United States District Court, E.D. Missouri, Northern Division
TRUDY R. EARNEST, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.
MEMORANDUM AND ORDER
CATHERINE D. PERRY, UNITED STATES DISTRICT JUDGE
Trudy R. Earnest brings this action under 42 U.S.C. §
1383(c)(3) seeking judicial review of the Commissioner's
final decision denying her application for supplemental
security income (SSI) under Title XVI of the Social Security
Act, 42 U.S.C. §§ 1381, et seq. Because
the Commissioner failed to consider the entirety of the
record in determining Earnest's residual functional
capacity (RFC), I will reverse the decision and remand for
filed her application for SSI in April 2013, claiming that
she became disabled on July 1, 2007, because of fibromyalgia,
allodynia, hyperalgesia, chronic pain, sacroiliac joint pain,
sciatica pain and spasms, degenerative disc disease,
arthritis, high RH factor, severe musculoskeletal pain,
tingling and numbness in feet, shooting pain down legs, and
chronic pain in joints. (Tr. 185-95, 209.) Earnest later
amended her alleged onset date to March 12, 2013. (Tr.
On August 6, 2013, the Social Security Administration denied
Earnest's claim for benefits. (Tr. 68-115.) Upon
Earnest's request, a hearing was held before an
administrative law judge (ALJ) on April 29, 2015, at which
Earnest and a vocational expert testified. (Tr. 31-67.) The
ALJ issued a written decision on June 5, 2015, denying
Earnest's claim for benefits, finding that she could
perform work as it exists in significant numbers in the
national economy. (Tr. 17-26.) On August 2, 2016, upon review
of additional evidence, the Appeals Council denied
Earnest's request for review of the ALJ's decision.
(Tr. 1-5.) The ALJ's determination thus stands as the
final decision of the Commissioner. 42 U.S.C. § 405(g).
action for judicial review, Earnest contends that the
ALJ's decision is not supported by substantial evidence
on the record as a whole. Specifically, Earnest argues that
the ALJ erred by discounting the opinion of her treating
nurse practitioner and failed to adequately consider her
impairment of fibromyalgia when assessing her RFC. Earnest
requests that the matter be remanded to the Commissioner for
further consideration. For the reasons that follow, I will
reverse the decision and remand for further proceedings.
Before the ALJ
hearing on April 29, 2015, Earnest testified in response to
questions posed by the ALJ and counsel.
time of the hearing, Earnest was forty-four years old. She
went to school through the eleventh grade and later obtained
her GED. She also trained and was certified as a certified
nurse's assistant. Earnest lives in a house with her
husband and two sons, who are ten and eight years old. She
stands five feet, seven inches tall and weighs 200 pounds.
(Tr. 36-38, 54.)
Work History Report shows that she worked as a line worker
from 1992 to 1995. From 1996 to 1998, she worked as a
caretaker. Earnest worked at Hannibal Regional Hospital from
1998 to 1999 in phlebotomy. She worked in customer service
from 1999 to 2004. (Tr. 244.) Earnest testified that she
stopped working in 2007 after her son was born with spina
bifida. She testified that the stress brought on by that
circumstance caused many mental, physical, and emotional
problems, and she could not go back to work. (Tr. 42-43.)
testified that she has been diagnosed with fibromyalgia and
that the condition affects her entire body. She experiences
stiffness, tingling and numbness in her hands and feet,
achiness in her legs and feet, and a lot of pelvic pressure.
(Tr. 45-47.) Burning and stabbing pain in her joints and
sacroiliac area shoots down her legs and into her feet. (Tr.
39-40.) Earnest testified that she elevates her legs and
performs certain exercises to try to alleviate the pain. She
also alternates applying ice packs and heat throughout the
day, and she sleeps on an ice pack at night. (Tr. 47-49.) She
takes hydrocodone every four to six hours for pain and uses a
TENS unit three or four times a day. (Tr. 44, 49-50.)
testified that her fibromyalgia pain is more severe in areas
where she suffered fractures from an earlier automobile
accident - her left wrist, right shoulder, left ankle, and
some ribs. She hardly uses her left hand because of
significant pain; and her neck, shoulder, and ankle
constantly pop and ache. Earnest also had cervical spine
surgery in 2002 and had a plate and four screws placed in her
neck. She experiences stiffness and pain in the neck area
because of arthritis and has difficulty sleeping because of
the condition. (Tr. 40-42.)
testified that she experiences migraine headaches three to
four times a week. They last over three hours and she
sometimes experiences nausea and vomiting with the headaches.
For these headaches, Earnest takes pain medication and lies
down on ice packs in a dark room. She also uses her TENS
unit. Earnest also has tension headaches two to three times a
week. (Tr. 43-45.)
has also been diagnosed with depression and takes medication
for the condition. Earnest testified that an abusive
childhood is the source of her depression. (Tr. 53-54.)
addition to hydrocodone, Earnest takes ibuprofen, Aleve,
Savella, Prozac, and lorazepam for her impairments. (Tr.
51-52.) Her medication helps the pain for short periods, but
her pain is chronic. (Tr. 58.) Earnest testified that she has
many side effects from her medication, including irritable
bowel syndrome, constipation, profuse sweating, anxiety, dry
mouth, dry skin, and “brain fog.” (Tr. 53.)
her exertional abilities, Earnest testified that she can
stand for about fifteen minutes before she experiences pain.
(Tr. 39.) Sitting in a straight-back chair causes pain.
Earnest testified that she does not sit a lot because of
pain. (Tr. 48.) Lying flat on her back is most comfortable
for her. (Tr. 51.) Earnest can lift two or three pounds, but
she tries not to lift anything because of her neck condition.
(Tr. 55.) Earnest testified that she experiences pain and
gets dizzy and lightheaded if she bends, squats, or stoops.
her daily activities, Earnest testified that she goes to bed
around 8:30 p.m. and wakes up every three hours because of
pain. She gets up in the morning at 6:00 a.m. Her children
dress and feed themselves before school. Earnest testified
that she spends most of her day resting in bed. (Tr. 50-51.)
Her husband does a lot of the housework and takes care of the
lawn. She has an adult daughter and an aunt who help care for
the children. (Tr. 38-39.) Earnest can drive but does so only
when she has to and then only for short distances. For longer
distances, she makes arrangements with a transportation
service. She shops with her husband. Earnest has difficulty
with some personal care, such as shaving her legs and
brushing her hair. She bathes three or four times a week, and
her husband sometimes helps her. (Tr. 55-57.)
Vocational Expert Testimony
Watts, a vocational expert, testified at the hearing in
response to questions posed by the ALJ and counsel.
Watts characterized Earnest's past work as a customer
service clerk as semi-skilled and light, and as a home health
aide as semi-skilled and medium. The ALJ asked Mr. Watts to
consider a person the same age, education, and past work as
Earnest and to assume the person was limited
to lifting no more than 20 pounds occasionally, 10 pounds
frequently. Sit, stand, or walk six hours in an eight-hour
day. No climbing ropes, ladders, scaffolding. Only occasional
climbing ramps, stairs, balance, stoop, kneel, crouch, crawl.
Occasional reaching or working overhead. Occasional operation
of pedals or foot controls. The work would need to be simple,
repetitive and routine. Only occasional contact with
coworkers and supervisors or the general public.
(Tr. 59.) Mr. Watts testified that such a person could not
perform Earnest's past relevant work but could perform
other work, such as light and unskilled work as an order
caller, router, and inspector. (Tr. 59-60.)
then asked Mr. Watts to assume the same individual but that
she was limited to lifting ten pounds occasionally and less
than ten pounds frequently, and could stand or walk only two
hours in an eight-hour workday. Mr. Watts testified that such
a person could perform sedentary, unskilled work as a
bonder/semi-conductor, service waiter, or dowel inspector.
then asked Mr. Watts to assume the person from the second
hypothetical to require a sit/stand option at work with a
need to change position every ten to twenty minutes. Mr.
Watts testified that such a person could continue to perform
work as a bonder/semi-conductor and dowel tester as well as
work as a wait tester and final assembler. (Tr. 63-64, 66.)
Mr. Watts further testified that if this person missed work
more than three or four days each month, or was off task at
least twenty percent of the time, she would not be
employable. (Tr. 64-65.)
response to counsel's questions regarding the jobs
identified, Mr. Watts testified that work as a
bonder/semi-conductor requires occasional use of the hands
and that all other work requires frequent use of the hands.
August 1, 2008, Earnest visited her treating physician, Dr.
David J. Knorr, seeking treatment for poison ivy. Routine
examination showed tenderness and some ...