JOHN E. McDERMOTT, Magistrate Judge.
On July 20, 2017, John C. Huddleston ("Plaintiff" or "Claimant") filed a complaint seeking review of the decision by the Commissioner of Social Security ("Commissioner") denying Plaintiff's application for Social Security Disability Insurance benefits. The Commissioner filed an Answer on October 30, 2017. On February 22, 2018, the parties filed a Joint Stipulation ("JS"). The matter is now ready for decision.
Pursuant to 28 U.S.C. § 636(c), both parties consented to proceed bef ore this Magistrate Judge. After reviewing the pleadings, transcripts, and administrative record ("AR"), the Court concludes that the Commissioner's decision must be affirmed and this case dismissed with prejudice.
Plaintiff is a 53 year-old male who applied for Social Security Disability Insurance benefits on July 30, 2014, alleging disability beginning April 15, 2014. (AR 110.) The ALJ determined that Plaintiff had not engaged in substantial gainful activity since April 15, 2014, the alleged onset date. (AR 112.)
Plaintiff's claim was denied initially on September 26, 2014, and on reconsideration on November 26, 2014. (AR 110.) Plaintiff filed a timely request for hearing on December 3, 2014. (AR 110.) Plaintiff appeared and testified at hearings held on January 29, 2016, and October 14, 2016, in Los Angeles, California. (AR 110.) Plaintiff was represented by Mario Davila, a non-attorney representative. (AR 110.) Attorneys/co-representatives Max Ortega and Robina Ali represented Plaintiffs at the hearings. (AR 110.) Vocational experts ("VE") Carmen Roman and Elizabeth Brown-Ramos also appeared and testified at the hearings. (AR 110.)
The ALJ issued an unfavorable decision on January 9, 2017. (AR 110-122.) The Appeals Council denied review on May 19, 2017. (AR 1-4.)
As reflected in the Joint Stipulation, Plaintiff raises the following disputed issues as grounds for reversal and remand:
Under 42 U.S.C. § 405(g), this Court reviews the ALJ's decision to determine whether the ALJ's findings are supported by substantial evidence and free of legal error.
Substantial evidence means "`more than a mere scintilla,' but less than a preponderance."
This Court must review the record as a whole and consider adverse as well as supporting evidence.
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 . . . can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). The Commissioner has established a five-step sequential process to determine whether a claimant is disabled. 20 C.F.R. §§ 404.1520, 416.920.
The first step is to determine whether the claimant is presently engaging in substantial gainful activity.
If the claimant cannot perform his or her past relevant work or has no past relevant work, the ALJ proceeds to the fifth step and must determine whether the impairment prevents the claimant from performing any other substantial gainful activity.
In this case, the ALJ determined at step one of the sequential process that Plaintiff has not engaged in substantial gainful activity since April 15, 2014, the alleged onset date. (AR 112.)
At step two, the ALJ determined that Plaintiff has the following medically determinable severe impairment: right knee pain and weakness post total knee replacement. (AR 112-114.) The ALJ also determined that Plaintiff's left ankle and foot impairment, right shoulder impairment, and obesity were not severe.
At step three, the ALJ determined that Plaintiff does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments. (AR 114.)
The ALJ then found that Plaintiff had the RFC to perform light work as defined in 20 CFR § 404.1567(b), with the following limitations:
(AR 114-120.) In determining the above RFC, the ALJ made an adverse credibility determination that Plaintiff's subjective symptom allegations were "not entirely consistent" with the medical and other evidence of record. (AR 115.)
At step four, the ALJ found that Plaintiff is unable to perform his past relevant work as a respiratory therapist and an actor/extra. (AR 120-121.) The ALJ, however, also found that, considering the Claimant's age, education, work experience, and RFC, there are jobs (representative occupations) that exist in significant numbers in the national economy that the Claimant can perform such as parking lot cashier, merchandise marker, and garment sorter. (AR 121-122.)
Consequently, the ALJ found that Claimant is not disabled, within the meaning of the Social Security Act. (AR 122.)
Plaintiff alleges disability due to a right knee impairment. (AR 115.) Although the ALJ determined that Plaintiff's right knee impairment was a medically determinable severe impairment (AR 112), the ALJ nonetheless found that Plaintiff could perform a reduced range of light work. (AR 114.) Plaintiff also alleged disability due to a number of other impairments that the ALJ found to be nonsevere. (AR 113-114.) Plaintiff contends that the ALJ's step two findings that Plaintiff's left ankle and foot impairment, shoulder impairment, and obesity are not severe (AR 113-114) are unsupported by substantial evidence. The Court disagrees.
At step two of the sequential inquiry, the ALJ determines whether the claimant has a medically severe impairment or combination of impairments.
Preliminarily, the Court observes that, because the ALJ found Plaintiff's right knee impairment was severe and therefore proceeded beyond step two in the sequential evaluation, there can be no harmful error from the ALJ's nonseverity determinations.
An MRI of Plaintiff's left ankle on November 2, 2015, showed mild to moderate osteoarthritic changes, moderate calcaneocuboid joint effusion, thickening of ligaments with a chronic partial tear, and mild to moderate fluid in the tendons. (AR 113, 557.) In April 2016, however, examination of Plaintiff's ankles and feet revealed normal contour and alignment of the ankles. (AR 113, 715.) There was no tenderness. (AR 113, 715.) Range of motion was full and painless and he had five out of five motor strength. (AR 113, 715.) Based on these objective medical findings, the ALJ found Plaintiff's left foot and ankle impairment to be nonsevere but included protective limitations on walking, standing, pushing and pulling in the RFC. (AR 113.)
Plaintiff notes that in January 2016 he required a left ankle fiberglass cast and was told to elevate his leg as much as possible. (AR 690, 58.) Plaintiff, however, admitted at the hearing the cast was only temporary. (AR. 61.) By April 2016, he had no cast and no ankle issues. (AR 715.) Plaintiff also contends that in September 2016 he was planning to undergo ankle fusion surgery (AR 1129), but Plaintiff points to no medical opinion recommending it, and the treatment note Plaintiff cites indicates only mild ankle osteoarthritis with intact joint space and painless range of motion. (AR 1129.) Even if Plaintiff had a severe left ankle impairment at this time, it would not satisfy the 12 month durational requirement.
In December 2015, Plaintiff complained of pain in the right shoulder. (AR 113, 573.) He was found to have adhesive capsulitis and mild degenerative changes. (AR 113, 559.) As of April 2016, however, Claimant's right shoulder had full and painless range of motion. (AR 113, 714.) There was negative impingement sign and negative cross arm abduction sign. (AR 113, 714.) There was no instability of the right shoulder. (AR 113, 714.) The ALJ found the impairment nonsevere but included protective restrictions in the RFC. (AR 113.)
Plaintiff stresses the December 2015 finding of shoulder pain, but he was only referred for physical therapy. (AR 579.) This was successful because by April 2016 he had full and painless range of motion in the shoulder. (AR 113, 714.) Plaintiff also points to a treatment note dated September 19, 2016, that Plaintiff presented with frozen right shoulder since 2015 (AR 1115), but this note does not acknowledge the April 2016 finding that Plaintiff had full and painless range of motion. Any deterioration after the April 2016 finding would not meet the 12 month durational requirement as considered by the ALJ. (AR 120.)
The ALJ found that Plaintiff was extremely obese but found that Level III obesity in itself does not cause significant limitations in his ability to perform basic work activities and therefore was nonsevere. (AR 113-114.) Plaintiff contends that the ALJ failed to perform an individualized assessment and failed to consider whether Plaintiff's obesity in combination with his other orthopedic impairments would equal a listed impairment. Plaintiff, however, failed to present any evidence supporting additional functional limitations beyond those included in the ALJ's RFC.
Obesity, moreover, is not itself disabling and is no longer a listed impairment.
This case, too, is more like
Plaintiff disagrees with the ALJ's assessment of the record evidence in determining whether Plaintiff's left foot and ankle impairment, right shoulder impairment, and obesity are severe, but it is the ALJ's responsibility to resolve conflicts in the medical evidence and ambiguities in the record.
The ALJ's conclusion that Plaintiff's left foot and ankle impairment, right shoulder impairment, and obesity are not severe is supported by substantial evidence. Any error in the ALJ's determination of severity, moreover, would be harmless because the ALJ did not stop at step two of the sequential evaluation, but proceeded to consider those impairments, severe or not, in subsequent steps and to accommodate those impairments in Plaintiff's RFC.
Plaintiff contends that the ALJ's RFC for a reduced range of light work is not supported by substantial evidence. More specifically, Plaintiff asserts that the ALJ did not give specific, legitimate reasons for rejecting the opinions of Plaintiff's treating physicians, Dr. Myles Spar and Dr. Abid Chaudry. Plaintiff also argues that the opinion of Dr. Warren Yu and other physicians relied on by the ALJ are not supported by substantial evidence. The Court disagrees.
The ALJ's RFC is not a medical determination but an administrative finding or legal decision reserved to the Commissioner based on consideration of all the relevant evidence, including medical evidence, lay witnesses, and subjective symptoms. See SSR 96-5p; 20 C.F.R. § 1527(e). In determining a claimant's RFC, an ALJ must consider all relevant evidence in the record, including medical records, lay evidence, and the effects of symptoms, including pain reasonably attributable to the medical condition. Robbins, 446 F.3d at 883.
In evaluating medical opinions, the case law and regulations distinguish among the opinions of three types of physicians: (1) those who treat the claimant (treating physicians); (2) those who examine but do not treat the claimant (examining physicians); and (3) those who neither examine nor treat the claimant (non-examining, or consulting, physicians).
Where a treating doctor's opinion is not contradicted by another doctor, it may be rejected only for "clear and convincing" reasons.
Claimant alleges disability due to a right knee impairment (AR 112, 115.) On December 27, 2013, Plaintiff underwent a right knee menisectomy to repair a medial meniscus tear. (AR 115, 367.) At a February 10, 2014 follow-up, he had returned to his former level of activity prior to the surgery. (AR 115-116, 367.) His right lower extremity had full range of motion with minimal tenderness to palpation along the joint line. (AR 115-116, 367.) Beginning June 2014, however, Plaintiff complained of increasing right knee pain. (AR 116, 362.) In November 2014, he was approved for total knee replacement surgery which occurred in March 2015. (AR 116.)
Starting April 2015, Plaintiff underwent extensive physical therapy. (AR 116-117.) In May 2015, he was "doing great," and his pain was well controlled. (AR 116, 483, 1176.) In June 2015, he was doing better three months out from surgery. (AR 116, 487.) On September 1, 2015, he reported that his right knee was much better but still not great. (AR 116, 602.) In November 2015, Plaintiff reported that his right knee was better post total knee replacement but still numb. (AR 117, 594.) In December 2015, Plaintiff's pain was 3 on a scale of 10 and he reported great improvement since beginning physical therapy, but did report pain and limited range of motion. (AR 117, 655.)
On April 3, 2016, Claimant underwent a consulting orthopedic examination with Dr. Warren Yu. (AR 117, 712-722.) Dr. Wu observed that Plaintiff has dramatically improved his knee pain since the March 10, 2015 total knee pain replacem ent surgery but continues to have quad weakness and thigh numbness. (AR 117, 712.) Dr. Yu found normal alignment and contour in the knees, mild tenderness, no effusion or instability, and full extension with 115 degrees of flexion. (AR 117, 714.) Range of motion in the ankes and feet was full and painless, and motor strength in the upper and lower extremities was preserved. (AR 117, 715.) Dr. Yu noted Claimant could walk with a limp on the right side about a block without a cane (AR 117, 713), but may require the use of a cane for long distance ambulation. (AR 118, 716, 718.) Dr. Wu assessed Plaintiff with a reduced range of light work RFC and indicated that Plaintiff could stand or walk four hours in an eight hour day and bend, crouch, stoop, and crawl occasionally. (AR 118, 715-716.)
The ALJ adopted most of Dr. Yu's restrictions and added a sit/stand option. (AR 118.) The ALJ also found no substantial need for a cane for work. (AR 118.) The ALJ's RFC, then, was based on Dr. Yu's opinion and the documented record of Plaintiff's improvement with physical therapy. (AR 118.)
Plaintiff contends that Dr. Yu's opinion lacks substantial evidence because it is inconsistent with his clinical examination findings. A physician's opinion may be rejected if it is inconsistent with his or her treatment notes.
Plaintiff's next contention is that Dr. Yu failed to adequately consider Plaintiff's pain and medication side effects. Plaintiff, however, cites no evidence to support his assertion. Dr. Yu reported Plaintiff's medications of Ibuprofen, Tramadol, and Vicodin for breakthrough pain. (AR 712, 713.) Dr. Yu's opinion is replete with consideration of Plaintiff's pain. Plaintiff's disagreement with Dr. Yu's conclusions does not mean they are unsupported by substantial evidence.
Dr. Yu's RFC as modified by the ALJ is based on substantial evidence. Plaintiff failed to provide specific, legitimate reasons for rejecting it. The ALJ did not err in relying on Dr. Yu's opinion.
Plaintiff contends that the ALJ erred in discounting the RFC assessments of Plaintiff's treating physicians, Dr. Myles Spar and Dr. Abid Chaudry. The Court disagrees.
In November 2014, Dr. Spar indicated Plaintiff was cleared to undergo a total knee replacement. (AR 116, 398-400.) Dr. Spar filled out a lower extremities impairment questionnaire (AR 390-397) indicating Plaintiff did not need a hand held device to walk and could regularly carry out activities of daily living. (AR 118, 392-393.) He opined Plaintiff could lift 20 pounds occasionally and could sit, stand or walk only one hour in an eight hour day. (AR 118, 393.) He also opined that Plaintiff could not kneel, bend, or stoop. (AR 118, 396.) Dr. Spar wrote a letter on December 16, 2014, stating that Plaintiff's suspected disability would end up lasting more than 12 months since it started in June 2014 and he was not anticipated to have surgery until March 2015. (AR 119, 418.) He completed a form in January 2015 indicating Claimant was disabled and unable to work. (AR 119, 432.)
The ALJ credited Dr. Spar's light work lift and carry restrictions and agreed with his opinion that Plaintiff did not need a cane, but rejected Dr. Spar's postural limitations as "more extreme than justified by the Claimant's documented activity level" (AR 118, 119), which is a reference to the extensive physical therapy records showing improvement. An ALJ may reject a physician's opinion that is unsupported by the record as a whole.
Dr. Spar completed another lower extremities questionnaire dated November 19, 2015, after Plaintiff's March 2015 right knee replacement surgery. (AR 119, 524, 531.) Dr. Spar found that Claimant needed a cane to ambulate, could stand only one hour a day, and could never kneel, bend, or stoop. (AR 119.) He opined Plaintiff would miss work more than three times per month. (AR 119.) The ALJ gave this opinion little weight because it was inconsistent with Dr. Spar's earlier opinion and with Dr. Yu's subsequent opinion in April 2016, and because it does not adequately take into account the continuing rehabilitation of his right knee through physical therapy. (AR 119.) Plaintiff challenges the ALJ's finding of inconsistency with Dr. Spar's earlier opinion, but Dr. Spar in November 2014 found Plaintiff did not need a cane but in November 2015 found he did because of his left ankle. (AR 526.) In April 2016, Dr. Yu found Plaintiff was able to walk despite a limp on the right side. (AR 117.) Plaintiff's ankles and feet were entirely normal with full and painless range of motion and no edema. (AR 715.) As for Plaintiff's right knee, Dr. Yu found normal alignment and contour, intact motor strength, and preserved sensation and some numbness over the thigh area. (AR 714-715.) Dr. Yu opined that Plaintiff may require use of a cane for long distance ambulation but not for shorter walks. (AR 716, 718.) Dr. Spar found in November 2015 that Plaintiff could not kneel, bend, or stoop, but by April 2016 Dr. Yu found Plaintiff could do so. (AR 530, 713-714, 716.) Dr. Yu's independent clinical findings five months later are substantial evidence.
On December 22, 2015, Dr. Spar opined Plaintiff would miss more than three days a week because of a right shoulder impairment. (AR 120, 563-67.) Dr. Spar found Plaintiff could not lift more than five pounds and rarely use his right arm to handle objects. (AR 565.) Dr. Spar did not indicate that Plaintiff's shoulder impairment was expected to last at least 12 months. (AR 564.) The ALJ afforded little weight to this opinion. (AR 120.) Plaintiff did not have an initial physical therapy evaluation for his shoulder until January 21, 2016. (AR 120, 642.) The ALJ found that Plaintiff's right shoulder substantially improved within months, as Plaintiff had full and painless range of motion at Dr. Yu's examination in April 2016. (AR 120, 714.) There was no instability of the right shoulder. (AR 120, 714.) Indeed, the ALJ found Plaintiff's right shoulder impairment nonsevere and added restrictions to the RFC. (AR 120, 113.) Plaintiff does not contend that the ALJ erred in affording Dr. Spar's third opinion little weight.
Dr. Abid Chaudry, a podiatrist, completed a lower extremities impairment questionnaire on January 21, 2016. (AR 119, 692-700.) Dr. Chaudry opined Plaintiff required use of a cane, could stand or walk for zero to one hour, was unable to carry out activities of daily living, could not lift more than 10 pounds, and needed to elevate his legs. (AR 695-697.) He assessed no limitations in kneeling, bending, or stooping. (AR 699.) The ALJ gave Dr. Chaudry's opinion little weight because it inaccurately implies that Claimant was worse after the right knee replacement surgery instead of better, it is materially more restrictive than the other medical opinions already discussed, and it is not consistent with the physical therapy records and Dr. Yu's April 2016 opinion. (AR 119.) Dr. Chaudry's January 2016 RFC limitations are more severe than those of Dr. Spar's November 2015 RFC, even though the opinions are but two months apart. Dr. Spar indicated Plaintiff could carry out activities of daily living independently and without assistance (AR 527) whereas Dr. Chaudry opined Plaintiff could not carry out activities of daily living. (AR 696.) Dr. Spar indicated Plaintiff did not need to elevate his legs (AR 528) but Dr. Chaudry said he did. (AR 697.) As for Plaintiff's ankle impairment, the ALJ found that the evidence did not support even a severe impairment as discussed above. (AR 113.) Imaging of the ankle showed only mild to moderate osteoarthritic changes and a partial ligament tear. (AR 113, 557.) Dr. Yu in April 2016 found normal contour and alignment of the ankles, no tenderness, full and painless range of motion, and five out of five motor strength. (AR 113, 714-15.)
Plaintiff contends that the ALJ overlooked the length of Plaintiff's treating relationship with Dr. Spar, which is one of the factors in 20 C.F.R. § 404.1527(c) that the Ninth Circuit in
Plaintiff disputes the ALJ's assessment of the medical evidence, but again it is the ALJ's responsibility to resolve conflicts in the medical evidence and ambiguities in the record.
The ALJ properly considered the medical evidence. The ALJ provided specific, legitimate reasons supported by substantial evidence for rejecting the opinions of Dr. Spar and Dr. Chaudry.
Plaintiff contends that the ALJ improperly discounted Plaintiff's subjective symptoms allegations. The Court disagrees.
The test for deciding whether to accept a claimant's subjective symptom testimony turns on whether the claimant produces medical evidence of an impairment that reasonably could be expected to produce the pain or other symptoms alleged.
In determining Plaintiff's RFC, the ALJ concluded that Plaintiff's medically determinable impairments reasonably could be expected to cause his alleged symptoms. (AR 115.) The ALJ, however, also found that Plaintiff's statements regarding the intensity, persistence, and limiting effects of these symptoms are "not entirely consistent" with the medical evidence and other evidence in the record. (AR 115.) Because the ALJ did not make any finding of malingering, he was required to provide clear and convincing reasons supported by substantial evidence for discounting Plaintiff's credibility.
Preliminarily, Plaintiff cites SSR 96-7p as the governing SSA advice on the credibility of subjective complaints. That advice, however, has been superseded by SSR 16-3p, which provides that credibility findings "must contain specific reasons for the weight given to the individual's symptoms, be consistent with and supported by the evidence, and be clearly articulated so the individual and any subsequent reviewer can assess how the adjudicator evaluated the individual's symptoms."
The ALJ discounted Plaintiff's subjective symptom allegations for a number of reasons. First, the ALJ found that the RFC assessment is "supported by the clear weight of the evidence over the entire period pertinent to this claim, including the medical opinions." (AR 120.) An ALJ is permitted to consider whether there is a lack of medical evidence to corroborate a claimant's alleged symptoms so long as it is not the only reason for discounting a claimant's credibility.
Second, the ALJ noted daily activities inconsistent with disabling limitations, which is a legitimate consideration in evaluating credibility.
The ALJ discounted Plaintiff's subjective symptoms for clear and convincing reasons supported by substantial evidence.
At step five of the sequential process, the ALJ determined that Plaintiff, based on the assessed RFC, was capable of performing the light work unskilled occupations of merchandise marker, garment sorter, and parking lot cashier. (AR 121-122.) Plaintiff argues that the ALJ's RFC limitations preclude these occupations and that the RFC was wrongly assessed because it should have included the need for a cane. These arguments lack merit.
The ALJ's RFC includes no more than occasional overhead reaching with the right upper extremity and a sit/stand option. (AR 114.) Plaintiff claims that these limitations would preclude the three occupations and that the ALJ failed to obtain an explanation from the VE for the apparent conflict as required.
Plaintiff also challenges the ALJ's RFC because it does not include the requirement of a cane.
The ALJ's step five determination that Plaintiff could perform the occupations of merchandise marker, garment sorter, and parking lot cashier is supported by substantial evidence.
The ALJ's nondisability determination is supported by substantial evidence and free of legal error.
IT IS HEREBY ORDERED that Judgment be entered affirming the decision of the Commissioner of Social Security and dismissing this action with prejudice.