Filed: Jun. 18, 2020
Latest Update: Jun. 18, 2020
Summary: Case: 19-12656 Date Filed: 06/18/2020 Page: 1 of 11 [DO NOT PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT _ No. 19-12656 Non-Argument Calendar _ D.C. Docket No. 4:18-cv-00529-JEO ISAAC FLOWERS, Plaintiff-Appellant, versus SOCIAL SECURITY ADMINISTRATION, COMMISSIONER, Defendant-Appellee. _ Appeal from the United States District Court for the Northern District of Alabama _ (June 18, 2020) Before MARTIN, ROSENBAUM, and GRANT, Circuit Judges. PER CURIAM: Case: 19-12656 Da
Summary: Case: 19-12656 Date Filed: 06/18/2020 Page: 1 of 11 [DO NOT PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT _ No. 19-12656 Non-Argument Calendar _ D.C. Docket No. 4:18-cv-00529-JEO ISAAC FLOWERS, Plaintiff-Appellant, versus SOCIAL SECURITY ADMINISTRATION, COMMISSIONER, Defendant-Appellee. _ Appeal from the United States District Court for the Northern District of Alabama _ (June 18, 2020) Before MARTIN, ROSENBAUM, and GRANT, Circuit Judges. PER CURIAM: Case: 19-12656 Dat..
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Case: 19-12656 Date Filed: 06/18/2020 Page: 1 of 11
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 19-12656
Non-Argument Calendar
________________________
D.C. Docket No. 4:18-cv-00529-JEO
ISAAC FLOWERS,
Plaintiff-Appellant,
versus
SOCIAL SECURITY ADMINISTRATION,
COMMISSIONER,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Northern District of Alabama
________________________
(June 18, 2020)
Before MARTIN, ROSENBAUM, and GRANT, Circuit Judges.
PER CURIAM:
Case: 19-12656 Date Filed: 06/18/2020 Page: 2 of 11
Isaac Flowers appeals the district court’s order affirming the denial of his
applications for disability insurance benefits and supplemental security income.
Flowers argues that the administrative law judge failed to accord proper weight to
the opinion of one of his treating physicians. Finding no error, we affirm.
I.
Flowers claims that he has been disabled since he injured his back and neck
in a car accident. He says that he is unable to work due to back and neck pain,
shoulder problems, and pain in his feet, all arising from his injuries in the accident,
and left-eye blindness since birth. Medical records that Flowers submitted in
support of his applications for benefits showed that he presented to the hospital on
August 9, 2013, reporting that he had been involved in a low-speed head-on
collision and complaining of back, neck, and shoulder pain. CT scans taken on the
day of the accident showed a normal cervical and lumbar spine. Flowers was
diagnosed with a cervical sprain and lumbar spine sprain and released.
Flowers was treated by an orthopedic specialist, who prescribed pain
medication, a muscle relaxant, steroids, and physical therapy. Despite this
treatment, Flowers continued to report neck and back pain without improvement.
MRI imaging of the cervical and lumbar spine taken several weeks after the
accident showed mild stenosis at three cervical vertebrae from central disc bulging,
minimal to mild foraminal encroachment at sections of the cervical and lumbar
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spine, and minimal transverse thecal sac narrowing between two vertebrae of the
lumbar spine. The imaging showed no evidence of cervical disc herniation.
Flowers consulted with a neurosurgeon, Dr. James White, who examined
him and reviewed his imaging. Dr. White stated that Flowers’s MRI studies
showed “some mild stenosis at both levels obviously predating the accident with
no evidence of herniation or other surgical pathology” and recommended a referral
to pain management.
In October 2014, Dr. Sathyan Iver examined Flowers at the request of the
state disability determination service. Dr. Iyer’s examination showed that Flowers
had normal gait, grip strength, and muscle power of the arms and legs; full range of
motion of the neck, shoulders, elbows, wrists, hips, knees, and ankles; and full
mobility of the spine except for some limitation in his lumbar spine flexion. Dr.
Iver diagnosed Flowers with possible degenerative disc disease of the lumbar spine
and decreased vision in the left eye since birth. He opined that these conditions
could result in some impairment of functions involving bending, lifting, pushing,
pulling, and overhead activities, and some impairment of functions requiring
binocular vision such as driving, working at heights, and working around
machinery.
Dr. William Hartzog, an orthopedic specialist, examined Flowers on several
occasions in late 2016. Flowers complained of joint pain all over, headaches, neck
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pain, and lower back pain that traveled upward into his shoulders and sometimes
radiated downward into his legs. Flowers stated that the pain kept him awake at
night. On one occasion, Flowers rated his pain as 8 out of 10. Dr. Hartzog noted
that on examination, Flowers had no sensory or motor deficits but had some
limitation in flexion of his lumbar spine. He diagnosed Flowers with chronic
mechanical back pain with probable disc degeneration and prescribed pain
medication and home exercises.
In October 2016, Dr. Hartzog filled out a one-page physical capacities form
for Flowers, indicating that Flowers could sit upright for three hours at a time and
stand for one hour at a time; that he would need to lie down, sleep, or sit with his
legs propped up for four to five hours in an eight-hour day; that he would be off
task about 40% of the time in an eight-hour work day, in addition to regular
breaks; and that he would miss 15 days of work per month—all due to chronic
cervical and lumbar strain since 2012. Dr. Hartzog also stated that side effects
from Flowers’s medications included drowsiness, dizziness, difficulty focusing,
and difficulty concentrating.
Dr. Jarrod Warren completed an independent medical evaluation of Flowers
in February 2017. Dr. Warren noted that Flowers complained of persistent low
back pain and neck pain that had worsened since an accident in August 2013. Dr.
Warren stated that Flowers’s physical examination was generally unremarkable
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except for mild localized tenderness, and he noted that Flowers’s description of his
low back pain was out of proportion to both his exam findings and the 2013
imaging studies. Dr. Warren completed a physical capacities form stating that
Flowers could sit upright for three hours at a time and stand for one hour at a time;
that he would need to lie down, sleep, or sit with his legs propped up for less than
30 minutes in an eight-hour day; that he would be off task about 10% of the time in
an eight-hour work day, in addition to regular breaks; and that he would miss five
to seven days of work per month due to his chronic low back pain.
At a hearing before the ALJ, Flowers testified that he had constant joint,
back, and neck pain that interfered with his daily activities and kept him from
working. He testified that he could sit in a chair for only 15 to 20 minutes at a time
before having to get up, that he could not do any household chores due to pain, and
that his pain woke him up after four or five hours of sleep every night. Flowers
testified that the pain medication that Dr. Hartzog prescribed for him helped a little
bit sometimes, but “not like it should,” and the home exercises did not help.
A vocational expert testified that there was no work available in the national
economy for a person who had to lie down or sleep four to six hours in an eight-
hour work day, or who had to be off task 40% of the day in addition to normal
breaks. The vocational expert also testified that a person who had to miss two or
more days of work per month was not able to work. The ALJ asked the vocational
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expert about a hypothetical individual of Flowers’s age and with his education and
work experience who could perform work at the sedentary exertional level with
occasional pushing and pulling with arms and legs; occasional climbing of ramps
and stairs but no climbing of ropes, ladders, or scaffolds; occasional balancing,
kneeling, crouching, or stooping, but no crawling; and frequent reaching, including
occasional overhead reaching. The ALJ added that the hypothetical individual
should avoid concentrated exposure to extreme heat and cold, vibrations, and
humidity, as well as hazardous machinery or unprotected heights. He would be
able to understand and remember short and simple instructions, perform simple
and routine repetitive tasks, and deal with occasional, well-planned workplace
changes, but could not read instructions or reports or perform mathematical
calculations. The vocational expert testified that such an individual could not
perform any of Flowers’s past work, but that work existed within those limitations
in the national or regional economy, including positions as an assembler, inspector,
or hand loader.
The ALJ determined that Flowers was not disabled because he could still
perform a limited range of sedentary work, including jobs that existed in sufficient
numbers in the national economy. In making the disability determination, the ALJ
gave Dr. Hartzog’s opinions little weight, finding that his opinions were not
supported by his treatment notes or his discussion of Flowers’s subjective
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complaints. The ALJ also gave limited weight to Dr. Warren’s responses on the
physical capacities form, finding that the responses were inconsistent with Dr.
Warren’s own diagnostic impressions following his physical examination of
Flowers. The ALJ gave more weight to Dr. Warren’s physical examination
findings, which the ALJ considered to be more consistent with Dr. Iyer’s findings
and the medical evidence of record. The ALJ gave significant weight to Dr. Iyer’s
opinions, finding that they were consistent with the medical evidence of record.
Flowers filed a complaint for review of the denial of benefits in federal
district court. The district court affirmed the agency’s decision, and Flowers now
appeals.
II.
In Social Security cases where the ALJ denies benefits and the Appeals
Council denies review, we review the ALJ’s decision as the Commissioner’s final
decision. Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). “Our review is
‘the same as that of the district court,’ meaning we neither defer to nor consider
any errors in the district court’s opinion.” Henry v. Comm’r of Soc. Sec.,
802 F.3d
1264, 1267 (11th Cir. 2015) (internal citations omitted).
We review a Social Security case to “determine whether the Commissioner’s
decision is ‘supported by substantial evidence and based on proper legal standards.
Substantial evidence is more than a scintilla and is such relevant evidence as a
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reasonable person would accept as adequate to support a conclusion.’” Winschel v.
Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011) (citation omitted). We
will affirm the Commissioner’s decision if we conclude, upon consideration of the
record as a whole, that substantial evidence supports it. Lewis v. Callahan,
125
F.3d 1436, 1439 (11th Cir. 1997). Under this standard of review, we “may not
decide the facts anew, reweigh the evidence, or substitute our judgment for that of
the [Commissioner].”
Winschel, 631 F.3d at 1178 (alteration in the original)
(quoting Phillips v. Barnhart,
357 F.3d 1232, 1240 n.8 (11th Cir. 2004)).
III.
To qualify for Social Security benefits, a claimant must show that he is
disabled. Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003);
Doughty, 245
F.3d at 1278. The Social Security Act defines “disability” as the “inability 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 Act also provides that a claimant is
disabled only if his impairment is “of such severity that he is not only unable to do
his previous work but cannot, considering his age, education, and work experience,
engage in any other kind of substantial gainful work which exists in the national
economy.”
Id. § 423(d)(2)(A).
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Social Security regulations outline a five-step process that the ALJ must use
to determine whether a claimant is disabled. During this process, the ALJ
considers (1) the claimant’s work activity, (2) the medical severity of the
claimant’s impairments, (3) whether any impairment or combination of
impairments is equivalent to an impairment listed in the regulations, (4) the
claimant’s residual functional capacity and his ability to perform his past relevant
work, and (5) if the claimant cannot perform past relevant work, whether he can
perform other work found in the national economy based on his residual functional
capacity and commensurate with his age, education, and experience. 20 C.F.R.
§§ 404.1520(a)(4), 416.920(a)(4); see Phillips, 357 F.3d at 1237–38. If, as the
ALJ found here, the claimant does not meet the requirements for any listed
impairment and can perform other work, then he is not disabled. 20 C.F.R.
§§ 404.1520(a)(4)(v) & (g)(1); 416.920(a)(4)(v) & (g)(1).
Flowers focuses on the ALJ’s determination that he has the residual
functional capacity to perform a limited range of sedentary work. His sole
argument on appeal is that the ALJ failed to give sufficient weight to Dr. Hartzog’s
opinions about his work limitations and failed to give adequate reasons for
assigning less weight to those opinions.
At step four, the ALJ must “‘assess and make a finding about [the
claimant’s] residual functional capacity based on all the relevant medical and other
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evidence’ in the case.” Phillips, 357 F.3d at 1238 (alteration in the original)
(quoting 20 C.F.R. § 404.1520(e)). A claimant’s residual functional capacity is
“the most [he] can still do despite” the limitations caused by his impairments. 20
C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). The ALJ must give the opinion of a
claimant’s treating physician “substantial or considerable weight unless ‘good
cause’ is shown to the contrary.”
Lewis, 125 F.3d at 1440 (citation omitted). Good
cause exists where (1) the treating physician’s opinion was not reinforced by the
evidence; (2) the evidence supported a contrary finding; or (3) the treating
physician’s opinion was conclusory or inconsistent with the doctor’s own medical
records.
Id. The “ALJ must state with particularity the weight given to different
medical opinions and the reasons therefor.”
Winschel, 631 F.3d at 1179.
Here, the ALJ articulated adequate reasons for giving Dr. Hartzog’s opinions
less weight. The ALJ’s decision stated that Dr. Hartzog’s opinions were “not
supported in his treatment notes and is [sic] discussion of the claimant’s subjective
complaints.” Dr. Hartzog’s treatment notes documented Flowers’s continued
complaints of joint pain and back and neck pain, and on one occasion—the date
that Dr. Hartzog completed the physical capacities form—Flowers complained of
pain that he rated as an 8 out of 10. Otherwise, however, Dr. Hartzog did not make
any notations regarding the severity of Flowers’s pain complaints, and his physical
examination findings showed that Flowers had no sensory or motor deficits and
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only mild limitations in his lumbar spine flexion. Moreover, Dr. Hartzog attributed
Flowers’s chronic pain to his car accident injury, which was described as mild in
contemporaneous treatment records and imaging reports. And Dr. Hartzog’s
treatment plan—pain medication and home exercises—did not reflect the dire
situation described in his physical capacities report.
“We will not second guess the ALJ about the weight the treating physician’s
opinion deserves so long as he articulates a specific justification for it.” Hunter v.
Soc. Sec. Admin., Comm’r, 808 F.3d 818, 823 (11th Cir. 2015). We conclude that
the ALJ articulated legitimate reasons for discounting Dr. Hartzog’s opinions about
Flowers’s physical limitations, and that substantial evidence supports the ALJ’s
disability determination. We therefore affirm.
AFFIRMED.
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