Ina Watkins v. COmmissioner of Social Security

FILED
U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
FEBRUARY 9, 2012
JOHN LEY
CLERK
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 11-12678
Non-Argument Calendar
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D.C. Docket No. 3:10-cv-00100-TEM
INA WATKINS,
Plaintiff-Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Middle District of Florida
________________________
(February 9, 2012)
Before HULL, PRYOR and KRAVITCH, Circuit Judges.
PER CURIAM:
Appellant Ina Watkins appeals the magistrate judge’s order affirming the

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Social Security Commissioner’s denial of her applications for disability insurance
benefits, 42 U.S.C. § 405(g), and supplemental security income (“SSI”) benefits,
42 U.S.C. § 1383(c)(3). After review, we vacate and remand for additional1
proceedings consistent with this opinion.
I. FACTUAL BACKGROUND
In October 2003, Watkins filed an application for disability and SSI
benefits, alleging that she was unable to work as of October 6, 2003, due to carpal
tunnel syndrome and chronic neck pain resulting from a 1988 injury to her neck
and several subsequent cervical spine surgeries. Watkins’s application was denied
initially and on reconsideration.
After three hearings, the ALJ issued a decision denying Watkins benefits.2
Following the five-step evaluation process, the ALJ found that: (1) Watkins had
not engaged in substantial gainful activity since October 6, 2003; (2) Watkins had
severe impairments of cervical spine disorder, carpal tunnel syndrome and a back
disorder; (3) none of Watkins’s impairments, alone or in combination, met or
The parties consented to proceeding before a magistrate judge.1
After the first hearing, the ALJ issued a decision denying benefits, which the Appeals2
Council vacated. The ALJ held a second hearing and issued a second decision denying benefits.
The Appeals Council denied review. On judicial review, the district court reversed the ALJ’s
second decision. On remand, the ALJ held a third, supplemental hearing before issuing the third
decision that is the subject of this appeal.
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medically equaled a listed impairment; (4) Watkins had the residual functional
capacity (“RFC”) to perform sedentary work, except that she: (a) could only
occasionally climb, crawl, balance, stoop, crouch and kneel; (b) needed to avoid
repetitive use of her hands to push and pull or operate hand controls; (c) could
only occasionally use the bilateral upper extremities for overhead reaching; (d)
must avoid concentrated exposure to vibrations, hazardous machinery and open
heights; and (e) must alternate sitting and standing every thirty minutes; but
Watkins was unable to perform her past relevant work as a credit analyst, billing
clerk and data entry clerk; and (5) given Watkins’s age, education, work
experience and RFC, Watkins had “acquired work skills from past relevant work
that are transferable to other occupations with jobs existing in significant numbers
in the national economy,” including dispatcher, appointment clerk for medical
sources and information clerk.
In determining Watkins’s RFC, the ALJ stated that he gave “great weight”
to the opinions of Dr. George Feussner, a neurologist, and Dr. Bruce Steinberg, an
orthopedic surgeon, who are Watkins’s treating physicians in this case. Dr.
Steinberg treated Watkins’s carpal tunnel syndrome in her hands and arthritis in
her thumbs. Dr. Feussner saw Watkins for her neck pain.
The ALJ correctly noted that Dr. Feussner had completed a “Residual
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Functional Capacity Evaluation” that indicated, among other things, that Watkins:
(1) “could sit for 30 minutes at one time, sit for 4-5 hours a day with a 5 minute
stretch break each hour, stand for 1-2 hours at a time, and stand for a total of 4-5
hours a day, with a 5 minute stretch break each hour”; and, most importantly for
this appeal, (2) “could work for a total of 5 to 6 hours a day, 5 days a week, if
[Watkins] were allowed a sit/stand option.” The ALJ also correctly noted that Dr.
Steinberg, after performing surgeries on Watkins’s wrists, opined that she had
reached maximum medical improvement and “released her to full duty . . . [with] a
10 minute break for each hour of repetitive activity.” The ALJ concluded that
“[t]aking all of these work restrictions together, . . .[Watkins] can do sedentary
work functions if she is allowed the freedom to shift positions at will, and avoids
repetitive use of her hand for pushing and pulling.”3
Because sedentary jobs existed in the national economy that Watkins could
perform, the ALJ concluded that Watkins was not disabled. On judicial review,4
The ALJ gave “very limited weight” to the opinion of Dr. Joseph Cauthen, a neurologist3
who also treated Watkins’s neck pain. We find no merit to Watkins’s challenge to this
evidentiary determination. The ALJ specifically articulated reasons for giving limited weight to
Dr. Cauthen’s opinion, namely that it was inconsistent with Watkins’s own testimony as to her
activities and with other objective medical evidence. These reasons constitute good cause and
are supported by substantial evidence.
Although it does not appear that Watkins appealed the ALJ’s third decision to the4
Appeals Council, the Commissioner waived the exhaustion requirement by not raising it in the
district court or in this Court. See Crayton v. Callahan, 120 F.3d 1217, 1222 (11th Cir. 1997)
(citing Weinberger v. Salfi, 422 U.S. 749, 765-67, 95 S. Ct. 2457, 2467 (1975)).
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the magistrate judge entered an order affirming the ALJ’s decision. Watkins filed
this appeal.
II. DISCUSSION
A. Five-Step Sequential Evaluation
An ALJ uses a five-step sequential evaluation to determine whether the
claimant is disabled, which considers: (1) whether the claimant is engaged in
substantial gainful activity; (2) if not, whether the claimant has a severe
impairment; (3) if so, whether the severe impairment meets or equals an
impairment in the Listing of Impairments in the regulations; (4) if not, whether the
claimant has the RFC to perform her past relevant work; and (5) if not, whether,5
in light of the claimant’s RFC, age, education and work experience, there are other
jobs the claimant can perform. See 20 C.F.R. §§ 404.1520(a)(4), (c)-(f),
416.920(a)(4), (c)-(f); see also Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir.
2004). If the claimant proves that she cannot do her past relevant work at the
Residual functional capacity, or RFC, is a medical assessment of what the claimant can5
do in a work setting despite any mental, physical or environmental limitations caused by the
claimant’s impairments and related symptoms. 20 C.F.R. §§ 404.1545(a), 416.945(a). RFC
includes physical abilities, such as sitting, standing or walking, and mental abilities, such as the
ability to understand, remember and carry out instructions or to respond appropriately to
supervision, co-workers and work pressure. Id. §§ 404.1545(b)-(c), 416.945(b)-(c). The ALJ’s
finding as to a claimant’s RFC is based on all the relevant evidence in the record, including any
medical evidence, and is used in steps four and five of the sequential evaluation to determine
whether the claimant can do her past relevant work or any other work. Id. §§ 404.1545(a)(1), (5),
416.945(a)(1), (5).
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fourth step, the burden shifts to the Commissioner to show, at the fifth step, that
the claimant can perform other work available in the economy. Jones v. Apfel,
190 F.3d 1224, 1228 (11th Cir. 1999).
B. Watkins’s Claim
Watkins argues that the ALJ erred by finding that she had the RFC to
perform a limited range of sedentary work for a full eight hours a day. Watkins
points to Dr. Feussner’s RFC evaluation, to which the ALJ gave “great weight,”
and argues that Dr. Feussner stated that even with a sit/stand option, Watkins
could work only between five and six hours in an eight hour work day.6
“It is well-established that the testimony of a treating physician must be
given substantial or considerable weight unless ‘good cause’ is shown to the
contrary.” Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1159 (11th Cir.
2005) (quotation marks omitted); see also 20 C.F.R. §§ 404.1527(d)(1)-(2),
416.927(d)(1)-(2). The ALJ must state with particularity the weight given to7
Our review is limited to whether the ALJ’s decision is supported by substantial evidence6
and based on proper legal standards. Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158
(11th Cir. 2004). Under this limited standard of review, we may not make findings of fact,
reweigh the evidence or substitute our judgment for that of the Commissioner. Moore v.
Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). We will reverse, however, if the ALJ fails to
apply the correct legal standards or fails to provide sufficient reasoning to allow us to determine
that the proper legal standards were applied. Keeton v. Dep’t of Health & Human Servs., 21
F.3d 1064, 1066 (11th Cir. 1994).
Good cause exists “when the: (1) treating physician’s opinion was not bolstered by the7
evidence; (2) evidence supported a contrary finding; or (3) treating physician’s opinion was
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different medical opinions and the reasons therefore. Sharfarz v. Bowen, 825 F.2d
278, 279 (11th Cir. 1987). Moreover, “[t]he ALJ must clearly articulate the
reasons for giving less weight to the opinion of a treating physician, and the
failure to do so is reversible error.” Lewis v. Callahan, 125 F.3d 1436, 1440 (11th
Cir. 1997); see also 20 C.F.R. §§ 404.1527(d)(2), 416.927(d)(2) (requiring the
agency to “give good reasons” for not giving weight to a treating physician’s
opinion).
Here, in determining Watkins’s RFC, the ALJ explicitly addressed and gave
great weight to Dr. Feussner’s RFC evaluation. And, in summarizing the RFC
evaluation, the ALJ noted that Dr. Feussner had opined that Watkins could not
work more than five or six hours in an eight hour workday if she had a sit/stand
option (“sit/stand limitation”). However, the ALJ failed to incorporate Dr.
Feussner’s sit/stand limitation into his RFC finding or to give a reason for not
doing so. Moreover, the ALJ did not include Dr. Feussner’s sit/stand limitation in
the hypothetical questions posed to the vocational expert. Thus, the ALJ erred8
when he failed to address Dr. Feussner’s sit/stand limitation.
conclusory or inconsistent with the doctor’s own medical records.” Phillips, 357 F.3d at 1241.
The ALJ’s hypothetical question to the vocational expert asked whether there were jobs8
in the economy for a person with Watkins’s RFC who could “[s]tand/walk four to five hours in
an eight hour day, sit four to five hours in an eight hour day.”
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Although the ALJ is not required to specifically refer to every piece of
evidence in the record, he is required to “sufficiently explain[ ] the weight he has
given to obviously probative exhibits.” Cowart v. Schweiker, 662 F.2d 731, 735
(11th Cir. 1981). The ALJ also must “clearly articulate the reasons for giving less
weight” to a treating physician’s opinion. Lewis, 125 F.3d at 1440. Without a
clear explanation of the ALJ’s treatment of Dr. Feussner’s sit/stand limitation, we
cannot determine whether the ALJ’s ultimate decision on the merits was rational
and supported by substantial evidence.
The Commissioner argues that Dr. Feussner’s sit/stand limitation is
inconsistent with Dr. Feussner’s other statements in his RFC evaluation and with
Dr. Steinberg’s release of Watkins to “full duty.” This point is debatable.9
However, even if it is true, the ALJ did not offer this or any other explanation in
The Commissioner argues that Dr. Feussner’s sit/stand limitation is inconsistent with his9
other RFC findings that Watkins could work for four to five hours while standing (“standing
limitation”) and for four to five hours while sitting (“sitting limitation”). This argument assumes
that Dr. Feussner’s sitting limitation and standing limitation can be read together to mean that
Watkins could work a total of eight to ten hours of sitting and standing per day. However, it is
equally plausible that Dr. Feussner’s RFC statements mean that Watkins can work no more than
five total hours per day if she either stands or sits, but that, if she combines sitting and standing,
she can work up to six total hours per day.
Similarly, the Commissioner argues that Dr. Feussner’s sit/stand limitation is inconsistent
with Dr. Steinberg’s finding that Watkins could return to “full duty” with only the limitation that
she have ten minute breaks each hour of repetitive activity. However, Dr. Steinberg was treating
Watkins’s carpal tunnel syndrome in her hands, not her neck pain. When Dr. Steinberg stated
that Watkins had reached maximum medical improvement and released Watkins to “full duty,”
he arguably was referring to Watkins’s impairments in her hands, not her neck. We leave the
resolution of these issues to the ALJ on remand.
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his apparent decision to discount Dr. Feussner’s sit/stand limitation. We cannot
affirm based on a post hoc rationale that “might have supported the ALJ’s
conclusion.” See Owens v. Heckler, 748 F.2d 1511, 1516 (11th Cir. 1984)
(involving ALJ’s failure to explain credibility finding); see also Winschel v.
Comm’r of Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011) (involving ALJ’s
failure to mention treating physician’s opinion). On remand, the ALJ must
explicitly consider and explain the weight to be accorded to Dr. Feussner’s
opinion as to how many hours per day Watkins can work with a sit/stand option,
incorporate this finding into the RFC determination and re-examine, at steps four
and five, whether there is work Watkins can perform. We express no opinion on
the merits of Watkins’s claims for benefits.10
Accordingly, we reverse the district court’s judgment and remand the case
with instructions that it be returned to the Commissioner for further proceedings
consistent with this opinion.
REVERSED AND REMANDED.
We recognize Watkins’s claim that she is disabled because, if she can work only five or10
six hours with a sit/stand option, she cannot work a full eight hour work day, which Watkins’s
argues is required at step five in the sequential evaluation. See Soc. Sec. Ruling 96-8p, 61 Fed.
Reg. 34,474 (July 2, 1996). Because the ALJ’s RFC assessment failed to address the sit/stand
limitation, we need not address this issue, but direct the ALJ to do so in the first instance.
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