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Jeffries v. Berryhill

United States District Court, E.D. Missouri, Eastern Division

January 25, 2017

KIM JEFFRIES, Plaintiff,
NANCY A. BERRYHILL,[1] Acting Commissioner of Social Security, Defendant.



         Kim Jeffries (“Plaintiff”) appeals the decision of the Commissioner of Social Security (“Defendant”), denying Plaintiff's application for disability benefits. Plaintiff argues that, in assessing her residual functional capacity, the Administrative Law Judge did not properly account for the days that Plaintiff would allegedly miss work due to doctor's appointments. Because the ALJ's decision is supported by substantial evidence, this Court AFFIRMS. See 42 U.S.C. § 405(g).

         I. Introduction

         A. Background Medical Information

         Plaintiff is a 59 year-old woman who initially alleged disability due to anxiety, crying spells, left knee surgery, and hearing voices. (Tr. 90) Plaintiff alleged that her impairments left her unable to work since April 1, 2008. (Id.) At the administrative hearing in this matter, Plaintiff testified that she also suffered from back and hip pain prior to March 30, 2011, her date of last insured, and that she could only sit for 10-15 minutes, but also admitted that this limitation was mostly due to “nerves” and that she was not having a lot of pain in 2011. (Tr. 48) Plaintiff also testified to pain resulting from carpal tunnel syndrome, mostly in her right hand, which limited her to carrying 3-4 pounds with that hand, caused her to drop things, and limited her ability to do tasks such as buttoning shirts, using a key, and handling money. (Tr. 52, 42)

         As to her mental impairments, Plaintiff reported that her bipolar disorder caused issues with memory, concentration, completing tasks and understanding. (Tr. 271) For example, Plaintiff alleged that she “forget[s] directions, ” and has to “recheck” instructions. (Id.) Plaintiff also testified that she was less sociable than previously, and she was hearing voices once or twice a week. Paranoia and inability to make decisions were other reported symptoms. (Tr. 44-46)

         The medical evidence related to her physical impairments shows Plaintiff has a history of wrist issues, but the evidence is mixed with regard to her back and hip pain. As to her wrist, Plaintiff has had multiple carpal tunnel surgeries, and an exam in August, 2009, noted decreased strength in the right hand, and severe thenar muscle wasting. (Tr. 376, 379) Plaintiff was diagnosed with right ulnar nerve damage with a history of carpal tunnel release surgery. (Id.)

         As to her back and hip pain, a CT scan in July of 2011 revealed grade 1 spondylolisthesis with spondylolysis at ¶ 4-5.[3] On the other hand, an August 2009 consultative examination had mostly normal findings. (See Tr. 376) (finding no tenderness or spasm; normal gait and station, with no assistive device; full range of motion of the spine, and all extremities; toe and heel walk without difficulty and squatted to the floor and recovered without complaint; normal muscle strength in the lower extremities; reflexes and sensory were normal)

         With regard to Plaintiff's mental impairments, the medical evidence shows a long history of treatment for mental health impairments, but it also shows that Plaintiff generally responded well to treatment and medication, and that periods of more severe symptoms coincided with temporary situational stressors. Plaintiff's mental health treatment records date from June of 2007, when she was treated at Psych Care Consultant. (Tr. 319-22) Plaintiff was diagnosed with major depressive disorder, bipolar disorder, and polysubstance abuse. At that time, Plaintiff alleged symptoms such as racing thoughts, anxiety, mood swings, depression, hallucinations, and difficulty interacting with others. (Tr. 319)

         At the same time, however, treatment notes also indicate that Plaintiff was generally alert and cooperative, as well as well groomed. (Id.) Plaintiff demonstrated logical thoughts, with intact insight and judgment. These treatment notes did not appear to document significant mental impairments, but noted problems dealing with temporary stressors, such as a jail term of 120 days, or substance abuse relapses. The treatment notes in the years prior to Plaintiff's date last insured indicate that Plaintiff was doing well and that her medications were helping. (See, e.g., Tr. 416)

         B. Procedural History

         As a result of Plaintiff's physical and mental health issues, Plaintiff applied for Title II disability benefits on January 13, 2012. Plaintiff's alleged onset date is April 1, 2008, and her date last insured is March 30, 2011. Plaintiff's claim was initially denied on May 14, 2012. Plaintiff requested a hearing before an administrative law judge (“ALJ”), and the ALJ held a hearing on May 28, 2014, at which Plaintiff testified, with counsel present. A vocational expert (“VE”) testified regarding Plaintiff's past work, and the availability of work for someone with Plaintiff's age, education, work experience, and functional limitations. (Tr. 35-78)

         In a decision dated June 18, 2014, the ALJ found Plaintiff not disabled. (Tr. 12-23) In arriving at this decision, the ALJ followed the familiar five-step process laid out in the Commissioner's regulations. At step one, the ALJ found Plaintiff did not engage in substantial gainful activity between the time of her alleged onset date and her date last insured. (Tr. 14) At step two, the ALJ found that Plaintiff suffered from the severe impairments of “grade 1 spondylolisthesis with spondylolysis at ¶ 4-5, right carpal tunnel syndrome, major depressive disorder, and bipolar disorder with psychotic features.” (Tr. 14) At step three, the ALJ found Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments.[4] (Tr. 15-16)

         Before proceeding to step four, the ALJ evaluated Plaintiff's residual functional capacity (“RFC”) on the basis of the medical evidence of record, Plaintiff's hearing testimony, and the relevant opinion evidence. In this regard, the ALJ found Plaintiff capable of performing light work, with the following restrictions:

[Plaintiff] could perform occasional lifting up to 20 pounds and the frequent lifting/carrying up to 10 pounds. The claimant could perform standing or walking 6 hours out of an 8-hour workday. The claimant could perform work that does not require climbing on ropes, ladders, or scaffolds, and requires no more than occasional climbing on ramps and stairs. The claimant could perform occasional stooping, kneeling, crouching, or crawling. Fine fingering with the right dominant upper extremity was limited to occasional. The claimant was able to understand, remember, and carry out simple to moderately complex instructions consistent with semi-skilled work. The claimant could tolerate occasional contact with co-workers, supervisors, and the general public.

(Tr. 17) In making this finding, the ALJ evaluated Plaintiff's credibility and weighed the relevant opinion evidence.

         As to Plaintiff's credibility, the ALJ found that Plaintiff's assertions of disabling functional limitations and pain were “not entirely credible.” (Tr. 20) The ALJ based this adverse credibility determination on numerous factors. The ALJ found that the objective medical evidence and diagnostic testing was not consistent with Plaintiff's allegations of total disability. (Tr. 20) Additionally, the ALJ found Plaintiff's reported daily activities-including loading the dishwasher, sweeping, using a computer, driving, preparing simple meals, shopping in stores, and socializing with family and friends-were not consistent with allegations of total disability, and in fact required the same “physical and mental abilities” required to obtain and maintain employment. (Tr. 20-21) The ALJ also considered that Plaintiff's poor work history- which showed only sporadic working, and only one year since 2001 which approached substantial gainful employment. The ALJ concluded that Plaintiff's work history did “not ...

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