Opinion
Civil Action 4:20-CV-00820-RMG-TER
05-11-2021
TRIZENIA LAKENYA BRISBON, Plaintiff, v. ANDREW M. SAUL, Commissioner of Social Security; Defendant.
REPORT AND RECOMMENDATION
Thomas E. Rogers, III United States Magistrate Judge
This is an action brought pursuant to Section 205(g) of the Social Security Act, as amended, 42 U.S.C. Section 405(g), to obtain judicial review of a “final decision” of the Commissioner of Social Security, denying Plaintiff's claim for disability insurance benefits (DIB) and supplemental security income (SSI). The only issues before the Court are whether the findings of fact are supported by substantial evidence and whether proper legal standards have been applied.
I. RELEVANT BACKGROUND
A. Procedural History
Plaintiff filed her applications for DIB and SSI on March 4, 2016 and July 14, 2016, alleging inability to work since December 15, 2015. Her claims were denied initially and upon reconsideration. Thereafter, Plaintiff filed a request for a hearing. A hearing was held on October 5, 2018, at which time Plaintiff and a vocational expert (VE) testified. (Tr. 12). The Administrative Law Judge (ALJ) issued an unfavorable decision on January 10, 2019, finding that Plaintiff was not disabled. (Tr. 28). Plaintiff filed a request for review of the ALJ's decision, which the Appeals Council denied on December 27, 2019, making the ALJ's decision the Commissioner's final decision. (Tr. 1-4). Plaintiff filed this action on February 24, 2020. (ECF No. 1).
B. Plaintiff's Introductory Facts
Plaintiff was born on September 12, 1979, and was thirty-six years old on the alleged disability onset date. (Tr. 26). Plaintiff had at least a high school education and has past work experience as a passport specialist and payroll technician. (Tr. 26). Plaintiff alleges disability originally due to brain aneurysm, seizure, back/body pain, muscle spasms, depression, numbness/tingling in left foot and leg, some fingers and right hand, bad/sharp headaches, light/sound sensitivity, blood clot in right lung, shortness of breath, and chest pain during yawning/hiccups. (Tr. 53-54).
December 2015
On December 15, 2015, Plaintiff was seen in the emergency room for loss of consciousness, dizziness, and headache. (Tr. 314). Impression after imaging was mild acute subarachnoid hemorrhage with possible mild diffuse cerebral edema and early hydrocephalus. Plaintiff was admitted and transferred to MUSC. Plaintiff received balloon assisted endovascular coiling of her ruptured aneurysm. Plaintiff had five children and her goal was to get home by Christmas. (Tr. 435). Plaintiff had occupational therapy and it was noted she needed a home safety evaluation for the readjustment to her home given her new light/sound sensitivities. (Tr. 453). Plaintiff was discharged on December 25. (Tr. 463).
On December 28, 2015, Plaintiff presented to the emergency room with back pain. Plaintiff endorsed a headache, photosensitivity, fever, difficulty walking, and back pain. (Tr. 396). Plaintiff reported she was only discharged three days prior after coiling of her aneurysm. A CT was negative for anything acute; Plaintiff was admitted for pain control. (Tr. 398). Diagnosis was headache disorder. Assessment was symptoms consistent with aseptic meningitis and some possible inflammation of lower lumbar spinal nerve roots. (Tr. 400). Plaintiff's course was complicated with hyponatremia. (Tr. 403). On December 30, 2015, Plaintiff was discharged. (Tr. 396).
2016
On January 5, 2016, Plaintiff was seen by FNP Howard. (Tr. 657). Upon exam, Plaintiff was ill-appearing, lethargic, confused, with speech difficulty, and decreased memory. Plaintiff had confused, cooperative, flat affect.
On January 18, 2016, Plaintiff was seen in the emergency room for chest pain. (Tr. 357). Plaintiff was negative for headaches and positive for fever and weakness. Diagnosis was right pulmonary embolism. Plaintiff was admitted to the ICU. (Tr. 360). On January 22, 2016, Plaintiff was discharged. After, Plaintiff reported she was doing well and had chest pain only with hiccups or sneezing. Plaintiff reported pain was controlled with medication. (Tr. 356).
On January 28, 2016, Plaintiff was seen by FNP Howard. (Tr. 651). Upon exam, Plaintiff was ill-appearing, lethargic, confused, with speech difficulty, and decreased memory. Plaintiff had confused, cooperative, flat affect. (Tr. 652).
On February 3, 2016, Plaintiff was seen by PA Relic of neurology. After aneurysm and embolism, now, Plaintiff was doing well from a neurologic standpoint but with some fatigue and shortness of breath with exertion that was improving. (Tr. 355). Review of systems was negative for headaches. (Tr. 355). Plaintiff was to return in four months for an angiogram. (Tr. 356).
On February 25, 2016, Plaintiff was seen by FNP Howard for back pain/headaches. (Tr. 643). Plaintiff continued to note headaches as a problem.
On April 19, 2016, Plaintiff was seen by FNP Howard. (Tr. 638). Reason for appointment was noted release to go back to work, occasional muscle aches/headaches, and norco refill. Plaintiff examined with head/face swelling, edema, and neurologic weakness in right hand. Plan was to try to decrease oxycodone and work 2-4 hours a day for 2-3 days per week. Plaintiff was trying to go on field trips, was not resting, and “will probably do ok to try to return to work.” (Tr. 639). Oxycodone was refilled; FMLA paperwork was completed. (Tr. 640).
Plaintiff alleged she returned to work in May 2016 but with a 100% subsidy where she came to work but produced no work. Plaintiff was helped to and from locations like the bathroom and car. (Tr. 246).
On May 24, 2016, Plaintiff was seen by FNP Howard. Plaintiff reported headaches and difficulty with focus. Severity had not improved. Plaintiff was concerned about taking oxycodone daily, but Tylenol did not help. Plaintiff wanted paperwork for return to work completed. Plaintiff reported fatigue but stated “trying to get in all children's activities and doing more than if she was at work as a passport processor, now thinking that she would be better financially with total disability.” (Tr. 636). Upon exam, Plaintiff was lethargic and had head swelling to right side of face. Mouth droop was getting better. Plaintiff had tried to work that day but could not tolerate the light and was too fatigued. (Tr. 637).
On June 12, 2016, Plaintiff completed a function report. (Tr. 269). Plaintiff reported she could not perform her work as required due to computer and lighting causing flares. Plaintiff's hand writing is affected and she has body stiffness. (Tr. 260). Plaintiff reported she takes care of children. (Tr. 263). Plaintiff reported she cleans house. Plaintiff does laundry in small loads. (Tr. 264). Plaintiff shops in stores once every two weeks with lots of breaks. Plaintiff reported going to church on Sundays. Plaintiff reported her head hurts. Plaintiff reported stress caused headaches. (Tr. 268).Plaintiff reported medications of Oxycodone, amlodipine, aspirin, warfarin, Tylenol, and Advil. Plaintiff reported side effects of drowsiness, dizziness, fatigue, upset stomach, bruising, and excessive bleeding. (Tr. 269). Plaintiff reported trying to return to work increased her headaches. Plaintiff later reported that she has to stay in the dark and quiet most of the time. (Tr. 291).
On June 17, 2016, Plaintiff had a cerebral angiogram. (Tr. 766). Impression was “stable occluded left anterior to indicating artery aneurysm.” (Tr. 767).
On June 22, 2016, Plaintiff was seen by FNP Howard. (Tr. 756, 774). Same exact history of headaches as prior visits was listed under history. Exam still showed head swelling. Headaches were specifically listed under assessments but under treatment, only “Others: patient is unable to work.” (Tr. 757).
On July 7, 2016, Plaintiff began physical therapy for moderate to severe headaches, pain throughout entire body, left sided paresthesia, and generalized weakness. Plaintiff reported that her surgeon told her the pain she was experiencing was due to the extra blood in her spinal canal and it will reabsorb with time and the pain should go away. (Tr. 667). Plaintiff reported sometimes laying down made headaches worse. Physical therapy notes are mostly about gait, extremity, and overall body pain. (Tr. 667-699). On July 25, Plaintiff reported “she saw the chiropractor for awhile and ended up with severe headaches. She says she's still having headaches, which come on every now and then. She says the mornings are the worst, and she gets a lot of stiffness.” (Tr. 701). On July 28, Plaintiff reported a pain level of three with a headache. (Tr. 706). Cervical retractions intensified her headache so they were not performed. (Tr. 706). On August 1, Plaintiff had a pain level of 4 with her head and wore sunglasses due to light exacerbating symptoms. (Tr. 710). Before treatment, her headache was a throbbing pain level 4; after, it was better at ¶ 2-3. (Tr. 710-711). Plaintiff removed her sunglasses by the end stating she was feeling better. (Tr. 711). On August 3, Plaintiff reported a pain level of three with constant headaches sometimes her entire head and most of the time at the base of her skull. Plaintiff reported she was not taking as many pain pills and therapy had helped. (Tr. 714). By August 9, Plaintiff reported she was much improved in walking and walked around the mall with her kids without getting tired. (Tr. 721). Plaintiff reported a headache at a pain level of 2 where it was barely enough to feel it. (Tr. 721). On August 11, 2016, Plaintiff reported she was heavily medicated, was unable to give an accurate pain level, and she drove to therapy. (Tr. 726). Plaintiff was drowsy throughout exercises and kept her eyes closed. (Tr. 726). On August 23, Plaintiff reported a pain level of 2, an annoying sensation in her head. (Tr. 739).
On September 8, 2016, Plaintiff was seen by FNP Howard. (Tr. 753). Upon exam, Plaintiff looked much better; her head was getting better. Her face was symmetrical. (Tr. 754). Headaches were listed under assessment but not under treatment. (Tr. 754-755).
On September 12, 2016 Plaintiff was seen by Dr. Sohn, of MUSC. (Tr. 764). Plaintiff reported her headache form was pressure and throbbing pain ranging between four and nine. (Tr. 779). Plaintiff reported location as both temples, forehead, back of head, and all over head. Plaintiff reported headaches were daily and constant, changing in severity through out the day. Sometimes, the headaches were worse with physical activities and associated with nausea, photophobia, and phonophobia. There was no specific aura before headaches. Plaintiff has feeling of weakness and paresthesia in her left side. Triggers of headaches are stress, barometric change, bright light, loud noise, and sleep deprivation. Plaintiff reports neck pain or shoulder pain during headaches. Plaintiff was currently taking Excedrin and Oxycodone as abortives and taking aspirin, warfarin, and Norvasc. Plaintiff had tried Tylenol and Aleve. (Tr. 779). Assessment was chronic daily headache, headache attributed to cranial vascular disorder(ruptured ACA aneurysm s/p coiling), and medication overuse headache. (Tr. 764). Under plan, life style modification was discussed including diet, exercise, sleep, massage, and decrease stress. (Tr. 764). Neurontin was started as preventative. Plaintiff was to take OTC pain medication less than two days a week to prevent medication overuse headaches. Plaintiff was to document headaches in a diary. (Tr. 765).
On November 3, 2016, Plaintiff was seen by Dr. Duc. Plaintiff received an injection for neck and shoulder pain. (Tr. 866).
On November 14, 2016, an examining consultant, Dr. Fishburne, Ph.D. examined Plaintiff. (Tr. 780). Plaintiff had been driven by her aunt. The only records reviewed were Plaintiff's own reports in a function report. Plaintiff reported her medications caused her no problems. Plaintiff reported she has never sought mental health treatment. Plaintiff is typically happy. (Tr. 780). Plaintiff reported she had suicidal thoughts a couple of days ago. Plaintiff has no plans and stays alive for her children. Plaintiff attends church three times a month. (Tr. 781). Plaintiff reported she was not working because her doctor has not released her to return to work. On a typical day, Plaintiff gets kids off to school, does some chores, runs an errand, watches television, sits on the porch, and spends time with family. Plaintiff reported limited mobility and slowed thought process. Plaintiff last drove two days prior. Others do shopping. Plaintiff reads every other day. Plaintiff gets out in public four times a week. Crowd noises cause her to become confused. “She reports problems with concentration because she loses her train of thought and has difficulty refocusing. She has memory problems. She has difficulty recalling recent events and has forgotten appointments.” (Tr. 782). Plaintiff was wearing sunglasses. Upon exam, Plaintiff's thinking was clear and goal directed. Her mood was appropriate and affect was full range. Plaintiff scored a 26/30 on the mini mental which was normal. Impression was mild depression secondary to aneurysm surgery. (Tr. 783). Plaintiff was able to understand and carry out simple instructions without difficulty. Concentration was borderline impaired. Memory and processing speed for simple tasks appeared adequate. (Tr. 783).
On November 15, 2016, non-examining state agency consultant, Dr. Farish-Ferrer, Ph.D. opined Plaintiff's impairments were not expected to preclude performance of simple, repetitive work tasks in a setting that does not require ongoing interaction with the public. (Tr. 59). Plaintiff was moderately limited in the ability to complete a normal workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. (Tr. 65). Plaintiff would be capable of performing simple tasks for at least two hour periods of time and would occasionally miss a day of work due to psychiatric symptoms. Plaintiff was expected to have initial difficulty performing activities within a schedule and responding to changes in work setting but should be able to make a satisfactory adjustment. (Tr. 66).
At reconsideration, migraine was found as nonsevere. (Tr. 96). In April 2017, state agency consultant Steadham affirmed. (Tr. 98). Steadham found Plaintiff could interact appropriately with the public. (Tr. 106).
On November 15, 2016, Plaintiff was seen by PA Meltzer and Dr. Walker. Plaintiff reported initially she benefitted from neurontin, but then felt she got used to it and the headaches have returned to occurring every day. After starting neurontin, she had 2-3 headaches a week. Over the past month, the headaches are not occurring every day and are constant. The pain is located in bilateral frontal region and throbbing in nature. Pain level is 3-6 in severity. Plaintiff had nausea, photophobia, phonophobia, osmophobia, blurry vision, and tinnitus with headaches. Plaintiff reported improvement in pain when laying down but worsening when bending over. Plaintiff reported dizziness with headaches, which worsens if she moves quickly. More severe pain at a six occurs four to five times a week and lasts two hours. (Tr. 828). When the pain starts to increase, she usually just lays down and rides it out. She previously took Excedrin and felt that it helped but has discontinued use of all abortive medications since her last Dr. Sohn visit. Triggers are bending over and constant noise. Plaintiff only sleeps four hours. Neurontin was the first preventative she tried; she had no side effects. (Tr. 828). Plaintiff had appropriate attention with good resistance to distraction. Plaintiff's Neurontin dose was increased. Plaintiff was told of the importance of limiting abortive medication use to prevent analgesic overuse headaches.
On December 13, 2016, Plaintiff was seen by FNP Howard. (Tr. 789). Headache history is exactly as noted as nearly one year prior. Upon exam, Plaintiff looked much better. Oxycodone and Norvasc were refilled. (Tr. 839).
On December 13, 2016, Plaintiff was seen by Dr. Duc. Plaintiff received an injection for neck and shoulder pain. (Tr. 865).
On December 15, 2016, FNP Howard stated in a letter that: as previously noted, “I am not able to determine the extent of your disability and the social security office will direct you to the appropriate physician. I do not advise you to try to return to work, nor do I think that you are able to return to work because of the aneurysm and consequences.” (Tr. 787). Another letter a day prior stated: “I cannot process any disability claims and they will direct you to the appropriate physician I hope you are feeling well.” (Tr. 788).
2017
On January 3, 2017, Plaintiff was seen by FNP Howard. (Tr. 797). Headache history was the same as it had been, except with the addition of “multiple forms have been filled out for her to help with her disability, I advised her that I cannot proclaim total disability though.” (Tr. 797). Headaches were listed under both assessments and treatment. (Tr. 798). Under treatment for headaches, it is stated Plaintiff was advised that she is referred to pain management for the oxycodone. Plaintiff reported understanding that she will not be able to get prescription refilled with FNP Howard. (Tr. 798). Plaintiff “has requested another disability form to be filled out in detail. I asked her to also get the neurologist to fill out the form.” (Tr. 798).
On January 18, 2017, Plaintiff was seen by PA Meltzer of MUSC. (Tr. 821). (Tr. 821). Plaintiff presented as very tearful and upset. Plaintiff reported increasing her Neurontin to four times a day but experiencing severe nausea, disorientation, and drowsiness. Plaintiff takes Oxycodone and states she must take at least two a day in order to function. “She hates being on the pain medication, but is unable to come off of it.” Plaintiff tried to stop cold turkey the past weekend and had withdrawal symptoms. Plaintiff reported being upset that her primary told her to go see pain management. Plaintiff was upset that her primary would not write Oxycodone anymore. “She is uncomfortable with the idea of a pain contract and feels it is limiting her ability to get treated for pain if needed.” Despite taking Oxycodone and Neurontin, Plaintiff reported experiencing constant pain. (Tr. 822). Plaintiff was tearful because she did not want to stay on medication but did not know how to stop. (Tr. 822). Plaintiff was also upset about continued effects from her aneurysm. Plaintiff had intact memory and appropriate attention with good resistance to distraction. (Tr. 822). Plaintiff was told the value of seeing a pain specialist. Oxycodone would not be prescribed by PA Meltzer either. Cymbalta was prescribed for depression, pain, and headaches. (Tr. 823). Plaintiff was encouraged to see a therapist.
On January 25, 2017, Plaintiff was seen by Dr. Rosenberg of MUSC. (Tr. 817). Plaintiff reported she was changing providers from her prior primary care provider because she felt she was not receiving adequate care. “Headache is modestly controlled on current regimen per neuro clinic. Continues to take Oxy since CVA 1 year ago but wishes to stop. Has tried on her own but was unable.” (Tr. 817). For most of the exam, she is wearing sunglasses or covering her eyes. (Tr. 818). “Mild residual functional deficits but remains out of work due to CVA.” Plaintiff follows the headache with the neurology headache clinic and takes Gabapentin, Cymbalta, and Oxy; Gabapentin and Oxy was deferred to them. Plaintiff was referred to Dr. Barth for discussion about enrollment in narcotic discontinuation. (Tr. 819).
On January 31, 2017, Dr. Duc gave Plaintiff an injection for shoulder and neck pain, which reduced pain from an eight to a two. (Tr. 862). Plaintiff received an injection for occipital headaches due to pain from the base of her skull to the top of her head. (Tr. 864).
On February 28, 2017, Plaintiff was seen by Dr. Kee for a psychological evaluation. (Tr. 846). Plaintiff reported constant headaches, left sided, frontal, and right sided. Plaintiff reported headaches were daily and severe. Plaintiff reported a recent injection from Dr. Duc decreased her pain and helped her thinking clear up because of the decreased pain. Plaintiff reported taking three Excedrin tension a week. Plaintiff reported sleep, lying down, and heat helped her headaches. Plaintiff reported triggers of bright lights, noises, and repetitive noises increase her headaches. (Tr. 846). Plaintiff reported trying to help children with homework, play games, and be active with them. Her mother helps with cooking and cleaning. (Tr. 847). Plaintiff reported problems with memory and concentration secondary to headaches and changes after the aneurysm. Plaintiff had good days and bad days. (Tr. 847). Plaintiff had anxiety and depression and would benefit from therapy. (Tr. 849). Plaintiff was seen in March, then it was noted she cancelled because of no insurance. (Tr. 848).
On March 1, 2017, Plaintiff was seen by Dr. Miller of MUSC. (Tr. 809). Plaintiff reported she continued to have headaches with photophobia and saw a pain management doctor Dr. Duc for her headache since the last visit. Plaintiff reported she continued to have ups and downs with her pain. Plaintiff reported she received an injection with overall improvement. Plaintiff reported duloxetine helped headaches and mood; Plaintiff had not required Excedrin. Assessment was post traumatic headache. (Tr. 811). “Mild residual functional deficits but remains out of work due to CVA.” (Tr. 811). Plaintiff follows the headache with the neurology headache clinic and takes Gabapentin, Cymbalta, and Oxy; Gabapentin and Oxy were deferred to them. Plaintiff was referred to Dr. Barth for discussion about enrollment in narcotic discontinuation. Plaintiff did not want such treatment at that time. (Tr. 812). Oxycodone was continued.
On March 28, 2017, Plaintiff was seen by Dr. Itharat for trouble with depth perception. (Tr. 852). For photophobia, Plaintiff was to use artificial tears. Headaches were noted as better. As to VF defect, it was noted the exam was inconsistent; he could not find an ocular etiology for her deficit. (Tr. 853). Plaintiff was seen for the same problems in December 2016. (Tr. 860).
On March 30, 2017, Plaintiff was seen by Dr. Duc. Plaintiff was seen for low back pain, cervicalgia, and headaches. Plaintiff responded to chronic narcotic therapy, which enabled Plaintiff to participate in activities of daily living and have a semblance of normal life. Plaintiff reported good pain control on current medication regimen. Plaintiff denied any excessive sedation or psychomotor retardation. Plaintiff had intact memory. Norco/Baclofen was continued. (Tr. 867). In February 2017, there was a similar report; Plaintiff had a “great month.” (Tr. 868). The same was said of January 2017. (Tr. 869). Plaintiff had a “good month” in December 2016. (Tr. 870).
On April 4, 2017, Dr. Kee, Ph.D. completed a report. (Tr. 875). Plaintiff had blunted/flat affect and depressed mood. Plaintiff had mildly distractible attention/concentration, mild memory deficit, and low average cognitive ability. (Tr. 875). Plaintiff had adequate ability to complete basic activities of daily living. Plaintiff had poor ability to complete complex tasks. Plaintiff had good ability to relate to others. Poor rating was due to constant headaches interrupting thinking and concentration. (Tr. 875).
On April 27, 2017, Plaintiff was seen for a sore throat. Plaintiff reported no change in her chronic headaches and photophobia “which have persisted since” her aneurysm. (Tr. 885). After the exam about an upper respiratory infection, Plaintiff asked about pain medications for headaches/back. (Tr. 891).
On May 12, 2017, Plaintiff was seen at the emergency room but left without treatment. (Tr. 893). On May 15, 2017, Plaintiff was seen by Dr. Sohn. Plaintiff had headaches from a level four to a nine. Plaintiff reported she is seen by PA Meltzer and Dr. Duc. Plaintiff reported an injection helped her headache, but she still has daily headaches that are reduced in intensity by nerve block and medications. Plaintiff denied significant medication side effects. Plaintiff stated she needs other pain management due to insurance. (Tr. 895). Lifestyle modification was discussed. Neurontin and Cymbalta were continued. Plaintiff was to follow up with new pain management. Plaintiff was to use pain medication less than two days a week to reduce medication overuse headaches. (Tr. 897). Plaintiff was seen in the emergency room the same day for abdominal pain; Plaintiff stated she was too busy to wait to be seen the prior days. (Tr. 904). Plaintiff was given IV morphine. (Tr. 909).
On June 1, 2017, Plaintiff was seen by Dr. Tslen for pain. (Tr. 913). Plaintiff's last Oxy prescription was filled April 24; she reported not having any for 1-2 weeks. It was noted Plaintiff had a history of several generalized nonspecific complaints every month. (Tr. 913). Plaintiff complained of general aches and nausea. “She is very tearful and expresses frustration that no one is willing to write her opiate medications for her.” (Tr. 913). It was suspected that Plaintiff had possible opiate withdrawal instead of somatization related to anxiety. Plaintiff seemed to significantly improve with reassurance. “She still is adamant that she should have an opiate prescription and she was advised that this clinic would not be willing to write any opiates for her as she has no indication for pain medications at this time.” (Tr. 915).
On June 12, 2017, Plaintiff was seen by Dr. Bigelow to establish primary care. (Tr. 917). Plaintiff still had trouble with chronic post traumatic headaches since her aneurism. Plaintiff took Cymbalta and gabapentin with some relief. Plaintiff had done well with injections in the past. Plaintiff saw Dr. Duc for pain management in the past, but he does not accept Medicaid. Plaintiff did not wish to start opioids but found cervical injections helpful. (Tr. 918). Plaintiff was to continue with new pain management referral. Plaintiff was now off of narcotic medication. Plaintiff's hypertension was well controlled. (Tr. 921).
On July 13, 2017, Plaintiff was seen by Dr. Bigelow for back pain. (Tr. 922). Upon exam, Plaintiff was tender to palpation across trapezius muscles. Plaintiff was to see pain management in four days. Plaintiff was to try a short course of naproxen with tizanidine. (Tr. 925).
On July 17, 2017, Plaintiff was seen by Dr. Gama and Dr. Smith. Plaintiff's history was daily headaches with past treatment with oxycodone with no relief and significant relief from cervical blocks. Pain was all over her head. (Tr. 927). Pain was achy and constant but varied in intensity. Alleviating factor was sitting quietly. Aggravating factors were noise and light. Associated symptom was photophobia. Current pain score was six. Plaintiff had tried Oxy, Tylenol, bultabital, fioricet, and muscle relaxants. (Tr. 928). Plaintiff wore sunglasses at the exam and walked slowly. Upon exam, Plaintiff had tenderness to palpation throughout and tense paraspinal muscles. (Tr. 930). Assessment was chronic daily headache. Plaintiff was referred to cognitive behavioral therapy for chronic pain/headache and was to receive occipital nerve blocks in two weeks. (Tr. 931).
On July 18, 2017, Plaintiff was seen by PA Meltzer. (Tr. 933). Plaintiff reported she was previously doing well. But three weeks prior, headaches started to increase and were now occurring every day every 4 hours. Onset was variable and duration was 1-2 hours. Pain was located in frontal and occipital regions and down into her neck/back. Pain was aching but sometimes sharp, stabbing, and shooting. Pain level was between a seven and ten. Plaintiff reported nausea and vomiting with the headaches only when she was in a car. Plaintiff reported photophobia, phonophobia, and osmophobia with her headaches. Occasionally, she had tinnitus with her headaches. Plaintiff was not currently taking any narcotics and was going to get injections. Plaintiff had very poor sleep. (Tr. 924). The only preventatives tried are Neurontin and Cymbalta. Plaintiff admitted to taking Excedrin Tension daily often multiple times a day as her abortive medication. Upon exam, Plaintiff had intact memory and appropriate attention with good resistance to distraction. (Tr. 935). Elavil was started to help with headaches and sleep. (Tr. 936). Plaintiff was advised to limit abortives to twice a week or less to prevent analgesic overuse headaches. (Tr. 937).
On August 16, 2017, Plaintiff was seen by Dr. Smith for occipital nerve blocks. (Tr. 938). Plaintiff received good pain relief. (Tr. 939). Current pain level was four. (Tr. 939). Upon exam, Plaintiff wore sunglasses and walked slowly. Plaintiff had tenderness to palpation throughout head and tense paraspinal muscles. (Tr. 940). Plaintiff was still waiting for therapy appointment. (Tr. 941).
On September 7, 2017, Plaintiff was seen by Dr. Bigelow. (Tr. 942). Plaintiff “states that there have been no improvements in her health-naproxen did help.” (Tr. 942). Upon exam, Plaintiff had tenderness to palpation across trapezius muscles. (Tr. 945). Current neck and back pain symptoms seemed muscular. Given prior improvement with naproxen, meloxicam was started. (Tr. 946).
On October 9, 2017, Plaintiff was seen by Dr. Bigelow. (Tr. 947). Plaintiff had some improvement in neck pain with meloxicam. Later, it is stated it helped immensely and she was currently doing fairly well. (Tr. 948). Upon exam, Plaintiff had tenderness to palpation across trapezius muscles. (Tr. 950). Plaintiff's neck and back pain were doing much better on meloxicam. (Tr. 950).
On October 12, 2017, Plaintiff received injections for daily headache with good pain relief from Dr. Smith. (Tr. 953-955). Plaintiff reported the last injections were very helpful. (Tr. 955). Upon exam, Plaintiff was tender to palpation over the nuchal ridges and underlying occipital nerves with reproduction of occipital neuralgia. (Tr. 955). Assessment was chronic daily headache and occipital headache. At that visit, a small amount of steroid was used, but in the future, local anesthetic would be used alone. (Tr. 956).
On October 26, 2017, Plaintiff was seen by NP Stewart of neurology. (Tr. 957). Plaintiff reported her headaches had greatly improved. “She attributes this to both her medications and occipital blocks which are provided by pain management. Migraines are usually triggered by bright lights. Her last severe headache was at the first part of this month.” (Tr. 957). Upon exam, Plaintiff had appropriate attention with good resistance to distraction. (Tr. 960). Plaintiff was to limit abortives and continue Elavil. (Tr. 961).
On December 6, 2017, Plaintiff had an angiogram to evaluate aneurysm. Impression was previous coil embolization of an anterior communicating artery aneurysm with interval development of a small neck recurrence that measures 3.3mm x 2.6 mm. (Tr. 969). Repeat treatment was recommended.
On December 20, 2017, Plaintiff was seen by Dr. Smith and Dahl. (Tr. 972). Plaintiff had five trigger point injections. (Tr. 972). Plaintiff rated occipital neuralgia and myofascial pain at seven. Plaintiff described pain as tight and throbbing with photophobia and phonophobia. Plaintiff reported trigger point injections in October 2017 immensely decreased her pain to a two. Plaintiff was to have repeat aneurysm coiling in January 2018. Upon exam, right occipital pain was reproducible with palpation under nuchal ridge. (Tr. 973).
2018
On January 18, 2018, Plaintiff was seen by Dr. Larrew of neurosurgery. (Tr. 975). Plaintiff presented for re-embolization. Plaintiff had recurrence of aneurysm. (Tr. 976). Impression was an aborted embolization of a previously treated anterior communicating artery aneurysm with coils that demonstrates complete obliteration. Reconstructions and additional obliques demonstrated that the previously thought recurrent portion of the aneurysm was likely the A2 segment coursing adjacent to the coil mass. (Tr. 981). Course was later noted that imaging showed a very small residual neck aneurysm. “Because of this, the risk of embolization and future anticoagulation was felt to be more significant than the risk of aneurysm rupture.” (Tr. 986). Plaintiff's next angiogram was in three years. (Tr. 990).
On January 22, 2018, Plaintiff was seen by Dr. Sohn for headaches. (Tr. 992). “Her headache has gotten better since 07/2017 after she added Elavil for preventative medication(although almost daily headache, but severity decreased a lot). Plaintiff denied side effects of medication except dry mouth. Plaintiff slept well with Elavil. (Tr. 993). Assessments were chronic daily headache-some improved and headache attributed to aneurysm. (Tr. 994). Lifestyle modification was discussed. (Tr. 994). Medication was continued. Plaintiff was told to minimize abortive medication for medication overuse headaches. (Tr. 995).
On March 6, 2018, Plaintiff was seen by Dr. Bigelow. (Tr. 1016). Headaches were not listed as an assessment. Meloxicam, Cymbalta, and Gabapentin were listed under neck and back pain. (Tr. 1020).
On March 20, 2018, Plaintiff received trigger point injections. (Tr. 1022). Plaintiff was seen by Dr. Serafini and Lataille. Plaintiff rated pain as an eight primarily on right side of head radiating down with photophobia and phonophobia. Plaintiff reported the December 2017 injection helped her pain a good deal with a level 2-3 and the relief lasted 2.5 months. (Tr. 1024).
On May 8, 2018, Plaintiff was seen by Dr. Bigelow. Headaches were not listed as an assessment, but noted in history. (Tr. 1031).
On May 21, 2018, Plaintiff was seen by PA Lueking for headache neurology followup. (Tr. 1036). Plaintiff reported when she has a headache, it is a level 10 with nausea, photophobia, and phonophobia. Plaintiff reported daily episodes lasting about one hour each time. Plaintiff uses Excedrin tension 1-2 times per day as an abortive. Plaintiff complained of widespread pain and reported the neurontin felt like it was not doing anything. Plaintiff had worsening pain before each injection. Plaintiff denied any negative medication side effects. (Tr. 1039). Plaintiff had appropriate attention with good resistance to distraction. (Tr. 1042). Assessment was post traumatic headache, possible fibromyalgia, and medication overuse headache. Neurontin was switched to Lyrica; Gabapentin was stopped. “The patient is also overusing [OTC] pain medication. Patient was advised to limit all abortive medications to 2x/week or less to prevent analgesic overuse headaches.” (Tr. 1044).
On May 24, 2018, Plaintiff was seen in the emergency room. (Tr. 1055). Plaintiff complained of body aches and chest pain. Plaintiff endorsed headache over the course of that day that was bandlike in distribution and described as a typical headache for her. (Tr. 1055). It was likely Plaintiff had a virus. (Tr. 1059).
On June 13, 2018, Plaintiff was seen by Dr. Serafini in the middle of her more classic migraine episodes with photophobia, phonophobia, nausea, clouding of sensorium, numbness, and agitation. “This is similar to her migraine HA component of her much larger HA syndrome.” The current migraine episode was “now going into three weeks duration which she states can be typical for her.” (Tr. 1061). Plaintiff's other occipital neuralgia pain is different than that of her migraine headaches. (Tr. 1062). On review of systems, Plaintiff had diplopia, blurred vision, visual changes, light sensitivity, ear pain, nausea, vomiting, headache, numbness, pain, and weakness. Plaintiff was wearing sunglasses. (Tr. 1062). Upon exam, Plaintiff had right and left occipital pain reproducible with palpation under nuchal ridge, reproducing some but not all of typical pain. (Tr. 1062). Assessments were neuralgia, neuritis, occipital neuralgia, migraine with aura and with status migrainosus, not intractable, chronic tension-type headache, not intractable, acute on chronic headache, and chronic daily headache. The nerve blocks in two weeks would help with some component of Plaintiff's headache syndrome but would not address the more migraine like component. (Tr. 1063).
On June 25, 2018, Plaintiff was seen by PA Lueking. (Tr. 1064). Plaintiff reported since last visit she continued all her medications and added Topamax. Plaintiff reported side effects of paresthesias. Plaintiff denied any relief from her headaches. Plaintiff stated she continued to have headaches daily. Plaintiff reported her headaches have not changed in location, character, quality, severity, or associated symptoms. (Tr. 1067). Plaintiff was not able to start Lyrica because insurance denied it. (Tr. 1067). Plaintiff reported extreme irritability. Plaintiff reported seeing a psychiatrist years ago. (Tr. 1068). Upon exam, Plaintiff had appropriate attention with good resistance to distraction. (Tr. 1070). Topamax was to be tapered since she had side effects and no relief. Lyrica approval was to be worked on as it was believed to be of great benefit for headaches, paresthesias, and neuropathic pain. Depakote was added for headaches and mood. Plaintiff was referred to psychiatry. “The patient is also overusing [OTC] pain medication. Patient was advised to limit all abortive medications to 2x/week or less to prevent analgesic overuse headaches.” (Tr. 1072).
C. The ALJ's Decision
In the decision of January 10, 2019, the ALJ made the following findings of fact and conclusions of law (Tr. 12):
1. The claimant meets the insured status requirements of the Social Security Act through December 31, 2019.
2. The claimant has not engaged in substantial gainful activity since December 15, 2015, the alleged onset date (20 CFR 404.1571 et seq., and 416.971 et seq.).
3. The claimant has the following severe impairments: status post aneurysm repair, migraines, and myofascial pain (20 CFR 404.1520(c) and 416.920(c)).
4. The claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).
5. After careful consideration of the entire record, I find that the claimant has the residual functional capacity to perform sedentary work as defined in 20 CFR 404.1567(a) and 416.967(a) except with additional limitations. Due to postural limitations, the claimant is limited to occasional balancing, stooping, crouching, crawling, kneeling, and climbing of ramps or stairs. However, the claimant must never climb ladders or scaffolds. Additionally,
the claimant must avoid exposure to loud background noise or work hazards. Despite mental deficits, the claimant is able to concentrate sufficiently in two-hour increments to perform simple, repetitive tasks. Although the claimant is able to adjust to occasional changes in work setting or procedures, the claimant is unable to perform production pace rate work.
6. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 416.965).
7. The claimant was born on September 12, 1979 and was 36 years old, which is defined as a younger individual age 18-44, on the alleged disability onset date (20 CFR 404.1563 and 416.963).
8. The claimant has at least a high school education and is able to communicate in English (20 CFR 404.1564 and 416.964).
9. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is"not disabled," whether or not the claimant has transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).
10. Considering the claimant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1569, 404.1569a, 416.969, and 416.969a).
11. The claimant has not been under a disability, as defined in the Social Security Act, from December 15, 2015, through the date of this decision (20 CFR 404.1520(g) and 416.920(g)).
II. DISCUSSION
Plaintiff argues generally that the RFC is not supported by substantial evidence. Plaintiff argues specifically that the ALJ failed to consider Plaintiff's ability to perform the RFC on a regular and continuing basis, noting Plaintiff's central complaint of migraines. Plaintiff argues that the subjective symptom evaluation informed the RFC determination.
The Commissioner argues that the ALJ's decision is supported by substantial evidence.
A.LEGAL FRAMEWORK
1.The Commissioner's Determination-of-Disability Process
The Act provides that disability benefits shall be available to those persons insured for benefits, who are not of retirement age, who properly apply, and who are under a “disability.” 42 U.S.C. § 423(a). Section 423(d)(1)(A) defines disability 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 at least 12 consecutive months. 42 U.S.C. § 423(d)(1)(A).
To facilitate a uniform and efficient processing of disability claims, regulations promulgated under the Act have reduced the statutory definition of disability to a series of five sequential questions. See, e.g., Heckler v. Campbell, 461 U.S. 458, 460 (1983) (discussing considerations and noting the “need for efficiency” in considering disability claims). An examiner must consider the following: (1) whether the claimant is engaged in substantial gainful activity (“SGA”); (2) whether he has a severe impairment; (3) whether that impairment meets or equals an impairment included in the Listings; (4) whether such impairment prevents claimant from performing PRW; and (5) whether the impairment prevents him from doing SGA. See 20 C.F.R. § 404.1520. These considerations are sometimes referred to as the “five steps” of the Commissioner's disability analysis. If a decision regarding disability may be made at any step, no further inquiry is necessary. 20 C.F.R. § 404.1520(a)(4) (providing that if Commissioner can find claimant disabled or not disabled at a step, Commissioner makes determination and does not go on to the next step).
The Commissioner's regulations include an extensive list of impairments (“the Listings” or “Listed impairments”) the Agency considers disabling without the need to assess whether there are any jobs a claimant could do. The Agency considers the Listed impairments, found at 20 C.F.R. part 404, subpart P, Appendix 1, severe enough to prevent all gainful activity. 20 C.F.R. § 404.1525. If the medical evidence shows a claimant meets or equals all criteria of any of the Listed impairments for at least one year, he will be found disabled without further assessment. 20 C.F.R. § 404.1520(a)(4)(iii). To meet or equal one of these Listings, the claimant must establish that his impairments match several specific criteria or be “at least equal in severity and duration to [those] criteria.” 20 C.F.R. § 404.1526; Sullivan v. Zebley, 493 U.S. 521, 530 (1990); see Bowen v. Yuckert, 482 U.S. 137, 146 (1987) (noting the burden is on claimant to establish his impairment is disabling at Step 3).
In the event the examiner does not find a claimant disabled at the third step and does not have sufficient information about the claimant's past relevant work to make a finding at the fourth step, he may proceed to the fifth step of the sequential evaluation process pursuant to 20 C.F.R. § 404.1520(h).
A claimant is not disabled within the meaning of the Act if he can return to PRW as it is customarily performed in the economy or as the claimant actually performed the work. See 20 C.F.R. Subpart P, § 404.1520(a), (b); Social Security Ruling (“SSR”) 82-62 (1982). The claimant bears the burden of establishing his inability to work within the meaning of the Act. 42 U.S.C. § 423(d)(5).
Once an individual has made a prima facie showing of disability by establishing the inability to return to PRW, the burden shifts to the Commissioner to come forward with evidence that claimant can perform alternative work and that such work exists in the regional economy. To satisfy that burden, the Commissioner may obtain testimony from a VE demonstrating the existence of jobs available in the national economy that claimant can perform despite the existence of impairments that prevent the return to PRW. Walls v. Barnhart, 296 F.3d 287, 290 (4th Cir. 2002). If the Commissioner satisfies that burden, the claimant must then establish that he is unable to perform other work. Hall v. Harris, 658 F.2d 260, 264-65 (4th Cir. 1981); see generally Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987) (regarding burdens of proof).
2. The Court's Standard of Review
The Act permits a claimant to obtain judicial review of “any final decision of the Commissioner [ ] made after a hearing to which he was a party.” 42 U.S.C. § 405(g). The scope of that federal court review is narrowly-tailored to determine whether the findings of the Commissioner are supported by substantial evidence and whether the Commissioner applied the proper legal standard in evaluating the claimant's case. See id.; Richardson v. Perales, 402 U.S. 389, 390 (1971); Walls, 296 F.3d at 290 (citing Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990)).
The court's function is not to “try these cases de novo or resolve mere conflicts in the evidence.” Vitek v. Finch, 438 F.2d 1157, 1157-58 (4th Cir. 1971); see Pyles v. Bowen, 849 F.2d 846, 848 (4th Cir.1988) (citing Smith v. Schweiker, 795 F.2d 343, 345 (4th Cir. 1986)). Rather, the court must uphold the Commissioner's decision if it is supported by substantial evidence. “Substantial evidence” is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson, 402 U.S. at 390, 401; Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005). Thus, the court must carefully scrutinize the entire record to assure there is a sound foundation for the Commissioner's findings and that her conclusion is rational. See Vitek, 438 F.2d at 1157-58; see also Thomas v. Celebrezze, 331 F.2d 541, 543 (4th Cir. 1964). If there is substantial evidence to support the decision of the Commissioner, that decision must be affirmed “even should the court disagree with such decision.” Blalock v. Richardson, 483 F.2d 773, 775 (4th Cir. 1972).
B. ANALYSIS
Headaches
Plaintiff argues generally that the RFC is not supported by substantial evidence. Plaintiff argues specifically that the ALJ failed to consider Plaintiff's ability to perform the RFC on a regular and continuing basis, noting Plaintiff's central complaint of migraines. Plaintiff argues that the subjective symptom evaluation informed the RFC determination. Plaintiff notes that the ALJ cited to multiple exam findings of no head tenderness and normal affect but argue this had nothing to do with ability to function during a migraine where Plaintiff was at the provider while experiencing an episode and had photophobia, phonophobia, nausea, clouding of sensation, numbness, and agitation appearing uncomfortable, walking slowly, wearing sunglasses and had reproducible discomfort on palpation. Plaintiff notes that Plaintiff had tried a variety of treatment. Plaintiff notes the ALJ noted some improvement in October 2017 without noting Plaintiff returned in December 2017 with headache complaints and found to have a small recurrence of her aneurysm. Thus, Plaintiff notes the ALJ erred in stating there was no reoccurrence after the 2015 surgery.
An adjudicator is solely responsible for assessing a claimant's RFC. 20 C.F.R. §§ 404.1546(c), 416.946(c). In making that assessment, she must consider the functional limitations resulting from the claimant's medically determinable impairments. Social Security Ruling (“SSR”) 96-8p, 1996 WL 374184, at *2. This ruling provides that: “The RFC assessment must include a narrative discussion describing how the evidence supports each conclusion, citing specific medical facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily activities, observations).” SSR 96-8, *7. “ALJs may not rely on objective medical evidence (or the lack thereof)-even as just one of multiple factors-to discount a claimant's subjective complaints regarding symptoms of fibromyalgia or some other disease that does not produce such evidence.” Arakas v. Comm'r, Soc. Sec. Admin., 983 F.3d 83, 97 (4th Cir. 2020). The ALJ at step three is to “consider the individual's symptoms when determining his or her residual functional capacity and the extent to which the individual's impairment-related symptoms are consistent with the evidence in the record.” SSR 16-3p, at *11.
The ALJ noted Plaintiff's testimony regarding headaches. Plaintiff testified she could not work currently because she has problems with decreased comprehension and recurrent headaches. Plaintiff testified her headaches occur every other day. (Tr. 18). Plaintiff testified she received pain blocks about a year ago and they helped her headaches. (Tr. 19). Plaintiff testified her headaches last 15-20 days. “Once she takes her medications, the claimant testified that her headache pain gets toned down to where she can function.” (Tr. 19). The ALJ then summarized treatment notes similar to the court's detailed summary above. (Tr. 19-24). The ALJ's findings as to headaches are that Plaintiff appears to be less limited than alleged. (Tr. 24). The ALJ finds that there are multiple inconsistencies between allegations and treatment history.
The ALJ erroneously states she had no reoccurrence of aneurysm. (Tr. 24). Plaintiff did in fact undergo neurosurgery for re-embolization. It was later aborted because imaging showed a very small residual neck aneurysm and the risk of “embolization and future anticoagulation was felt to be more significant than the risk of aneurysm rupture.” (Tr. 986).
The ALJ stated:“Contrary to the claimant's allegations, her treatment notes indicate good success with occipital nerve blocks suggesting that the claimant's migraine headaches are less frequent and less intense.” (Tr. 24).This statement by the ALJ ignores the treatment by a specialist who stated occipital nerve blocks only help one component of Plaintiff's headache syndrome and occipital nerve blocks do not address her migraines. (Tr. 1063). In June 2018, Dr. Serafini, board certified in pain medicine and anesthesiology, examined Plaintiff when she was in the middle of her more classic migraine episodes with photophobia, phonophobia, nausea, clouding of sensorium, numbness, and agitation. “This is similar to her migraine HA component of her much larger HA syndrome.” The current migraine episode was “now going into three weeks duration which she states can be typical for her.” (Tr. 1061). Plaintiff's other occipital neuralgia pain is different than that of her migraine headaches. (Tr. 1062).Upon exam, Plaintiff had right and left occipital pain reproducible with palpation under nuchal ridge, reproducing some but not all of typical pain. (Tr. 1062). The nerve blocks in two weeks would help with some component of Plaintiff's headache syndrome but would not address the more migraine like component. (Tr. 1063).
The ALJ stated: “Additionally, the medical record fails to identify any objective support for the cause of the claimant's alleged concentration deficits.” (Tr. 24). The ALJ stated that Plaintiff's testimony belies that she is unable to work due to problems with decreased comprehension and headaches because she testified coherently during the hearing and responded appropriately to the questioning which denoted adequate ability to comprehend. (Tr. 24-25). The ALJ stated Plaintiff's medications lessened her headache pain and treatment with pain blocks helped her headaches. (Tr. 25). The ALJ noted that Plaintiff did continue to receive treatment for recurrent headaches and that some notes suggested headaches were from medication overuse. (Tr. 25-26). “In October of 2017, the claimant began nerve blocks for headaches with initial great results. However, in June of 2018, the claimant was back to complaining of daily headaches.” (Tr. 26). Noise restrictions were in the RFC due to headache trigger. (Tr. 26).
The ALJ must consider whether Plaintiff can perform the RFC on a regular and continuing basis. 20 C.F.R. § 404.1545. SSR 96-8p explains that, “a ‘regular and continuing basis' means 8 hours a day, for 5 days a week, or an equivalent work schedule.” The ALJ”s opinion is lacking in explanation of the impact of Plaintiff's headaches and types of headaches on Plaintiff's ability to sustain work activity on a regular and continuing basis. The ALJ does note that Plaintiff complained of daily headaches to her treating specialists regularly. The ALJ found migraines were severe, and Plaintiff's impairments were capable of causing some of her alleged symptoms. (Tr. 14, 24). The ALJ did not discuss which symptoms were supported by the evidence and which were not. Viewing the opinion as a whole, the ALJ may have cited to multiple normal exams of range of motion and affect, but these findings are less relevant when looking at Plaintiff's ability to function on a continuing basis during a headache.
As to the ALJ's finding that Plaintiff's allegations were inconsistent with her treatment history, the ALJ did not provide an accurate and logical bridge from the evidence to his finding. The ALJ is obligated to consider all evidence, not just that which is helpful to his decision. Gordon v. Schweiker, 725 F.2d 231, 235-36 (4th Cir. 1984); Murphy v. Bowen, 810 F.2d 433, 437 (4th Cir. 1987). Because the Court finds the ALJ's analysis with respect to the above issues is a sufficient basis to remand the case to the Commissioner, the undersigned does not specifically address Plaintiff's additional allegations of error. See Boone v. Barnhart, 353 F.3d 203, 211 n.19 (3d Cir. 2003) (remanding on other grounds and declining to address claimant's additional arguments). Upon remand, the Commissioner should consider each of Plaintiff's allegations of error, including, but not limited to: the RFC determination and the subjective symptom evaluation. “[T]he ALJ must consider all the record evidence and cannot ‘pick and choose' only the evidence that supports his position.” Loza v. Apfel, 219 F.3d 378, 393 (5th Cir. 2000).
III. CONCLUSION
In conclusion, it may well be that substantial evidence exists to support the Commissioner's decision in the instant case. The court cannot, however, conduct a proper review based on the record presented. Accordingly, pursuant to the power of the Court to enter a judgment affirming, modifying, or reversing the Commissioner's decision with remand in social security actions under sentence four of Sections 205(g) and 1631(c)(3) of the Social Security Act, 42 U.S.C. Sections 405(g) and 1338(c)(3), it is recommended that the Commissioner's decision be reversed and that this matter be REMANDED to the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g) for further proceedings in accordance with this opinion.