Submitted: February 8, 2017
from United States District Court for the Western District of
Missouri - St. Joseph
SMITH,  BENTON and SHEPHERD, Circuit Judges.
SHEPHERD, Circuit Judge.
Gann appeals the decision of the district court affirming the
decision of the Commissioner denying her application for
disability insurance benefits (DIB) and supplemental security
income (SSI) under the Social Security Act. 42 U.S.C. §
401 et seq.; 42 U.S.C. § 1381 et seq. Having
jurisdiction under 28 U.S.C. § 1291 and finding
substantial evidence lacking to support the ALJ's denial,
we reverse and remand for proceedings consistent with this
applied for DIB and SSI benefits alleging a disability onset
of July 12, 2011, due to "degenerative disc disease,
arthritis, eye problems, neck injury, migraines, and sinus
problems." After reviewing the record and conducting a
hearing including testimony by Gann and a vocational expert,
the ALJ determined that Gann "is not disabled under . .
. the Social Security Act, " and therefore, DIB and SSI
benefits were denied. The Appeals Council denied Gann's
request for review. Gann sought review of the
Commissioner's decision in the United States District
Court for the Western District of Missouri which subsequently
entered a final judgment affirming the decision of the
Commissioner. This appeal followed.
has a long history of multiple health problems to which she
attributes her alleged disability. First, she has at least
two psychiatric issues-"major depressive disorder,
recurrent, severe without psychotic features" and
post-traumatic stress disorder (PTSD). Documentation
supporting these diagnoses includes notations in the medical
record from medical doctors (MD), psychologists (Psy.D.),
nurse practitioners (NP), and qualified mental health
professionals (QMHP). During her medical visits seeking
treatment for her psychiatric disorders, she has complained
of crying spells, anxiety, nervousness, suicidal ideation,
anger, and insomnia. Her medical providers have prescribed
multiple psychiatric medications during the course of her
care including Celexa, trazadone, mirtazepine, Cymbalta, and
Gann has complained of low-back pain since before a lumbar
spine fusion surgery performed in 2001. She continued to have
pain after the back surgery, which one of her doctors
described as "all too common of a result." Multiple
health professionals have treated her back pain, including
several MDs, NPs, and physical therapists. To treat her back
pain, the professionals have (1) prescribed narcotic pain
medications (including Vicodin and Lortab), (2) ordered
diagnostic tests (including an MRI), (3) performed invasive
treatments (including facet joint injections), (4) prescribed
assistive devices to help with her gait (including canes and
wheelchairs), and (5) prescribed "in-home services"
to help with her activities of daily living. Her lumbar spine
MRI revealed "facet spondylosis and hypertrophy . . .
coincid[ing] with the area of pain she indicates." A
pain management doctor who performed facet injections for her
back pain diagnosed her with "facet syndrome
lumbar" and "post laminectomy syndrome." One
provider recommended that she stand for no more than
"five minutes at a time, sit for [no more than] 30
minutes at a time, lift no weight, " and "never
bend, stoop or perform fine manipulation."
Gann has a plethora of other medical issues which she alleges
contribute to her disability including migraine headaches,
severe insomnia, obesity, restless leg syndrome (RLS), knee
arthritis, and dizziness with frequent falling. She has
reported migraine headaches occurring up to seven times per
week and lasting around six hours per episode; her migraines
were treated with prescriptions for Topamax and Imitrex.
Professionals have prescribed Ambien to treat her insomnia.
She is 5'3, " 235 to 250 pounds, and has been
described as morbidly obese. Her RLS is treated with
prescription Requip. Both of her knees have been injected
with steroids to treat the arthritis. Her dizziness and falls
have been attributed to inner ear problems (chronic otitis
media) and treated with prescriptions for physical therapy
and medications. She has complained of neck pain at times,
and she has a history of alcohol abuse. Global Assessment of
Functioning (GAF) scores of 50 and 30 have been assigned to
her by health professionals at various times during her care.
result of her health issues, at least two doctors expressed
concerns regarding Gann's ability to adapt to a work
environment. Dr. C. William Breckenridge, Psy.D., said:
"Her ability to adapt to a work environment appears to
be highly marginal at this time." (emphasis
added). Similarly, Dr. Raphael Smith, Psy.D., noted
"adaptive limitations" and an "ability to
respond appropriately to changes in the work setting"
that is "moderately limited." Smith noted that Gann
cannot work in a setting that "require[s] frequent or
intense . . . change in routine."
contends on appeal that the ALJ's residual functional
capacity assessment and the hypothetical question posed to
the vocational expert did not include all of her limitations.
review de novo the district court's decision to affirm
the ALJ's denial of social security DIB and SSI.
Lawson v. Colvin, 807 F.3d 962, 964 (8th Cir. 2015).
"By statute, '[t]he findings of the Commissioner of
Social Security as to any fact, if supported by substantial
evidence, shall be conclusive.'" Howard v.
Massanari, 255 F.3d 577, 580 (8th Cir. 2001) (quoting 42
U.S.C. § 405(g)). "If substantial evidence
in the record as a whole supports the ALJ's decision,
then this Court will affirm the denial of benefits."
Lawson, 807 F.3d at 964 (emphasis added).
"Substantial evidence is less than a preponderance but .
. . enough that a reasonable mind would find it adequate to
support the conclusion." Id. (alteration in
original) (internal quotation marks omitted). Our review
"is more than an examination of the record for the
existence of substantial evidence in support of the
Commissioner's decision . . . . [W]e also take into
account whatever in the record fairly detracts from that
decision." Haley v. Massanari, 258 F.3d 742,
747 (8th Cir. 2001) (internal quotation marks omitted).
However, "[w]e may not reverse the Commissioner's
decision merely upon a finding that we would have reached a
contrary conclusion." Vandenboom v. Barnhart,