Lucas v. Sullivan

• Decision Date: 14 December 1990
• Docket Number: No. 89-8697,89-8697
• Citation: 918 F.2d 1567
• Parties: , Unempl.Ins.Rep. CCH 15811A Shernita LUCAS, Plaintiff-Appellant, v. Louis W. SULLIVAN, Secretary of the U.S. Dept. of Health & Human Services, Defendant-Appellee.
• Court: U.S. Court of Appeals — Eleventh Circuit

Page 1567

918 F.2d 1567

31 Soc.Sec.Rep.Ser. 518, Unempl.Ins.Rep. CCH 15811A

Shernita LUCAS, Plaintiff-Appellant, v. Louis W. SULLIVAN, Secretary of the U.S. Dept. of Health &

Human Services, Defendant-Appellee.

No. 89-8697.

United States Court of Appeals, Eleventh Circuit.

Dec. 14, 1990.

Denise Marshall, Albany, Ga., Phyllis J. Holmen, Georgia Legal Services Program, Atlanta, Ga., Rachael G. Henderson, Georgia Legal Services Program, Waycross, Ga., for plaintiff-appellant.

Michael Daniel, Asst. U.S. Atty., Macon, Ga., for defendant-appellee.

Appeal from the United States District Court for the Middle District of Georgia.

Before CLARK, Circuit Judge, MORGAN and HILL ^*, Senior Circuit Judges.

CLARK, Circuit Judge:

Appellant Shernita Lucas appeals the district court's affirmance of the decision by an Administrative Law Judge (ALJ) denying her claim for Supplemental Security Income benefits. We reverse the district court's order and remand this case to the Secretary because we find that the Secretary failed to fully and fairly develop the record, failed to fully consider the combination of her impairments, and failed to evaluate certain testimony.

BACKGROUND

At the time of the hearing before the ALJ in December 1987, Ms. Lucas was 29 years old. She completed school through the tenth grade, but her reading skills are at the fourth or fifth grade level and her math skills are at a fifth or sixth grade level. Her past relevant work history includes work as a hotel maid and a teacher's aide. Ms. Lucas testified at the hearing that she was fired from her previous job because of seizures, but the record also indicates that she was fired from her job as a teacher's aide because of interpersonal differences with parents. She testified that she has had 26 or 27 seizures in the last three months and had not missed a dosage of medicine in the last six months. She also testified that she stopped drinking alcohol the preceding year. Ms. Lucas's neighbor and friend testified that Ms. Lucas had a minimum of four seizures a week; and one week, she had 30 seizures.

The record reveals the following about Ms. Lucas's lengthy and complicated medical and psychological history as it relates to her various impairments. Because her family does not have a history of epilepsy Five months later, Ms. Lucas was admitted to Orlando Regional Medical Center because she was exhibiting inappropriate and bizarre behavior. She was released and then readmitted two days later in an acute psychotic state accompanied by auditory hallucinations, religious preoccupations, paranoid delusions, and impaired judgment. The treating physician, Dr. Ansley, reported that her condition possibly could have been brought on by acute alcohol intoxication, that her Dilantin level was below therapeutic range, and that she had not been taking her Dilantin as recommended. Between March 10, 1981 and July 14, 1981, Ms. Lucas was treated as an outpatient at Southwest Community Mental Health Center, where she was also referred to the Epilepsy Society for assistance. During this time, she complained of nervousness, feelings of paranoia, auditory hallucinations, confusion, symptoms of depression, and blackouts. Her treating therapist indicated that her emotional problems were secondary to her neurological disorder. The epilepsy research lab also reported her Dilantin and Phenobarbital levels below therapeutic range in July 1982 and March 1983.

or other seizure disorders, the apparent cause of Ms. Lucas's seizure disorder is a cerebral injury caused by a blow to her head when she was sixteen years old. Dr. John Scott, a neurologist, was the first physician of record to treat Ms. Lucas. On April 9, 1981, he performed an electroencephalogram (EEG) on her which revealed a low amplitude left temporal and right frontal spike discharge when Ms. Lucas was asleep. Dr. Scott prescribed Dilantin to control her seizures.

In June of 1982, Dr. Gutman, a consulting psychiatrist, examined Ms. Lucas and found that she "had a slight paranoia about her," but that she would be able to do simple repetitive tasks under ordinary supervision and respond appropriately to supervisors and co-workers. In April, October, and December of 1983, and January 1984, Ms. Lucas was treated in the Orlando Regional Medical Center emergency room. On all four occasions, she was treated for seizures, abdominal pain and schizophrenic behavior, and on the April 1983 admission, her Dilantin and Phenobarbital levels were below therapeutic range.

In 1984, Ms. Lucas returned to her hometown of Albany, Georgia. At the request of the Secretary, she was examined by Dr. Long, a psychologist. He diagnosed her as having adjustment reaction with mixed emotions and borderline intellectual functioning, with a full scale IQ of 76. He reported indications that Ms. Lucas exhibits wide swings in mood, low level of psychological energy, tends to give up quickly, and has problems in expressing herself effectively. He noted that she was quite limited in terms of general fact comprehension because of cultural deprivation. He reported that she admitted drinking alcohol in the past, but denied drinking in recent months. He also indicated that she reported having constant headaches. He concluded that she had "sufficient capacity to function in specific work areas," but that her seizures would be an interfering factor, especially at the frequency she was reporting (4-5 times/day).

Dr. Martin, a consulting family practitioner, examined Ms. Lucas on December 28, 1984. He reported that her seizure medication was below therapeutic levels, although she indicated that she took her medication as prescribed. He also noted that she admitted to occasional use of alcohol.

On February 5, 1985, Ms. Lucas made an initial visit to Dr. Parrot, a physician. While in Dr. Parrot's office, she suffered a seizure with tonic-clonic posture, tremors and drooling, and post-ictal derangement. Dr. Parrot immediately admitted her to Palmyra Park Hospital, and hospital lab tests indicated that her Dilantin level was within therapeutic range. Two days later, her serum blood level of Phenobarbital was also found to be within the therapeutic range. On February 9, 1985, Ms. Lucas was transferred to Phoebe Putney Memorial Hospital because of recurrent episodes of uncontrolled shouting and swearing, behavior characteristic of temporal lobe epilepsy. During these hospital stays, Dr. Baker, a neurologist, diagnosed Ms. Lucas In October 1985, Ms. Lucas sought treatment from Dr. Poulos, who diagnosed her as having partial complex seizures and paranoid schizophrenia, and indicated that she had poor insight into her medical problems. He prescribed Dilantin, Valproic Acid and Mellaril. He reported that Ms. Lucas stated that she took her medication, but that her seizure medication levels were below therapeutic range.

as having a complex partial seizure state, psychomotor seizure post-traumatic and behavior adjustment reaction secondary to the seizures, and possible paranoid schizophrenia. He prescribed Dilantin and Depakene for treatment of her seizures, and Mellaril for treatment of her psychological symptoms. After being released from the hospital, Ms. Lucas returned to see Dr. Baker. She informed him that she had cut back on the Mellaril because it made her drowsy all the time, which is a common side effect of Mellaril.

Dr. Cotes, a psychiatrist, first saw Ms. Lucas on March 23, 1986. He stated that although he was not treating Ms. Lucas for her seizure disorder, he "would expect the diagnosis of Gran Mal seizures to be correct, and would expect Gran Mal seizures at the frequency she is having to exclude the possibility of holding gainful and competitive employment." He prescribed Desyrel and Tranzene to treat her psychological symptoms. In August 1986, Ms. Lucas underwent another consultative psychological examination by Dr. Powers, a clinical psychologist. He diagnosed Ms. Lucas as having Dysthymic Disorder ¹ and Borderline Intellectual Functioning resulting from psychosocial deficiencies, thus confirming her previous psychological evaluations.

Ms. Lucas discontinued her treatment with Dr. Poulos, and returned to see Dr. Baker in October 1986. Dr. Baker observed that the impact of the seizure disorder on her personality was more dramatic. He described her as being aggressive and hostile, with a "chip on her shoulder," and as exhibiting paranoia. He found that her Dilantin and Valproic Acid levels suggested that she was taking her medication. He also requested that Ms. Lucas keep a calendar of her seizures, which calendar indicates that she had five seizures in July, five in August and ten in September 1986. In an effort to treat her personality disorder, Dr. Baker prescribed Lithium. On January 16, 1987, he noted that the Lithium had made a significant difference in her personality. However, when he saw her again in June 1987, she reported that she had gotten into a fight, had a seizure and had been taken to jail. He found her medication levels to be below therapeutic levels, and suggested that she may not have been taking her medication faithfully.

One month later, the police were called to investigate a disturbance at her home. Upon his arrival, the police officer saw Ms. Lucas running at him in the street with a brick in her hand. The policeman shot her in the hip, and she was admitted to Phoebe Putney Memorial Hospital. Her Dilantin level was found to be slightly above therapeutic levels upon her admission. After undergoing surgery, she was transferred to Southwestern State Hospital on August 6, 1987 for a psychiatric evaluation. Upon admission to Southwestern State, her Dilantin level was found to be below therapeutic levels. After twenty days of hospitalization, her Dilantin level remained subtherapeutic.

While at Southwestern, Dr. Lingao, a physician, treated Ms. Lucas, and reported that she admitted to some drinking, but was hesitant to...