Ward v. Astrue
| Decision Date | 27 February 2012 |
| Docket Number | CASE NO.: 1:11-cv-147-TFM [wo] |
| Parties | SUE ANN WARD, Plaintiff, v. MICHAEL J. ASTRUE, Commissioner of Social Security, Defendant. |
| Court | U.S. District Court — Middle District of Alabama |
Sue Ann Ward ("Complainant" or "Plaintiff" or "Ward") filed applications under Titles II and XVI of the Social Security Act ("Act"), 42 U.S.C. §§ 401-33 and 1381-83c, respectively, on February 20, 2007, for a period of disability which allegedly began on August 15, 2005. (Tr. 164-71, 180-86). Ward's application was denied (Tr. 61-79) and after missing the original court date on January 29, 2008, due to being hospitalized with pneumonia (Tr. 437-41) she testified at a hearing before an Administrative Law Judge ("ALJ") on April 16, 2009. (Tr. 51-54, 29-50). The ALJ issued an unfavorable decision on June 30, 2009. (Tr. 13-15). The Appeals Council considered additional information after initially rejecting review on August 27, 2010, (Tr. 7-9) but affirmed its own decision to reject any further review on February 4, 2011. (Tr. 1-3). The rejection of review made the ALJ's decision the final decision of the Commissioner of Social Security("Commissioner").1 See Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). Ward timely filed her administrative appeal.
The Court has jurisdiction over this lawsuit pursuant to 42 U.S.C. §§ 405(g) and the parties consent to the undersigned rendering a final judgment in this lawsuit pursuant to 28 U.S.C. § 636 (c)(1) and M.D. Ala. LR 73.1. See also Docs 12 and 13. For the reasons that follow, the Court AFFIRMS the Commissioner's decision.
Ward seeks judicial review of the Commissioner's decision denying her application for disability insurance benefits and supplemental security income. United States District Courts may conduct limited review of such decisions to determine whether they comply with applicable law and are supported by substantial evidence. 42 U.S.C. § 405 (2006). The Court may affirm, reverse and remand with instructions, or reverse and render a judgment. Id.
Ward was born on February 5, 1956, and was 49 years old at the time of her alleged onset date and 53 years old at the time of the ALJ's decision. (Tr. 164, 28). Ward has an eighth grade education and no GED. (Tr. 33). Ward testified that her disabilities include chronic headaches occurring 5 or 6 times a month which last for "2 or 3 days at atime." (Tr. 31-50). Ward also testified to suffering from numbness in arms and legs, pain in neck and shoulder, a chemical imbalance that affects her mental capacity, depression and anxiety, and hepatitis C. Id.
The ALJ found Ward suffers from the following severe impairments: "Major Depressive Disorder, Anxiety Disorder, Postherpetic Trigeminal Neuralgia, Headaches, Borderline Intellectual Functioning, Hepatitis C, and back/neck pain[]." (Tr. 19). The ALJ found that none of these impairments, either individually or collectively, "meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1." (Tr. 20).
Ward presented medical evidence which spans fifteen years. Ward was evaluated by Dr. Charles R. Hicks, Jr., M.D., in July and November of 2001. Dr. Hicks opines that ward suffers from Dysthymia, a "relational problem related to mental disorder." (Tr. 247-50). Dr. Hicks stated Ward has an "[o]ccupational problem" but is otherwise "unremarkable" in multiple aspects of her evaluation. Id. From March 2004, through May 2007, Ward was seen four times at the Southeast Alabama Medical Center Emergency rooms for chronic headaches, chest pain, and neck/shoulder pain. (Tr. 251-79, 409-15).
Ward presented medical records from Family Practice of Abbeville from May 1993, through April 2006. (Tr. 280-338). The Family Practice of Abbeville records indicate that Ward has headaches, was in a car wreck in May 2003, as well as complaintsof pain in her neck and shoulder, plus a Hepatitis C diagnosis. Several records indicate that Ward smokes one and a half packs of cigarettes a day. Id. Other items mentioned are Ward's "cold intolerance," glasses, ulcers, rash, arm and hand pain, claims of depression, and other ailments. Id. It is notable that the headaches are repeated several times throughout these records, almost always accompanied by a request to be excused from work, but "[b]rain parenchyma shows no signal abnormality or mass effect" with the impressions or brain scans being "unremarkable." (Tr. 334). The three heart examinations note "no evidence of acute or active cardiac or pulmonary disease" between December 1997 and December 2001. (Tr. 336-338).
Ward submitted medical records from SpectraCare concerning her mental health treatment from October 2006, through January 2009. (Tr. 341-73, 475-89). A reoccurring theme through these records is the development and implementation of "coping skills." Id. It is noted on August 22, 2006, after the alleged onset date when Ward testified that she was no longer working that "[s]he reports not really interacting with others with exception to talking to people at work." (Tr. 346). Ward demonstrated a "fluctuating self-esteem and poor relationship choices" including living "with addicted roommate." (Tr. 348, 354).
Dr. David C. Gostley, Psy.D., evaluated Ward on April 9, 2007, and diagnoses Ward as one with "Borderline Intellectual Functioning" commenting that "her intelligence is expected to remain the same." (Tr. 374-76). Ward was seen on April 10,2007, by Dr. Sam R. Banner, M.D., for a physical evaluation for "chronic headaches, neck and back pain." (Tr. 377-82). Dr. Banner's diagnoses Ward as suffering from headaches, chronic neck and back pain, hepatitis C, and depression. Id. He also noted that "claimant will need long term medical care." (Tr. 380). Dr. Banner evaluated Ward again on May 15, 2009. (Tr. 465). Dr. Banner's diagnosis Ward with chronic cervical spine and back pain, hepatitis C, and depression. Id. Notably the diagnosis did not include headaches.
The psychiatric review and RFC-Mental of Ward was done on May 9, 2007, Dr. Gordon J. Rankart, Psy.D. (Tr. 391-409). Dr. Rankart found Ward suffers from depression but found only moderate limitations in maintaining social functioning and maintaining concentration, persistence, or pace. Id. Mild limitation was found in dailyliving activities and no episodes of decompensation were noted. Id. Dr. Rankart stated that Ward's "ability to understand remember and carry out instructions as well as respond appropriately to supervisors, co-workers and work pressures in a work setting is mildly to moderately impaired, ability to function independently and manage finances is unimpaired." (Tr. 403). Dr. Rankart also noted that there was "[n]o current psych meds or counseling" and that Ward was "[c]apable of simple-task employment." Id.
Ward was seen for evaluations from June 2008, through April 2009, at the Primary Care of Southwest Georgia. (Tr. 415-26, 443-52). Ward met with Jane L. Gordon, FNP, and Dr. Ruth Evans, M.D., wherein her depression with anxiety was noted but she was also assessed multiple times for "[t]obacco use disorder" and pneumonia. Id.
A psychological evaluation on May 18, 2009, by Dr. J. Walter Jacobs, Ph.D., concludes Ward suffers from "Major Depression, Recurrent, Mild to Moderate." (Tr. 453-61). Dr. Jacobs stated that "Ward has a long history of depression and has been treated intermittently throughout her life." While assessing her daily activities Dr. Jacobs noted:
Ms. Ward lives in a rent-free apartment. She arises early each morning remarking that she is "used to working." She has breakfast and starts chores. During the morning, she will often nap in a chair or watch television. She washes clothes and cleans house. Her favorite pastime is listening to music and collecting coupons. In the past, she has enjoyed reading, but has lost interest in this activity.
(Tr. 456). When commenting on her judgment and insight Dr. Jacobs said it was "[g]rossly intact" and that relating to her thought process "[t]here was no loosening ofassociation, confusion or tangentiality." (Tr. 455). Ward was given a moderate restriction on carrying out complex instructions, in her ability to make judgments on complex work-related decisions, and understanding/remembering complex instructions. (Tr. 458). Ward was mildly restricted in understanding and remembering simple instructions, carrying out simple instructions, and making judgments on simple work-related decisions. Id.
As noted above, Dr. Banner performed another medical evaluation on May 15, 2009, at which time his diagnoses of Ward was "Chronic Cervical Spine and Back Pain," Hepatitis C, and depression. (Tr. 465). There was no diagnosis for headaches in Dr. Banner's 2009 diagnosis, which is in contrast to a diagnosis for chronic headaches in his 2007 medical evaluation of Ward. Compare (Tr. 380) with (Tr. 465).
Ward attended therapy again from September 2008 until April 2009, at the Wiregrass Mental Health Board, Inc., where Ward repeatedly stated that "things have been going well with her and [she] didn't have any personal issues to discuss." (Tr. 490-96).
The Court reviews a social security case to determine whether the Commissioner's decision is supported by substantial evidence...
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