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Skaggs v. Commissioner of Social Security

United States District Court, N.D. Ohio, Eastern Division

June 15, 2017



          Kathleen B. Burke United States Magistrate Judge.

         Plaintiff Jennifer L. Skaggs (“Plaintiff” or “Skaggs”) seeks judicial review of the final decision of Defendant Commissioner of Social Security (“Defendant” or “Commissioner”) denying her applications for social security disability benefits. Doc. 1. This Court has jurisdiction pursuant to 42 U.S.C. § 405(g). This case is before the undersigned Magistrate Judge pursuant to the consent of the parties. Doc. 13. As explained more fully below, the Administrative Law Judge's reasons for discounting Skaggs' credibility are not supported by the record and/or are not sufficiently explained to allow this Court the ability to determine whether the credibility assessment is supported by substantial evidence. Accordingly, the Court REVERSES and REMANDS the Commissioner's decision for further proceedings consistent with this opinion.

         I. Procedural History

         Skaggs filed applications for Disability Insurance Benefits (“DIB”) and Supplemental Security Income (“SSI”) on February 13, 2013. Tr. 136, 247, 251. She alleged a disability onset date of September 1, 2005, (Tr. 136, 247, 251), but later amended her alleged onset date to July 20, 2011 (Tr. 36, 136). Skaggs alleged disability due to fibromyalgia, rheumatoid arthritis, neuropathy, lumbar radiculopathy, carpal tunnel syndrome, hand numbness, polyneuropathy, DDD, diabetes mellitus - type 2, sciatica, vertigo, obesity, and depression. Tr. 71, 157, 174, 271. Skaggs' applications were denied initially (Tr. 157-172) and upon reconsideration by the state agency (Tr. 174-185). Thereafter, she requested an administrative hearing. Tr. 186. On November 13, 2014, Administrative Law Judge Yvette N. Diamond (“ALJ”) conducted an administrative hearing. Tr. 33-70.

         In her December 19, 2014, decision (Tr. 133-154), the ALJ determined that Skaggs was not under a disability within the meaning of the Social Security Act from July 20, 2011, through the date of the decision (Tr. 149). Skaggs requested review of the ALJ's decision by the Appeals Council. Tr. 21. On March 21, 2016, the Appeals Council denied Skaggs' request for review, making the ALJ's decision the final decision of the Commissioner. Tr. 1-7.

         II. Evidence

         A. Personal, vocational and educational evidence

         Skaggs was born in 1974. Tr. 38, 147, 247. At the time of the hearing, Skaggs was 40 years old. Tr. 38. She was divorced with two adult children, ages 21 and 22. Tr. 38. She lived in a house with her two children. Tr. 38. She weighed 285 pounds and was 5 feet tall. Tr. 38. Skaggs graduated from high school and attended college but she did not complete one full year of college. Tr. 39, 272.

         Skaggs' past work included self-employment as an in-home daycare provider. Tr. 40. She performed that work from 2004 to 2010. Tr. 40. Skaggs performed the in-home daycare work herself, having a maximum of six children in her care at a time. Tr. 40. From 2005 until 2007, the age ranges of the children in her care were 3 months up to 11 years old. Tr. 40-41. In 2009 and 2010, Skaggs only cared for older children. Tr. 41. She was unable to care for babies and toddlers because she was unable to pick them up. Tr. 41. She stopped her in-home daycare work in 2010. Tr. 40. After Skaggs stopped working as an in-home daycare provider, she applied for one cashier job. Tr. 43.

         Prior to her in-home daycare work, in 2002, Skaggs worked as an assistant supervisor in a pre-school for 3-year olds. Tr. 41. Prior to the pre-school work, Skaggs also worked as a sales clerk/stock clerk/cashier in a toy store and as a mortgage loan representative. Tr. 42-43.

         B. Medical evidence

         1.Treatment history

         Skaggs is an obese woman (Tr. 410, 419) who seeks disability based on her multiple medical conditions. Since 2005 through at least 2014, Skaggs has been diagnosed with and treated for various conditions, including urinary problems (Tr. 368-405, 541-543, 546, 625), diarrhea (Tr. 429-431, 456-458, 469, 477-480, 482-483, 485-486, 544-545, 546, 573-578), heartburn (Tr. 544-545), rheumatoid arthritis (Tr. 356, 490-503, 505, 555-556, 594-602), fibromyalgia (Tr. 356, 419, 431, 504, 506, 551-552, 555, 579-593, 594-602), diabetes mellitus, type II (Tr. 540, 552, 555-556), back and leg pain (Tr. 406-428, 504, 514-516, 536, 553, 571-572, 579-593, 603-611, 626-627), sensory loss/neuropathy (Tr. 504, 537-539, 540, 603-611, 625-632), foot pain (Tr. 540, 623-624), speech difficulty (603, 606, 607), and depression (Tr. 485-486, 489, 552, 555-556). In 2013 through the first part of 2014, Skaggs lost her medical insurance coverage and could not afford medical treatment, including medications. Tr. 47-48, 102, 282, 289, 297, 517, 527.

         2. Opinion evidence

         a. Physical impairment medical opinions

         Consultative examining physician's opinion

         On May 6, 2013, Marsha D. Cooper, M.D., saw Skaggs for a consultative evaluation. Tr. 517-525. Skaggs' daughter was with her at the visit. Tr. 519. Skaggs complained of heartburn, swollen legs, her fingers getting stuck sometimes, aches in her body all the time, urinary and fecal incontinence, and low back pain. Tr. 517. Skaggs indicated she had been off of her medication since January because her child had turned 18 years old and she lost her medical card, which was really the reason why she was applying for disability. Tr. 517. On examination, Dr. Cooper observed that Skaggs was “very obese, short statured female, [and] somewhat theatrical.” Tr. 519. Dr. Cooper's examination of Skaggs' spine revealed a negative straight leg raise, loss of lordotic curve, and no gross deformities. Tr. 519. There was no cyanosis, clubbing or edema in Skaggs' extremities and Skaggs' pedal pulses were good at 3/4. Tr. 519. There were no effusions, redness, heat or gross deformities observed in Skaggs' bones/joints. Tr. 519. Dr. Cooper also observed that Skaggs was slightly pigeon-toed with her right foot; she did not require assistive devices; she had a normal cadence to her gait; and she had no issues with weight transfer or balance. Tr. 519. Skaggs' deep tendon reflexes were equal and symmetric at 2/4; she had normal right and left hand grips; normal finger to nose with eyes open and closed; normal manual dexterity; Rhomberg and Babinski were normal; and Skaggs had normal balance. Tr. 519. With the exception of slight limitations in range of motion with flexion and extension of the dorsolumbar spine, range of motion testing was normal. Tr. 522-525. Manual muscle testing was normal. Tr. 521.

         Dr. Cooper's clinical impression was that:

The claimant's physical complaints do not correlate with any of the findings that I find. Additionally, her back pain can easily be explained by her gross obesity. Her innumerable somatic complaints however, do not correlate to the clinical findings. This candidate is capable of sedentary work with no issues. No abnormal neurologic findings are found. There are no abnormal findings of the cardiovascular or pulmonary system. Her intellect is excellent as well.

Tr. 519-520.

         Reviewing physicians' opinions

         On May 21, 2013, state agency reviewing physician Leon D. Hughes, M.D., completed a physical RFC assessment. Tr. 78-80. Dr. Hughes opined that Skaggs could occasionally lift/carry 20 pounds and frequently lift/carry 10 pounds; stand/walk a total of 4 hours; sit about 6 hours; and push/pull unlimitedly other than as shown for lift/carry. Tr. 78. Dr. Hughes explained that the exertional limitations were based on Skaggs' massive obesity, noting that her BMI wavered between 55 and 60. Tr. 78. Dr. Hughes also opined that Skaggs had the following postural limitations: occasional climbing ramps/stairs, stooping, kneeling, crouching, and crawling and never climbing ladders/ropes/scaffolds. Tr. 78-79. Dr. Hughes explained that the postural limitations were based on Skaggs' massive obesity and DJD.[1] Tr. 79. Dr. Hughes opined that Skaggs was limited to frequent handling and fingering due to CTS.[2] Tr. 79. Dr. Hughes also opined that Skaggs would be required to avoid hazards, i.e., unprotected heights, due to her obesity. Tr. 79-80.

         Upon reconsideration, on July 2, 2013, state agency reviewing physician John L. Mormol, M.D., completed a physical RFC assessment. Tr. 107-109. Dr. Mormol reached the same opinions as Dr. Hughes regarding Skaggs' limitations.[3] Tr. 107-109.

         b. Mental impairment medical opinions

         Consultative examining psychologist's opinion

         On August 5, 2013, consultative examining psychologist Wayne Morse, Ph.D., conducted a consultative evaluation. Tr. 526-534. Skaggs drove herself to the evaluation. Tr. 526. Skaggs' chief complaints were back pain, which started at age 7 due to a motor vehicle accident; rheumatoid arthritis, which was diagnosed at age 18 months; chronic diarrhea; and diabetes. Tr. 526-527. Skaggs indicated that her diabetes was well under control with medication but she was not taking medication due to a lack of medical insurance. Tr. 527. She reported that her pain level increases with any type of physical activity. Tr. 527. Dr. Morse noted that, in 2012, Skaggs reported having 10-12 bowel movements per day and was referred to a physician for a colonoscopy. Tr. 527. As far as activities of daily living, Skaggs reported that she has good days and bad days so her ability to perform household chores depends on how she is feeling on a particular day. Tr. 528. She reported that her symptoms had been “seriously interfering with her functioning for most of her life, but especially the past 3 years.” Tr. 528. Dr. Morse observed that Skaggs had a difficult time walking and sitting due to her back problems and she shifted uncomfortably in her seat and had to stand up and walk around during the evaluation briefly to relieve her discomfort. Tr. 529. Skaggs' overall mood was depressed and anxious with a broad and appropriate affect. Tr. 529. She was very tearful when talking about her mental health symptoms. Tr. 529. She reported suicidal thoughts with a plan but she expressed no serious intent or sense of immediacy. Tr. 529.

         Dr. Morse diagnosed major depressive disorder, recurrent, severe without psychotic features; specific phobia (situational type); post-traumatic stress disorder; dissociative disorder (not otherwise specified); learning disorder (not otherwise specified). Tr. 530. Dr. Morse opined that Skaggs' prognosis was poor, indicating that Skaggs did not feel the need for mental health treatment; her medical problems continued to deteriorate, which exacerbated her mental health issues; and without psychotherapy and psychotropic medication, it was very unlikely that her currents symptoms would improve. Tr. 531. Dr. Morse indicated Skaggs had “serious medical issues that limit her mobility and exacerbate her psychopathology.” Tr. 531.

         With respect to Skaggs' functional abilities, Dr. Morse opined that Skaggs would have no difficulty remembering work-like procedures and no difficulty understanding and remembering very short and simple instructions but she would have difficulty understanding and remembering detailed instructions due to her dissociative symptomatology. Tr. 532. He opined that Skaggs would have no difficulty carrying out very short and simple instructions, as well as detailed instructions but she would have considerable difficulty sustaining an ordinary routine, performing at a consistent pace, making simple work-related decisions, and completing a normal workday without frequent interruptions from her dissociative symptomatology, limited physical mobility, and anxiety. Tr. 532. Dr. Morse opined that the evidence suggested that Skaggs had great difficulty interacting with the general public due to her social anxiety and fear of men and those symptoms would significantly interfere with her ability to work in coordination with others, ask simple questions, request assistance or respond appropriately to criticism from supervisors but she would be able to maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness. Tr. 532-533. Dr. Morse also opined that the evidence suggested that Skaggs would be unable to respond appropriately to changes in the work setting, set realistic goals, make plans independently of others, or engage in activities independent of supervision or direction; she needed a great deal of assistance managing household chores and her finances but she was able to care for her personal hygiene; and she would have considerable difficulty managing normal, everyday work pressures. Tr. 533.

         Reviewing psychologist's opinions

         Upon reconsideration, on August 13, 2013, state agency reviewing psychologist Leslie Rudy, Ph.D., completed a Psychiatric Review Technique (“PRT”) (Tr. 104-105) and Mental RFC Assessment (Tr. 109-111).

         In the PRT, Dr. Rudy found that Skaggs would have mild restrictions in activities of daily living; moderate difficulties in maintaining social functioning and in maintaining concentration, persistence, or pace; and no repeated episodes of decompensation. Tr. 105. In the Mental RFC Assessment, Dr. Rudy found no understanding and memory limitations but found some ...

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