 67 F.3d at 1561; 20 C.F.R. § 404.1529.
A claimant's subjective testimony supported by medical evidence that satisfies the standard is itself sufficient to support a finding of disability. Foote, 67 F.3d at 1561. "If the ALJ decides not to credit a claimant's testimony as to her pain, he must articulate explicit and adequate reasons for doing so." Id. at 1561-62; see also SSR 96-7p, 1996 WL 374186, at *2 ("It is not sufficient for the adjudicator to make a single, conclusory statement that `the individual's allegations have been considered' or that `the allegations are (or are not) credible.'"). A reviewing court will not disturb a clearly articulated credibility finding with substantial supporting evidence in the record. Foote, 67 F.3d at 1562. The lack of a sufficiently explicit credibility finding may give grounds for a remand if the credibility is critical to the outcome of the case. Id.
In order to determine whether the ALJ's credibility determination in this case is sufficiently explicit and supported by substantial evidence, it is helpful to review Claimant's testimony at both administrative hearings, the order from the Appeals Council, and the ALJ's decision. On November 17, 2011, Claimant testified as follows:
R. 130-34. As set forth above, on May 21, 2012, the Appeals Council remanded the matter to the ALJ, in part, because the ALJ "made no particular finding regarding the credibility of these subjective complaints. . . ." R. 188.
On October 25, 2012, the ALJ held a second hearing in this case. R. 101-23. At the hearing, the ALJ stated that the case was remanded, in part, for the ALJ "to take a look at the claimant's headaches." R. 103. At the second hearing, the Claimant testified as follows:
R. 107-17. Thus, Claimant testified that while she received some relief in her headache symptoms while on Fioricet and Semitogram, she has been unable to obtain those medications or continue her treatment with the neurologist since her Medicaid insurance expired. R. 107-08. Claimant further testified that she continues to experience headaches three to four times a week, with minimal relief, and she cannot perform any activity while experiencing a headache. R. 107-17.
On November 15, 2012, the ALJ issued a decision finding Claimant not disabled. R. 81-93. In the decision, the ALJ specifically notes that she was "instructed to address the claimant's credibility in regards to her headaches. . . ." R. 81.
The ALJ found that Claimant retains the following residual functional capacity (the "RFC"):
R. 84. Thus, the ALJ found that the Claimant retains the RFC for a reduced range of light work. R. 84. In making this finding the ALJ states that she "considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical and other evidence, based on the requirements of [the regulations and Social Security Rules]." R. 85.
With respect to the Claimant's testimony, the ALJ states the following:
R. 89. Thus, the ALJ's summary of Claimant's testimony does not address Claimant's testimony that she is no longer taking the medications prescribed by her neurologist because she can no longer afford to see the neurologist. R. 89. Immediately following this summary, the ALJ makes the following credibility determination:
R. 89. Thereafter, the ALJ proceeds to provide reasons for the above-stated credibility determination. R. 90.
The ALJ states:
R. 90 (emphasis added and some citations omitted). Thus, as one of the reasons for finding Claimant's subjective statements not credible, the ALJ states Claimant' headache symptoms had improved since being placed on Fioricet. R. 90. The ALJ does not address Claimant's testimony that she is no longer taking Fioricet or being treated by a neurologist after losing her insurance. R. 90, 107-109. Later, the ALJ states that "[a]ll of the claimant's alleged limitations, including her headaches have been considered in determining her [RFC]. The activities of daily living and medical reports analyzed above support this [RFC]." R. 91. A review of the ALJ's December 15, 2011 decision (R. 178-79) reveals that the credibility determination therein is nearly identical to the ALJ's credibility determination in the November 15, 2012 decision (R. 90).
The ALJ's credibility determination with respect to Claimant's subjective allegations of symptoms and limitations resulting from her headaches is not supported by substantial evidence. The Claimant clearly testified that she is no longer able to obtain a prescription for Fioricet or Semitrogram, or receive treatment from her neurologist, due to a lack of insurance. R. 107-08. Claimant further testified that since she cannot afford those medications, she continues to experience headaches three to four times per week and continues to have headaches upon waking with only minimal relief from Naproxen. R. 109, 117. In the decision, the ALJ focuses on the relief Claimant experienced while on Fioricet, but never addresses Claimant's testimony that she no longer has access to that medication. R. 89-90. Without ALJ articulating how she resolved the Claimant's testimony that she no longer has access to that medication due to a lack of insurance (R. 107-09), the Court cannot conclude that the ALJ's credibility determination is supported by substantial evidence. See Dawkins v. Bowen, 848 F.2d 1211, 1213 (11th Cir. 1988) ("[W]hile a remediable or controllable medical condition is generally not disabling, when a claimant cannot afford the prescribed treatment and can find no way to obtain it, the condition that is disabling in fact continues to be disabling in law.") (internal citations and quotations omitted).
Based on the forgoing, the Court finds that the case must be remanded for further proceedings. See, e.g., Howell v. Astrue, No. 8:10-cv-2175-T-26TGW, 2011 WL 4002557, at *4-5 (explaining that the proper remedy is remanding case to Commissioner due to ALJ's failure to provide a meaningful explanation for his credibility determination).
For the reasons stated above, it is
SSR 96-7p, 1996 WL 374186, at *1 (1996).
