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[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 17-14169
Non-Argument Calendar
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D.C. Docket No. 1:16-cv-00132-WTH-CAS
WILLIAM EVERETT BRIGHTMON,
Plaintiff-Appellant,
versus
SOCIAL SECURITY ADMINISTRATION, COMMISSIONER,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Northern District of Florida
________________________
(August 2, 2018)
Before MARTIN, ROSENBAUM, and JILL PRYOR, Circuit Judges.
PER CURIAM:
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William Everett Brightmon appeals the district court’s order affirming the
Commissioner of the Social Security Administration’s (the “Commissioner”)
decision to deny his applications for supplemental-security income and disability-
insurance benefits (collectively, “disability benefits”). See 42 U.S.C. §§ 405(g),
1383(c)(3). On appeal, Brightmon argues that the Administrative Law Judge’s
(“ALJ”) findings that he had a high-school education and the residual functional
capacity (“RFC”) to perform a full range of work at the medium exertional level
were not supported by substantial evidence.
I. Background
Brightmon alleges disability as of June 25, 2013, based on a combination of
mental and physical impairments, including osteoarthritis, schizoaffective disorder,
and substance abuse.1 He was 59 at the alleged onset date and 62 by the time of
the hearing before the ALJ in April 2015. In the parlance of the Social Security
Administration, he was of “advanced age” at onset and “closely approaching
retirement age” by the time of the hearing. See 20 C.F.R. § 404.1563(d), (e).
Brightmon has a high-school education and past work experience as a laborer.
A. Medical Records and Opinion Evidence
1
Brightmon originally claimed a disability-onset date in December 2011, which he later
amended to June 2013.
2
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The medical evidence regarding Brightmon’s physical impairments—which
are the sole focus of this appeal—reflects that he has been treated for, among other
issues, pain in his neck, back, knees, and shoulder, and right-arm weakness.
Medical records through the end of 2013 are sparse and do not show any
significant problems. An x-ray taken in June 2013 showed mild degenerative
change in the thoracic and cervical spine. And Brightmon reported chronic pain in
his knees in August 2013. Otherwise, his exams were fairly normal. In October
2013, for example, he denied back pain or muscle aches to Dr. John Desrochers,
and the doctor’s findings were benign.
In December 2013, the state disability agency denied reconsideration of its
denial of Brightmon’s application for disability benefits. As part of that denial, a
state-agency medical consultant reviewed Brightmon’s medical records and
offered an RFC assessment, opining that he could perform medium work. The
medical consultant found that he could lift 50 pounds occasionally and 25 pounds
frequently and could stand, walk, and sit for six hours each in an eight-hour
workday.
Beginning with the 2015 records, the medical records reflect increased
treatment for Brightmon’s neck, back, arm, and knee problems. In February 2015,
a doctor noted that Brightmon had severe degenerative joint disease in his cervical
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neck bones.2 In March 2015, he was diagnosed with right-arm weakness, chronic
neck pain, lumbago, degenerative arthritis of the cervical spine, and chronic knee
pain. An x-ray taken in April 2015 revealed moderate to severe degenerative joint
disease in his cervical spine.
After the April 2015 hearing, the ALJ ordered a physical consultative
examination, which Dr. Robert Greenberg conducted in June 2015. Dr.
Greenberg’s examination found decreased range of motion of the cervical and
lumbar spine, both hips, and right wrist, pain on motion of the cervical and lumbar
spine, and full range of motion of the knees and all other extremities. Other
findings included straight-leg-raising pain for both legs; normal gait and station; no
need for a cane or other assistive ambulatory device; difficulty tandem walking and
walking on heels and toes; inability to stoop; decreased right grip strength (4/5);
and no difficulty buttoning and unbuttoning his clothing. Dr. Greenberg assessed
Brightmon as having “[o]steoarthritis of the cervical spine, lumbar spine, right
wrist, both hips, and both knees.” Dr. Greenberg also noted that Brightmon had
experienced complications from recent esophageal surgery, resulting in the
placement of a gastronomy tube (“G-tube”) in his mid-abdomen to deliver nutrition
2
The treatment notes do not specify the basis for this finding, but it appears that the
doctor performed a CT scan of Brightmon’s neck, along with x-rays of his chest.
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directly to the stomach. Brightmon had lost over 25 pounds since the surgery one
month earlier.
Dr. Greenberg completed a medical-source statement of ability to do work-
related activities and an RFC evaluation. In both assessments, Dr. Greenberg
opined that Brightmon’s impairments prevented him from performing work-related
activities that required heavy exertion or prolonged standing, walking, or bending.
In August 2015, Brightmon was treated for neck pain with radiating arm
pain, right-arm weakness, and ongoing low-back and bilateral buttocks pain. Dr.
Steven Bailey found tenderness and pain on motion in the cervical and lumbosacral
spine, and tenderness in the buttocks and hips. Dr. Bailey assessed Brightmon as
having clear “symptoms of cervical radiculopathy as well as chronic low-back pain
with possible neurogenic claudication,” and he ordered magnetic-resonance-
imaging scans (“MRIs”) of the cervical and lumbar spine. The MRIs, taken in
September 2015, showed, among other problems, foraminal compression
bilaterally in the mild range in the cervical spine and “some significant
degenerative disc disease and bilateral facet arthropathy” in the lumbar spine. At a
follow-up visit in October 2015, Dr. Bailey’s physician assistant found diminished
range of motion of the cervical spine and mild tenderness in the lower lumbar
spine.
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In September 2015, Brightmon was treated by Dr. Jerry Costain for chronic
pain in his neck, lower back, and right shoulder. At the initial visit, Brightmon had
right-shoulder tenderness with limited range of motion but full strength.
Brightmon was seen again two weeks later. The notes for the “musculoskeletal”
portion of the physical exam on that date state generally, “Normal range of motion.
He exhibits tenderness. He exhibits no edema.” The notes then go on to describe
in more detail the exams of Brightmon’s right shoulder and knees. Brightmon no
longer had right-shoulder tenderness. His right knee had mild joint effusion with
full range of motion and full strength. The treatment notes do not indicate that a
spinal exam was performed. Dr. Costain prescribed pain medication and
recommended trying physical therapy.
B. ALJ’s Unfavorable Decision
In December 2015, the ALJ issued an unfavorable decision finding
Brightmon not disabled. The ALJ determined that, despite his physical and mental
impairments, Brightmon was able to perform a full range of work at the medium
exertional level with non-exertional limitations on the complexity of the tasks
involved and interaction with others. Relying on the testimony of a vocational
expert, the ALJ found that Brightmon could not perform his past work as a laborer
but that he could transition to other work in the national economy.
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In concluding that Brightmon was capable of performing medium work, the
ALJ reviewed the medical evidence and found that, while the evidence was
consistent with multilevel degenerative disc disease of the cervical and lumbar
spine, objective clinical findings were “minimal” and treatment was conservative.
The ALJ gave “little weight” to Dr. Greenberg’s findings of decreased range of
motion, opining “that the claimant was recovering from recent abdominal surgery
which likely reduced his ability to perform full range of motion.” With regard to
the findings of the other doctors who examined Brightmon, the ALJ described Dr.
Costain’s findings as “fairly benign, showing a full range of motion of the spine
with full strength, full range of motion of the knee with full strength, and no
tenderness of the shoulders.” As for Dr. Bailey, the ALJ stated that his findings
“fail[ed] to show more than some cervical and lumbosacral spine, bilateral hip, and
bilateral buttock tenderness.” The ALJ also noted that Brightmon had normal
muscle bulk and tone, normal strength, normal gait and stance, and no more than
minimal treatment for his impairments. Overall, the ALJ found that “the lack of
objective medical findings and the lack of treatment suggest[] that his
musculoskeletal symptoms are not as limiting as alleged and would not prevent the
performance of medium exertional work.”
Regarding the opinion evidence, the ALJ gave Dr. Greenberg’s assessed
limitations “little weight” because they were not consistent with his own evaluation
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or with the objective medical evidence as a whole. Again, the ALJ discredited Dr.
Greenberg’s findings of decreased range of motion because, in the ALJ’s view,
they were more likely due to Brightmon’s recent surgery. The only other opinion
evidence came from a state-agency medical consultant, who evaluated
Brightmon’s RFC based on the record as of December 2013 and opined that he
was capable of performing a full range of medium work. The ALJ gave “great
weight” to this opinion, stating that it was consistent with the medical record as a
whole.
The Appeals Council denied review of the ALJ’s decision, and the district
court affirmed the ALJ’s decision in federal district court. Brightmon now appeals
to this Court, arguing primarily that substantial evidence does not support the
ALJ’s finding that he was capable of full-time medium work. We have jurisdiction
under 42 U.S.C. § 405(g), and we now vacate and remand.
II. Discussion
“In Social Security appeals, we must determine whether the Commissioner’s
decision is supported by substantial evidence and based on proper legal standards.”
Winschel v. Comm’r of Soc. Sec.,
631 F.3d 1176, 1178 (11th Cir. 2011) (quotation
marks omitted). “Substantial evidence is more than a scintilla and is such relevant
evidence as a reasonable person would accept as adequate to support a
conclusion.” Lewis v. Callahan,
125 F.3d 1436, 1440 (11th Cir. 1997). We must
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affirm a decision that is supported by substantial evidence even if the evidence
preponderates against the agency’s findings. Ingram v. Comm’r of Soc. Sec.,
496
F.3d 1253, 1260 (11th Cir. 2007). And we may not reweigh the evidence, decide
the facts anew, or substitute our judgment for that of the ALJ.
Winschel, 631 F.3d
at 1178.
Though our review is deferential, “we do not act as automatons,” and,
instead, “[w]e must scrutinize the record as a whole to determine if the decision
reached is reasonable and supported by substantial evidence.” MacGregor v.
Bowen,
786 F.2d 1050, 1053 (11th Cir. 1986). A decision is not supported by
substantial evidence if the ALJ “reached the result that [he] did by focusing upon
one aspect of the evidence and ignoring other parts of the record.” McCruter v.
Bowen,
791 F.2d 1544, 1548 (11th Cir. 1986). The ALJ must state with at least
some measure of clarity the grounds for her decision, and we will not affirm
“simply because some rationale might have supported the ALJ’s conclusions.”
Winschel, 631 F.3d at 1179.
Under the Social Security Act, a person is disabled if he is unable “to engage
in any substantial gainful activity by reason of any medically determinable
physical or mental impairment.” 42 U.S.C. § 423(d)(1)(A). Regulations outline a
five-step, sequential evaluation process ALJs must use to determine whether a
claimant is disabled: (1) whether he is currently engaged in substantial gainful
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activity; (2) whether he has a severe impairment or combination of impairments;
(3) whether the impairment meets or equals the severity of a specified impairment
in the Listing of Impairments; (4) whether he can perform his past relevant work
despite his impairments; and (5) whether he can perform other work found in the
national economy.
Winschel, 631 F.3d at 1178; see 20 C.F.R.
§§ 404.1520(a)(4)(i)–(v), 416.920(a)(4)(i)–(v).
At step four of the sequential analysis, the ALJ must determine a claimant’s
RFC by considering all relevant medical and other evidence. Phillips v. Barnhart,
357 F.3d 1232, 1238 (11th Cir. 2004). The RFC is an assessment of a claimant’s
ability to do work despite his impairments.
Lewis, 125 F.3d at 1440. Relevant
evidence includes a claimant’s medical history, medical signs, laboratory findings,
and statements about how the symptoms affect the claimant. 20 C.F.R.
§§ 404.1545(a)(3), 416.945(a)(3).
The claimant’s RFC also comes into play at step five, when “the
Commissioner must determine that significant numbers of jobs exist in the national
economy that the claimant can perform.”
Winschel, 631 F.3d at 1180. An ALJ
may make this determination either by obtaining the testimony of a vocational
expert or by applying the Medical-Vocational Guidelines (the “grids”).
Id. The
grids direct a finding of “disabled” or “not disabled” based on a combination of
vocational factors, including a claimant’s maximum exertion level, age, education,
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and previous work experience. See 20 C.F.R. pt. 404 subpt. P, app. 2. As relevant
here, the grids direct a finding of not disabled for an individual closely
approaching retirement age (aged 60 or older) who is limited to medium work, has
a high-school education, and lacks previous or skilled work experience. 20 C.F.R.
pt. 404, subpt. P, app. 2 § 203.06. The same individual who is limited to light
work instead of medium work, however, is disabled.
Brightmon challenges the sufficiency of the evidence to support the ALJ’s
finding that he has the RFC to perform medium work. “Medium work requires the
ability to lift 50 pounds, to carry 25 pounds frequently, and to do a good deal of
walking and standing.” Francis v. Heckler,
749 F.2d 1562, 1564 (11th Cir. 1985);
see 20 C.F.R. § 404.1567(d). The Commissioner has elaborated on the definition
of “medium work” in Social Security Ruling (“SSR”) 83-10, which is binding on
ALJs. See 20 C.F.R. § 402.35(b)(1). According to SSR 83-10,
The considerable lifting required for the full range of medium work
usually requires frequent bending-stooping. (Stooping is a type of
bending in which a person bends his or her body downward and
forward by bending the spine at the waist.) Flexibility of the knees as
well as the torso is important for this activity. (Crouching is bending
both the legs and spine in order to bend the body downward and
forward.) . . . In most medium jobs, being on one’s feet for most of
the workday is critical. Being able to do frequent lifting or carrying of
objects weighing up to 25 pounds is often more critical than being
able to lift up to 50 pounds at a time.
SSR 83-10, available at
1983 WL 31251.
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Here, we conclude that substantial evidence does not support the ALJ’s
finding that Brightmon had the RFC to perform medium work. The ALJ provided
two main reasons for his decision: (1) it was consistent with a state-agency medical
consultant’s RFC determination that Brightmon could perform medium work; and
(2) the medical records overall, in the ALJ’s view, showed “minimal” objective
clinical findings and treatment. Both reasons are problematic.
The RFC assessment of the state-agency medical consultant, to which the
ALJ gave “great weight,” does not provide substantial evidence on the record as a
whole. That is because the medical consultant’s assessment was not based on the
record as a whole. It was based on the medical record as of December 2013, when
the only evidence of note was a June 2013 x-ray showing mild degenerative
change in the thoracic and cervical spine.
Since December 2013, however, the medical record is much more developed
regarding Brightmon’s physical impairments, particularly his lower back and neck
problems. He has been diagnosed with osteoarthritis of the cervical spine, lumbar
spine, right wrist, both hips, and both knees, as well as with right-arm weakness.
He underwent imaging scans, which showed moderate to severe degenerative joint
disease in his cervical spine and significant degenerative disc disease and bilateral
facet arthropathy in the lumbar spine. And doctors made clinical findings of
decreased range of motion in his cervical and lumbar spine and both hips, pain on
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motion of the cervical and lumbar spine, and tenderness in all of these areas. All
of this evidence is materially relevant to whether Brightmon can perform the
“considerable lifting” and “frequent bending-stooping” usually required for the full
range of medium work. See SSR 83-10, available at
1983 WL 31251.
However, no expert apart from Dr. Greenberg, whose opinion the ALJ
rejected, expressed an opinion about what these post-December 2013 records
meant for Brightmon’s ability to work despite his impairments. And the fact that
the ALJ’s RFC assessment mirrored an RFC assessment given in December 2013,
before any of this evidence existed, makes it difficult to say that the ALJ properly
“[took] into account and evaluate[d] the record as a whole.”
McCruter, 791 F.2d at
1548.
To be sure, the ALJ discussed some of the evidence that was contrary to the
decision, particularly Dr. Greenberg’s evaluation, but the ALJ’s reasons for
rejecting that evidence are problematic as well. In determining that clinical
findings overall were minimal, the ALJ gave “little weight” to Dr. Greenberg’s
findings, following a physical examination, that Brightmon had limited range of
motion in his neck, back, hips, and wrist as a result of his osteoarthritis. The ALJ
reasoned that the actual cause of the limited range of motion was “likely” his
recent surgery, specifically the placement of a G-tube in his mid-abdomen.
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Yet it is generally improper for an ALJ to substitute his own judgment for
that of a medical expert because, among other reasons, ALJs are not medical
experts. Graham v. Bowen,
786 F.2d 1113, 1115 (11th Cir. 1986); Freeman v.
Schweiker,
681 F.2d 727, 731 (11th Cir. 1982). In rejecting Dr. Greenberg’s
findings, the ALJ did not cite any expert opinion supporting his view as to why
Brightmon had limited range of motion, for there is none. Nor did the ALJ explain
the medical basis for concluding that the placement of the G-tube would have
affected range of motion in his neck, back, hips, or wrist. Notably, the record does
not contain records of the surgery. The Commissioner suggests without further
elaboration that the ALJ’s finding was a matter of “logical[] reason[ing]” or
common sense. But the more accurate word for it is “speculation.” In short, the
ALJ made an impermissible medical judgment unsupported by the record.3
What’s more, the ALJ disregarded other evidence that was consistent with
Dr. Greenberg’s findings. See
McCruter, 791 F.2d at 1548 (“It is not enough to
discover a piece of evidence which supports that decision, but to disregard other
contrary evidence.”). The ALJ stated that Dr. Bailey’s findings failed to show
more than some tenderness in the cervical and lumbar spine, both hips, and
3
The ALJ’s rejection of Dr. Greenberg’s finding of decreased grip strength is likewise
problematic. Dr. Greenberg did not tie that finding to “hand abnormalities,” so the absence of
hand abnormalities does not contradict the finding, particularly when other evidence indicates
that Brightmon experienced right-arm weakness as a complication of his neck injuries. Nor is
the fact that Brightmon was capable of fine and gross manipulation inconsistent with decreased
grip strength.
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buttocks. But Dr. Bailey’s treatment notes also indicate pain on motion of the
cervical and lumbar spine, symptoms of cervical radiculopathy, and, significantly,
diminished range of motion in the cervical spine. Moreover, the ALJ’s description
of the overall evidence as showing “minimal” objective findings is difficult to
square with imaging scans showing “moderate to severe” osteoarthritis of the
cervical spine and “significant” degenerative disc disease and bilateral facet
arthropathy in the lumbar spine. 4
Nor is there any expert evidence in the record, apart from Dr. Greenberg’s
evaluation, which the ALJ rejected, regarding Brightmon’s ability to work after
December 2013. As we have explained above, we agree with the ALJ to the extent
that the medical record as of December 2013, when the medical consultant gave
the RFC assessment, was fairly benign. But the medical record has changed
substantially since that time. And no medical expert apart from Dr. Greenberg
opined about Brightmon’s ability to work despite the physical impairments
indicated in the records after December 2013.
For all of these reasons, the ALJ’s finding that Brightmon had the RFC to
perform a full range of medium work despite his impairments through December
4
While it is true, as the Commissioner urges, that the ALJ is permitted to resolve
conflicts in the evidence, see Watson v. Heckler,
738 F.2d 1169, 1172 (11th Cir. 1984) (stating
that it is the ALJ’s responsibility to resolve conflicts in the evidence, including evaluations of a
claimant’s RFC), the ALJ did not resolve conflicts between clinical findings in reaching the
decision. Rather, the ALJ found the medical evidence as a whole consistent with “minimal
objective clinical findings.” That determination, however, is not supported by the record.
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2015, when the ALJ issued his decision, is not supported by substantial evidence.
That finding was not supported by any expert evidence for the time period after
December 2013, and the ALJ reached his decision by improperly disregarding
evidence favorable to Brightmon. We therefore vacate the judgment of the district
court and remand with instructions to remand this case to the Commissioner for
further proceedings regarding Brightmon’s eligibility for disability benefits. 5
As for ALJ’s finding that Brightmon had a high-school education,
substantial evidence supports that determination. Indeed, Brightmon reported that
he had that he had earned a high-school diploma and testified that he had attended
some junior college. Even assuming that the ALJ could have found that
Brightmon had a “limited” education based on a psychological assessment, the
record supports the ALJ’s contrary finding. And Brightmon provides no support
for his assertion that graduation from a segregated high school, in and of itself,
does not, as a matter of law, qualify as a high-school education under the grids.
VACATED AND REMANDED.
5
We express no opinion regarding Brightmon’s eligibility for benefits on remand.
16
