United States District Court, M.D. Tennessee, Nashville Division
A. TRAUGER UNITED STATES DISTRICT JUDGE.
before the court is the plaintiff Myscellent Christina
Shelton-Cox's Motion for Judgment on the Administrative
Record (ECF No. 14), to which the defendant Social Security
Administration (SSA) has responded (ECF Nos. 16), and the
plaintiff has filed a reply (ECF No. 17). Upon consideration
of the parties' briefs and the transcript of the
administrative record (ECF No. 10),  and for the reasons given
herein, the plaintiff's Motion for Judgment on the
Administrative Record will be denied and the decision of the
SSA will be affirmed.
Magistrate Judge Referral
avoid any further delay in the resolution of this matter, the
court will VACATE the referral to the magistrate judge.
Motion for Judgment on the Administrative Record
plaintiff filed an application for disability insurance
benefits under Title II of the Social Security Act and an
application for supplemental security income
(“SSI”) under Title XVI of the Social Security
on November 16, 2011, (Tr. 177-80, 181-89), alleging
disability onset as of April 30, 2010, (Id.), due to
mild retardation and learning disabilities. (Tr. 229). The
plaintiff subsequently amended the disability onset date to
February 14, 2011. (Tr. 60.) The plaintiff's claim to
benefits was denied at the initial and reconsideration stages
of state agency review. As a result, the plaintiff requested
de novo review of her case by an Administrative Law
Judge (ALJ). The ALJ heard the case on May 27, 2014, when the
plaintiff appeared with counsel and gave testimony. (Tr.
57-82.) Testimony was also received from a
vocational expert. (Id.) At the conclusion of the
hearing, the matter was taken under advisement until July 1,
2014, when the ALJ issued a written decision finding that the
plaintiff was not disabled. (Tr. 18-45.) That decision
contains the following enumerated findings:
1. The claimant meets the insured status requirements of the
Social Security Act through December 31, 2015.
2. The claimant has not engaged in substantial gainful
activity since February 14, 2011, the alleged onset date (20
CFR 404.1571 et seq., and 416.971 et seq.).
3. The claimant has the following severe impairments: Urge
Incontinence Disorder, Attention Deficit Hyperactivity
Disorder, Major Depressive Disorder, and Borderline
Intellectual Functioning (20 CFR 404.1520(c) and 416.920(c)).
4. The claimant does not have an impairment or combination of
impairments that meets or medically equals the severity of
one of the listed impairments in 20 CFR Part 404, Subpart P,
Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526,
416.920(d), 416.925 and 416.926).
5. [T]he claimant has the residual functional capacity to
perform a full range of work at all exertional levels but
with the following nonexertional limitations: She is limited
to jobs where there is no concentrated exposure to pulmonary
irritants, and where the claimant requires access to a
restroom within the work area. From a mental perspective, the
claimant can understand, remember, carry out and maintain
attention, concentration, persistence and pace for simple
tasks with normal breaks spread throughout the day. In
addition, she can interact appropriately with others and
adapt to routine changes within this type of work
6. The claimant is unable to perform any past relevant work
(20 CFR 404.1565 and 416.965).
7. The claimant was born on August 14, 1976 and was 34 years
old, which is defined as a younger individual, age 18-49, on
the alleged disability onset date (20 CFR 404.1563 and
8. The claimant has at least a high school education and is
able to communicate in English (20 CFR 404.1564 and 416.964).
9. Transferability of job skills is not material to the
determination of disability because using the
Medical-Vocational Rules as a framework supports a finding
that the claimant is “not disabled, ” whether or
not the claimant has transferable job skills (See SSR 82-41
and 20 CFR Part 404, Subpart P, Appendix 2).
10. Considering the claimant's age, education, work
experience, and residual functional capacity, there are jobs
that exist in significant numbers in the national economy
that the claimant can perform (20 CFR 404.1569, 404.1569(a),
416.969, and 416.969(a)).
11. The claimant has not been under a disability, as defined
in the Social Security Act, from February 14, 2011, through
the date of this decision (20 CFR 404.1520(g) and
(Tr. 23-24, 29, 36-38.)
November 30, 2015, the Appeals Council denied the
plaintiff's request for review of the ALJ's decision
(Tr. 1-6), thereby rendering that decision the final decision
of the SSA. This civil action was thereafter timely filed,
and the court has jurisdiction. 42 U.S.C. § 405(g). If
the ALJ's findings are supported by substantial evidence
based on the record as a whole, then those findings are
Review of the Record
following summary of the medical record is taken from the
Discussion, physical. With regard to the
claimant's urge incontinence disorder, it is needful to
reiterate that her testimony regarding the medical condition
factoring into her employment terminations goes to general
credibility, since it directly contradicts what she told an
evaluator at Ex. IF or mental health professionals at Ex. 2F
about such incidents as fighting on the job, sleeping during
duty time, and so forth. Such credibility items do not
require belaboring, but it does mean that one must rely more
fully on the objective medical evidence in such matters. Even
then, one finds multiple reasons for pause:
• Records from Dr. Swan from February 2011 reflect the
claimant's urinary incontinence impairment dates back to
childhood, and as such, would be very remote to the point of
alleged onset. In objective testing, the claimant did
demonstrate a loss of urine related with an urge at a volume
of infusion as low as 180 ml, consistent with her stated
symptoms (Ex. 18F at 5). In March of 2011, it was determined
that she had failed medical therapy, so the treatment plan
called for the trial of a sacral nerve stimulator, and the
same was implanted.
• In a January 2012 office visit, the claimant alleged
that the sacral nerve stimulator had never worked; however an
interrogation of the unit was within normal limits and it was
also determined that there were multiple settings the
claimant had not tried; she was shown how to change these in
order to optimize the results (Ex. 18F).4 There
was no further mention of difficulty in Dr. Swan's
records until July 2013, with onset of renewed difficulties
only two months earlier (id.).
4 According to the January 18, 2012 treatment
notes: “Patient was not feeling stimulation. Using the
physician programmer [it was determined] only program 1 had
been used. I reviewed with the patient how to use the patient
programmer. She was able to turn the amps up to 3.8 and did
feel stimulation vaginally. We also tested program 2 and she
did feel stimulation vaginally at 2.5 amps.” (Ex. 18F).
• The claimant's consultative evaluation occurred
during the above sequence, in May 2012. She does not appear
to allege genitourinary difficulty at that time, but rather,
the complaints were musculoskeletal or pulmonary in nature.
Although this was a limited exam, and the genitourinary
system is typically out of scope even with a regular physical
exam, it must also be pointed out that she exhibited normal
ambulation, and there was no mention of her needing to
interrupt the evaluation at any time secondary to impending
or actual loss of bladder control (Ex. 10F).
• Although the impairment is not specific to kidney
function, it should also be observed that an ultrasound of
the kidneys was normal as of January 2012, and later, kidney
function labs in October 2012 were within normal limits as
well (Ex. 22F).
• Well woman exam at the Vine Hill Community Clinic
(March 2013): In the range of symptoms, no mention of
complaints specific to the bladder or genitourinary system,
but only mention regarding the absence of menstruation.
Female genitourinary exam was unremarkable and included a
non-tender bladder (Ex. 22F).
• Well woman exam at the Vine Hill Community Clinic
(October 2013): Range of symptoms negative for bladder habits
and dysmenorrhea. Unremarkable exam. Urine culture was sent
off; however, there were no reports of abnormalities
associated with the culture (Ex. 22F).
• One finds no significant information regarding
genitourinary complaints following July 2013.
The picture that emerges is one where the claimant indeed has
a severe impairment involving her urge incontinence disorder.
However, the treatment evidence also indicates that the use
of a sacral nerve stimulator was useful in controlling
symptoms once the claimant learned how to program it
correctly according to the treating physician's
instructions. Thus, the weight of the evidence indicates that
although the claimant would need access to a restroom within
the work area, she would not have episodes of a frequency or
magnitude as was alleged, in the setting of such treatment.
* * *
Discussion, mental. With regard to the
claimant's alleged borderline intellectual functioning, .
. . it suffices to say that the claimant's robust
activities of daily living-with a correspondingly high level
of adaptive functioning-are clearly inconsistent with the
notion that the impairment was severe enough to prevent
simple and unskilled work. Again, one finds a number of
inconsistencies that call into question the accuracy of her
cognitive measurements from both 2011 and 2014.
Although one may suppose that the 1994 cognitive assessment
at Ex. 15E would be limited in its probative value in
relation to her current level of functioning, it remains
highly relevant for three purposes. First, the assessment
stands for the proposition that at all times during the
period in question, the claimant's borderline
intellectual functioning was medically determinable, since it
appears to be the only one where the validity of the scores
is not terribly subject to question.
Second, the claimant's performance or processing speed
indices were consistently in the 70's over all WAIS
administrations, consistent with a finding that the claimant
has the impairment. However, third, one does not find a
reasonable explanation as to how it was the claimant achieved
high-borderline indices as far as the full-scale or verbal
components were concerned (which had been 78 and 81,
respectively), yet scored one or more standard deviations
below that in her 2011 and 2014 evaluations (which were both
63 as to the 2014 evaluation).
Ultimately, the claimant's borderline intellectual
functioning results in a limitation in favor of simple and
unskilled work. However, because of the substantial doubts
that were raised by the last two WAIS administrations,
together with the other objective evidence . . ., together
with the claimant's activities of daily living, the
weight of the evidence did not support a finding of greater
functional limitations by virtue of this impairment.
Attention turns to the claimant's remaining severe mental
impairments, one finds reason to doubt the veracity of her
subjective allegations. To summarize significant items from
the medical evidence:
• Centerstone (intake: December 2008, termination:
January 2010)(Ex. 1F)
o Entire interval prior to alleged onset date
o Did not resume treatment until intake on March 11, 2011,
just after the alleged onset date, and more than a year after
o She reports that she has worked in security and is licensed
to carry a gun (this, in turn, is certainly inconsistent with
someone who also alleges intellectual disability)
o Was noted at the time as friendly, cooperative, open and
• Centerstone (March-August 2011, formal termination:
December 2011) (Ex. 3F)
o In April 2011psychiatric evaluation:
• Reports graduating with special education diploma and
is currently taking classes towards her GED (see p. 70)
• Mental status exam largely unremarkable with euthymic
mood, average intelligence, intact judgement
• ADHD was the only diagnosis at the time; however, it
goes on to say that the basis for the diagnosis was unclear
• GAF score of 60
o May 2011: Medical management: Unremarkable mental status;
reports feeling okay but wants something for distractibility;