United States District Court, N.D. Georgia, Atlanta Division
ORDER A N D OPINION 
J. BAVERMAN UNITED STATES MAGISTRATE JUDGE
Pamela V. (“Plaintiff”) brought this action
pursuant to section 205(g) of the Social Security Act, 42
U.S.C. § 405(g), to obtain judicial review of the final
decision of the Commissioner of the Social Security
Administration (“the Commissioner”) denying her
application for Disability Insurance Benefits
(“DIB”) under the Social Security
For the reasons below, the undersigned
AFFIRMS the final decision of the
filed an application for DIB on or about January 12, 2014,
alleging disability commencing on March 30, 2012. [Record
(hereinafter “R”) 187]. Plaintiff's
application was denied initially and on reconsideration.
[See R109-10]. Plaintiff then requested a hearing
before an Administrative Law Judge (“ALJ”).
[R153-54]. An evidentiary hearing was held on May 4, 2016,
during which Plaintiff amended her onset date to March 6,
2011. [R59-77]. The ALJ issued a decision on August 1, 2016,
denying Plaintiff's application on the ground that she
had not been under a “disability” at any time
from March 6, 2011, through March 31, 2016, the date
Plaintiff was last insured. [R18-45]. Plaintiff sought review
by the Appeals Council, and the Appeals Council denied
Plaintiff's request for review on July 11, 2017, making
the ALJ's decision the final decision of the
then filed an action in this Court on October 27, 2017,
seeking review of the Commissioner's decision. [Doc. 1].
The answer and transcript were filed on March 14, 2018.
[See Docs. 5, 6]. On April 10, 2018, Plaintiff filed
a brief in support of her petition for review of the
Commissioner's decision, [Doc. 10]; on May 10, 2018, the
Commissioner filed a response in support of the decision,
[Doc. 11]; and on May 31, 2018, Plaintiff filed a reply brief
in support of her petition for review, [Doc. 14]. The matter
is now before the Court upon the administrative record, the
parties' pleadings, and the parties' briefs,
it is accordingly ripe for review pursuant to 42 U.S.C.
STANDARD FOR DETERMINING DISABILITY
individual is considered disabled for purposes of disability
benefits if he is unable to “engage in any substantial
gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result
in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.” 42
U.S.C. § 423(d)(1)(A). The impairment or impairments
must result from anatomical, psychological, or physiological
abnormalities which are demonstrable by medically accepted
clinical or laboratory diagnostic techniques and must be of
such severity that the claimant is not only unable to do
previous work but cannot, considering age, education, and
work experience, engage in any other kind of substantial
gainful work that exists in the national economy. 42 U.S.C.
burden of proof in a Social Security disability case is
divided between the claimant and the Commissioner. The
claimant bears the primary burden of establishing the
existence of a “disability” and therefore
entitlement to disability benefits. See 20 C.F.R.
§ 404.1512(a). The Commissioner uses a five-step
sequential process to determine whether the claimant has met
the burden of proving disability. See 20 C.F.R.
§ 404.1520(a); Doughty v. Apfel, 245 F.3d 1274,
1278 (11th Cir. 2001); Jones v. Apfel,
190 F.3d 1224, 1228 (11th Cir. 1999). The claimant
must prove at step one that he is not undertaking substantial
gainful activity. See 20 C.F.R. §
404.1520(a)(4)(i). At step two, the claimant must prove that
he is suffering from a severe impairment or combination of
impairments that significantly limits his ability to perform
basic work-related activities. See 20 C.F.R. §
404.1520(a)(4)(ii). At step three, if the impairment meets
one of the listed impairments in Appendix 1 to Subpart P of
Part 404 (Listing of Impairments), the claimant will be
considered disabled without consideration of age, education,
and work experience. See 20 C.F.R. §
404.1520(a)(4)(iii). At step four, if the claimant is unable
to prove the existence of a listed impairment, he must prove
that his impairment prevents performance of past relevant
work. See 20 C.F.R. § 404.1520(a)(4)(iv). At
step five, the regulations direct the Commissioner to
consider the claimant's residual functional capacity,
age, education, and past work experience to determine whether
the claimant can perform other work besides past relevant
work. See 20 C.F.R. § 404.1520(a)(4)(v). The
Commissioner must produce evidence that there is other work
available in the national economy that the claimant has the
capacity to perform. Doughty, 245 F.3d at 1278 n.2.
To be considered disabled, the claimant must prove an
inability to perform the jobs that the Commissioner lists.
any step in the sequence a claimant can be found disabled or
not disabled, the sequential evaluation ceases and further
inquiry ends. See 20 C.F.R. § 404.1520(a)(4).
Despite the shifting of burdens at step five, the overall
burden rests on the claimant to prove that he is unable to
engage in any substantial gainful activity that exists in the
national economy. Doughty, 245 F.3d at 1278 n.2;
Boyd v. Heckler, 704 F.2d 1207, 1209
(11th Cir. 1983), superseded by statute on
other grounds by 42 U.S.C. § 423(d)(5), as
recognized in Elam v. R.R. Ret. Bd., 921 F.2d 1210, 1214
(11th Cir. 1991).
SCOPE OF JUDICIAL REVIEW
limited scope of judicial review applies to a denial of
Social Security benefits by the Commissioner. Judicial review
of the administrative decision addresses three questions: (1)
whether the proper legal standards were applied; (2) whether
there was substantial evidence to support the findings of
fact; and (3) whether the findings of fact resolved the
crucial issues. Washington v. Astrue, 558 F.Supp.2d
1287, 1296 (N.D.Ga. 2008); Fields v. Harris, 498
F.Supp. 478, 488 (N.D.Ga. 1980). This Court may not decide
the facts anew, reweigh the evidence, or substitute its
judgment for that of the Commissioner. Dyer v.
Barnhart, 395 F.3d 1206, 1210 (11th Cir.
2005). If substantial evidence supports the
Commissioner's factual findings and the Commissioner
applies the proper legal standards, the Commissioner's
findings are conclusive. Lewis v. Callahan, 125 F.3d
1436, 1439-40 (11th Cir. 1997); Barnes v.
Sullivan, 932 F.2d 1356, 1358 (11th Cir.
1991); Martin v. Sullivan, 894 F.2d 1520, 1529
(11th Cir. 1990); Walker v. Bowen, 826
F.2d 996, 999 (11th Cir. 1987) (per curiam);
Hillsman v. Bowen, 804 F.2d 1179, 1180
(11th Cir. 1986) (per curiam); Bloodsworth v.
Heckler, 703 F.2d 1233, 1239 (11th Cir.
evidence” means “more than a scintilla, but less
than a preponderance.” Bloodsworth, 703 F.2d
at 1239. It means such relevant evidence as a reasonable mind
might accept as adequate to support a conclusion, and it must
be enough to justify a refusal to direct a verdict were the
case before a jury. Richardson v. Perales, 402 U.S.
389, 401 (1971); Hillsman, 804 F.2d at 1180;
Bloodsworth, 703 F.2d at 1239. “In determining
whether substantial evidence exists, [the Court] must view
the record as a whole, taking into account evidence favorable
as well as unfavorable to the [Commissioner's]
decision.” Chester v. Bowen, 792 F.2d 129, 131
(11th Cir. 1986) (per curiam). Even where there is
substantial evidence to the contrary of the ALJ's
findings, the ALJ decision will not be overturned where
“there is substantially supportive evidence” of
the ALJ's decision. Barron v. Sullivan, 924 F.2d
227, 230 (11th Cir. 1991). In contrast, review of
the ALJ's application of legal principles is plenary.
Foote v. Chater, 67 F.3d 1553, 1558 (11th
Cir. 1995); Walker, 826 F.2d at 999.
STATEMENT OF FACTS 
was 47 years old on her amended alleged onset date and 52
years old on her date last insured of March 31, 2016. [R63,
187, 193]. She has a college degree and previously worked as
a claims examiner and an administrative assistant. [R71, 75,
219]. She also served in the Air Force Reserves until she was
honorably discharged in 2011. [R64, 289, 438]. Plaintiff
alleges she is unable to work because of degenerative disk
disease, chest pain, fatigue, cardiomyopathy,  coronary artery
disease,  sleep apnea, anxiety, depression, and
hypertension. [R63, 65-66, 218].
hearing before the ALJ, Plaintiff testified that she was
diagnosed with cardiomyopathy in 2009 and got a defibrillator
in August 2010. [R65]. She stated that she lives with chest
pain and increased fluid on her lungs, to the point where she
chokes in her sleep and has daily wheezing. [R65]. She
reported that her energy level is very low, she needs breaks
when climbing as few as six stairs, and she has increasing
fatigue. [R65]. She also testified that she has severe low
blood pressure and that her heart medication has
blood-pressure-lowering elements in it, so it is constantly
pushing her blood pressure down in the “danger zone,
” which is more of a strain on her heart. [R65-66].
When asked about noncompliance with medication, she stated
that she has periodically adjusted her medications depending
on how she is feeling; for example, her heart medication
causes her blood pressure to drop to very low levels, so she
sometimes cuts back on it, and she sometimes takes her
diuretics at night to avoid the need for frequent bathroom
visits during the day. [R65, 67].
also related that she had been diagnosed with sleep apnea and
used a CPAP device for sleeping, especially with all
the wheezing she had. [R66]. She stated that when she sits,
her chest starts to feel fatigued-like a
“pulling” in her chest-and she has to lie down.
additionally testified that her daily activities vary
depending on her symptoms. [R67-68]. She lies down during the
day with a variable frequency. [R67]. She reported that a lot
of it has to do with excess fluid buildup: the fluid buildup
in her lungs makes her fatigued, [R69], so she takes
diuretics and is constantly going to the bathroom-four to
five times an hour. [R67]. After sitting up she has to lie
down for a couple hours until she gets some energy and starts
feeling better, and then she can get up and do whatever she
has to do for the day or around the house. [R67]. She stated
that she does not cook much anymore, but she does household
chores and errands. [R68]. She reported that some days she
does not go out at all, and when she is out she tries to do
whatever she has to do so that she does not have to go out
for days at a time. [R67].
adult function report dated February 19, 2014, Plaintiff
reported that she drove, shopped for groceries, and did
chores, although the chores took longer because of chest
agitation and fatigue. [R227-28]. She also indicated that she
needed no assistance in managing her activities of daily
living, including personal hygiene, dress, and toilet use.
1999, Plaintiff was diagnosed with non-Hodgkin's lymphoma
and was treated with chemotherapy. [R311, 317, 321, 328].
After chemotherapy, she developed secondary cardiomyopathy
with an ejection fraction of fifteen percent. [R525]. In January
2005, she had moderate cardiomyopathy with a left ventricular
ejection fraction of thirty percent without significant
valvular disease. [R318]. An echocardiogram in 2009 showed an
ejection fraction of fifteen to twenty percent. [R318]. In
August 2010, she had an automatic implantable cardiac
defibrillator placed in her chest. [R318, 328]. In September
2011, it was noted that Plaintiff had no evidence of
congestive heart failure or fluid overload at that time.
from a new patient examination taking place on August 24,
2012, with Karen Y. Luster, M.D., of Capstone Medical Group,
indicate that Plaintiff complained of dizzy spells, joint
pain, loud snoring, sleepiness, weight gain, wheezing,
shortness of breath, palpitations, chest pain, back pain,
nocturia, headache, insomnia, memory loss, blurry vision, leg
edema, and fatigue. [R297-300]. Plaintiff's ejection
fraction had improved to twenty-five percent. [R300].
appointment with Dr. Luster taking place on October 3, 2012,
Plaintiff reported that her equilibrium felt off, she had
fallen from a stepladder, and she was having difficulty
walking due to knee pain from the fall. [R301-02]. She was
noted to be limping and was diagnosed with “pain and
limb, ” and it was also noted that her congestive heart
failure restricted medication options. [R302]. Dr. Luster
prescribed tramadol. [R302].
presented to the VA Medical Center on January 8, 2013, with
complaints of intermittent chest pain that was worse when she
was overly tired. [R379]. She reported that her energy level
fluctuated and that she had occasional shortness of breath
and dizziness with lying down, sitting up, or driving, with
an increase in events in the last year. [R379]. She also
reported anxiety with stress. [R380].
Medical Center mental-health evaluation notes from January
23, 2013, indicate that in the late 1980s, Plaintiff was in a
car crash in which her car slid under a tractor-trailer, she
suffered injuries, and she had to be cut from her vehicle.
[R365]. She reported that since that time she has experienced
flashbacks and extreme anxiety, particularly when driving.
[R365]. She indicated that her anxiety became so great that
she limited her driving and finally sought treatment in 2013.
visit to the VA Medical Center taking place on January 24,
2013, Plaintiff reported that she was intermittently
compliant with her medications and was not taking her statin.
[R359]. She also stated that she had shortness of breath with
one flight of stairs; intermittent sharp sub-sternal chest
pain without provocation; intermittent palpitations;
“fluttering”; and intermittent dizziness. [R359,
362]. Her examination showed normal heart and lung readings
and no pedal edema. [R361]. She was switched to
Toprol and advised to be compliant with the
rest of her medications, and her doctors considered
increasing her losartan and discontinuing
stress test taking place at the VA Medical Center on January
30, 2013, revealed no significant perfusion defects and
normal wall motion, and the left ventricular ejection
fraction was calculated at 58 percent. [R338-39, 390]. The
test was characterized as a “normal myocardial
perfusion study.” [R339, 390].
from April 29, 2013, indicate that Plaintiff was out of
digoxin and called to reorder multiple medications through
the VA with some difficulty. [R352-54].
returned to the VA Medical Center cardiology clinic for
follow-up on May 1, 2013. [R341]. Her problem list included
New York Heart Association (“NYHA”) class III
cardiomyopathy and coronary atherosclerotic heart
disease-one-vessel disease with left-heart catheterization in
2009. [R336]. She said she was doing well and
had recently been in New York, caring for an uncle, [R336],
although she also reported chest pain that had been ongoing
for four to five weeks and chronic problems of dizziness and
shortness of breath when going up stairs, [R341, 345]. She
indicated that she ran out of digoxin at that time but had no
chest pain, shortness of breath, palpitations, orthopnea or
PND (paroxysmal nocturnal dyspnea), and stated that she was
otherwise compliant with her medications. [R336]. She had a
normal examination, and because she was using furosemide
(Lasix) daily, supplemental potassium was recommended.
11, 2013, VA Medical Center cardiologist Brian Kaebnick,
M.D., indicated that Plaintiff had two recent cardiac tests:
a nuclear stress test on January 30, 2013, to evaluate her
coronary arteries, and a repeat echocardiogram in June 2013.
[R327]. The nuclear stress test indicated an ejection
fraction of 58 percent and did not show any large areas of
ischemia, and the repeat echocardiogram indicated an ejection
fraction of 35 to 40 percent. [R327]. The doctor noted that
ejection fractions measured during nuclear stress tests may
be falsely elevated and stated that the echocardiogram more
accurately reflected Plaintiff's current cardiac function
and therefore would be used to grade her heart dysfunction.
progress notes dated July 11, 2013, indicate that Plaintiff
had been started on Imdur on her last visit but could
not tolerate it due to headaches. [R328]. She reported that
she continued to have angina symptoms with moderate
activities like cleaning floors or raking leaves that abated
with rest. [R328]. It was noted that although she continued
to experience angina pain, she had some improvement in her
ejection fraction after she started congestive heart failure
medications, was stable, and did not want to try a new
medication. [R331]. Sublingual nitroglycerine was
prescribed for use as needed. [R331].
DeKalb Community Service Board assessment dated September 27,
2013, indicates that Plaintiff reported being active but
tiring easily from her heart condition. [R292].
returned to Dr. Luster on December 11, 2013, with complaints
of sharp chest pain with exertion and fatigue that had lasted
for two weeks. [R304]. She reported that she had to sit for
30 minutes once before she could do much. [R304]. She also
reported that she was “doing a cleanse” and
therefore had stopped her medications. [R304]. Examination
revealed that her lungs were clear, jugular venous distension
was flat,  she had 2 edema in both her legs,
and she was tender to palpation from the right breast
radiating from the sternum to 2 o'clock. [R304]. For her
fatigue/malaise, she was directed to stop Cymbalta delayed
release capsule and start escitalopram,  [R304]; for
her congestive heart failure, she was directed to continue
digoxin, losartan, spironolactone,  and furosemide, [R305];
her chest pain was attributed to two possible
components-post-surgical pain and anxiety-and she was to
start Cymbalta, [R305]; and for her anxiety disorder, she was
directed to attend counseling, use “sleepy time”
tea, and use melatonin as needed, [R305].
Plaintiff returned to Dr. Luster on January 8, 2014, her
chest pain symptoms had improved, she was sleeping better,
and she felt rested. [R306]. Plaintiff reported that she had
been told that she only had sleep apnea symptoms when she
slept on her back. [R306]. Her examination was normal.
[R306]. She was diagnosed with anxiety disorder, NOS; chest
pain; and fatigue/malaise. [R306]. Proper positioning was
encouraged for her positional obstructive sleep apnea.
testing taking place on March 3, 2014, showed that Plaintiff
had a good response to ...