Mills v. N.C. Dep't of Health & Human Servs.

794 S.E.2d 566, 251 N.C. App. 182, 2016 N.C. App. LEXIS 1303, 2016 WL 7367987
CourtCourt of Appeals of North Carolina
DecidedDecember 20, 2016
DocketCOA16-487
StatusPublished
Cited by4 cases

This text of 794 S.E.2d 566 (Mills v. N.C. Dep't of Health & Human Servs.) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mills v. N.C. Dep't of Health & Human Servs., 794 S.E.2d 566, 251 N.C. App. 182, 2016 N.C. App. LEXIS 1303, 2016 WL 7367987 (N.C. Ct. App. 2016).

Opinion

DAVIS, Judge.

*183 This appeal requires us to address the analysis that must be undertaken in evaluating a claimant's application for Medicaid disability benefits. Sue Mills ("Petitioner") appeals from the trial court's order affirming a determination by the North Carolina Department of Health and Human Services ("DHHS") that she was not disabled and, therefore, not entitled to such benefits. After careful review, we vacate the trial court's order and direct the court to remand this case to DHHS for further proceedings consistent with this opinion.

Factual Background

Petitioner is a 54-year-old woman who has a history of illnesses and symptoms that began in the 1990s. During her thirties, she was employed as a housekeeper, resulting in "some deterioration" in her lower back. During her early forties, her lower back pain worsened, and she experienced anxiety, nerves, and depression. By the time she turned fifty, Petitioner was suffering from migraine headaches, continued anxiety and depression, pain in her lower back, problems using her hands, strain on her neck and shoulders, weakness in her legs, and a variety of other health-related issues.

Petitioner applied to the Social Security Administration ("SSA") for Social Security disability benefits in 2013. An administrative law judge (the "ALJ") conducted a disability hearing, and on 24 October 2013, the ALJ issued a decision (the "Social Security Decision") determining that Petitioner was not disabled. Petitioner appealed the Social Security Decision, and her appeal is currently pending in federal court.

Approximately eight months after the Social Security Decision was issued, Petitioner applied to the Haywood County Department of Social Services (the "DSS") for Medicaid disability benefits. On 23 July 2014, her application *568 was denied. Petitioner appealed the decision to DHHS, and a hearing was held before State Hearing Officer Linda Eckert (the "SHO") on 8 October 2014.

On 16 October 2014, the SHO issued a Notice of Decision (the "Agency Decision"), which determined that: (1) Petitioner was 51 years of age and had obtained a GED; (2) she was not presently working and had not worked since May 2014; (3) Petitioner had no "relevant past *184 work"; (4) she had "a medical history of chronic pain, degenerative disc disease, thoracic compression fracture, vitamin D deficiency, chronic obstructive pulmonary disease, migraine headaches, esophageal reflux, hyperlipidemia, lumbar radiculopathy, lumbar spondylosis, osteopenia, varicose veins, carpal tunnel syndrome, [and] anxiety and depression"; and (5) "[b]y May 2015, the [Petitioner] will retain the ability to engage in light work...."

The SHO then summarized Petitioner's medical history and made the following pertinent findings of fact:

6. In an October 2013 decision, the [SSA] Administrative Law Judge opined that the Appellant has the residual functional capacity to perform light work with occasional posturals; no climbing of ladders, ropes or scaffolds; frequent bilateral fingering; and avoidance of concentrated exposure to hazards. Appellant was also limited to simple, routine, repetitive work with occasional public contact. This opinion is given great weight as it is consistent with and supported by the objective evidence.
7. The Appellant's medically determinable impairments are at least theoretically capable of producing at least some of the general subjective symptoms alleged by the Appellant. However, the Appellant's testimony as to the specific intensity, persistence, and limiting effects of the pain and other subjective symptoms is not persuasive in view of the inconsistencies with the medical evidence. For example, the Appellant testified she experiences migraine headaches twice a month which are at a pain level of 20/10; however, the medical evidence does not reflect that the Appellant reported to the treating or examining physicians that she experiences such extreme symptoms. It is not credible that the Appellant could experience such extreme symptoms but fail to report them to the treating physicians.

Based on these findings of fact, the SHO made the following conclusions:

1. Appellant is not engaging in Substantial Gainful Activity as defined in 20 CFR 416.910.
2. Appellant's impairments of chronic pain, degenerative disc disease, vitamin D deficiency, chronic obstructive *185 pulmonary disease, migraine headaches, esophageal reflux, hyperlipidemia, lumbar radiculopathy, lumbar spondylosis, osteopenia, varicose veins, carpal tunnel syndrome, anxiety and depression are severe but do not meet or equal the level of severity specific in 20CFR [sic] Part 404, Appendix 1 to Subpart P (Listing of Impairments). Appellant's impairment of thoracic compression fracture is currently at a disabling severity, but is not expected to meet the duration requirement of remaining at a disabling severity for a period of twelve continuous months as specified in 20 CFR 416.909.
3. Considering the combination of all impairments and related symptoms, by May 2015 the Appellant will have the residual functional capacity ... to engage in light work with occasional stooping and crouching; no climbing of ladders, ropes or scaffolds; frequent but not constant fingering; avoidance of concentrated exposure to heights and hazards; avoidance of concentrated exposure to dust and fumes; and to work that is low stress, nonproduction in nature and does not require extensive interaction with the general public. The effects of pain have been evaluated under 20 C.F.R. 404.1529 and Fourth Circuit law as set forth in Hyatt v. Sullivan, 899 F.2d 329 (4th Cir. 1990) [.]
4. The Appellant's non-exertional limitations of occasional stooping and crouching; no climbing of ladders, ropes and scaffolds; frequent but not constant fingering; avoidance of concentrated exposure to heights and hazards; avoidance of concentrated exposure to dust and fumes; and to work that is low stress, nonproduction in nature *569 and does not require extensive interaction with the general public do not significantly reduce the occupational base of light work available in the economy.... Considering the Appellant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy as specified in 20 CFR 416.966

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794 S.E.2d 566, 251 N.C. App. 182, 2016 N.C. App. LEXIS 1303, 2016 WL 7367987, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mills-v-nc-dept-of-health-human-servs-ncctapp-2016.