Combs v. Commissioner of Social Security

          OPINION AND ORDER

          SUSAN COLLINS, UNITED STATES MAGISTRATE JUDGE

         Plaintiff 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”).^[2] (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.

         I. PROCEDURAL HISTORY

         Combs 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.

         Combs 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).

         II. FACTUAL BACKGROUND^[3]

         At the 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).

         A. Combs's Testimony at the Hearing

         Combs 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).

         Combs 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 56).

         When 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).

         Combs 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 44-45).

         When 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).

         B. Summary of the Relevant Medical Evidence

         On 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).

         On 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).

         On 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).

         On 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 ...