United States District Court, N.D. Iowa, Eastern Division
REPORT AND RECOMMENDATION
Williams Chief United States Magistrate Judge
plaintiff, Jill L. Snyder (claimant), seeks judicial review
of a final decision of the Commissioner of Social Security
(Commissioner) denying claimant's application for
disability insurance benefits (DIB) under Title II of the
Social Security Act (Act), 42 U.S.C. § 401 et
seq. For the reasons that follow, I recommend the
District Court affirm the Commissioner's decision.
is a 56-year-old woman and was 52 years old at the time of
the filing of her application for disability benefits on June
23, 2013. (AR 160). Claimant's alleged disability onset
date was November 13, 2009. (AR 160). Claimant met the
qualifications for insured status through March 31, 2015. (AR
181). The Commissioner denied claimant's application
initially and upon reconsideration. (AR 103-06, 108-11). The
ALJ held a video hearing on February 3, 2015. (AR 34). The
ALJ issued her decision finding claimant not disabled on
March 27, 2015. (AR 26). The appeals council denied review of
the ALJ's finding of not disabled on June 22, 2016, and
the ALJ's decision became the final decision of the
Commissioner. (AR 1).
August 22, 2016, claimant filed a complaint in this Court.
(Doc. 1). On March 2, 2017, claimant filed her brief (Doc.
11), and on March 30, 2017, the Commissioner filed her brief.
(Doc. 14). On April 10, 2017, claimant also filed a reply
brief. (Doc. 15). On April 11, 2017, the Court deemed this
case ready for a decision and the Honorable Linda R. Reade,
United States District Court Judge, referred this case to me
for a Report and Recommendation. (Doc. 13).
OF RELEVANT FACTS FROM THE RECORD
agency consultant, Stephen Elliot, Ph.D., reviewed
claimant's application for disability at the initial
level. (AR 86). At the initial level a consultative
examination (CE) was requested and psychologist Dr. Scott
prepared a report pursuant to that CE. (AR 80). Dr. Elliot
found that the claimant had the following severe medically
determinable impairments: gastritis and duodenitis, anxiety
disorders, and somatoform disorders. (AR 78). Dr. Elliot
found that these medically determinable disorders could cause
the claimant's pain and other symptoms, but that the
claimant's statements about the intensity, persistence,
and functionally limiting effects of the symptoms were not
supported by the objective medical evidence. (AR 79).
Elliot found that claimant's statements about her
physical limitations were not supported by her statements of
her daily activities being significantly limited, but her
statements about her mental limitations were consistent with
the medical record. (AR 80). Dr. Elliott determined that
claimant's history of osteoporosis was well documented
and that she had wedge deformities at several places in her
spine and was recommended therapy and Reclast. (AR 82). Dr.
Elliott noted that at her GI exam in 2013, the doctor noted
“[n]o edema, muscle mass is preserved, muscle strength
is also preserved, and gait examined and was normal.”
(AR 83). Dr. Elliot then noted claimant's GI issues and
noted that claimant's diarrhea had turned to constipation
and that she had had less problems with vomiting and that
claimant followed a special diet for her gastrointestinal
issues. (AR 82). Dr. Elliott also noted that she had gained
weight in 2012 and at her last visits, “was described
as stable and is doing well.” (AR 82). Dr. Elliott
found little objective medical evidence to support the claims
of hyperparathyroidism, chronic migraines, PRIM or
aldosteronism. (AR 82). Dr. Elliott found that many of
her diagnoses were supported by objective medical evidence,
but that claimant's osteoporosis would not cause the pain
described by claimant. (AR 82). Dr. Elliott also determined
that claimant's reports of her limitations were undercut
by her described daily activities of cooking, shopping,
driving, walking, and caring for her grandchildren as well as
third party reports. (AR 82).
Christiansen, Ph.D., performed a mental RFC evaluation at the
initial level. (AR 84). He found claimant did have memory
limitations such that claimant's ability to understand
and remember detailed instructions would be moderately
limited as well as sustained concentration limitations which
would also limit her ability to carry out detailed
instructions and maintain attention. (AR 83). Dr.
Christiansen also noted that claimant's ability to
complete a normal workday and workweek without interruptions
from psychologically base symptoms and perform at a
consistent pace without an unreasonable number and length of
rest periods would be moderately limited. (AR 83). Dr.
Christiansen found that claimant's reported limitations
were consistent with the file and that claimant's ability
to carry out instructions, maintain attention, concentration,
pace and ability to remember and understand instructions were
fair to good. (AR 84). Additionally, Dr. Christiansen stated
that claimant was able to interact appropriately with
supervisors and would be capable of doing simple and routine
work-like activities. (AR 84).
reconsideration, the claimant was found to have the medically
determinable impairments of gastritis and duodenitis, anxiety
disorder, and somatoform disorders. (AR 94). Dr. Laura
Griffith, D.O., considered the new evidence of a worsening
condition submitted by the claimant including that she had
experienced severe diarrhea and constipation due to her
gastroparesis, which caused bloating and weight gain which
increased her chances of having another bone fracture and
that because of her osteoporosis she was limited to lifting
only five pounds. (AR 98). Dr. Griffith determined that this
additional information did not significantly change the prior
record and that the prior determination was consistent with
the record. (AR 98). Myrna Tashner, Ed.D., evaluated
claimant's file upon reconsideration and found that
claimant's additional alleged memory loss did not change
the prior mental RFC determination. (AR 100).
Victor Mujica, M.D., treated claimant in 2012 at the Covenant
Clinic in Waterloo, Iowa. (AR 274). Dr. Mujica provided a
second opinion for claimant's GI issues due to her
dissatisfaction with prior treatment for gastroparesis in
September of 2012, and reported that she reported inability
to tolerate a regular meal, nausea, vomiting and unexpected
weight change, but no major abdominal pain. (AR 282 &
286). In August of 2012, Dr. Mujica noted that claimant had
normal range of motion, though claimant reported nausea,
vomiting, abdominal pain, and constipation. (AR 303). At the
same visit Dr. Mujica noted that she was well oriented and
had normal mood and affect, her thought content was normal,
though she did report anxiety. (AR 282). In November of 2012,
claimant again saw Dr. Mujica, where he stated,
“[claimant] has been following a puree diet as
recommended with excellent tolerance. She has gained some
weight. She feel [sic] overall improved. She denies any major
episode of nausea, vomiting or abdominal pain.” (AR
November of 2012, claimant was seen at the Cedar Valley Bone
Health Institute to discuss treatment options for her
osteoporosis. (AR 292). At that visit it was documented that
she had lost 2.25 inches in height. (AR 292). Claimant was
diagnosed with severe osteoporosis and the report indicated
vertebral fracture deformities in the spine. (AR 298).
Claimant was assessed to have a 23% risk of major
osteoporotic fracture and 11% risk of hip fracture in the
next 10 years. (AR 313).
first of January, 2013, claimant was seen by Dr. Ravindra
Mallavarapu, M.D., at the Allen Memorial Hospital for upset
stomach and nausea, with reported back pain. (AR 334). At
this visit she was noted as having a full range of motion
with no edema, or joint deformity. (AR 335).
saw Dr. Matthew Kettman, M.D., regularly and he was her
primary treating physician. On October 9, 2012, he saw
claimant and she reported that she had back and neck pain due
to a fall, for a follow-up for her migraine headaches, a
follow-up for her GI issues, and she also reported problems
with insomnia and depression. (AR 444). At a follow-up visit
to her hospital visit in January 2013, with Dr. Kettman,
claimant reported continuing abdominal pain and diarrhea and
racing thought, inability to sleep, anxiety, and depression.
(AR 346). But claimant also reported “feel[ing]
better.” (Id.). Dr. Kettman noted that more
than 50% of the 25-minute visit had been discussing
claimant's depression. (AR 348). At a visit to Dr.
Kettman in February, 2013, Dr. Kettman noted that claimant
was bipolar and her condition was unstable, but noted that
she was doing well and did not “have any current
symptoms associated with the condition or current treatment
regimen.” (AR 352). He also noted the claimant had
normal affect with no obvious cognitive defects in memory or
recognition during speech. (AR 354). Three weeks later on
February 28, 2013, claimant visited Dr. Kettman for a
follow-up for her depression and reported that she felt more
emotional and her mood was not better and felt her condition
had been worsening since beginning the new medication. (AR
355). In June of 2013, claimant reported that she was doing
well and had no active complaints. (AR 362). At the same
appointment claimant reported no nausea, good intake, no
vomiting, no abdominal pain, no diarrhea and no constipation.
4, 2013, claimant visited Dr. Kettman complaining of
constipation despite taking her medications. (AR 426).
Claimant had an appointment with Dr. Tarek Daoud, M.D., on
June 18, 2013, for a follow-up where she stated she was doing
well and had no active complaints. (AR 451).
August 29, 2013, claimant visited the Mayo Clinic and during
her appointment Dr. Robert Kraichely, M.D., noted that
claimant had been following a gastroparesis diet and that she
had “done reasonably well with this, ” and she
was not experiencing vomiting. (AR 517). However, Dr.
Kraichely went on to state that after “requiring
vancomycin due to contracting C. diff colitis” she had
had trouble with her bowels. (AR 517). He went on to state:
She really tends towards significant constipation, sometimes
going over a week without a bowel movement. This is in spite
of having fairly good oral intake. She has required
laxatives, typically stimulants . . .. These [claimant's
prescription medication to regulate bowel movements] do not
seem to help. She will have liquid bowel movements, but it is
very difficult to initiate a bowel movement . . . and has
required some significantly increased time on the commode to
have bowel movements. The unpredictability of the effects of
the laxatives has kept her pretty much in the house for much
of the last several months.
of 2013, claimant's friend Ms. Deike, completed a
function report for claimant. (AR 180). She stated that at
that time claimant cared for her grandchildren on a regular
basis, did not need reminders to take care of personal
grooming, was able to prepare her own meals, do light
cleaning, and light loads of laundry. (AR 174-75). Ms. Deike
also indicated that the claimant drove and went to the
grocery store by herself weekly. (AR 176). Ms. Deike stated
that claimant had no problem handling money. (Id.).
Ms. Deike stated that claimant had a limited ability to
ingest regular foods, had difficulty concentrating, and
memory problems due to her migraines. (AR 175-77). Claimant
reportedly socialized on a weekly basis with friends, her
daughters, and left her home to go to church and the grocery
store. (AR 177). Claimant's socialization had been
hindered by her illness as she did not feel well enough to
socialize and her bipolar disorder would hinder her because
she would have mood swings and become irritated easily making
it difficult for her to interact with others. (AR 178 &
180). Ms. Deike also reported limitations regarding
claimant's ability to perform many tasks, such as
lifting, squatting, bending, standing, walking, kneeling,
climbing stairs, her memory, task completion, concentration
and ability to get along with others. (AR 178). Ms. Deike
reported claimant could walk five or six blocks continuously
without requiring a break. (AR 178).
fall of 2013, claimant visited the Mayo Clinic for
osteoporosis and for constipation (AR 548 & 523), saw Dr.
Daoud for routine follow-ups (AR 552 & 575), and was
examined by state consultant Dr. Scott (whose findings are
discussed at length in the Section VII. A.). In
February of 2014, claimant's potassium levels were
stable. (AR 624). In December of 2014, claimant saw Dr.
Kettman, who reported that despite claimant reporting that
she had severe symptoms, she was “[t]aking nothing as
medication” (AR 666) and visited the Mayo Clinic for
her osteoporosis (AR 600-01).
February of 2015, at the hearing before the ALJ, claimant
testified to the following: She suffers from past sexual
abuse. (AR 51). Claimant testified that she could only walk
one block before her hips hurt. (AR 56-57). She testified
that she could not crawl, kneel, use ladders, bend over
without pain, or twist. (AR 57). Claimant also testified that
she did not handle stress well as it triggered her bipolar
moods, which in difficult social situations caused her to be
“upset” or “fly[ ] off the handle.”
(AR 53). She stated that her anxiety caused her to
“excessively worry” and gave her “lots of
sleepless nights.” (Id.). She stated that she
could not concentrate for more than five minutes. She
testified that she drove three times a week, and if she drove
for longer than 12 minutes, then she needed frequent stops
due to pain. (AR 58). She stated that she could not babysit
her grandchildren anymore, and the last time she did was the
past summer and she ended up “hurting too much.”
(AR 59). Claimant also stated that she washed dishes but with
breaks, did her own laundry, went grocery shopping with a
best friend who carried the groceries for her, and sometimes
attended church. (AR 60-62).
DISABILITY DETERMINTATIONS AND THE BURDEN OF
disability is defined as “the inability to engage in
any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be
expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12
months.” 42 U.S.C. §§ 423(d)(1)(A),
1382c(a)(3)(A). An individual has a disability when, due to
his physical or mental impairments, he “is not only
unable to do his previous work but cannot, considering his
age, education, and work experience, engage in any other kind
of substantial gainful work which exists . . . in significant
numbers either in the region where such individual lives or
in several regions of the country.” 42 U.S.C.
§§ 423(d)(2)(A), 1382c(a)(3)(B). If the claimant is
able to do work which exists in the national economy but is
unemployed because of inability to get work, lack of
opportunities in the local area, economic conditions,
employer hiring practices, or other factors, the ALJ will
still find the claimant not disabled.
determine whether a claimant has a disability within the
meaning of the Act, the Commissioner follows the five-step
sequential evaluation process outlined in the regulations.
Kirby v. Astrue, 500 F.3d 705, 707-08 (8th Cir.
2007). First, the Commissioner will consider a claimant's
work activity. If the claimant is engaged in substantial
gainful activity, then the claimant is not disabled.
“Substantial” work activity involves physical or
mental activities. “Gainful” activity is work
done for pay or profit, even if the claimant did not
ultimately receive pay or profit.
if the claimant is not engaged in substantial gainful
activity, then the Commissioner looks to the severity of the
claimant's physical and mental impairments. If the
impairments are not severe, then the claimant is not
disabled. An impairment is not severe if it does not
significantly limit a claimant's physical or mental
ability to perform basic work activities. Kirby, 500
F.3d at 707.
ability to do basic work activities means the ability and
aptitude necessary to perform most jobs. These include: (1)
physical functions such as walking, standing, sitting,
lifting, pushing, pulling, reaching, carrying, or handling;
(2) capacities for seeing, hearing, and speaking; (3)
understanding, carrying out, and remembering simple
instructions; (4) use of judgment; (5) responding
appropriately to supervision, co-workers, and usual work
situations; and (6) dealing with changes in a routine work
setting. Bowen v. Yuckert, 482 U.S. 137, 141 (1987);
20 C.F.R. § 404.1521(b)).
if the claimant has a severe impairment, then the
Commissioner will determine the medical severity of the
impairment. If the impairment meets or equals one of the
presumptively disabling impairments listed in the
regulations, then the claimant is considered disabled
regardless of age, ...