Lester v. Dep't of Soc. Servs.

Decision Date16 January 2014
Docket NumberNo. SD 32457.,SD 32457.
Citation439 S.W.3d 229
PartiesTambra LESTER, Petitioner–Appellant, v. DEPARTMENT OF SOCIAL SERVICES, FAMILY SUPPORT DIVISION, Respondent–Respondent.
CourtMissouri Court of Appeals

Amanda D. Anthony, Overland, MO, Attorney for Appellant.

Theresa A. Yoffie, St. Louis, MO, Attorney for Respondent.



Tambra Lester (Claimant) appeals from a judgment entered by the Circuit Court of Iron County affirming a decision and order from the Director of the Missouri Department of Social Services, Family Support Division (the Director). The Director's decision affirmed the denial of Claimant's application for MO HealthNet for the Aged, Blind and Disabled (MHABD) benefits, based on a determination that Claimant was not permanently and totally disabled.

On appeal, Claimant contends the trial court erred in affirming the Director's denial of benefits because: (1) that decision was not based in law, in that the Director failed to properly apply certain federal regulations; and (2) that decision was not supported by substantial evidence and was arbitrary, capricious and unreasonable, in that the Director failed to accord proper weight to medical opinion evidence. Finding no merit in either contention, we affirm.

Standard of Review

“On appeal, we review the decision of the administrative agency, not the judgment of the circuit court.” Cruz v. MO. Dept. of Social Services, 386 S.W.3d 899, 902 (Mo.App.2012). Section 536.140.2 limits our review to determining whether the administrative agency's decision:

(1) Is in violation of constitutional provisions;
(2) Is in excess of the statutory authority or jurisdiction of the agency;
(3) Is unsupported by competent and substantial evidence upon the whole record;
(4) Is, for any other reason, unauthorized by law;
(5) Is made upon unlawful procedure or without a fair trial;
(6) Is arbitrary, capricious or unreasonable;
(7) Involves an abuse of discretion.

Id.1 This Court examines the whole record to determine whether there is sufficient evidence to support the decision. Dambach v. Department of Social Services, Family Support Div., 313 S.W.3d 188, 191 (Mo.App.2010). We must examine the record in the light most favorable to the Division's decision and disregard evidence that might support findings different from those of the Division.” Id. In addition, [t]he determination of the credibility of witnesses is within the province of the director.” Chrismer v. Missouri State Div. of Family Services, 816 S.W.2d 696, 700 (Mo.App.1991) ; Rader v. Missouri State Div. of Family Services, 810 S.W.2d 346, 348 (Mo.App.1991). We will not substitute our judgment for that of the Director on factual matters, but questions of law are matters for the independent judgment of this Court. Cruz, 386 S.W.3d at 902 ; see Dambach, 313 S.W.3d at 191. “If the Division's decision is supported by substantial and competent evidence found in the record, then the Division's decision should be affirmed.” Garrett v. Missouri Dept. of Social Services, 57 S.W.3d 916, 919 (Mo.App.2001). We have summarized the relevant facts in accordance with the foregoing principles.

Factual and Procedural Background

In March 2010, Claimant was 51 years of age. She injured her ankle

while working as a housekeeper at a motel. Dr. Craig Ruble diagnosed Claimant's injury as a distal fibular fracture and treated Claimant for several months. Her treatment included frequent ice and elevation, anti-inflammatory medication and physical therapy. The doctor noted continued improvement and progress throughout Claimant's treatment.

In April 2010, while recovering from the ankle injury

, Claimant complained to Dr. Ruble of mid-to-low back pain. Claimant reported the pain as on-and-off aching that was occasionally sharp and severe. Dr. Ruble diagnosed a lumbar strain after examination and x-rays revealed no abnormalities, fractures, dislocations or significant degeneration of the lumbar spine. The doctor recommended Claimant apply ice and/or heat frequently to her back and continue anti-inflammatory medication. He also ordered one physical therapy visit to set up a home exercise program for Claimant's back.

In May 2010, Claimant followed up with her chiropractor, Dr. Steven McAdams. He diagnosed Claimant as having a sprain or strain of the lumbar spine with associated subluxations and muscle spasms.

On May 10, 2010, after completion of Claimant's prescribed physical therapy sessions for her ankle and continued improvement, Dr. Ruble released Claimant to work an eight-hour day with the assistance of a boot, with weight bearing as tolerated. Although instances of ankle swelling or soreness were noted in follow-up appointments in May and June, Claimant's range of motion, strength, stability and pain levels continued to improve. Dr. Ruble prescribed at-home daily exercises, ice and elevation, compression hosiery and anti-inflammatory medication. Throughout these follow-up appointments, Dr. Ruble consistently reaffirmed that Claimant was able to work full duty with the assistance of a boot or ankle brace.

Thereafter, Claimant returned to work, but only for a short time. In June 2010, Claimant stopped working. According to her, she was not able to work because the demands of the job caused her right ankle and calf to swell.

On July 19, 2010, at Claimant's final appointment with Dr. Ruble, the doctor noted good range of motion of her ankle, no tenderness, and good strength and stability. Although he mentioned in his notes that Claimant was no longer employed, he maintained his recommendation that [a]s far as work, she is obviously still full duty.” He went on to state that Claimant is “at maximum medical improvement” and released Claimant to her own care.

In January 2011, Claimant applied for MHABD benefits, claiming that she was permanently and totally disabled. Claimant listed her disabling physical symptoms and problems as “pain & stiffness in back, neck & ankle, headaches, limited mobility[.] She reported “depression” as her mental health symptom and problem. Claimant submitted her application and medical information on her complaints to the Medical Review Team (the Team). On March 30, 2011, the Team determined that Claimant was ineligible for MHABD benefits because she was not permanently and totally disabled. Claimant then requested an administrative hearing.

On June 1, 2011, a hearing officer held a telephone hearing, at which several medical records were introduced into evidence. These records included a one-page report from Claimant's chiropractor, Dr. McAdams; and Dr. Ruble's records, which contained detailed examination summaries, imaging reports and physical therapy notes. The medical evidence also included records from Claimant's primary care physician, Dr. Stephanie Moniz, who had treated Claimant for low back pain on September 14, 2010 and February 8, 2011.

On the latter date, Dr. Moniz also completed residual functional capacity (RFC) questionnaires concerning Claimant's physical and mental capabilities. Based upon Claimant's responses to the questions, Dr. Moniz concluded that: (1) Claimant could only sit or stand less than two hours in an eight-hour work day; (2) she would be restricted in bending, twisting or stooping; and (3) she could only occasionally lift less than 10 pounds. The doctor also opined that Claimant would be frequently limited in her ability to focus on and handle stress related to her work tasks. Dr. Moniz characterized Claimant's ability to return to work as “poor.”

During the hearing, Claimant testified about her physical and mental conditions and how they restricted her daily activities. In addition to low-back and ankle pain, Claimant testified that she suffers from wrist pain and weakness, headaches and depression. When questioned about her ability to return to any of her prior jobs in housekeeping, cashiering or waitressing, Claimant stated that she could no longer perform those jobs. Claimant admitted, however, that she is able to: (1) do light gardening; (2) walk daily up to a quarter of a mile; (3) perform most of her own housekeeping, including laundry in her basement; (4) prepare her own meals; and (5) drive. Claimant testified that her highest level of education is one year of college. She also testified that she applied for Social Security, but was denied on the basis that she was not disabled.

Thereafter, the Director issued a decision affirming the Team's denial of MHABD benefits. The Director found that Claimant had not met her burden of proving that she was permanently and totally disabled. Although the Director found that Claimant was not gainfully employed and that her condition was “severe,” Claimant's medical conditions did not meet or equal Social Security disability listings “as set forth in 20 C.F.R., Ch. III, Part 404, Subpart P, Appendix 1....” Specifically, the Director considered disability listings for Claimant's “spinal condition,” her “leg and ankle injury

” and “depression.” The Director further found that Claimant was able to do past relevant work because:

Dr. Ruble returned claimant to full duty in May 2010. Dr. Ruble's and Dr. McAdams' X–Ray reports do not demonstrate Claimant suffers from a severe spinal condition. Dr. Moniz's report is simply not enough to overcome the other medical evidence.

Lastly, the Director found that Claimant is able to do other work because:

Claimant testified that she is able to walk a quarter of a mile. Claimant testified she is able to do laundry in the basement of her home. She is able to do light gardening such as watering the flowers and pulling weeds.
Claimant has experience as a cashier and experience in the food service industry. Claimant has one year of college education. There is no medical evidence that Claimant could not do other work. There is nothing in the record to support that Claimant is not capable of performing other work.
Considering Claimant's [RFC], educational level, and prior work experience, there is

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    ...“examine[ ] the whole record to determine whether there is sufficient evidence to support the decision.” Lester v. Dep't of Soc. Servs., 439 S.W.3d 229, 231 (Mo.App.S.D.2014). We generally “will not substitute our judgment for that of the [agency] on factual matters.” Id. If we determine th......
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