Submitted: January 11, 2017
from United States District Court for the Eastern District of
Arkansas - Helena
SMITH  and KELLY, Circuit Judges, and
SIPPEL,  District Judge.
Combs appeals from the district court's order affirming
the Administrative Law Judge's (ALJ) denial of her
application for disability insurance benefits and
supplemental security income. Because we conclude that the
ALJ failed to fully and fairly develop the record, we reverse
and remand for further factual findings.
applied for disability benefits on July 2, 2012, alleging a
disability onset date of May 17, 2012. She claims she is
disabled as a result of the combined effects of rheumatoid
arthritis, osteoarthritis, asthma, and obesity. Combs was
born on December 24, 1961, and has a ninth grade education.
She last worked as a housekeeper at a nursing home and was
fired for talking on her cell phone.
held a hearing on Combs' application on January 9, 2014,
at which Combs and a Vocational Expert (VE) testified. Combs
testified at the hearing, providing the following
information. She is 5'3" tall and weighs 240 pounds.
She was first told by a doctor that she had arthritis in
August 2011; a little later, she was diagnosed with
rheumatoid arthritis by a doctor who prescribed meloxicam for
the arthritis and tramadol for pain. The medications
"eased the pain whereas [she] can basically deal with it
a little bit, but it didn't take the pain away, but it
made it bearable a little bit." She has swelling
"from [her] knees all the way down to [her] foot, "
which is worsened by walking and standing. She can walk for
about five minutes at a time, but then she has to stop
because of the pain in her lower back, knees, and feet. She
can only stand for two or three minutes before having to sit
down and prop up her legs, which sometimes lessens the
swelling. She can sit for one hour but spends the day
changing positions. Her hands sometimes cramp up so much she
cannot use them-"they just get stuck." She has pain
daily, and has restless leg syndrome, which disturbs her
sleep. She is prescribed amitriptyline, which helps but does
not eliminate the problem.
daily activities consist mostly of sitting on her couch or
walking around the house in an effort to keep her legs from
stiffening. She sometimes goes to her daughter's house,
but because she has trouble getting up from her
daughter's couch, she prefers to sit at home where she
can be more comfortable. She can shop only if a motorized
cart is available. She can make herself a sandwich, but can
only cook for her family if she has a chair in the kitchen,
where she can sit down after standing for two or three
minutes. She sometimes does dishes. She does not have the
strength in her hands to wring mops or wipe surfaces, and she
can no longer play with her grandchildren.
presented medical records spanning the time period from July
2011 to September 2014 from St. Bernards Regional Medical
Center, AR Care, Jonesboro Church Health Center, and NEA
Baptist Clinic. Henry Allen, M.D., of AR Care, diagnosed
Combs with rheumatoid arthritis in November 2011 and
prescribed meloxicam, cyclobenzaprine, and tramadol to treat
the arthritis and accompanying pain. Combs has continued
treatment with various medical providers for this condition,
including Dr. Allen, Beata Majewski, M.D., and Jennifer Long,
APN, and these providers continue to prescribe pain
medication-including toradol, hydrocodone, and tramadol-for
"severe pain" due to her rheumatoid arthritis.
X-rays showed severe degenerative changes in both of
Combs' knees, narrowing of the joint space in her wrists
and in the fingers of both hands. Treatment notes from Dr.
Allen, Dr. Majewski, and APN Long reported swelling, warmth,
and tenderness in Combs' hands, wrists, knees, and
ankles, as well as painful range of motion, but "no
acute distress" and "normal movement of all
extremities." None of these medical treatment providers
offered an opinion about Combs' ability to function in
only medical opinions regarding Combs' residual
functional capacity (RFC) that the ALJ considered were from two
State agency medical consultants: Robert Redd, M.D., who
conducted an initial review of Combs' medical records,
and Sharon Keith, M.D., who reviewed Combs' records at
the reconsideration level. Neither doctor examined Combs. Dr.
Redd opined that Combs was able to lift ten pounds
occasionally and less than ten pounds frequently and was
therefore limited to sedentary work. In Dr. Keith's
opinion, Combs was capable of work at the light exertional
level and could lift twenty pounds occasionally and ten
the hearing, the ALJ issued a decision on July 18, 2014,
analyzing Combs' disability following the five-step
sequential evaluation process outlined in 20 C.F.R.
§§ 420.1520(a)-(f). At the first and second steps,
the ALJ determined that Combs had not engaged in substantial
gainful activity since her alleged disability onset date, and
had the following severe impairments: rheumatoid arthritis,
fibromyalgia, and obesity. At step three, the ALJ determined
that Combs did not have an impairment or combination of
impairments listed in or medically equal to one listed in
Appendix 1, Subpart P, Regulation No. 4.
next considered Combs' RFC. The ALJ found Combs'
subjective complaints of pain not entirely credible in large
part based on treatment notes made by her medical providers
that she was in "no acute distress" and "had
normal movement of all extremities." The ALJ gave
"some weight" to Dr. Redd's opinion but
concluded Dr. Keith's opinion was more consistent with
the record as a whole. Relying on Combs' medical records
and Dr. Keith's opinion, as well as the VE's
testimony, the ALJ determined Combs had the RFC to perform
light work as defined in 20 C.F.R. § 404.1567(b) with
the following limitations: she can only frequently use her
hands to finger and grasp; only occasionally climb ladders,
ropes, scaffolds, ramps, or stairs; and only occasionally
balance, stoop, kneel, crouch, and crawl. Because Combs'
past work as a hotel housekeeper did not require her to
perform any work-related activities precluded by her RFC, the
ALJ concluded Combs was capable of performing her past
relevant work and so was not disabled. Alternatively, the ALJ
found that Combs could perform other jobs that existed in
significant numbers in the national economy, such as a
cashier or a fast food worker.
August 6, 2015, the Appeals Council denied Combs' request
for review. She sought judicial review and, on May 25, 2016,
the district court affirmed the Commissioner's denial of
Combs' claims. In ...