KENDALL J. NEWMAN, Magistrate Judge.
Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying plaintiff's application for Disability Insurance Benefits ("DIB") under Title II 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 April 28, 1961, has at least a high school education, and previously worked as a credit manager, office manager, branch manager, office supervisor, and accounting supervisor.
In a decision dated August 11, 2010, the ALJ determined that plaintiff had not been under a disability, as defined in the Act, from May 3, 2003, plaintiff's alleged disability onset date, through September 30, 2008, plaintiff's date last insured. (AT 37-45.) The ALJ's decision became the final decision of the Commissioner when the Appeals Council denied plaintiff's request for review on February 10, 2012. (AT 1-5.) Thereafter, plaintiff filed this action in federal district court on April 6, 2012, to obtain judicial review of the Commissioner's final decision. (ECF No. 1.)
Plaintiff has raised the following issues: (1) whether the ALJ violated Social Security Ruling 02-1p in analyzing plaintiff's obesity and its impact on her functioning; and (2) whether the ALJ improperly discounted the opinion of consultative examining psychiatrist Dr. Wong.
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") as follows:
(AT 40.)
At step four, the ALJ found, based on plaintiff's RFC and the vocational expert's testimony, that plaintiff was capable of performing her past relevant work as a credit manager, office manager, branch manager, office supervisor, and accounting supervisor (which were all sedentary occupations) through the date last insured. (AT 44.) Accordingly, the ALJ concluded that plaintiff had not been under a disability, as defined in the Act, from May 3, 2003, plaintiff's alleged disability onset date, through September 30, 2008, the date last insured. (
In this case, plaintiff's treatment records document her complaints of knee, leg, ankle, foot, hip, back, hand, elbow, arm, neck, and shoulder pain; surgeries related to a left knee ligament reconstruction, left knee arthroscopy, and a fracture of her left leg; and diagnoses of degenerative arthritis, degenerative joint disease, diabetes, and potential carpal tunnel syndrome. (
At the time of the administrative hearing, plaintiff was 5'2" tall and weighed 250 pounds, which amounted to a Body Mass Index ("BMI") of approximately 45.7, with a BMI of 30 or greater indicating obesity. (AT 16, 464.) There is no serious dispute that plaintiff's obesity exacerbates the symptoms attributable to her other conditions to some extent. For example, the treatment notes document that plaintiff has been advised to lose weight in order to reduce her leg/knee pain. (
The pertinent question in this case is the degree to which plaintiff's obesity impacts her other symptoms and functional limitations, and whether their combined effect renders her disabled. Although none of plaintiff's treating physicians submitted assessments of her physical functional capacity, plaintiff was evaluated by two consultative examiners — Dr. Jenna Brimmer (who was board certified in internal medicine) and Dr. Fariba Vesali (who was board certified in physical medicine and rehabilitation)—on whose opinions the ALJ substantially relied to formulate plaintiff's RFC. (AT 348-53, 409-13.)
On this appeal, plaintiff does not challenge the substance of the consultative examiners' opinions or the weight that the ALJ gave those opinions. Instead, plaintiff contends that the ALJ failed to consider the interactive effects of plaintiff's obesity on her other impairments, in violation of SSR 02-1p. For the reasons discussed below, that argument lacks merit.
SSR 02-1p provides, in part, as follows:
SSR 02-1p, at *6. For these reasons, when a claimant raises an issue concerning her obesity, or the record evidence reasonably triggers the ALJ's duty to independently inquire into the potential effects of a claimant's obesity, the ALJ must consider the interactive effect between the claimant's obesity and other conditions.
Nevertheless, as SSR 02-1p also makes clear, certain BMI levels may indicate obesity and the extent of obesity, but they "do not correlate with any specific degree of functional loss." SSR 02-1p, at *2. SSR 02-1p further notes that the Commissioner "will not make assumptions about the severity or functional effects of obesity combined with other impairments. Obesity in combination with another impairment may or may not increase the severity or functional limitations of the other impairment. We will evaluate each case based on the information in the case record." SSR 02-1p, at *6.
Here, the ALJ's decision explicitly considered plaintiff's obesity, noting that "the claimant has a Body Mass Index of 45.7 [Ex. 21F2], indicating extreme obesity. However, no treating or examining physician herein has opined obesity causes more than a minimal loss of function. Accordingly, the undersigned finds obesity is not a severe impairment, even assuming it exacerbates the claimant's symptoms." (AT 44.) Based on this isolated portion of the ALJ's decision, plaintiff argues that the ALJ only considered limitations caused by plaintiff's obesity alone and failed to consider their interactive effect with limitations caused by other impairments. However, plaintiff's argument ignores the ALJ's thorough summary of the treatment records and other medical evidence that preceded that portion of the decision, including the ALJ's consideration of the opinions of consultative examiners Drs. Brimmer and Vesali, which clearly took account of plaintiff's obesity. (AT 41-44.)
Consultative examiner and board certified internal medicine physician, Dr. Brimmer, who reviewed plaintiff's medical records and examined plaintiff on June 23, 2008, specifically noted that plaintiff was obese with a height of 5'2" and a weight of 229 pounds. (AT 348, 350, 353.) Based on a physicial examination of plaintiff, Dr. Brimmer diagnosed plaintiff with (1) left knee pain status post two arthroscopic surgeries, with some decreased knee range of motion, decreased strength, atypical exam, and abnormal station and gait; (2) recent left tibia and fibula fracture requiring surgery, with hardware in place and some ankle swelling; (3) type II diabetes; and (4) a history of depression and anxiety (with assessment deferred to a mental health specialist). (AT 352.) Dr. Brimmer opined that plaintiff could stand/walk for 6 hours in an 8-hour workday; sit without limits; lift and carry 20 pounds occasionally and frequently; and bend or stoop without limits, but crouch only occasionally. (
Consultative examiner Dr. Vesali, who was board certified in physical medicine and rehabilitation, reviewed plaintiff's medical records, and performed an orthopedic evaluation of plaintiff on March 31, 2009, likewise noted plaintiff's height of 5'2" and weight of 220 pounds. (AT 409-10, 413.) After completing her physical examination, Dr. Vesali diagnosed plaintiff with (1) chronic left knee pain status post left knee ligament reconstruction in 2008, status post left tibia-fibular fracture status post open reduction internal fixation; (2) possible left knee osteoarthritis; and (3) myofascial neck and right upper extremity pain. (AT 412.) Dr. Vesali opined that plaintiff could stand/walk for 4 hours in an 8-hour day; sit for 6 hours in an 8-hour day, with breaks every two hours for stretching; and lift/carry 10 pounds frequently and 20 pounds occasionally. (AT 412-13.) Plaintiff did not need an assistive device for ambulation and had no manipulative or environmental limitations, but Dr. Vesali noted that plaintiff should not engage in frequent climbing, crouching, kneeling, and crawling. (AT 413.)
Both consultative examiners personally examined plaintiff and reviewed plaintiff's medical records, and, as such, these examiners were well aware of plaintiff's obesity when they assessed plaintiff's functional limitations. Indeed, their reports set forth detailed and thorough clinical findings, including notations regarding plaintiff's height, weight, and resultant obesity. It is certainly well within their clinical expertise to opine as to the functional limitations resulting from all of plaintiff's combined impairments, including plaintiff's obesity. In formulating plaintiff's RFC, the ALJ substantially relied on these opinions and in fact gave plaintiff the benefit of the doubt by assessing slightly more restrictive limitations than those assessed by Drs. Brimmer and Vesali — in particular, finding that plaintiff could lift 20 pounds occasionally and 10 pounds frequently, stand/walk for only 2 hours in an 8-hour workday, and sit for 6 hours in an 8-hour workday. (AT 40.)
Therefore, the court finds that the combined or interactive effect of plaintiff's obesity and other impairments was appropriately considered in formulating plaintiff's RFC. As such, any failure by the ALJ to more precisely articulate the obesity impact analysis in the decision was harmless error.
The record in this case also contains no mental functional capacity assessment by a treating source, but plaintiff underwent a consultative psychiatric examination by board certified psychiatrist Dr. Patrick Wong. (AT 354-56.) Plaintiff contends that the ALJ failed to provide specific and legitimate reasons for discounting the opinion of Dr. Wong.
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.
Consultative examining psychiatrist Dr. Wong examined plaintiff on July 2, 2008. (AT 354, 356.) In the course of his evaluation, Dr. Wong reviewed plaintiff's medical records and noted plaintiff's chief mental complaints to be depression and anxiety resulting from conflicts with her son and her health problems. (AT 354.) Plaintiff reported wanting to stay in bed and sleep all the time, withdrawing from contact with other people and her family, and experiencing a general loss of interest, but attempting to stay active by watching TV, reading, and sometimes writing cards to friends. (
Upon examination, Dr. Wong observed that plaintiff was "quite overweight" at about 5'3'' tall and a weight of around 230 pounds. (AT 354-55.) However, he found plaintiff to be neatly dressed and groomed, oriented with no fluctuation in her level of consciousness, easily engaged, and socially appropriate and cooperative. (AT 355.) She exhibited no psychomotor hyperactivity and had good eye contact, a full and well modulated affect, and a mildly depressed mood. (
Dr. Wong diagnosed plaintiff with "depression not otherwise specified, relatively chronic and situationally related to her health problems" and a GAF of 70 (at the time of the evaluation and in the previous year).
(AT 356.)
The ALJ gave reduced weight to Dr. Wong's opinion, in particular his statement that "[t]he probability of functional deterioration due to typical workplace stresses is elevated," noting that plaintiff never sought mental health treatment other than reporting stress to her primary care physician, suggesting her depression is not as severe as she suggests." (AT 43-44, 356.) The ALJ also pointed to the opinion of non-examining state agency psychiatrist Dr. Walk, who reviewed plaintiff's medical records and Dr. Wong's report, and opined that plaintiff's mental impairment was not severe and that plaintiff only had mild limitations with respect to activities of daily living, maintaining social functioning, and maintaining concentration, persistence, or pace. (AT 44, 357-67, 369, 371.)
The court agrees with plaintiff, at least in part, that the ALJ's characterization of plaintiff merely "reporting stress" to her primary care physician somewhat understates the history of plaintiff's mental impairments. Plaintiff's treatment records note that she had a long-standing history of depression, was at times tearful, and received prescription medication for depression and anxiety. (
As Dr. Wong himself observed, plaintiff had no history of psychiatric hospitalization, did not seek any treatment from a mental health specialist, and the bulk of her medical records related to her orthopedic problems. (AT 354.) Although plaintiff's primary healthcare provider diagnosed plaintiff with recurrent major depression (AT 266), plaintiff was also noted to be stable on her medications, and Dr. Wong actually opined that plaintiff did not have a "history of persistent changes in vegetative function necessary to suggest the presence of a major depressive episode." (AT 354.) Dr. Wong himself essentially assessed mild to moderate mental limitations, and the Ninth Circuit Court of Appeals has previously held that moderate mental limitations do not even require vocational expert testimony.
To the extent that Dr. Wong's extremely vague reference to an "elevated" probability of functional deterioration due to typical workplace stresses can be construed as imposing more than mild to moderate mental limitations, that opinion is conclusory and minimally supported, and can be rejected on that basis. (AT 356.)
In light of the above, substantial evidence supports the ALJ's determination to give reduced weight to Dr. Wong's opinion, at least to the extent that the opinion significantly limits plaintiff's ability to work beyond the assessed RFC.
Plaintiff argues that because the ALJ herself did not specifically cite all of the above-mentioned reasons for discounting Dr. Wong's opinion, the court should not consider such post-hoc rationalizations for the ALJ's decision. However, the gist of the ALJ's reasoning for discounting Dr. Wong's opinion was that the medical evidence and treatment records did not support the alleged severity of plaintiff's depression and related mental symptoms. (AT 43-44.) Thus, by considering the record evidence outlined above, the court is not inventing a new ground of decision; rather, such evidence is additional support for the ALJ's decision.
For the foregoing reasons, the court finds that the ALJ's decision was free from prejudicial error and supported by substantial evidence in the record as a whole. Accordingly, IT IS HEREBY ORDERED that:
1. Plaintiff's motion for summary judgment (ECF No. 15) is DENIED.
2. The Commissioner's cross-motion for summary judgment (ECF No. 16) is GRANTED.
3. Judgment is entered for the Commissioner.
4. The Clerk of Court is directed to close this case and vacate all dates.
IT IS SO ORDERED.
The claimant bears the burden of proof in the first four steps of the sequential evaluation process.