United States District Court, N.D. Indiana, Fort Wayne Division
TAMMY N. COMBS, Plaintiff,
COMMISSIONER OF SOCIAL SECURITY, sued as Nancy A. Berryhill, Acting Commissioner of Social Security Administration,  Defendant.
OPINION AND ORDER
COLLINS, UNITED STATES MAGISTRATE JUDGE
Tammy N. Combs appeals to the district court from a final
decision of the Commissioner of Social Security
(“Commissioner”) denying her application under
the Social Security Act (the “Act”) for
Disability Insurance Benefits (“DIB”) and
Supplemental Security Income
(“SSI”). (DE 1). For the following reasons, the
Commissioner's decision will be REVERSED, and the case
will be REMANDED to the Commissioner for further proceedings
in accordance with this Opinion and Order.
applied for DIB and SSI alleging disability as of January 23,
2013. (DE 11 Administrative Record (“AR”)
166-81). The Commissioner denied Combs's application
initially and upon reconsideration. (AR 105-23). After a
timely request, a hearing was held on November 21, 2014,
before Administrative Law Judge Steven Neary (“the
ALJ”), at which Combs, who was represented by counsel,
and a vocational expert, Robert Barkhaus (the
“VE”), testified. (AR 34-62). On January 21,
2014, the ALJ rendered an unfavorable decision to Combs,
concluding that she was not disabled because despite the
limitations caused by her impairments, she could perform a
significant number of light-exertional jobs in the economy,
including cashier, sales attendant, and cafeteria attendant.
(AR 17-28). The Appeals Council denied Combs's request
for review (AR 1-3), at which point the ALJ's decision
became the final decision of the Commissioner. See
20 C.F.R. §§ 404.981, 416.1481.
filed a complaint with this Court on May 19, 2016, seeking
relief from the Commissioner's final decision. (DE 1).
Combs advances several arguments in this appeal, asserting
that the ALJ: (1) failed to account for all of her severe and
non-severe impairments, and the combination thereof, when
assessing her residual functional capacity
(“RFC”); (2) failed to properly evaluate her
obesity; and (3) improperly discounted the credibility of her
symptom testimony by failing to give weight to her strong
work history and by overemphasizing her daily activities,
including that she was the caregiver for her disabled son.
(DE 20 at 14-22).
time of the ALJ's decision, Combs was 46 years old (AR
166); had a high school diploma and an associate's degree
(AR 37, 206); and possessed past work experience as a
licensed practical nurse (AR 207). In her application, she
alleged disability due to hypertension, anemia, depression,
heart disease, hypothyroidism, parathyroidism, anxiety,
diabetes, obesity, migraines, and plantar fasciitis. (AR
205). Later, she also alleged pain in her back, hips, feet,
shoulders, and hands, as well as numbness in her shoulders
and hands. (AR 232-33).
Combs's Testimony at the Hearing
testified as follows at the hearing: Combs lives with her
husband and her 28-year-old autistic son. (AR 37). She is
five feet, two inches tall and weighed 222 pounds at the
time. (AR 37). She had not had health insurance for the past
few years. (AR 42).
stated that she could no longer work as a nurse due to
“emotional problems” that began after her mother
passed away. (AR 38). She experiences racing thoughts that
impair her concentration and her ability to work. (AR 43).
She frequently cries and gets very emotional. (AR 43). She
had started attending counseling earlier in the year. (AR
asked why she could not do some type of work other than
nursing, Combs stated that her carpal tunnel syndrome causes
numbness and tingling in her fingers and from her elbows to
her wrist, causes her to drop things, and prevents her from
lifting more than a gallon of milk. (AR 38-39, 45-46). She
had experienced carpal tunnel syndrome symptoms for years,
but it had worsened in the past two years. (AR 42).
also stated that a bulging disc in her neck prevents her from
raising her arms above shoulder level and causes her constant
pain from between her shoulder blades to the top of her neck.
(AR 39-41). She had the neck pain when she was still working,
but it had worsened in the past two years. (AR 50). She takes
Neurontin for these symptoms, which causes her side effects
of feeling dizzy, tired, and a dry mouth. (AR 40). Combs also
stated that her legs swell during the day and that she has to
lie down intermittently. (AR 41). This problem also occurred
while she was working, but it had recently worsened. (AR 50).
She estimated that she could stand for five minutes before
needing to move for 20 minutes, and that she could walk for
50 to 100 feet before needing to rest due to her legs
swelling. (AR 43-44, 52-53). For this problem, Combs elevates
her legs intermittently and takes Hydrochlorothiazide and
Lasix, which causes her to have to urinate frequently. (AR
41, 50-52). When asked whether she could perform a sedentary
job, Combs stated that sitting exacerbates her upper back
pain and that she can only sit for 30 minutes at a time. (AR
asked about her typical day, Combs testified that she
primarily stays home, watches television, and performs some
household tasks at her own pace. (AR 46-47, 53-54). She
cannot vacuum or sweep the floors due to pain in her arms.
(AR 47). She performs most of her self care independently,
but sometimes needs assistance with washing or combing her
hair or cleaning her bottom. (AR 47). She rarely drives a
car, but does drive to the grocery nearby. (AR 47-48). The
ALJ also asked Combs about information in the record
indicating that she was caring for not only her autistic son,
but also various other family members. (AR 48). Combs
responded that her sister had now moved in and was helping
her care for these family members. (AR 48).
Summary of the Relevant Medical Evidence
February 27, 2012, Combs saw Dr. Bret Kueber at DeKalb
Medical Services for her hypertension, diabetes, and
hyperlipidemia. (AR 263-65). Her symptoms included fatigue.
(AR 263). She had excellent compliance with medications and
was without medication side effects. (AR 264). A
musculoskeletal exam was normal, with full range of motion
and strength. (AR 264). She was advised to engage in regular
aerobic physical activity, such as brisk walking, for 30
minutes a day, most days of the week, and to avoid going
barefoot or wearing tight fitting shoes. (AR 265).
December 12, 2012, Combs went to the emergency room for
discomfort in her mid-chest and right scapular region. (AR
271). A physical examination was normal other than minimal
epigastric discomfort and trace edema in her ankles. (AR
271). Her blood pressure was initially 200/79, but during her
visit it normalized to 153/66. (AR 271-72). A chest X-ray was
normal. (AR 272). She was instructed to follow up with her
family physician. (AR 272).
February 11, 2013, Combs returned to the emergency room for a
headache and high blood pressure. (AR 268-69). Her blood
pressure was initially 188/88. (AR 268-69). However, after
medications were administered, her blood pressure reduced to
144/75, and her headache resolved. (AR 268-69). She was to
visit St. Martins Clinic the following day. (AR 268).
February 28, 2013, Andrew Miller, Psy.D., completed a mental
status exam at the request of the state agency. (AR 279-82).
Combs told Dr. Miller that she had no life because she takes
care of her husband who has dementia and her autistic son.
(AR 280). She described her typical day as performing
household chores, including cleaning, making the beds, and
vacuuming. (AR 281-82). She was taking several medications,
including Prozac, but did not think they were helping her;
she complained of fatigue as a medication side effect. (AR
280). On mental status exam, Combs demonstrated sufficient
attention, persistence, insight, understanding, and
concentration; she had a good memory and was a good
historian. (AR 282). Dr. Miller wrote that she was likely to
have good social interactions. (AR 282). He opined that
Combs's daily activities appeared to be simple and that
her ability to ...