JOHN E. OTT, Chief Magistrate Judge.
Plaintiff Sharon D. Kilgore brings this action, through counsel, pursuant to 42 U.S.C. § 405(g), seeking review of the final decision of the Acting Commissioner of Social Security ("Commissioner") denying Plaintiff's applications for a period of disability and disability insurance benefits ("DIB") and for supplemental security income benefits ("SSI"). (Doc.
Plaintiff protectively filed applications for a period of disability and DIB and for SSI on October 5, 2010, alleging disability beginning October 1, 2009. (R. 115-229, 151).
Plaintiff requested the Appeals Council review the ALJ's decision. The Appeals Council declined Plaintiff's request for review. (R. 1-3). Therefore, the ALJ's decision represents the final decision of the Commissioner. (Id.) Plaintiff thereafter timely filed this action for judicial review under 42 U.S.C. § 405(g), asserting that the findings of the Commissioner are not based upon substantial evidence and that improper legal standards were applied. (Doc. 1).
In reviewing claims brought under the Social Security Act, this court's role is a narrow one: "Our review of the Commissioner's decision is limited to an inquiry into whether there is substantial evidence to support the findings of the Commissioner, and whether the correct legal standards were applied." Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002); see also Lamb v. Bowen, 847 F.2d 698, 701 (11th Cir. 1988). The court gives deference to factual findings and reviews questions of law de novo. Cornelius v. Sullivan, 936 F.2d 1143, 1145 (11th Cir. 1991). The court "may not decide the facts anew, reweigh the evidence, or substitute [its] judgment for that of the [Commissioner], rather [it] must scrutinize the record as a whole to determine if the decision reached is reasonable and supported by substantial evidence." Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990) (quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)) (internal quotations and other citation omitted). "The Commissioner's factual findings are conclusive if supported by substantial evidence." Wilson, 284 F.3d at 1221 (citing Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990); Allen v. Bowen, 816 F.2d 600, 602 (11th Cir. 1987)). "Substantial evidence" is "more than a scintilla and is such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Winschel v. Comm'r of Social Sec., 631 F.3d 1176, 1178 (11th Cir. 2011) (internal quotations and citations omitted). As just noted, conclusions of law made by the Commissioner are reviewed de novo. Cornelius, 936 F.2d at 1145. "No ... presumption of validity attaches to the [Commissioner's] conclusions of law." Wiggins v. Schweiker, 679 F.2d 1387, 1389 (11th Cir. 1982).
At the time of the ALJ's decision in this case, Plaintiff was forty-four years old with a marginal education having left school during the seventh grade.
Dr. Fowler also submitted an opinion letter dated February 9, 2012, in which he stated that he did not believe Plaintiff was capable of returning to work. (R. 301). Dr. Fowler's records reflect that Plaintiff began complaining of back and leg pain during an examination on October 12, 2009. (R. 233). In December of that year, Dr. Fowler began prescribing Lortab to alleviate pain and recommended that Plaintiff see an orthopedic specialist. (R. 228). In August 2010 Plaintiff requested a hard back brace from Dr. Fowler, which he subsequently prescribed. (R. 220). In October, she again returned to see Dr. Fowler but stated that the pain was less with use of medication. (R. 218). When Plaintiff saw Dr. Fowler in May 2011 she reported her pain as being 2/3 out of 10, though the doctor noted her range of motion was still limited. (R. 319). However, when Plaintiff returned in September 2011 and again in January 2012, she stated her pain was at level 9 out of 10. (R. 311). During this same period of time, Dr. Fowler was also treating Plaintiff for her high-blood pressure and thyroid problems with medication. Additionally, he began prescribing Plaintiff Zoloft for depression in February 2011. (R. 325).
Dr. Fetter's records reflect similar observations to Dr. Fowler, noting pain in the back, hips, and legs with some limited range of motion. (R. 202-215). Dr. Gill determined that the Plaintiff was experiencing lower back pain due in part to a history of degenerative disc disease arthrosis. He noted a wedge fracture at L5. (R. 267). However, he also noted that Plaintiff was capable of walking with a normal gait; was capable of squatting and raising to standing while holding a table; had a fairly wide range of motion; and was able to bend her hip and knee joints. (Id.) Dr. Estock reported that Plaintiff appeared to have a mild case of adjustment disorder with depression, which was not severe. (R. 284). Dr. Heilpern reported that Plaintiff's claims of pain were generally consistent with the presence of degenerative disc disease and wedge fracture. (R. 291). However, Dr. Heilpern also opined that Plaintiff should still be capable of standing for up to six hours out of an eight hour day; sitting for six hours out of an eight hour day; lifting up to ten pounds frequently and 20 pounds occasionally; and should generally be capable of performing work with some limitations. (R. 286-293).
The ALJ found that Plaintiff has severe physical impairments of osteoarthritis of the pelvis and lumbar spine at L2-L5 and a history of a wedge fracture at L5.
Plaintiff argues the ALJ erred in that her RFC findings are not based on substantial evidence. (Doc. 12 at 10). Specifically, she states that the ALJ erred (1) in not giving greater weight and consideration to the opinion of Dr. Fowler, Plaintiff's treating physician, (2) in not including limitations due to Plaintiff's use of a back brace in the hypothetical questions posed to the Vocational Expert and (3) in failing to order an MRI examination. (Id. at 10-14).
As noted above, the ALJ found that Plaintiff was capable of performing "light work" with certain limitations. (R. 22). Plaintiff's over-arching challenge is that this conclusion is wrong because the ALJ's RFC findings are not based on adequate evidence or a fair and fully developed record. (Doc. 12 at 10-14). The Commissioner responds that the evidence is sufficient and there was no need for an MRI in assessing Plaintiff's RFC. (Doc. 13 at 22-23).
An RFC is an "individual's maximum remaining ability to do sustained work activities in an ordinary work setting on a regular and continuing basis ... [which] means 8 hours a day for 5 days a week, or an equivalent work schedule." SSR 96-8p, 1996 WL 374184 (July 2, 1996). It "involves determining the claimant's ability to do work in spite of his impairments" in consideration of all relevant evidence. Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997); see also 20 C.F.R. §§ 404.1545(a), 416.945(a). It is the responsibility of the Commissioner to determine a claimant's RFC. See Robinson v. Astrue, 365 F. App'x 993, 999 (11th Cir. 2010) (stating that "the task of determining a claimant's residual functional capacity and ability to work is within the province of the ALJ, not of doctors"). As recently noted by Chief Judge Karon O. Bowdre:
Thompson v. Colvin, 2014 WL 1278085, *2-3 (N.D. Ala. 2014); see also 20 C.F.R. § 416.946(c) (stating, "the administrative law judge or the administrative appeals judge at the Appeals Council ... is responsible for assessing your residual functional capacity").
It is also well-settled that Plaintiff bears the burden of proving that he is disabled. See 20 C.F.R. § 416.912(a) ("In general, you have to prove to us that you are blind or disabled. This means that you must furnish medical and other evidence that we can use to reach conclusions about your medical impairment(s)."); 20 C.F.R. § 416.912(c) ("Your responsibility. You must provide medical evidence showing that you have an impairment(s) and how severe it is during the time you say that you are disabled. You must provide evidence, without redaction, showing how your impairment(s) affects your functioning during the time you say that you are disabled, and any other information that we need to decide your claim."); Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003) (stating that "the claimant bears the burden of proving that he is disabled, and, consequently, he is responsible for producing evidence in support of his claim").
Plaintiff first argues that the ALJ did not properly consider all of the relevant evidence in assessing Plaintiff's RFC. (Doc. 12 at 10). Specifically, Plaintiff contends that the ALJ did not give proper weight and consideration to the opinion of Dr. Fowler, Plaintiff's primary treating physician. (Id. at 11). This court finds that there is substantial evidence to support the ALJ's RFC findings regarding Plaintiff and the weight given to the opinion of Dr. Fowler.
"In assessing the medical evidence, the ALJ was required to state with particularity the weight given to the different medical opinions
The ALJ scrupulously examined the opinion given by Dr. Fowler in light of the record evidence and clearly articulated her reasons for giving the opinion little weight. (R. 21-22.) Primarily, the ALJ decided that Dr. Fowler's opinion, as given in his opinion statement, was "inconsistent with his own treatment notes and [Plaintiff's] documented response to conservative treatment efforts the findings of the consultative examination, her abilities to return to work and operate a business, the claimant's reported activities of daily living ... and the other substantive evidence of record." (R. 22). The progress notes that were prepared by Dr. Fowler contemporaneously with Plaintiff's visits routinely describe her as being in no acute distress with substantial functionality and mobility.
Additionally, Dr. Fowler's opinion is inconsistent with the findings of Dr. Marlin D. Gill. (R. 22, 266-67). Upon examination, Dr. Gill found Plaintiff had some tenderness over the lumbar spine and sacral area, but had a normal gait, could squat all the way down and arise while holding a table for balance, could heel/toe walk without reported difficulty, and use her hands and arms normally with full range of motion and no limitations. (R. 18, 267). Dr. Gill further found that Plaintiff's back looked normal, her legs were symmetrical with good muscle tone, her right hip was non-tender, and she had a good range of motion, strength, and flexibility in her hips. (R. 18-19, 267). The ALJ therefore reasonably concluded that Dr. Fowler's conclusory opinion that Plaintiff was incapable of any work was inconsistent with Dr. Gill's findings on examination.
The ALJ also discounted Dr. Fowler's opinion because it was inconsistent with Plaintiff's daily activities as reported in a disability questionnaire, in which Plaintiff described a range of activities she performed, such as household chores, cooking, shopping, and taking care of children. (R. 22, 170-73). The inconsistencies between Dr. Fowler's opinion and his own treatment notes, Plaintiff's self-reported daily activities, and Dr. Gill's findings on examination, provide substantial evidence to support the ALJ's conclusion that Dr. Fowler's opinion was entitled to little weight.
Plaintiff further argues that the ALJ violated the regulations by requiring Dr. Fowler to base his opinion on objective findings alone. (Doc. 12 at 11); see 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2) (stating that a treating source "may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone"). While it is correct that the ALJ must consider the treating physician's unique perspective and opinion, that opinion is to be weighed in light of the overall record, and can be rejected with explicit and adequate reasoning. See Phillips, 357 F.3d at 1240-41. The ALJ has done just that, weighing and rejecting the opinion of Dr. Fowler in light of the overall record and offering explicit and adequate reasoning for doing so. Further, the record does not reflect that the ALJ ever stated or implied that Dr. Fowler's opinion could not be credited because it was not based on medical findings alone. (See generally R. 17-22). Nor does Plaintiff cite to any evidence in the record that would contradict this conclusion. In sum, the ALJ's assessment is supported by the record, and the ALJ applied the proper legal standards in assessing the weight of the opinion submitted by Dr. Fowler.
Plaintiff next contends that the ALJ "was required to include a hard back brace in all of her hypothetical questions to the VE." (Doc. 12 at 13). Further, Plaintiff argues that the ALJ did not properly credit Dr. Fowler's prescription of a rigid back brace in concluding the brace was not "medically necessary." (Id. at 12). The hypothetical questions posed to a VE must accurately and comprehensively reflect the claimant's characteristics, and a reviewing court must determine whether they are supported by substantial evidence. McSwain v. Bowen, 814 F.2d 617, 619-20 (11th Cir. 1987) (per curiam); Pendley v. Heckler, 767 F.2d 1561, 1562-63 (11th Cir. 1985) (per curiam). However, a hypothetical question need not incorporate alleged impairments that the ALJ has properly discredited or found to be unsupported by the medical evidence. Crawford, 363 F.3d at 1161.
Contrary to Plaintiff's assertions, the ALJ listed a number of adequate reasons for discounting Plaintiff's use of a back brace. (R. 19-20). The record reflects that the back brace was prescribed to Plaintiff as a discretionary measure, not because it was medically required. (R. 19, 220). Plaintiff requested the back brace to see if it would help with the discomfort she was experiencing. (Id.) Because there was no objective evidence that the back brace was medically required the ALJ was not obligated to include the back brace in the hypotheticals posed to the VE. See Broaster v. Colvin, No. CV113-032, 2014 WL 2199846, at *8 (S.D. Ga. May 27, 2014); Johnson v. Astrue, No. 5:11-cv-1666-KOB, 2012 WL 4339507, at *14 (N.D. Ala. Sept. 18, 2012) (finding ALJ properly rejected claimant's reliance on a cane for lack of medical documentation showing need and concluding ALJ was thus not required to pose a hypothetical that assumed restrictions due to using a cane).
Plaintiff relies on Mire v. Comm'r of Soc. Sec., No. 2:06-cv-1056, 2008 WL 482548 (S.D. Ohio Feb. 20, 2008), to support her assertion that the ALJ should have included the back brace in the hypotheticals posed to the VE. (Doc. 12 at 12). However, that case is distinguishable from the one at hand. In Mire, the claimant's treating physicians considered the use of a cane to be medically necessary, while the non-examining state agency physician determined it was non-obligatory. Id. at *4. On review before the district court the parties agreed that if the cane was medically necessary it would have a significant impact on the claimant's ability to perform light work. Id. As such the case was remanded for a determination of whether use of a cane was medically necessary, and in turn, the effect the use of a cane would have on the claimant's residual functional capacity. Id.
Unlike the treating physician in Mire, Dr. Fowler did not state that Plaintiff's back brace was medically required, nor did the ALJ give greater weight to the opinion of a non-treating physician on the issue. (R. 19, 220). Plaintiff's assertions that Dr. Fowler prescribed the back brace with instructions to wear it all day are simply not supported by the record. (Id.) Plaintiff cites to no other evidence in the record that would contravene the conclusion that the back brace was not medically required. As such, the ALJ's assessment is supported by the record, and the ALJ was not required to include the back brace in the hypotheticals posed to the VE.
Plaintiff next contends that the ALJ erred in failing to order an MRI on her behalf as an element of developing a full and fair record. (Doc. 12 at 13-14). The court disagrees. As has been already noted, the ALJ has a duty to develop the record fully and fairly. Wilson v. Apfel, 179 F.3d 1276, 1278 (11th Cir. 1999). In determining whether it is necessary to remand a case for development of the record, the Court considers "whether the record reveals evidentiary gaps which result in unfairness or clear prejudice." Salazar v. Comm'r of Soc. Sec., 372 F. App'x 64, 67 (11th Cir. 2010) (quoting Brown v. Shalala, 44 F.3d 931, 935 (11th Cir. 1995) (per curiam) (citation and quotation omitted)). Under the social security regulations, the ALJ may order additional consultative examinations if the medical evidence submitted by the claimant does not provide enough information about an impairment to determine whether the claimant is disabled. 20 C.F.R. § 416.917.
Nevertheless, the ALJ is not required to order additional examinations if the evidence in the record is sufficient to allow him to make an informed decision. Salazar, 372 F. App'x at 67 (citing Ingram v. Comm'r of Soc. Sec. Admin., 496 F.3d 1253, 1260 (11th Cir. 2007) (citation omitted)); see Holladay v. Bowen, 848 F.2d 1206, 1210 (11th Cir. 1988); Bailey v. Astrue, 739 F.Supp.2d 1365, 1377-78 (N.D. Ga. 2010) (finding there was sufficient evidence to support a disability determination without an MRI where record was unambiguous on presence of pain, and there was no indication that the doctors who provided opinions could not do so without an MRI); Dawson v. Colvin, No. 6:13-CV-741-AKK, 2014 WL 721945, at *3 (N.D. Ala. Feb. 24, 2014) (holding where record was adequately developed to make a disability determination, and no doctor recommended a new MRI, ALJ was not required to order an updated MRI). Additionally, "[w]hen alleging disability, the claimant carries the burden of proving that he is disabled, and he alone is responsible for producing evidence to support his claim." Bentley v. Astrue, 2012 WL 4479273, *2 (N.D. Ala. September 25, 2012) (citing 20 C.F.R. §§ 404.1512(a), 416.912(a); Ellison, 355 F.3d 1272, 1275 (11th Cir. 2003)).
To the extent Plaintiff argues that further development of the record was necessary in the form of an MRI "because an MRI is necessary to the ALJ's informed decision," the court again disagrees.
Nothing before this court suggests that the ALJ needed an MRI to assess Plaintiff's RFC. To the contrary, the record is replete with evidence supporting her determination. A consultative examination had already been conducted by Dr. Marlin Gill, and at that time he did not recommend an MRI. (R. 266-67). Nor was an MRI recommended by Dr. Robert Heilpern, the state agency medical consultant who reviewed the record and opined concerning Plaintiff's limitations. (R. 286-93). Moreover, Plaintiff has failed to show there is insufficient evidence in the record to support an overall disability determination.
Further, though the MRI exam is costly, Plaintiff has offered no argument as to why the cost of the procedure should have been a factor the ALJ was required to consider in deciding to order a consultative examination. (Doc. 12 at 13). Nor does Plaintiff offer argument that her difficulty in paying for the procedure obligated the ALJ to order it. (Id.) In the ALJ's decision the cost of the procedure was considered only as another factor to be weighed in determining Plaintiff's credibility. (R. 19). The ALJ considered that Plaintiff had not obtained an MRI allegedly due to cost but had not sought out indigent or government-subsidized healthcare, was able to maintain an expensive tobacco habit, and was receiving income from unemployment benefits. (R. 18-19). Taken as a whole, the ALJ determined that Plaintiff's failure to pursue additional treatments weighed in favor of finding that her treatment by her primary physician, Dr. Fowler, was adequate, which was not consistent with Plaintiff's allegations of disabling symptoms. (R. 19).
As such, the ALJ did not err in failing to order an MRI, nor was an MRI necessary to the informed decision of the ALJ. This claim is without merit because the ALJ's assessment is supported by the record. Plaintiff has pointed to nothing in the medical records disputing the ALJ's conclusion or warranting further inquiry. Finally, Plaintiff has shown no prejudice. While an MRI might have further enlightened the situation, it was not required.
In sum, the undersigned finds that the record is sufficient to support the ALJ's decision. She was not required under the circumstances to seek any additional consultative evidence. Plaintiff simply failed to carry her burden of proof in this matter.
For the reasons set forth above, the undersigned finds that the decision of the Commissioner is due to be