ALKA SAGAR, Magistrate Judge.
On January 6, 2015, Plaintiff, represented by counsel, filed a Complaint seeking review of the denial of his application for Disability Insurance Benefits. (Docket Entry No. 6). The parties have consented to proceed before the undersigned United States Magistrate Judge. (Docket Entry Nos. 12, 14). On May 21, 2015, Defendant filed an Answer along with the Administrative Record ("AR"). (Docket Entry Nos. 16-17). The parties filed a Joint Position Statement ("Joint Stip.") on August 19, 2015, setting forth their respective positions regarding Plaintiff's claims. (Docket Entry No. 19).
The Court has taken this matter under submission without oral argument.
On April 12, 2011, Plaintiff, formerly employed as a rehabilitation counselor and rehabilitation supervisor for the California Department of Rehabilitation (
Plaintiff requested that the Appeals Council review the ALJ's decision. (AR 8-11). The request was denied on November 3, 2014. (AR 1-5). The ALJ's decision then became the final decision of the Commissioner, allowing this Court to review the decision.
Plaintiff alleges that the ALJ failed to properly (1) reject the opinion of Plaintiff's treating physician, Dr. Serina; and (2) determine whether Plaintiff could perform his past relevant work. (
After consideration of the record as a whole, the Court finds that the Commissioner's findings are supported by substantial evidence and are free from material legal error.
Plaintiff asserts that the ALJ failed to provide specific and legitimate reasons for rejecting the opinion of Plaintiff's treating physician, Dr. Serina. (
Although a treating physician's opinion is generally afforded the greatest weight in disability cases, it is not binding on an ALJ with respect to the existence of an impairment or the ultimate determination of disability.
Enna Serina, M.D., a physician at Kaiser Permanente, treated Plaintiff from November 29, 2006 to September 23, 2012. (
The ALJ addressed Dr. Serina's opinion as follows:
(AR 25).
The ALJ properly discredited Dr. Serina's opinion because it was not supported by the objective medical evidence and was conclusory.
Although Plaintiff points to evidence supporting the existence of his physical impairments (i.e., atrial fibrillation, spinal stenosis of spinal region, diabetes, positive back pain, tender to palpation lumbar spinous processes, and foot pain),
As the ALJ found, the objective clinical or diagnostic findings do not support Dr. Serina's opinion concerning Plaintiff's limitations, specifically with respect to Plaintiff's abilities to stand, walk, sit and overhead reach and with respect to the number of days of work Plaintiff likely will miss each month.
The Kaiser Permanente records of Plaintiff's examinations do not contain findings that would support Dr. Serina's overly restrictive limitations.
On November 29, 2006, Dr. Serina found that Plaintiff had no acute distress, a normal heart rate, a non-distended and non-tender abdomen, and no edema (swelling) in the extremities.
On January 30, 2008, Dr. Serina noted that Plaintiff was taking medication for hyperlipidemia without any side effects, and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, and no edema in the extremities. (AR 323-32). On March 4, 2008, Dr. Serina noted that Plaintiff was taking medications for diabetes mellitus without any side effects, medications for hypertension and was doing well, and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, and no edema in the extremities. (AR 335-40). On June 3, 2008, Dr. Serina found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, no edema in the extremities, pupils were equal, round, and reactive to light and accommodation, extraocular movement was intact, eyes did not contain foreign bodies, and normal ears, sinuses, throat and neck. (AR 343-49). On October 29, 2008, Dr. Serina found that Plaintiff had no distress, normal head, ear, nose and throat, mild to moderate edema of the lower lip (but no erythema or tenderness), normal eyes, normal range of the motion of the neck, normal heart rate, normal pulmonary/chest, no problem with his feet, and no cervical adenopathy. (AR 352-64). On July 9, 2009, Dr. Serina noted that Plaintiff's atrial fibrillation with a rapid ventricular rate had been successfully controlled with Atenolol (which Plaintiff had stopped taking because of side effects) and that Plaintiff's hypertension was controlled, and found that Plaintiff had no distress, a normal heart rate, and no respiratory distress. (AR 393-400).
On July 30, 2009, Dr. Serina noted that, following a July 9, 2009 visit, Plaintiff had restarted medications for diabetes mellitus and hypertension but not the Atenol (because Plaintiff thought it made him tired) and that Plaintiff's blood pressure was stable and had improved with weight loss and change in diet, and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, no edema in the extremities, and normal ears, sinuses, throat and neck. (AR 403-14). On July 31, 2009, Dr. Serina noted that Plaintiff's paroxysmal atrial fibrillation had recently converted to a regular sinus rhythm, and found that Plaintiff was oriented and not in distress, Plaintiff's head was normocephalic and atraumatic, Plaintiff's right and left eyes exhibited no discharge and no scleral icterus, Plaintiff's neck had a normal range of motion, Plaintiff had a normal heart rate, Plaintiff had normal breath sounds and did not have respiratory distress, Plaintiff had a normal range of motion and did not have edema, and Plaintiff was alert and oriented. (AR 417-23. A September 6, 2009 emergency room visit for chest pain revealed nothing unusual except faint heart sounds. (AR 262-67). On September 15, 2009, Dr. Serina noted that Plaintiff had another episode of fast atrial fibrillation (but that his symptoms were stable and that he was able to walk 30 to 60 minutes a day and 7 times a week) and that a foot X-ray showed a linear small fracture ("There is a fracture of the distal mid-shaft of the first proximal phalanx."), and found the same findings as on July 31, 2009. (AR 426-34). A November 3, 2009 testing of Plaintiff's heart showed no perfusion defect, normal wall motion and thickening, left ventricular ejection fraction was greater than 65 percent, and "no evidence of infarct or ischemia." (AR 757). On December 9, 2009, Dr. Serina noted that Plaintiff had changed medications and reduced the amount of one medication for his diabetes mellitus, Plaintiff was taking Lisinopril for hypertension without side effects and Lovastatin for hyperlipedemia without side effects, and had not had another atrial fibrillation episode in the past 3 months, and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, no edema in the extremities, and normal ears, sinuses, throat and neck. (AR 442-49).
On January 17, 2011, Dr. Serina noted that Plaintiff's last paroxysmal atrial fibrillation episode was one year ago, in the past year Plaintiff's heart began to beat irregularly only once (for which Plaintiff took medication), and Plaintiff's blood pressure had been better since he cut back on alcohol, and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, no edema in the extremities and no lesions and intact sensation in the feet. (AR 464-73). On May 6, 2011, Dr. Serina sent a letter to Plaintiff stating that his hemoglobin A1c (average sugar test) and cholesterol were good and that his liver test was higher than normal but a little better than before. (AR 539-40). On July 6, 2011, Dr. Serina noted that Plaintiff's sugar level was lower due to a changed diet and weight loss, and Plaintiff was taking medications regularly for hypertension, and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, and no edema in the extremities. (AR 558-62). On July 20, 2011, Dr. Serina found that Plaintiff had no distress, no neck, pulmonary/chest or abdominal issues, a normal range of motion, and was alert and oriented. (AR 579-87). An August 25, 2011 eye examination revealed no remarkable findings, and assessed refraction disorder. (AR 640-44). On October 6, 2011, Dr. Serina noted that Plaintiff's potassium, kidneys, cholesterol and hemoglobin A1c tests were normal and that his liver tests were back to normal. (AR 655-58). An October 4, 2011 blood pressure check, noted that Plaintiff said he had been feeling well and reported no significant medication side effects. (AR 665-66). On December 29, 2011, Dr. Serina, after stating that Plaintiff "[w]ants to try to get social security disability for [diabetes mellitus]," noted that Plaintiff complained of trouble sleeping due to back pain or having to urinate, complained of right foot pain (which he claimed to have suffered for seven years) and stated that podiatry had recommended shoe inserts which had not helped, and complained of chronic low back pain caused by a degenerative disc disorder and spinal stenosis (which he claimed to have suffered for more than 30 years), and found that Plaintiff had no acute distress, a normal heart rate, clear lungs, a non-distended and non-tender abdomen, no edema in the extremities, no lesions and intact sensation in the feet (non-tender to palpation), a negative straight leg raise and "tender to palpation lumbar spinous processes," and a mildly enlarged prostate, and made the following assessments: hyperlipidemia, stable and Plaintiff should continue medications; hypertension, slightly elevated blood pressure but is normal at home; atrial fibrillation, stable, and Plaintiff should continue medications; spinal stenosis of lumbar region, chronic low back pain, but Plaintiff declines further treatment at this time; foot pain, but Plaintiff declines further evaluation or treatment and should follow up with podiatry if pain persists. (AR 512-22, 675-86).
On May 10, 2012, Dr. Serina found that Plaintiff had no acute distress, a normal hear rate, clear lungs, a non-distended and non-tender abdomen, no edema in the extremities, no lesions and intact sensation in the feet. (AR 740-46). An August 23, 2012 eye examination assessed a cataract in the left eye causing vision problems. (AR 802-09). A September 21, 2012 cataract preoperative examination noted that Plaintiff was complaining of decreased vision, and found that Plaintiff had a regular heart rate, clear lungs, a benign abdomen, no acute changes in the extremities, and was alert. (AR 850-52). In a progress noted dated September 26, 2012, Dr. Serina noted that Plaintiff's liver test was higher than before (and asked how much alcohol Plaintiff was drinking) and that Plaintiff's urine test showed more protein than before (and asked whether Plaintiff was taking Lisinopril daily). (AR 871-73).
As discussed by the ALJ (
As the ALJ noted (
The ALJ also noted that Plaintiff's high blood pressure readings were 123/76 and 136/84. (
Moreover, to the extent that Plaintiff is contending that the ALJ improperly rejected Dr. Serina's opinion that Plaintiff was only able to stand/walk for less than 2 hours in an 8-hour workday based on the opinion of the examining physician, Robert Nguyen, M.D. (Board Certified Internal Medicine), who on August 6, 2011 opined inter alia that Plaintiff could stand and walk 6 hours in an 8-hour workday (see AR 491; see also AR 24 [the ALJ gave Dr. Nguyen's opinion significant weight]
Dr. Nguyen's opinion about Plaintiff's ability to stand and walk 6 hours in an 8-hour workday was based on his own clinical findings — Plaintiff's blood pressure was 134/86, and there were no remarkable findings in the physical examination (normal results for Plaintiff's bilateral hand grip strength, skin, lymphatics, head, ears, eyes, nose and throat, neck, chest/lungs, cardiovascular, and abdomen, musculoskeletal, neck and back, except for "some tenderness to palpation with right arm abduction" and "mild lower back pain to straight leg raising test") or in the neurological examination (except for sensory being diminished to touch and vibrations on both feet), see AR 489-90 — and was consistent with medical expert James Haynes' testimony (see AR 34).
Plaintiff asserts that the ALJ failed to properly determine that Plaintiff could perform his past relevant work as a rehabilitation counselor and rehabilitation supervisor, because the vocational expert's testimony that those occupations would allow a person to alternate positions, upon which the ALJ relied, conflicted with the Dictionary of Occupational Titles ("DOT"). (See Joint Stip. at 15-24). Defendant asserts that the ALJ properly relied on the vocational expert's testimony because the DOT did not include information about a particular aspect of a job (such as the existence of a sit/stand option). (See Joint Stip. at 21-22).
As noted above, the ALJ found that Plaintiff had the capacities to stand and walk for 6 hours in an 8-hour workday with changing position every 30 minutes and to sit for 6 hours in an 8-hour workday with changing position every 1 hour.
At the initial hearing on September 25, 2012, the ALJ told the vocational expert to state whether his testimony conflicted with the DOT. The ALJ asked about the following hypothetical person — 61 years old; four or more years of college; a range of light work; lifting, pushing and pulling 20 pounds occasionally and 10 pounds frequently; standing and walking 8 hours in an 8-hour workday; sitting 8 hours in an 8-hour workday; frequently walking on uneven terrain; occasional ladders, ropes, scaffolds and working at heights; occasional bending, kneeling, stooping, crawling, and crouching; no heavy machinery; and past work as a rehabilitation counselor and as a rehabilitation supervisor. The vocational expert testified that such a person could perform the work of a rehabilitation counselor (DOT 045.107-042, Specific Vocational Preparation 8, skilled, sedentary) and a rehabilitation supervisor (DOT 045.117-010, Specific Vocational Preparation 8, skilled, light) as generally performed pursuant to the DOT and as actually performed by Plaintiff. (See AR 74-75).
At the supplemental hearing on March 13, 2013, the ALJ did not tell the vocational expert to state whether his testimony conflicted with the DOT. (See AR 38-44). The ALJ asked the vocational expert about the following hypothetical person — 61 years old; 4 or more years of college; lifting and carrying 20 pounds occasionally and 10 pounds frequently; standing and walking 6 hours, with a change of position every 30 minutes; sitting for 6 hours, with a change of position every 1 hour; occasional walking on uneven terrain; no climbing of ladders, ropes or scaffolds; no working at heights; occasional bending, kneeling, stooping, crawling, and crouching; no heavy machinery; no vibratory types of tools or instruments; and past work as a rehabilitation counselor and as a rehabilitation supervisor. The vocational expert testified that such a person could perform the work of a rehabilitation counselor and a rehabilitation supervisor as generally performed pursuant to the DOT and as actually performed by Plaintiff. (See AR 38-39). The ALL then changed the hypothetical to include the same limitations except for a 10 pound lifting and carrying limitation. The vocational expert testified that such a person could perform the work of a rehabilitation counselor as generally performed pursuant to the DOT and as actually performed by Plaintiff. (See AR 40-41).
After finding that rehabilitation counselor and rehabilitation supervisor were past relevant work (see AR 25-26), the ALJ wrote:
(AR 26).
Plaintiff correctly notes that the ALJ relied on the vocational expert's testimony at the supplemental hearing (at which the change of position for the sit/stand option was presented), but the ALJ did not question the vocational expert about whether his testimony concerning the hypothetical person's ability to perform past relevant work as a rehabilitation counselor and as a rehabilitation supervisor was consistent with the DOT. (See Joint Stip. at 16).
An ALJ may not rely on a vocational expert's testimony regarding the requirements of a particular job without first inquiring whether the testimony conflicts with the DOT, and if so, why it conflicts.
However, since the DOT for the jobs of rehabilitation counselor and rehabilitation supervisor (DOT 045.107-042 and DOT 045.117-010) do not address the sit/stand option, there was no conflict between the vocational expert's testimony and the DOT.
For the foregoing reasons, the decision of the Commissioner is affirmed.
LET JUDGMENT BE ENTERED ACCORDINGLY.
In any event, Plaintiff's claim is conclusory. Plaintiff has failed to allege who Drs. Pagnini and Skewis were, what their opinions were, or how the ALJ erred in rejecting their opinions.