Harrison v. Social Security Administration, Commissioner

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF ALABAMA

JASPER DIVISION

LINDA DARLENE HARRISON, )

)

Plaintiff, )

)

v. ) Case No.: 6:21-cv-205-AMM

)

SOCIAL SECURITY )

ADMINISTRATION, )

Commissioner, )

)

Defendant. )

MEMORANDUM OF DECISION

Plaintiff Linda Darlene Harrison brings this action pursuant to the Social

Security Act (the “Act”), seeking review of the decision of the Commissioner of

Social Security (“Commissioner”) denying her claim for a period of disability and

disability insurance benefits (“benefits”). See 42 U.S.C. § 405(g). Based on the

court’s review of the record, the court AFFIRMS the decision of the Commissioner.

I. Introduction

On August 7, 2019, Ms. Harrison protectively filed an application for benefits

under Title II of the Act, alleging disability as of September 26, 2018. R. 11, 98–

117. Ms. Harrison alleges disability due to bursitis in her hips, tendonitis in her

thighs, narcolepsy, hypertension, chronic myofascial pain disorder, and depression.

R. 99. She has at least a high school education and has past relevant work experience

as a teacher. R. 20.

The Social Security Administration (“SSA”) initially denied Ms. Harrison’s

application on October 18, 2019, and again denied it upon reconsideration on

February 18, 2020. R. 11, 117–18, 133, 135. On February 18, 2018, Ms. Harrison

filed a request for a hearing before an Administrative Law Judge (“ALJ”). R. 11,

149–50. That request was granted. R. 151–53, 166–70. Ms. Harrison received a

telephone hearing before ALJ Cynthia W. Brown on August 24, 2020. R. 11, 51–68.

On September 2, 2020, ALJ Brown issued a decision, finding that Ms. Harrison was

not disabled from September 26, 2018 through the date of her decision. R. 8–22. Ms.

Harrison was fifty-four years old at the time of the ALJ decision. R. 20, 22.

Ms. Harrison appealed to the Appeals Council, which denied her request for

review on December 14, 2020. R. 1–4, 196–98. After the Appeals Council denied

Ms. Harrison’s request for review, R. 1–4, the ALJ’s decision became the final

decision of the Commissioner and subject to district court review. On February 9,

2021, Ms. Harrison sought this court’s review of the ALJ’s decision. See Doc. 1.

II. The ALJ’s Decision

The Act establishes a five-step test for the ALJ to determine disability. 20

C.F.R. § 404.1520. First, the ALJ must determine whether the claimant is engaging

in substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). “Substantial work

activity is work activity that involves doing significant physical or mental activities.”

20 C.F.R. § 404.1572(a). “Gainful work activity” is work that is done for pay or

profit. 20 C.F.R. § 404.1572(b). If the ALJ finds that the claimant engages in

substantial gainful activity, then the claimant cannot claim disability. 20 C.F.R. §

404.1520(b). Second, the ALJ must determine whether the claimant has a medically

determinable impairment or a combination of medical impairments that significantly

limits the claimant’s ability to perform basic work activities. 20 C.F.R. §§

404.1520(a)(4)(ii), (c). Absent such impairment, the claimant may not claim

disability. Id. Third, the ALJ must determine whether the claimant’s impairment

meets or medically equals the criteria of an impairment listed in 20 C.F.R. § 404,

Subpart P, Appendix 1. See 20 C.F.R. §§ 404.1520(d), 404.1525, and 404.1526. If

such criteria are met, the claimant is declared disabled. 20 C.F.R. §

404.1520(a)(4)(iii).

If the claimant does not fulfill the requirements necessary to be declared

disabled under the third step, the ALJ still may find disability under the next two

steps of the analysis. The ALJ must first determine the claimant’s residual functional

capacity, which refers to the claimant’s ability to work despite her impairments. 20

C.F.R. §§ 404.1520(e), 404.1545. In the fourth step, the ALJ determines whether the

claimant has the residual functional capacity to perform past relevant work. 20

C.F.R. § 404.1520(a)(4)(iv). If the ALJ determines that the claimant is capable of

performing past relevant work, then the claimant is deemed not disabled. Id. If the

ALJ finds the claimant unable to perform past relevant work, then the analysis

proceeds to the fifth and final step. 20 C.F.R. § 404.1520(a)(4)(v). In this step, the

ALJ must determine whether the claimant is able to perform any other work

commensurate with her residual functional capacity, age, education, and work

experience. 20 C.F.R. § 404.1520(g)(1). Here, the burden of proof shifts from the

claimant to the Commissioner to prove the existence, in significant numbers, of jobs

in the national economy that the claimant can do given her residual functional

capacity, age, education, and work experience. 20 C.F.R. §§ 404.1520(g)(1),

404.1560(c).

The ALJ determined that Ms. Harrison would meet the insured status

requirements of the Act through December 31, 2020. R. 13. Next, the ALJ found

that Ms. Harrison had not engaged in substantial gainful activity since September

26, 2018, the alleged disability onset date. R. 13. The ALJ decided that Ms. Harrison

had the following severe impairments: osteoarthritis and narcolepsy. R. 13. The ALJ

found that Ms. Harrison’s depression, hypertension, chronic kidney disease, and

gastroesophageal reflux disease were “non-severe” impairments because “these

impairments constitute, at most, only slight abnormalities that cannot reasonably be

expected to produce more than minimal, if any, work-related limitations.” R. 14. The

ALJ found that Ms. Harrison’s fibromyalgia “is not a medically determinable

impairment” because it “cannot be established by medical signs and/or laboratory

findings.” R. 16. Overall, the ALJ determined that Ms. Harrison did not have “an

impairment or combination of impairments that meets or medically equals the

severity of one of the listed impairments” to support a finding of disability. R. 16.

The ALJ found that Ms. Harrison’s “statements concerning the intensity,

persistence[,] and limiting effects of these impairments are not consistent with the

objective medical evidence.” R. 18. The ALJ found that Ms. Harrison had the

“residual functional capacity to perform a range of light work” with certain

limitations. R. 17. The ALJ determined that Ms. Harrison may frequently balance,

but that she may occasionally stop, kneel, crouch, and crawl. R. 17. While the ALJ

found that Ms. Harrison may climb ramps and stairs, she may never climb ladders,

ropes, or scaffolds. R. 17. Further, the ALJ determined that Ms. Harrison must avoid

concentrated exposure to cold, heat, vibration, fumes, odors, and other pulmonary

irritants and any exposure to hazards. R. 17. Finally, the ALJ determined that Ms.

Harrison would need a sit-stand option, and she would remain on task. R. 17.

According to the ALJ, Ms. Harrison is “unable to perform any past relevant

work,” she is “an individual closely approaching advanced age,” and she has “at

least a high school education,” as those terms are defined by the regulations. R. 20.

The ALJ determined that “[t]ransferability of job skills is not material to the

determination of disability because applying the Medical-Vocational Rules directly

supports a finding of ‘not disabled,’ whether or not the claimant has transferable job

skills.” R. 20. Because Ms. Harrison’s “ability to perform all or substantially all of

the requirements of this level of work” was impeded by additional limitations, the

ALJ enlisted a vocational expert to ascertain whether there were a significant number

of jobs in the national economy that Ms. Harrison would be capable of performing.

R. 21. That expert testified that there are indeed a significant number of such jobs in

the national economy, such as a cashier, marker, and office helper. R. 21.

Based on these findings, the ALJ concluded that Ms. Harrison did not have a

disability as defined in the Act, from September 26, 2018 through the date of the

decision. R. 12, 21–22. Ms. Harrison now challenges that decision.

III. Factual Record

The medical records in the record span many years and cover various

complaints. However, Ms. Harrison alleged she became disabled on September 26,

2018. R. 11. Additionally, Ms. Harrison limits her arguments to her narcolepsy and

physical pain in her hips and legs, so the medical records concerning only those

impairments are discussed here.

A. Narcolepsy

Ms. Harrison presented to Dr. Jan Westerman at Pulmonary & Sleep

Associates of Jasper for a new sleep evaluation on April 11, 2006. R. 346. Ms.

Harrison was scheduled for a Polysomnogram and Mean Sleep Latency Test. R. 347.

Ms. Harrison completed the Polysomnography Study on April 27, 2006. R. 387. Ms.

Harrison completed the Mean Sleep Latency Test on April 28, 2006. R. 389. Ms.

Harrison returned to Dr. Westerman on May 1, 2006, after the completion of the

sleep study. R. 349. She was diagnosed with “narcolepsy without cataplexy.” R. 349.

Ms. Harrison was to undergo nap therapy and sleep hygiene and follow up in one

month. R. 350.

Ms. Harrison returned to Dr. Westerman on April 12, 2007. R. 351. At that

time she “ha[d] a negative Narcolepsy profile. She ha[d] pathologic

hypersomnolence.” R. 351. However, Dr. Westerman noted that he “believe[d] that

she does have narcolepsy.” R. 352. Ms. Harrison reported that the Provigil was not

as effective, and her dose was increased. R. 351. Ms. Harrison returned on April 10,

2008 to check her medications. R. 392. She was instructed not to drive and to follow

up in one month. R. 394. Ms. Harrison returned on May 27, 2008 for a refill of

medications. R. 397. At the time she was complaining of headaches. R. 397. She was

continued on Provigil with the addition of Ritalin and advised to return to the clinic

in six months. R. 399–400.

Ms. Harrison returned to Dr. Westerman on December 1, 2008. R. 403. Ms.

Harrison had not yet increased her Ritalin dose to twice a day, but was again

encouraged to do this. R. 406. She was also encouraged to engage in therapy,

increase her physical activity, and return in one month. R. 406. Ms. Harrison

returned on September 11, 2009. R. 408. She was still being treated with Provigil

and Ritalin, though she was not using nap therapy. R. 408. Ms. Harrison reported

experiencing “occasional headaches with Ritalin treatment.” R. 408. Ms. Harrison

was taken off Provigil and prescribed Nuvigil. R. 410. Ms. Harrison returned to

Pulmonary & Sleep Associates of Jasper on April 1, 2010 and was seen by Dr. John

Jessup. R. 417. Ms. Harrison reported that the Nuvigil “was not significantly better

than the Provigil,” and that the Ritalin, which she was taking twice in the afternoon,

was “helpful but . . . tend[s] to give her a headache.” R. 417. She was advised to get

more sleep at night, and she was prescribed Provigil to take in the afternoon. R. 419.

Ms. Harrison returned to Dr. Westerman on September 15, 2010. R. 421. Her

hypersomnia was “well controlled by current therapy,” which would be continued.

R. 423. However, her medication dose was higher than recommended and would be

considered by an endocrinologist in light of her hypertension. R. 423.

In 2015, Ms. Harrison reported to Dr. David Spalding that she “was on

Provigil for narcolepsy but was having side effects and is now off of that.” R. 468.

The assessment from Ms. Harrison’s December 7, 2016 visit to Premier

Health Center notes that she would be referred for narcolepsy. R. 522.

Dr. Bell referred Ms. Harrison to Dr. Alan Thomas of Pulmonary Associates

of the Southeast for a sleep evaluation. R. 920. Dr. Thomas noted her narcolepsy

diagnosis, and the history of present illness noted her severe hypersomnia. R. 920.

The assessment from Ms. Harrison’s December 1, 2017 visit to Premier

Health Center notes “Narcolepsy – sleep study.” R. 686. Ms. Harrison underwent a

sleep study under the supervision of Dr. Westerman on December 12, 2017. R. 668.

Ms. Harrison presented to Nurse Practitioner Aleisha Dunagan at Pulmonary

and Sleep Associates of Jasper on December 12, 2017. The History of Present Illness

states in part: “Patient was seen in this practice in the past and was diagnosed with

narcolepsy. Was treated with Provigil but stopped this a couple of years ago. She did

not feel that Provigil was helping and she was taking 600 mg per day.” R. 664. Ms.

Harrison reported that she tried Nuvigil, Adderall, and Ritalin, but “was unable to

take these,” and “Provigil was also ineffective.” R. 664. As a follow-up to her sleep

study, Ms. Harrison reported that she was “not interested in starting back on

[Provigil because] she felt this changed her personality completely.” R. 670. Ms.

Harrison was considering starting Xyrem. R. 670.

Ms. Harrison returned to Dr. Westerman on April 5, 2018 for a narcolepsy

follow-up and fatigue. R. 717. Ms. Harrison reported that she was “very sleepy

during the day and having [a] hard time staying awake.” R. 717. She stated that she

had researched Xyrem and did “not want to start this,” that Adderall was “not

effective,” and that “[P]rovigil worked but caused her personality changes.” R. 717.

Dr. Westerman decided to treat Ms. Harrison with Desoxyn, and if it proved to be

ineffective he noted that they may try Vyvanse. R. 719. Ms. Harrison was to return

in one month. R. 719.

On May 20, 2019, Ms. Harrison returned to Premier Health Center and the

medical records indicate she was taking Provigil for narcolepsy. R. 934. On August

15, 2019, Ms. Harrison reported to Dr. Bell that she had not been to a sleep specialist

since her last visit to Dr. Bell and reported that she did “not want to try Xyzal for

narcolepsy.” R. 888. Ms. Harrison presented to Premier Health Center on May 5,

2020, and the records indicate she was not taking medications for narcolepsy. R.

1241.

B. Physical Pain

Ms. Harrison was treated by the Jasper Podiatry Center in 2013 for heel pain.

R. 428–30. She was also treated in 2014 for pain in the bottoms of her feet. R. 431.

She was referred to and treated by Dr. William Krauss in 2015 for bilateral peripheral

neuropathy. R. 435. In January 2015, Ms. Harrison reported that her bilateral foot

pain “has created restriction of physical activities and has disrupted [her] sleep.” R.

437. She reported that it had been present for ten months, and she had tried Neurontin

without improvement. R. 438. She received injections in her plantar fascia in

November 2015. R. 436.

Ms. Harrison presented to Dr. David Spalding on September 22, 2015

complaining of all over pain. R. 468. She reported that she “had to retire because of

her foot and leg pain and disability.” R. 468. She noted that Mobic and Relafen didn’t

benefit her and Klonopin resulted in side effects. R. 468. She stated that her pain

wakes her up on a regular basis. R. 468. Dr. Spalding’s impression was that Ms.

Harrison did “have very significant bilateral trochanteric bursitis and iliotibial band

tendinitis,” which he believed was “creating a significant amount of her leg and foot

pain and dysesthesias and dysfunction.” R. 470. Dr. Spalding believed that it was

“exacerbating her problems with narcolepsy,” and that her “nonrestorative sleep” is

“caus[ing] some additional superimposed myofascial pain.” R. 470. Ms. Harrison

was treated with injections. R. 470.

Ms. Harrison returned to Dr. Spalding on October 28, 2015. R. 480. Dr.

Spalding noted that Ms. Harrison “still has significant active trochanteric bursitis

with a milder iliotibial band tendinitis and no evidence for rheumatoid arthritis so

we will have to retreat the trochanteric bursitis and be rigorous in her use of cold and

heat and protective measures.” R. 482. Ms. Harrison was treated with injections to

her trochanteric bursa. R. 482. Ms. Harrison returned to Dr. Spalding on December

10, 2015. Ms. Harrison reported that she had a slight improvement overall, but

significant trauma to her left hip after a fall. R. 484. She also reported that “[s]he

wakes at night with pain.” R. 484. She was treated with injections to her left

trochanteric bursa and her right and left iliotibial band tendon/fascia. R. 485. Dr.

Spalding wrote that Ms. Harrison “is making some progress especially on the right

side but this fall has interrupted her progress on the left side so she has persistence

of left trochanteric bursitis but resolution of trochanteric bursitis on the right and

with persistence of bilateral iliotibial band tendinitis which we have not been able to

treat but can start treating now. In 2 weeks we’ll start a careful stretching regimen

and then start introducing graded exercise program in a month and check her

progress in 2 months and hopefully she’ll be in a return to work at that point. She’ll

continue her mobic.” R. 485.

Ms. Harrison presented to Dr. Spalding on March 7, 2016 complaining of leg

and feet pain and bilateral hip pain. R. 465. She was diagnosed with bilateral leg and

foot pain, bilateral leg weakness, and chronic fatigue and received an injection in her

left trochanteric bursa. R. 467. Ms. Harrison underwent hip X-Rays that showed

“Alignment is anatomic without fracture or acute skeletal abnormality. Mild bilateral

degenerative osteoarthrosis of the hips noted.” R. 457. Ms. Harrison presented to Dr.

Spalding on March 14, 2016 complaining of bilateral hip and foot pain. R. 463. She

was diagnosed with trochanteric bursitis of both hips and was treated with an

injection in her right trochanteric bursa. R. 464.

Ms. Harrison returned to Dr. Spalding on September 20, 2016. R. 503. At this

visit, Dr. Spalding diagnosed her with chronic myofascial pain. R. 506. He noted

that there is “no clinical evidence on exam for rheumatoid arthritis or any other type

of systemic inflammatory arthritis.” R. 506. He also stated that Ms. Harrison has

“complete control of her trochanteric bursitis,” and “superimposed chronic

myofascial pain that did not get much improvement after controlling her trochanteric

bursitis.” R. 506. He recommended that her primary care physician or pain

management specialist “work on control of the myofascial pain,” and noted that Ms.

Harrison would try Flexeril. R. 506.

For primary care, Ms. Harrison was treated by Dr. Scott Dixon at Premier

Health Center. See R. 514. Ms. Harrison returned to Premier Health Center on

October 22, 2015 after falling on a bathtub and hurting her right ribs. R. 516. Ms.

Harrison returned to Premier Health Center on July 1, 2016 for leg pain and

hypertension. R. 515. Ms. Harrison returned to Premier Health Center on August 24,

2016 complaining of bodyaches, feet hurting all the time, and fatigue. R. 514. Ms.

Harrison returned to Premier Health Center on December 7, 2016. R. 522.

Ms. Harrison returned to Premier Health Center on April 27, 2017 to discuss

her disability paperwork. R. 517. She was assessed with chronic myofascial pain. R.

517. She returned for a six-month appointment on June 6, 2017. R. 520. Dr. Scott

Dixon of Premier Health Center wrote a letter dated June 12, 2017 that stated: “Mrs.

Harrison is disabled due to her diagnosis of chronic myofascial pain.” R. 519. Dr.

Dixon referred Ms. Harrison for an MRI of the lumbar spine without contrast for her

bilateral back and hip pain. R. 558. The July 18, 2017 MRI revealed “Facet

arthropathy at the lower 2 levels. No canal or foraminal stenosis. Tiny focal disc

protrusion in the right neural foramen at L4-5. No encroachment of the nerve

rootlet.” R. 558.

Dr. Dixon also referred Ms. Harrison to Dr. Charles Bell at Grandview

Rheumatology. R. 561. Ms. Harrison initially saw Dr. Bell on October 12, 2017. R.

565. She reported a history of narcolepsy and daytime sleepiness and taking herself

off of Provigil “due to change in attitude.” R. 566. Dr. Bell diagnosed her with

narcolepsy, myofascial pain, and plantar fasciitis, and referred her to physical

therapy. R. 567–68.

She saw Dr. Bell on November 21, 2017. Ms. Harrison reported continued

“hip discomfort” and “soft tissue pain.” R. 562. She also reported that she had “been

to PT; she is doing exercises. Pool therapy seems to be helpful.” R. 563. Ms.

Harrison reported being “unable to sleep due to pain in hips.” R. 563.

Dr. Dixon referred Ms. Harrison to Pulmonary & Sleep Associates of Jasper

in December 2017. R. 664. Ms. Harrison noted that her foot pain was “thought to be

worsened because she is not getting restorative sleep (per rheumatologist).” R. 664.

She also reported that her pain has progressively gotten worse. R. 664.

Ms. Harrison was seen by North Central Neurology Associates on January 3,

2018 for “progressive weakness.” R. 677. Ms. Harrison was referred “for very

typical fibromyalgia type pain,” and “describe[d] severe pain to the point that her

bed sheets cannot touch her feet.” R. 677. She was started on “very low-dose

Cymbalta for fibromyalgia.” R. 679. Ms. Harrison returned on March 14, 2018 to

follow up. R. 705. She stated that “Cymbalta did nothing for her fibromyalgia” and

she was “still having pain in hips and legs.” R. 705. The C-reactive protein test was

repeated, Ms. Harrison was given Trezix, and was advised to continue pool therapy.

R. 711. Based upon the results of the C-reactive protein test, Ms. Harrison was to

follow up with Dr. Bell. R. 712. Ms. Harrison returned on June 21, 2018 for a routine

follow-up appointment. R. 761. Ms. Harrison stated that she was seeing the

neurologist to follow up on headaches, fibromyalgia, weakness, and numbness and

that her rheumatologist wanted “to more aggressively treat her pain.” R. 761. The

visit notes indicate that the “[s]everity of pain is substantial without meds, but doing

very well with current medications.” R. 761. Ms. Harrison reported currently taking

Neurontin, Cymbalta, trezix, Vitamin D, and occasionally Vyvanse. R. 761. The plan

was to refill Cymbalta and trezix and for Ms. Harrison to continue on Vitamin D. R.

764. The neurologist noted that Ms. Harrison “may need additional scans and

possible pain clinic referral.” R. 764.

Ms. Harrison reported to Dr. Bell at Grandview Rheumatology on April 13,

2018 with bilateral hip, shoulder, and leg pain, especially leg pain at night. R. 903,

905. Although she was not doing PT, she was going to the gym three days a week

and walking on the treadmill, using mechanical massage, and a tanning bed. R. 905.

Dr. Bell advised that she continue exercising and stretching, try Cymbalta and

Neurontin, and return in six weeks. R. 907. Ms. Harrison reported to Dr. Bell at

Grandview Rheumatology on May 25, 2018. R. 899. She rated her pain at a five and

stated that “[b]oth legs are aching.” R. 899. She reported that the hip stretches were

not helpful for managing symptoms, she is on “a mild pain medication . . . which

has been only of modest benefit,” and she is walking some. R. 901. Dr. Bell noted

that “the current findings were most suggestive of a rheumatic condition related to

the underlying sleep disorder.” R. 902. He increased her Klonopin, encouraged

exercises and stretching, and advised her to return in six weeks. R. 903. Ms. Harrison

reported to Dr. Bell at Grandview Rheumatology on July 13, 2018. R. 895. At that

visit, she complained that her hips were “really hurting,” “the injections only last a

little while,” and that she “tried PT also for hips” but did not get much help. R. 895.

She reported that she weaned herself off Klonopin because of memory problems. R.

895. She requested “stronger pain medications for back and hip pain.” R. 897. Dr.

Bell started her on Norco, encouraged her to continue exercises and stretching, and

to return in three months. R. 899. Ms. Harrison reported to Dr. Bell at Grandview

Rheumatology on April 2, 2019. R. 890. She reported “more knee pain, foot and hip

pain.” R. 892. She also reported walking at the gym up to three miles on some

occasions and stretching. R. 892. Her Neurontin dose was 900 mg, but she was off

Cymbalta. R. 892, 894. She also reported that “PT is too expensive,” and she was

“[u]sing a tanning bed.” R. 892. She was encouraged to return in three months,

continue Norco, and continue exercises and stretching. R. 894. Ms. Harrison

reported to Dr. Bell at Grandview Rheumatology on August 15, 2019, and stated she

was experiencing foot and hip pain, joint swelling in her ankles, and morning

stiffness. R. 887. Dr. Bell increased her Norco and prescribed Prednisone. R. 889.

She was also advised to stop taking Ibuprofen for pain control due to chronic kidney

disease. R. 890. Ms. Harrison reported to Dr. Bell at Grandview Rheumatology on

November 21, 2019. R. 968. She was “unable to tolerate steroids” and had “not

be[en] going for exercise.” R. 972. Dr. Bell increased her Norco, advised her to avoid

all NSAIDs, and advised her to return in four months. R. 972.

Ms. Harrison reported to Dr. Bell at Grandview Rheumatology on May 11,

2020 for a three-month check-up and medication refills. R. 1053. She reported

having more pain going up and down stairs and requested pain medications. R. 1057.

Dr. Bell increased her Norco, advised her to avoid all NSAIDs, encouraged exercise

and conditioning, and advised her to return in three months. R. 1059.

IV. Standard of Review

This court’s role in reviewing claims brought under the Act is a narrow one.

The only issues before this court are whether the record reveals substantial evidence

to sustain the ALJ’s decision, see 42 U.S.C. § 405(g); Walden v. Schweiker, 672 F.2d

835, 838 (11th Cir. 1982), and whether the correct legal standards were applied, see

Lamb v. Bowen, 847 F.2d 698, 701 (11th Cir. 1988); Chester v. Bowen, 792 F.2d

129, 131 (11th Cir. 1986). The Act mandates that the Commissioner’s findings are

conclusive if supported by “substantial evidence.” Martin v. Sullivan, 894 F.2d 1520,

1529 (11th Cir. 1990); see 42 U.S.C. § 405(g). This court may not reconsider the

facts, reevaluate the evidence, or substitute its judgment for that of the

Commissioner; instead, it must review the record as a whole and determine if the

decision is reasonable and supported by substantial evidence. See Martin, 894 F.2d

at 1529 (citing Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)).

Substantial evidence falls somewhere between a scintilla and a preponderance

of evidence; “[i]t is such relevant evidence as a reasonable person would accept as

adequate to support a conclusion.” Martin, 894 F.2d at 1529 (quoting Bloodsworth,

703 F.2d at 1239). If the Commissioner’s factual findings are supported by

substantial evidence, they must be affirmed even if the preponderance of the

evidence is against the Commissioner’s findings. See Martin, 894 F.2d at 1529. No

decision is automatic, for “[d]espite th[e] deferential standard [for review of claims],

it is imperative that th[is] Court scrutinize the record in its entirety to determine the

reasonableness of the decision reached.” Bridges v. Bowen, 815 F.2d 622, 624 (11th

Cir. 1987) (citing Arnold v. Heckler, 732 F.2d 881, 883 (11th Cir. 1984)). Failure to

apply the correct legal standards is grounds for reversal. See Bowen v. Heckler, 748

F.2d 629, 635 (11th Cir. 1984).

V. Discussion

Ms. Harrison alleges that the ALJ’s decision should be reversed and remanded

because: (1) the Appeals Council failed to properly consider new evidence; (2) the

ALJ failed to properly consider the medical evidence of record; (3) the ALJ failed

to consider Dr. Dixon’s opinion; and (4) the ALJ improperly evaluated Ms.

Harrison’s credibility. Doc. 13 at 14, 18.

A. New Evidence

A claimant may present new evidence at each stage of the administrative

process, including to the Appeals Council. Ingram v. Comm’r, 496 F.3d 1253, 1261

(11th Cir. 2007). The Appeals Council will review a case if it “receives additional

evidence that is new, material, and relates to the period on or before the date of the

hearing decision, and there is a reasonable probability that the additional evidence

would change the outcome of the decision.” 20 C.F.R. § 404.970(a)(5).

Evidence is not new when it is cumulative of evidence already submitted to

the ALJ. Clough v. Comm’r, 813 F. App’x 436, 443 (11th Cir. 2020). Evidence is

material when it is “relevant and probative so that there is a reasonable possibility

that it would change the administrative result.” Milano v. Bowen, 809 F.2d 763, 766

(11th Cir. 1987). New evidence is chronologically relevant if “it relates to the period

on or before the date of the [ALJ] hearing decision.” 20 C.F.R. § 404.970(a)(5).

Medical opinions based on treatment occurring after the date of the ALJ’s decision

may still be chronologically relevant if they relate back to a time on or before the

ALJ’s decision. Washington v. Comm’r, 806 F.3d 1317, 1322 (11th Cir. 2015).

The Appeals Council is not required to provide a detailed rationale for why

each piece of new evidence fails to change the ALJ’s conclusion. Mitchell v.

Comm’r, 771 F.3d 780, 784 (11th Cir. 2014). The court reviews de novo whether

supplemental evidence is new, material, and chronologically relevant. Washington,

806 F.3d at 1321.

Ms. Harrison submitted evidence to the Appeals Council from a September

21, 2020 visit to Pulmonary and Sleep Associates of Jasper. R. 1308–11. Ms.

Harrison presented to Nurse Practitioner Dunagan to “follow up for narcole[ps]y.”

R. 1308. The History of Present Illness states: “She does have narcolepsy. She is

having trouble sleeping at night. She reports once she is falling asleep it is hard to

wake her up. She feels she could sleep all through the day. Patient has been tried on

Adderall but reports this caused massive headaches. Patient has also tried Provigil

and Nuvigil. She was on high doses of Provigil and felt she was addicted to it.” R.

1308. Ms. Harrison also reported that she “normally goes to bed from 10pm – 10am.”

R. 1308. Ms. Harrison stated it took “hours to fall asleep,” and she “experience[s]

nocturia so she wakes up several times per night.” R. 1308. The History of Present

Illness also states that Ms. Harrison has “extreme daytime sleepiness, ESS=14,” and

she “feels like she is only able to stay awake for 2 hours at a time[,] and then she is

extremely sleepy during the day[,] but at night, she has trouble falling to sleep and

staying asleep.” R. 1308. Ms. Harrison’s past medical history included “Narcolepsy

without cataplexy.” R. 1308. It was noted that she would try the medication Wakix,

but that although Nurse Dunagan thought Xyrem would be a good medication

“because it would help induce a deeper night time sleep,” Ms. Harrison had

researched the drug and did not want to try it. R. 1308.

Ms. Harrison complained of body aches and fatigue, but denied muscle

weakness, muscle swelling, joint weakness, joint stiffness, and joint inflammation.

R. 1309. The physical exam revealed no joint or limb tenderness, and Ms. Harrison

had normal gait, the ability to stand without difficulty, normal muscle tone, and

normal strength. R. 1310.

In addition to narcolepsy, Ms. Harrison was also diagnosed with sleep

disturbance, which was described as “trouble sleeping at night but extreme

sleepiness during the day.” R. 1311.

The Appeals Council “considered the reasons” Ms. Harrison “disagree[d]

with the [ALJ] decision.” R. 1. The Appeals Council “found that the reasons do not

provide a basis for changing the [ALJ’s] decision.” R. 1. The Appeals Council’s

determination specifically referenced the five pages of “Additional Evidence”

submitted by Ms. Harrison. R. 2. The Appeals Council concluded that the “additional

evidence does not relate to the period at issue.” R. 2.

The Appeals Council did not err in finding that the “additional evidence does

not relate to the period at issue.” R. 2. With respect to the additional evidence, Ms.

Harrison presented to Pulmonary and Sleep Associates of Jasper where she had a

treatment history. Medical providers from that clinic treated her narcolepsy from

2006 to 2010, in 2017, and in April 2018. Additionally, the additional evidence states

that Ms. Harrison presented to “follow up for narcole[ps]y.” R. 1308. However, there

is no indication that the information in the additional evidence related to the period

at issue – namely, the alleged onset date of September 26, 2018 through the date of

the ALJ’s decision, September 2, 2020. Nor could it be argued that the past medical

records at Pulmonary and Sleep Associates of Jasper related to that period because

Ms. Harrison was not treated as a patient after her alleged onset date until after the

date of the ALJ’s decision. The question before the court is whether Ms. Harrison

was “entitled to benefits during a specific period of time, which period was

necessarily prior to the date of the ALJ’s decision.” Wilson v. Apfel, 179 F.3d 1276,

1279 (11th Cir. 1999).

In any event, even if the additional evidence were chronologically relevant, it

does not change the result. First, the additional evidence is generally cumulative of

evidence already submitted to the ALJ because it reiterated Ms. Harrison’s

previously identified narcolepsy diagnosis, as well as nighttime sleep issues and

daytime sleepiness. It also referenced her medication history and her hesitancy at

trying Xyrem, both of which were discussed elsewhere in the medical record.

Second, the additional evidence is not material because there is not a reasonable

probability that it would change the administrative result because it reiterated what

was established in Ms. Harrison’s medical history and hearing testimony. Even

without the additional evidence, the ALJ identified Ms. Harrison’s narcolepsy as a

severe impairment in her disability determination.

B. Totality of Medical Evidence

An ALJ’s review “must take into account and evaluate the record as a whole.”

McCruter v. Bowen, 791 F.2d 1544, 1548 (11th Cir. 1986). There is no rigid

requirement that the ALJ specifically refer to every piece of evidence in his decision.

Jacobus v. Comm’r of Soc. Sec., 664 F. App’x 774, 776 (11th Cir. 2016). Instead,

the ALJ must consider the medical evidence as a whole and not broadly reject the

evidence in the record. Id. Erroneous statements of fact in the ALJ’s decision are

harmless when they do “not affect the ALJ’s ultimate determination.” Id. at 775-76;

see Diorio v. Heckler, 721 F.2d 726, 728 (11th Cir. 1983) (finding ALJ’s errors were

harmless when substantial evidence supported ALJ’s determination).

Ms. Harrison’s argument that the “ALJ failed to properly consider the totality

of the medical evidence” is two-fold. Doc. 13 at 18. First, she alleges that “the ALJ

stated [she] was not treated for her narcolepsy, but the ALJ’s conclusion is simply

untrue.” Id. Second, she alleges that the ALJ “cherry-picked portions of the record”

as it relates to physical pain and symptoms. Id. at 20.

The Commissioner argues that “the treatment records [Ms. Harrison] cites do

not at all contradict the ALJ’s statement that [her] narcolepsy was untreated in

September 2020.” Doc. 15 at 12. Additionally, the Commissioner argues that the

ALJ “weigh[ed] the evidence” and “carefully considered all of the medical

evidence,” including “positive findings on exam.” Id. at 14 (cleaned up).

When discussing Ms. Harrison’s narcolepsy and physical pain, the ALJ

initially identified both narcolepsy and osteoarthritis as severe impairments,

meaning they “constitute more than slight abnormalities and have more than a

minimal effect on the claimant’s ability to perform basic activities for a continuous

period of 12 months.” R. 13. The ALJ went on to determine Ms. Harrison’s residual

functional capacity. R. 17–20. In performing this administrative function, the ALJ

considered Ms. Harrison’s “symptoms and the extent to which these symptoms can

reasonably be accepted as consistent with the objective medical evidence and other

evidence.” R. 17.

The ALJ described Ms. Harrison’s testimony as:

The claimant alleges an inability to work due to narcolepsy

and chronic myofascial pain. She testified that she has had

narcolepsy for 15 years and it has worsened. She alleges

excruciating pain. She alleges she cannot sleep well due to

pain, and when she does it is miserable sleep. She alleges

that if she must drive, she drinks a Red Bull to stay awake.

R. 18. The ALJ acknowledged that “the evidence shows a history of treatment for

these impairments.” R. 18. With respect to Ms. Harrison’s narcolepsy, the ALJ also

stated:

In fact, the claimant was once in treatment for narcolepsy

but is not currently, so her underlying sleep disorder goes

untreated.

A review of the claimant’s treatment records from her

various providers, including Dr. Bell, her rheumatologist,

shows that she has not been back to her sleep specialist.

Dr. Bell offered her Xysal for narcolepsy, but she turned

it down because she was afraid of going into a deep sleep

at night when her husband was away, even though at the

hearing she reported she was always tired because she did

not sleep well. When offered medication, she turned it

down. She stopped taking Klonopin on her own, without

discussing it with her doctor, because her family felt she

was losing her memory.

R. 18.

The ALJ specifically acknowledged Ms. Harrison’s testimony regarding a

fifteen-year struggle with narcolepsy that had gotten worse. R. 18. The record is void

of treatment records from her sleep specialist from the alleged onset date through

the date of decision related to Ms. Harrison’s narcolepsy. See supra Section III.A.

As correctly noted by Ms. Harrison, she did report her narcolepsy and related

symptoms and medication struggles to both her primary care physician and Dr. Bell,

her rheumatologist, during the relevant period. See id.; R. 888, 934, 1241. In her

decision, the ALJ specifically discussed Ms. Harrison’s visit to Dr. Bell as well as

Dr. Bell’s opinion that Ms. Harrison’s physical symptoms were related to her

underlying sleep disorder. R 16, 18. Additionally, the ALJ acknowledged Ms.

Harrison’s reasons for not taking medication for narcolepsy. R. 18. The court

discerns no error in the ALJ’s treatment of the medical records related to narcolepsy.

Instead, substantial evidence supports the ALJ’s finding that while Ms. Harrison’s

narcolepsy was a severe impairment, her medical treatment records did not support

that she had disabling limitations as a result of her narcolepsy or limitations in her

residual functional capacity beyond those assessed.

When discussing Ms. Harrison’s pain, the ALJ identified osteoarthritis as a

severe impairment, R. 13, and evaluated her allegations of fibromyalgia and

determined it was not a medically determinable impairment under the SSA’s policy

interpretation, R. 14–15. The ALJ acknowledged that she “considered [Ms.

Harrison’s] complaints of myofascial pain as a severe medically determinable

impairment that restricts her ability to perform some of the demands of work.” R.

16. The ALJ referenced Ms. Harrison’s treatment by her rheumatologist, Dr. Bell,

and his assessment that her “physical findings are most suggestive of a rheumatic

condition related to the underlying sleep disorder.” R. 16 (cleaned up). The ALJ also

determined that Ms. Harrison’s osteoarthritis did not meet a listing because she “is

still able to ambulate effectively and perform fine and gross movements effectively.”

R. 16–17.

In formulating her residual functional capacity, the ALJ stated that:

[Ms. Harrison] complained of foot, knee, and hip pain and

[was] diagnosed with myofascial pain. She was initially in

physical therapy (PT) and doing well with exercise and

pool therapy, but she eventually stopped. She reported she

was no longer going to PT, but was going to the gym

several times a week and walking on the treadmill, getting

mechanical massages, and going to the tanning bed.

In addition, [Ms. Harrison’s] physical examinations show

no significant abnormalities. She has had some tenderness

in her fingers, elbows, shoulders, hips, and spine due to

myofascial pain, but she has normal gait and station,

ambulates normally, and her sensation is grossly intact.

Her gynecologist even noted normal gait and station. She

was taking Cymbalta, but she stopped. She was prescribed

Norco and Prednisone. She had a magnetic resonance

image (MRI) of her left hip and it was negative. An

electromyogram (EMG) and nerve conduction studies

(NCS) of her legs were negative. Dr. Bell consistently

noted at various visits that [her] physical findings are

“most suggestive of a rheumatic condition related to the

underlying sleep disorder”.

[Ms. Harrison] reported a pain level of 6 on November 21,

2019, so her Norco dosage was increased, but despite the

pain, she is able to perform her activities of daily living

(ADLs) with little difficulty. During a recent telephone

appointment, [Ms. Harrison] reported increased pain

because she was going up and down the steps at her

daughter’s home in South Carolina, where she was

currently staying.

R. 18–19 (internal citations omitted). After discussing this medical evidence, the

ALJ determined that Ms. Harrison’s “impairments would reasonably limit her to

light work as heavy lifting and carrying and prolonged standing and walking may

exacerbate her pain.” R. 19–20. The ALJ also imposed other limitations on Ms.

Harrison’s residual functional capacity in an effort to not exacerbate pain and as a

safety precaution to account for pain such as: limiting her ability to climb, limiting

her ability to perform certain postural maneuvers, limiting exposure to hazards,

limiting her exposure to environments that are known pain triggers, and giving her

a sit/stand option. R. 20. In light of the residual functional capacity, the ALJ

determined that Ms. Harrison was unable to perform her past relevant work as a

teacher. R. 20.

The ALJ’s decision demonstrates that she considered the entire record and did

not cherry-pick facts. She assessed medical records from various sources and cited

them throughout her findings. R. 15–20. The ALJ specifically cited positive

findings, Ms. Harrison’s complaints of pain to her doctors, and her use of pain

medication to manage her symptoms. And, the ALJ took care to incorporate Ms.

Harrison’s complaints of pain into her residual functional capacity, as well as

imposing additional limitations to account for and not exacerbate that pain. The

ALJ’s findings are supported by substantial evidence.

C. Dr. Scott Dixon’s Opinion

SSA regulations provide that “[s]tatements on issues reserved to the

Commissioner[]” are “neither valuable nor persuasive to the issue of whether [a

claimant is] disabled” and the SSA “will not provide any analysis about how we

considered such evidence in [the] determination or decision. 20 C.F.R. §

404.1520b(c)(3). Statements on issues reserved to the Commissioner include: (i)

Statements that a claimant is or is not disabled, blind, able to work, or able to perform

regular or continuing work; (ii) Statements about whether or not a claimant has a

severe impairment(s); (iii) Statements about whether or not a claimant’s

impairment(s) meets the duration requirement of the SSA; (iv) Statements about

whether or not a claimant’s impairment(s) meets or medically equals any listing; (v)

Statements about what a claimant’s residual functional capacity is using the agency’s

programmatic terms about the functional exertional levels instead of descriptions

about the claimant’s functional abilities and limitations; (vi) Statements about

whether or not a claimant’s residual functional capacity prevents her from doing past

relevant work; (vii) Statements that a claimant does or does not meet the

requirements of medical-vocational rule; and (viii) Statements about whether or not

a claimant’s disability continues or ends when the agency conducts a continuing

disability review. Id.

In contrast, under the regulations, “[a] medical opinion is a statement from a

medical source about what [a claimant] can still do despite [her] impairment(s) and

whether [she] has one or more impairment-related limitations or restrictions” in

listed abilities, including the “ability to perform physical demands of work activities,

such as sitting, standing, walking, lifting, carrying, pushing, pulling, or other

physical functions (including manipulative or postural functions, such as reaching,

handling, stooping, or crouching).” 20 C.F.R. § 404.1513(a)(2)(i).

At issue is a one-page “Attending Physicians Statement” submitted to

American Fidelity. R. 926. Dr. Scott Dixon, a primary care physician at Premier

Health Center, is listed as the Attending Physician. R. 926. However, the form was

completed by Nurse Practitioner Amanda Barton, and signed by Dr. Dixon. R. 926.

The Attending Physicians Statement lists narcolepsy and chronic myofascial pain as

Ms. Harrison’s diagnoses. R. 926. Under prognosis, the box “yes” is checked next

to these questions: “Is patient now Disabled? For Regular occupation?” and “For

any Occupation?” R. 926. Additionally selected is a Class 5 level of impairments,

“Severe limitation of functional capacity; [i]ncapable of minimum sedentary activity

*(75-100%).” R. 926. Finally, in the functional limitations/restrictions section,

Nurse Barton wrote: “Patient is unable to stand to teach” and “Chronic Myofascial

Pain.” R. 926.

With respect to this evidence, the ALJ stated: “Dr. Dixon opined that the

claimant is unable to teach due to chronic myofascial pain, but this is an issue

reserved to the Commissioner based on all the evidence.” R. 19 (cleaned up).

Ms. Harrison argues that “[t]he ALJ erroneously afforded no weight to the

opinions of Dr. Scott Dixon” and incorrectly concluded that “Dr. Dixon’s opinion is

an issue reserved to the Commissioner.” Doc. 13 at 21. Ms. Harrison also alleges

that the “ALJ mischaracterize[d] Dr. Dixon’s opinions.” Id. The Commissioner

argues that none of the statements “constituted a medical opinion within the meaning

of the regulations” and “were all statements on issues reserved to the

Commissioner.” Doc. 15 at 17.

The Attending Physicians Statement contained statements on issues reserved

for the Commissioner, and the ALJ properly refrained from providing analysis on

how those statements impacted her decision. First, the questions under the Prognosis

section expressly asked Nurse Barton and Dr. Dixon whether Ms. Harrison was

disabled. Second, the selection of a level of impairments in the Impairments section

specified a functional exertional level under the regulations – sedentary – and

classified Ms. Harrison’s impairments as severe. Third, Nurse Barton attested that

Ms. Harrison was unable to perform her past work. The ALJ did not err in her

treatment of these statements. Importantly, the ALJ agreed with Nurse Barton and

Dr. Dixon on Ms. Harrison’s standing limitations. In fact, the ALJ specifically found

that Ms. Harrison could not perform her past relevant work, limited Ms. Harrison to

light work with additional restrictions, and imposed a sit/stand option.

D. Credibility Determination

A claimant’s subjective complaints are insufficient to establish a disability.

See 20 C.F.R. § 416.929(a); Edwards v. Sullivan, 937 F.2d 580, 584 (11th Cir. 1991).

Subjective testimony of pain and other symptoms may establish the presence of a

disabling impairment if it is supported by medical evidence. See Foote v. Chater, 67

F.3d 1553, 1561 (11th Cir. 1995). The Eleventh Circuit applies a two-part pain

standard when a claimant claims disability due to pain or other subjective symptoms.

The claimant must show evidence of an underlying medical condition and either (1)

objective medical evidence that confirms the severity of the alleged symptoms

arising from the condition, or (2) that the objectively determined medical condition

is of such severity that it can reasonably be expected to give rise to the alleged

symptoms. See 20 C.F.R. § 416.929(a), (b); Social Security Ruling 16-3p, 2017 WL

5180304, at *3–*4 (Oct. 25, 2017) (“SSR 16-3p”); Wilson v. Barnhart, 284 F.3d

1219, 1225 (11th Cir. 2002).

If the first part of the pain standard is satisfied, the ALJ then evaluates the

intensity and persistence of a claimant’s alleged symptoms and their effect on her

ability to work. See 20 C.F.R. § 416.929(c); Wilson, 284 F.3d at 1225–26. In

evaluating the extent to which a claimant’s symptoms affect his capacity to perform

basic work activities, the ALJ will consider (1) objective medical evidence, (2) the

nature of a claimant’s symptoms, (3) the claimant’s daily activities, (4) precipitating

and aggravating factors, (5) the effectiveness of medication, (6) treatment sought for

relief of symptoms, (7) any measures the claimant takes to relieve symptoms, and

(8) any conflicts between a claimant’s statements and the rest of the evidence. See

20 C.F.R. § 416.929(c)(3), (4); SSR 16-3p at *4, *7–*8. “In determining whether a

claimant’s impairments limit [his] ability to work, the ALJ considers the claimant’s

subjective symptoms, which includes the effectiveness and side effects of any

medications taken for those symptoms.” Walker v. Comm’r, 404 F. App’x 362, 366

(11th Cir. 2010). To discredit a claimant’s statements, the ALJ must clearly

“articulate explicit and adequate reasons.” See Dyer, 395 F.3d at 1210.

An ALJ’s review “must take into account and evaluate the record as a whole.”

McCruter v. Bowen, 791 F.2d 1544, 1548 (11th Cir. 1986). There is no rigid

requirement that the ALJ specifically refer to every piece of evidence in his decision.

Jacobus v. Comm’r of Soc. Sec., 664 F. App’x 774, 776 (11th Cir. 2016). Instead,

the ALJ must consider the medical evidence as a whole and not broadly reject the

evidence in the record. Id.

A credibility determination is a question of fact subject only to limited review

in the courts to ensure the finding is supported by substantial evidence. See Hand v.

Heckler, 761 F.2d 1545, 1548–49 (11th Cir. 1985), vacated for rehearing en banc,

774 F.2d 428 (11th Cir. 1985), reinstated sub nom., Hand v. Bowen, 793 F.2d 275

(11th Cir. 1986). The Eleventh Circuit will not disturb a clearly articulated finding

supported by substantial evidence. Mitchell v. Comm’r, Soc. Sec. Admin., 771 F.3d

780, 782 (11th Cir. 2014). However, a reversal is warranted if the decision contains

no indication of the proper application of the pain standard. See Ortega v. Chater,

933 F. Supp. 1071, 1076 (S.D.F.L. 1996) (holding that the ALJ’s failure to articulate

adequate reasons for only partially crediting the plaintiff’s complaints of pain

resulted in reversal). “The question is not . . . whether [the] ALJ could have

reasonably credited [claimant’s] testimony, but whether the ALJ was clearly wrong

to discredit it.” Werner v. Comm’r of Soc. Sec., 421 F. App’x 935, 939 (11th Cir.

2011).

After explaining the pain standard, the ALJ considered Ms. Harrison’s

testimony about her symptoms to make her credibility determination. R. 17–20. The

ALJ described that testimony as follows:

The claimant alleges an inability to work due to narcolepsy

and chronic myofascial pain. She testified that she has had

narcolepsy for 15 years and it has worsened. She alleges

excruciating pain. She alleges she cannot sleep well due to

pain, and when she does it is miserable sleep. She alleges

that if she must drive, she drinks a Red Bull to stay awake.

R. 18. The ALJ “considered all symptoms and the extent to which these symptoms

can reasonably be accepted as consistent with the objective medical evidence and

other evidence.” R. 17. The ALJ acknowledged that the “evidence shows a history

of treatment for” narcolepsy and chronic myofascial pain. R. 18. The ALJ stated:

[Ms. Harrison’s] statements concerning the intensity,

persistence[,] and limiting effects of these impairments are

not consistent with the objective medical evidence. [Ms.

Harrison] alleges debilitating symptomatology and

limitations associated with her alleged impairments, yet

the evidence as a whole fails to confirm a disabling level

of functional limitations caused by any physical or mental

impairment. The description of the symptoms and

limitations, which [Ms. Harrison] has provided throughout

the record, has generally been inconsistent and

unpersuasive. While it is reasonable [Ms. Harrison] may

experience some symptoms that would cause some

exertional and non-exertional limitations, the objective

medical evidence does not support a complete inability to

work.

R. 18.

The ALJ considered the objective medical evidence during the relevant period

from Ms. Harrison’s rheumatologist, primary care doctor, and gynecologist. R. 18–

19. The ALJ discussed that Ms. Harrison “was doing well with exercise and pool

therapy,” had been to physical therapy, and was going to the gym and walking on

the treadmill. R. 18. While Ms. Harrison’s examinations showed tenderness and her

pain was treated with pain medicine, she had normal gait and station and ambulated

normally. R. 18. After considering this medical evidence along with the function

reports and hearing testimony, the ALJ concluded that

[Ms. Harrison’s] impairments would reasonably limit her to

light work as heavy lifting and carrying and prolonged

standing and walking may exacerbate her pain. For the same

reason, she is limited in her ability to climb and to perform

certain postural maneuvers that could exacerbate pain. Due to

possible slower reaction time due to pain, as a safety

precaution, [Ms. Harrison] is precluded from climbing

ladders, ropes, or scaffolds and from any exposure to hazards.

She is precluded from climbing ladders, ropes, or scaffolds

also because these pose a fall risk that could exacerbate pain

and cause new or further injury. She should avoid

concentrated exposure to extreme cold, heat, and vibration as

these environments are known pain triggers. She should avoid

fumes, odors, and other pulmonary irritants due to the

combination of her impairments. Due to OA, she would need

the option to sit or stand in performance of her job duties but

would remain on task.

R. 19–20.

Ms. Harrison again argues that the ALJ “cherry-pick[ed] facts that support her

assessment” and “failed to adequately evaluate her credibility.” Doc. 13 at 23. She

also argues that “[t]he ALJ fails to recognize that M[s]. Harrison received regular

treatment for severe and chronic pain and the medical evidence corroborates the

existence of pain.” Id. at 25. Ms. Harrison also argues that the “ALJ insinuates [she]

was non-compliant with physical therapy” and “discredits Ms. Harrison based on the

function report.” Id. at 26. The Commissioner argues that Ms. Harrison does not

identify any evidence the ALJ ignored and disagrees with Ms. Harrison’s

interpretation of the ALJ’s opinion. Doc. 15 at 21.

Substantial evidence supports the ALJ’s finding under the pain standard. The

ALJ specifically discussed Ms. Harrison’s long-time treatment for her impairments,

her positive exam findings, and her need for pain medication. In fact, she crafted her

residual functional capacity with additional limitations taking Ms. Harrison’s pain

(and desire not to exacerbate it) into account.

In analyzing Ms. Harrison’s testimony, the ALJ clearly discussed the

objective medical evidence. The ALJ’s decision indicates that she considered the

medical evidence as a whole and did not broadly reject the evidence in the record.

The ALJ mentioned that Ms. Harrison was no longer doing physical therapy in the

context of her explanation that Ms. Harrison’s subjective complaints were

inconsistent with the medical evidence in the record – namely, that Ms. Harrison had

been doing well with various therapy and exercising at the gym by walking on the

treadmill. With respect to Ms. Harrison’s function report, the ALJ simply stated that

she had considered it along with the other evidence in the record and pursuant to the

applicable regulations in forming her residual functional capacity.

The ALJ was not “clearly wrong” to discredit Ms. Harrison’s subjective

complaints. See Werner, 421 F. App’x at 938–39. Additionally, Ms. Harrison has

pointed to no evidence that would compel a different conclusion from that found by

the ALJ. There is no evidence in the record to support Ms. Harrison’s testimony that

her narcolepsy and pain prevents light work with the restrictions identified by the

ALJ. Accordingly, there is no error in the ALJ’s consideration of Ms. Harrison’s

subjective complaints.

VI. Conclusion

Upon review of the administrative record, the court finds the Commissioner’s

decision is supported by substantial evidence and in accord with the applicable law.

A separate order will be entered.

DONE and ORDERED this 29th day of September, 2022.

ANNA M. hans.

UNITED STATES DISTRICT JUDGE

38