KENDALL J. NEWMAN, Magistrate Judge.
Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying plaintiff's applications for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under Titles II and XVI, respectively, of the Social Security Act ("Act").
For the reasons that follow, the court denies plaintiff's motion for summary judgment, grants the Commissioner's cross-motion for summary judgment, and enters judgment for the Commissioner.
Plaintiff was born on February 20, 1961, obtained a high school education and took some college coursework, and previously worked as a letter carrier and commercial truck driver.
In a decision dated February 9, 2012, the ALJ determined that plaintiff had not been under a disability, as defined in the Act, from March 2, 2008, plaintiff's alleged onset date, through the date of the ALJ's decision. (AT 15-22.) The ALJ's decision became the final decision of the Commissioner when the Appeals Council denied plaintiff's request for review on June 10, 2013. (AT 1.) Thereafter, plaintiff filed this action in federal district court on August 5, 2013, to obtain judicial review of the Commissioner's final decision. (ECF No. 1.)
Plaintiff raises the following four issues: (1) whether the ALJ failed to properly consider Dr. Martin's opinion in assessing plaintiff's residual functional capacity ("RFC"); (2) whether the ALJ erred in not finding plaintiff's diabetes, heart disease, hypertension, and liver disease to be "severe impairments" at Step Two; (3) whether the ALJ improperly considered plaintiff's obesity under the standards articulated by Social Security Ruling 02-1p ("SSR 02-1p"); and (4) whether the ALJ made an improper credibility determination with respect to plaintiff's testimony.
The court reviews the Commissioner's decision to determine whether (1) it is based on proper legal standards pursuant to 42 U.S.C. § 405(g), and (2) substantial evidence in the record as a whole supports it.
The ALJ evaluated plaintiff's entitlement to DIB pursuant to the Commissioner's standard five-step analytical framework.
Before proceeding to step four, the ALJ assessed plaintiff's residual functional capacity ("RFC") for the relevant time period as follows:
(AT 18.)
At step four, the ALJ found that plaintiff was unable to perform any past relevant work. (AT 21.) Finally, at step five, the ALJ determined that, considering plaintiff's age, education, work experience, and RFC, there were jobs that existed in significant numbers in the national economy that plaintiff could have performed, including the representative occupations of collator operator, cleaner, housekeeping, and photocopy machine operator. (AT 22.)
Accordingly, the ALJ concluded that plaintiff had not been under a disability as defined in the Act from March 2, 2008, through the date of the ALJ's decision. (
First, plaintiff contends that the ALJ erred by crediting the opinion of Dr. Martin, an examining physician, "great evidentiary weight" in support of the ALJ's RFC determination that plaintiff is capable of performing light work, albeit with the restriction that he avoid certain occupational hazards, because the ALJ failed to consider Dr. Martin's statement that placing plaintiff on a "[t]emporary restriction from the workplace pending better control of sleep apnea symptoms seems reasonable and important" when coming to that conclusion. (AT 291.)
The weight given to medical opinions depends in part on whether they are proffered by treating, examining, or non-examining professionals.
To evaluate whether an ALJ properly rejected a medical opinion, in addition to considering its source, the court considers whether (1) contradictory opinions are in the record; and (2) clinical findings support the opinions. An ALJ may reject an uncontradicted opinion of a treating or examining medical professional only for "clear and convincing" reasons.
Here, Dr. Martin examined plaintiff on January 23, 2011, and noted that while plaintiff appeared obese and "quite fatigued," he had "[n]o florid difficulty getting on/off the exam table or moving about the [exam room]" and did not need an assistive device to move. (AT 289.) Dr. Martin further opined that plaintiff generally exhibited a normal range of motion, aside from plaintiff's ability to squat at only 75% of the full range with difficulty, and that his gait was "grossly normal," with plaintiff exhibiting the ability to walk on both his heels and toes. (AT 291.) In addition, Dr. Martin opined that plaintiff's strength and motor test results revealed that plaintiff exhibited normal strength and motor capabilities. (
(AT 291.)
As noted above, the ALJ gave Dr. Martin's opinion "great evidentiary weight." (AT 21.) Plaintiff contends, however, that this was done in error because the ALJ provides no discussion of Dr. Martin's recommendation that plaintiff be placed on a temporary workplace restriction until his sleep apnea is better controlled, which plaintiff claims supports a finding that plaintiff was unable to perform any work rather than the ALJ's finding that plaintiff could perform light work. (ECF No. 14 at 18-20.) Plaintiff's argument is without merit. While plaintiff is correct in noting that the ALJ did not dismiss or otherwise discuss Dr. Martin's recommendation that plaintiff be temporarily restricted from the workplace when assessing plaintiff's RFC, the ALJ's failure to mention this finding did not amount to error because Dr. Martin's overall opinion supported the ALJ's RFC determination.
When Dr. Martin's clinical findings and overall opinion are taken as a whole, they support the ALJ's conclusion that plaintiff is capable of performing light work with restrictions regarding working around workplace hazards. As noted above, Dr. Martin opined that plaintiff generally exhibited a largely normal range of motion, aside from difficulty with squatting and walking on grades, exhibited normal strength and motor capabilities, and otherwise had "no functional restrictions attributable to medical conditions for age-and habitus-appropriate activities." (AT 291.) The ALJ's RFC determination that plaintiff could perform "light work" as defined in 20 C.F.R. § 404.1567(b) and 20 C.F.R § 416.967(b) is in general accordance with these findings.
While Dr. Martin opined that a "[t]emporary restriction from the workplace pending better control of sleep apnea symptoms seems reasonable and important," the ALJ was not bound to adopt this conclusion as his own with respect to determining the ultimate issue of whether plaintiff is disabled within the meaning of the Act. The determination that a claimant meets the statutory definition of disability is a legal conclusion and is reserved to the Commissioner. 20 C.F.R. § 416.927(e);
Furthermore, Dr. Martin's opinion recommended only that plaintiff be temporarily restricted from the workplace in order to obtain better control over his sleep apnea symptoms. (
Next, plaintiff contends that the ALJ erred in his assessment at Step Two because he failed to discuss why plaintiff's Diabetes, Heart Disease, Hypertension, and Liver Disease were not listed as "severe impairments" despite the existence of evidence in the record that plaintiff suffered from these impairments. (ECF No. 14 at 20-21.)
Under the Commissioner's regulations, an impairment or combination of impairments is deemed to be severe at Step Two if it "significantly limits your physical or mental ability to do basic work activities." 20 C.F.R. §§ 404.1520(c), 404.1521(a). As the Ninth Circuit Court of Appeals has explained, "the step-two inquiry is a de minimis screening device to dispose of groundless claims. An impairment or combination of impairments can be found not severe only if the evidence establishes a slight abnormality that has no more than a minimal effect on an individual's ability to work."
Here, the ALJ found that only plaintiff's obesity and sleep apnea were "severe impairments" for purposes of Step Two (AT 17); the ALJ did not discuss whether any of the four impairments mentioned by plaintiff were "severe" for purposes of this step. Regardless, substantial evidence from the record supported the ALJ's Step Two determination that obesity and sleep apnea were plaintiff's only two impairments sufficiently severe for purposes of Step Two.
For example, Dr. Martin opined that while plaintiff had hypertension, there existed no "objective evidence of associated end-organ damage." (AT 291.) Furthermore, during the administrative hearing, plaintiff testified that his blood pressure was "a little high," but was overall "good" and well-controlled with the medications he was taking. (AT 55.) Regarding the health of plaintiff's liver, the radiology reports and progress notes from the Veterans Administration hospital indicated that it was "markedly echogenic" in a manner that was "compatible with diffuse hepatocellular disease or fatty infiltration" (AT 335, 358); however, nothing in the record suggests that this condition affected plaintiff in a way that significantly limited his ability to perform work-related activities. With respect to plaintiff's heart condition, the treating notes contain only findings of "mild cardiomegaly" with no evidence of any acute disease; multiple electrocardiograms indicated normal results. (
Moreover, even assuming arguendo that the ALJ technically erred by not finding that plaintiff's other impairments individually constituted severe disorders at Step Two, such error is harmless if the ALJ proceeded to consider the effects of that impairment at subsequent steps.
Plaintiff asserts in his reply that the ALJ's failure to include these impairments at Step Two was not harmless because "there is no indication at any level of the sequential evaluation that these additional impairments were considered or otherwise incorporated into plaintiff's RFC." (ECF No. 16 at 5.) Contrary to plaintiff's argument, the ALJ based his RFC assessment upon a careful review of the "all of the evidence" in the record. (AT 15.) The record contains references to plaintiff's hypertension, diabetes, heart condition, and liver condition, and it can be reasonably inferred that the ALJ at least "considered" each of these impairments in rendering his decision.
Plaintiff's third argument is that the ALJ erred by failing to properly consider his obesity throughout the sequential disability analysis. In particular, plaintiff asserts that the ALJ improperly discounted the impact plaintiff's obesity had on his sleep apnea and other impairments when the ALJ found that plaintiff's "symptoms . . . could be readily remedied by daily physical exercise and a change in his level of consumption of food that has resulted in significant weight gain. In short, his symptoms can be alleviated if he changes his sedentary lifestyle." (AT 20; ECF No. 14 at 23.) Plaintiff argues that this finding ran contrary to the Ninth Circuit Court of Appeals' holding in
SSR 02-1p
Here, the ALJ considered plaintiff's obesity throughout the sequential analysis. (AT 17-22.) For instance, the ALJ found that plaintiff's obesity was a "severe" impairment at Step Two of the sequential analysis. (AT 17.) This finding means that the ALJ must have determined that plaintiff's obesity had some material impact on plaintiff's ability to do basic work activities.
While the ALJ concluded that plaintiff's obesity impacted plaintiff's ability to work insofar as the obesity contributed to the impact of plaintiff's sleep apnea, the ALJ also concluded that plaintiff's obesity did cause any other complications beyond those already identified, specifically noting that there was no evidence in the record of plaintiff's obesity causing peripheral vascular disease or hypertensive cardiovascular disease. (AT 20.) The ALJ further determined that plaintiff's physical deconditioning that rendered plaintiff obese could "be remedied by daily physical exercise and a change in his level of consumption of food that has resulted in significant weight gain. In short, his symptoms can be alleviated if he changes his sedentary lifestyle." (
Contrary to plaintiff's argument, the ALJ's references to the impact of exercise and other lifestyle changes in his discussion of the effects of plaintiff's obesity on plaintiff's RFC were not made to emphasize the effect of any failure on plaintiff's part to follow treatment for obesity. In fact, the ALJ's discussion of the impact of plaintiff's obesity with regard to plaintiff's other impairments and overall RFC does not even mention that plaintiff failed to follow such treatment for his obesity. While the ALJ's discussion of plaintiff's obesity did include the ALJ's sentiments that plaintiff's "symptoms can be alleviated if he changes his sedentary lifestyle" and that plaintiff's obesity could "be remedied by daily physical exercise and a change in his level of consumption of food" (AT 20), the ALJ did not improperly invoke these sentiments in support of reasoning that plaintiff was not disabled because he failed to follow prescribed treatment for his obesity. Accordingly, plaintiff's reliance on
Furthermore, plaintiff fails to point to any evidence of particular functional limitations due to obesity beyond the only ones already addressed by the ALJ that would have materially impacted the ALJ's RFC analysis.
Based on the record, the ALJ adequately considered plaintiff's obesity in his RFC determination and throughout the five-step evaluation process. Plaintiff has not set forth, and there is no evidence in the record, of any functional limitations as a result of plaintiff's obesity that the ALJ failed to consider.
Finally, plaintiff argues that the ALJ improperly found plaintiff's testimony not credible. In particular, plaintiff argues that the ALJ's credibility determination was erroneous because the ALJ relied on the following improper reasons to support his finding: (1) plaintiff's failure to lose weight; (2) the purported existence of inconsistencies between plaintiff's reported symptoms and the objective medical evidence in the record; (3) the existence of discrepancies in the record and in plaintiff's testimony regarding plaintiff's alleged onset date; and (4) plaintiff's failure to comply with the prescribed use of this BiPAP machine. (ECF No. 14 at 25-30.)
A claimant's subjective statements and statements made by laypersons should be considered by the ALJ, but they need not always be accepted as true. In
However, "the ALJ is not required to believe every allegation of disabling pain, or else disability benefits would be available for the asking . . . ."
Neither the ALJ nor the Commissioner cited to evidence of malingering in the record, and there appears be none, so the ALJ was required to provide clear and convincing reasons for discounting plaintiff's credibility. Accordingly, the ALJ gave the following reasons for finding plaintiff's testimony not credible:
(AT 20-21.)
As an initial matter, plaintiff argues that the ALJ's finding plaintiff not credible on the basis that his symptoms associated with obesity could be remedied with a change in diet and exercise habits violates the Ninth Circuit Court of Appeals' holding in
The ALJ's next stated reason for finding plaintiff's testimony not credible is that plaintiff's testimony regarding his daily activities conflicted with the objective medical evidence in the record regarding plaintiff's physical functional capacity. (AT 21.) During the administrative hearing, plaintiff testified that he engaged in only a very limited range of living activities. For instance, plaintiff testified that he would once a week walk the distance of the driveway of his apartment complex, which would take him about fifteen minutes to complete. (AT 46.) Plaintiff also testified that he did not do laundry, change his bed's sheets, cook, vacuum, ride a bicycle, scrub the bathroom shower, mop the floor, or do any yard work. (AT 43-46.) Plaintiff further testified that the only exercise he was able to do were some unspecified swimming pool exercises and that he attempted to play tennis with his fiancé on four different occasions over the course of a two week period, but that each attempt resulted in him just hitting balls to his fiancé so that she could retrieve them for him. (AT 46.) When asked what he did as a hobby, plaintiff testified "I do nothing." (AT 47.) The ALJ determined that this testimony conflicted with plaintiff's medical records showing that plaintiff exhibited normal range of motion, sensation, reflexes, and motor functioning. (AT 21.)
Plaintiff argues that the ALJ's determination was in error because it did not take into account plaintiff's sleep apnea, which is the main impairment underlying plaintiff's claim that he is disabled. (ECF No. 14 at 30.) However, plaintiff's argument is without merit. The ALJ was not required under the relevant legal standard to find that the medical record conflicted with plaintiff's testimony concerning that particular alleged impairment in order to properly find plaintiff's testimony not credible. Rather, the ALJ needed only to point to a specific conflict between plaintiff's testimony and the medical record that is substantial enough to throw plaintiff's credibility into doubt.
Next, the ALJ found plaintiff not credible because plaintiff alleges a disability onset date of March 2, 2008, but told Dr. Martin during his consultative examination on January 23, 2011, that he had just been diagnosed with his alleged impairments six months prior to that examination. (AT 21.) Plaintiff asserts that this reason was also insufficient to find plaintiff not credible because it is unclear which impairments Dr. Martin referred to in his report and because other evidence in the record suggests that plaintiff's impairments, particularly his sleep apnea, had been diagnosed as many as ten years prior to Dr. Martin's examination. (ECF No. 14 at 29.) These arguments are not well-taken.
First, Dr. Martin's examination notes make it clear that he was referring to plaintiff being diagnosed with diabetes, high blood pressure, and sleep apnea when he stated in his January 23, 2011 report that "[plaintiff] reports being diagnosed with the above about six months ago after seeking urgent attention . . . for `chest pain.'" (AT 280.) Second, while the evidence in the record suggests that plaintiff may have suffered from sleep apnea as far back as ten years prior to Dr. Martin's examination (
Finally, the ALJ found plaintiff not credible for the reason that plaintiff was not wholly compliant with using his prescribed BiPAP breathing machine as directed. (AT 21.) Plaintiff argues that this reasoning was in error because the record shows that plaintiff repeatedly made attempts to use his BiPAP machine as prescribed when he slept, but was consistently unable to stay asleep because his use of the machine purportedly caused him to suffer anxiety attacks, nightmares, and claustrophobia. (ECF 14 at 27-28.) This argument is also without merit.
The claimant's "unexplained or inadequately explained failure to seek treatment or to follow a prescribed course of treatment" is a specific and legitimate reason for finding the claimant not credible.
Furthermore, substantial evidence in the record shows that plaintiff's purported reasons for not fully complying with his doctors' orders that he use the BiPAP machine on a regular basis when trying to sleep were inconsistent and inadequately explained plaintiff's failure to use the device as prescribed. For instance, the evidence shows that plaintiff sometimes told his doctors that he could not use the BiPAP machine because it would cause him to wake up in a panic thinking that it keeping him from breathing (AT 323-24), while, on other occasions, he told his doctors that he could not use the machine because it caused him to suffer from "vivid nightmares" about "murder and death" (AT 349, 353). Separate from the occasions where he would give the doctors one of these two reasons for not using the BiPAP as prescribed, plaintiff told his doctors that he would put the machine on when he went to bed, but when he "wakes up in [the] morning ... it is on the floor" without providing a reason for why he removed the machine during the night. (AT 374.) In January of 2011, plaintiff received a new mask for his BiPAP machine and told his doctors that the new mask was more comfortable to use. (AT 332.) However, plaintiff continued to not use the machine more than a few hours per night and continued to complain that the machine caused him to experience anxiety attacks. (AT 349, 374.)
The ALJ's credibility determination was supported by several specific and legitimate reasons for rejecting plaintiff's testimony. Accordingly, the ALJ did not err in finding plaintiff not credible.
For the foregoing reasons, IT IS HEREBY ORDERED that:
1. Plaintiff's motion for summary judgment (ECF No. 14) is DENIED.
2. The Commissioner's cross-motion for summary judgment (ECF No. 15) is GRANTED.
3. Judgment is entered for the Commissioner.
4. The Clerk of Court is directed to close this case and vacate all dates.
The claimant bears the burden of proof in the first four steps of the sequential evaluation process.
20 C.F.R. § 404.1567(b); 20 C.F.R § 416.967(b).