GREGORY J. KELLY, Magistrate Judge.
Plaintiff Philip L. Walker (the "Claimant") brings this action pursuant to the Social Security Act (the "Act"), as amended, 42 U.S.C. § 405(g), to obtain judicial review of a final decision of the Commissioner of the Social Security Administration (the "Commissioner") denying his claim for Social Security benefits. Doc. No. 1. Claimant argues that the Administrative Law Judge (the "ALJ") erred by failing to: (1) demonstrate good cause, supported by substantial evidence, for giving little weight to the opinions of Claimant's treating physician, Dr. Chewning; and (2) articulate specific reasons, supported by substantial evidence, for finding Claimant's subjective statements not credible to the extent they conflict with the ALJ's residual functional capacity assessment (the "RFC"). Doc. No. 19 at 11-16. For the reasons set forth below, the final decision of the Commissioner is
Claimant alleges an onset of disability date as of April 17, 2009, due to neck and back pain. R. 145-46. In 2006, a magnetic resonance imaging ("MRI") of Claimant's lumbar spine revealed a herniated nucleus pulposus at L5-S1 with left-sided radiculitis. R. 414. Claimant underwent back surgery, physical therapy, and pain management services. R. 18. Beginning in 2008, Claimant has been treated primarily by Dr. John Chewning, an osteopathic physician. R. 280-310, 359-83, 390-407. The issues in the case involve: two opinions offered by Dr. Chewning — an April 23, 2009 written opinion (R. 359) and Dr. Chewning's March 2, 2012 deposition where he testified as to Claimant's functional limitations (R. 360-81); the Claimant's subjective statements regarding his functional limitations (R. 28-56); and the ALJ's findings related thereto (R. 18-21).
Claimant argues the ALJ failed to articulate good cause, supported by substantial evidence, for giving little weight to Dr. Chewning's opinions. Doc. No. 19 at 11-14. The ALJ's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla — i.e., the evidence must do more than merely create a suspicion of the existence of a fact, and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion. Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995) (citing Walden v. Schweiker, 672 F.2d 835, 838 (11th Cir. 1982) and Richardson v. Perales, 402 U.S. 389, 401 (1971)); accord Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991). The District Court "may not decide the facts anew, reweigh the evidence, or substitute [its] judgment for that of the [Commissioner]." Phillips v. Barnhart, 357 F.3d 1232, 1240 n. 8 (11th Cir. 2004).
Weighing the opinions and findings of treating, examining, and non-examining physicians is an integral part of the ALJ's sequential evaluation process for determining disability. In cases like this one, involving the ALJ's handling of a treating physician's medical opinion, "substantial-evidence review . . . involves some intricacy." Gaskin v. Commissioner of Social Security, 533 Fed.Appx. 929, 931 (11th Cir. Aug. 14, 2013) (unpublished).
Absent good cause, the opinions of treating physicians must be accorded substantial or considerable weight. Lamb v. Bowen, 847 F.2d 698, 703 (11th Cir. 1988).
Johnson v. Barnhart, 138 Fed.Appx. 266, 269 (11th Cir. 2005).
On April 23, 2009, Dr. Chewning provided the following written opinion:
R. 359. Thus, Dr. Chewning opines that Claimant's functional limitations preclude gainful activity. R. 359.
On March 2, 2012, Claimant's counsel deposed Dr. Chewning concerning his treatment of Claimant and Dr. Chewning's opinions about Claimant's functional limitations. R. 360-81. Dr. Chewning testified that he treated Claimant every other month for two years until 2010, and then again four months prior the deposition. R. 364. Dr. Chewning opined that Claimant is diagnosed with lumbago, which means chronic back pain, malaise and fatigue, joint pain, and elbow pain. R. 365-66. When asked about the objective findings that support Claimant's chronic pain, Dr. Chewning testified as follows:
R. 366. With respect to Claimant's inability to stand without assistance, Dr. Clewing stated that he observed Claimant's wife assisting Claimant in standing in Dr. Chewning's lobby. R. 367. Dr. Chewning opined that the source of Claimant's chronic pain was "either a bulging disc or it was possibly a bone spur." R. 368. Dr. Chewning stated that he did not know what the pathology is for Claimant's malaise and fatigue. R. 368. Dr. Chewning also stated that, in addition to Claimant's chronic back pain, Claimant has elbow pain bilaterally, worse on the right, which "makes it impossible for him to fully extend his right elbow beyond . . . 120 degrees, but he also has difficulty lifting himself up." R. 369. Dr. Chewning testified that he is unaware of the cause of Claimant's elbow pain. R. 369.
In terms of treatment, Dr. Chewning testified that Claimant "has seen pain management," undergone physical therapy, Dr. Chewning has tried lumbar injections multiple times without relief, and medications, but the treatment has been unable to control Claimant's pain. R. 369-70. Dr. Chewning opined that Claimant's impairments make "it almost impossible" for Claimant to perform work activity. R. 368. Claimant is "unable to stand for extended period, he's unable to sit for extended periods of time, he can't get up without help, and due to the pain he's — he has a difficult time focusing on any activities or concentrating mentally for any extended period." R. 369.
Dr. Chewning also testified regarding his April 23, 2009 opinion. R. 372-75. Dr. Chewning testified that, in his opinion, Claimant's prior back surgery was unsuccessful because as long as Dr. Chewning has been treating Claimant he has been "unable to walk or move." R. 373. Dr. Chewning suspects that further surgery would not eliminate Claimant's functional limitations. R. 373. Dr. Chewning stated that he formed his opinions regarding Claimant's functional limitations based on the following:
R. 373-74. Thus, Dr. Chewning stated that he formed his opinions regarding Claimant's functional limitations through extensive histories obtained from Claimant and his wife, as well as testing in Dr. Chewning's office. R. 374.
With respect to the reasons why Claimant cannot engage in prolonged standing, Dr. Chewning testified as follows:
R. 374. Regarding Claimant's inability to engage in prolonged sitting, Dr. Chewning stated:
R. 375. Thus, Dr. Chewning explained why, in his opinion, Claimant cannot engage in prolonged standing or sitting. R. 374-75. Dr. Chewning opined that, due to chronic pain, Claimant could not perform a sedentary job, which required sitting, on and off, for six hours in an eight-hour workday. R. 375. Dr. Chewning opined that Claimant would be required to lay down for 10 to 20 minutes every thirty minutes, and that Claimant would miss work more than 3 times per month due to his impairments. R. 376, 379. Dr. Chewning stated that his April 23, 2009 opinion remains an accurate reflection of Claimant's current limitations. R. 377-78.
In the decision, the ALJ found, at step-two, that Claimant suffers from a severe impairment of "degenerative disc disease of the lumbar spine status post surgical repair." R. 15. The ALJ determined that Claimant retains the following RFC:
R. 17. Thus, Dr. Chewning's opinions are more restrictive than the ALJ's RFC finding. Compare R. 17 with R. 359-81. In arriving at the RFC determination, the ALJ provides a good summary of the medical record, including a June 2009 MRI and Dr. Chewning's treatment records. R. 18-20.
The ALJ states the following with respect to Dr. Chewning's opinions:
R. 20-21. Thus, the ALJ gives a good summary of Dr. Chewning's opinions. R. 20. With respect to Dr. Chewning's April 23, 2009 opinion, the ALJ gave it limited weight for the following reasons: (1) Dr. Chewning's treatment notes do not describe objective clinical signs nor do imaging studies reflect the need to lie down on an as needed basis; and (2) an opinion as to whether a claimant is able to work is reserved for the Commissioner and is not part of a medical opinion. R. 21. Regarding, Dr. Chewing's opinions offered at his deposition, the ALJ gives them little weight because: (1) they are not supported by his own treatment records that reflect essentially normal findings; (2) imaging studies failed to reveal more than mild abnormalities of the lumbar spine; (3) Claimant's testimony that he can drive for thirty minutes conflicts with Dr. Chewing's opinion that Clamant cannot sit for more than 10 minutes; and (4) notes from Dr. Chewing's most recent treatment of Claimant show largely normal findings. R. 21.
In short, the ALJ's decision demonstrates good cause, supported by substantial evidence, for giving limited or little weight to both of Dr. Chewing's opinions. In the decision, the ALJ correctly notes that a 2009 MRI "showed only mild diffuse disc bulging at L3-4 and L4-5, and no protrusion or significant stenosis, as well as postoperative changes at L5-S1 consistent with scarring." R. 18 (citing R. 280-81).
The ALJ also accurately describes Dr. Chewning's treatment records, stating:
R. 18-19 (citing R. 280-309, 390-410). While Dr. Chewing's treatment notes during the relevant period do show persistent, moderate to severe muscle spasms and pain (see R. 285, 287, 291, 293, 295, 297, 303-04, 306, 308), the ALJ's finding that Dr. Chewing's treatment notes are inconsistent with both of his opinions is supported by substantial evidence. See R. 280-309, 390-410.
In addition, the ALJ also accurately notes that Claimant testified that he has no problems with the use of his arms and hands (R. 40), and he can sit in a car while driving for thirty minutes at a time (R. 53). R. 21. Thus, substantial evidence supports the ALJ's finding that Dr. Chewning's opinion, with respect to Claimant's elbow impairments and inability to sit more than ten minutes, are inconsistent with the Claimant's own testimony. R. 21.
Based on the forgoing, the Court finds that the ALJ demonstrated good cause, supported by substantial evidence, for giving limited and/or little weight to Dr. Chewning's opinions. Accordingly, this argument is rejected.
Claimant argues that the ALJ's credibility finding is not supported by substantial evidence because the ALJ failed to articulate explicit reasons for determining that Claimant's subjective statements are not credible to the extent they conflict with the ALJ's RFC. Doc. No. 19 at 14-16. In the Eleventh Circuit, a three-part "pain standard" applies when a claimant attempts to establish disability through subjective symptoms. Under this standard, there must be: (1) evidence of an underlying medical condition and either (2) objective medical evidence that confirms the severity of the alleged symptom arising from the condition or (3) evidence that the objectively determined medical condition is of such severity that it can be reasonably expected to give rise to the alleged pain. Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991) (citing Landry v. Heckler, 782 F.2d 1551, 1553 (11th Cir. 1986)). "20 C.F.R. § 404.1529 provides that once such an impairment is established, all evidence about the intensity, persistence, and functionally limiting effects of pain or other symptoms must be considered in addition to the medical signs and laboratory findings in deciding the issue of disability." Foote v. Chater, 67 F.3d 1553, 1561 (11th Cir. 1995); 20 C.F.R. § 404.1529.
A claimant's subjective testimony supported by medical evidence that satisfies the standard is itself sufficient to support a finding of disability. Foote, 67 F.3d at 1561. "If the ALJ decides not to credit a claimant's testimony as to her pain, he must articulate explicit and adequate reasons for doing so." Id. at 1561-62. A reviewing court will not disturb a clearly articulated credibility finding with substantial supporting evidence in the record. Id. at 1562. The lack of a sufficiently explicit credibility finding may give grounds for a remand if credibility is critical to the outcome of the case. Id.
In the decision, the ALJ provides a thorough summary of Claimant's testimony. R. 18.
R. 18. Thus, the ALJ determined that Claimant's subjective statements were not credible to the extent they were inconsistent with the ALJ's RFC. See supra p. 7 (the ALJ's RFC).
Contrary to Claimant's argument, the ALJ devotes two pages of the decision describing the ALJ's reasons for making that credibility determination. R. 18-20. In short, the ALJ states the following reasons for the ALJ's credibility determination: (1) diagnostic imaging and treatment notes do no reveal significant functional limitations (R. 18-19); (2) Claimant's course of treatment has been conservative (R. 19); (3) Claimant's gap in treatment due to insufficient resources is not fully credible (R. 19); (4) Claimant's use of medications for relief of symptoms do not reflect limitations greater than those indicated in the RFC (R. 19); and (5) records reveal that Claimant "works outside often," swims on occasion, and was able to go boating once, which is inconsistent with Claimant's allegations of very limited daily activities (R. 19-20). The ALJ provides citations to the record for each of these reasons and, the Court finds that the reason offered by the ALJ for finding Claimant's subjective statements not credible are supported substantial evidence. See R. 18-20.
For the reasons stated above, it is
"2. When the existence of a medically determinable physical or mental impairment(s) that could reasonably be expected to produce the symptoms has been established, the intensity, persistence, and functionally limiting effects of the symptoms must be evaluated to determine the extent to which the symptoms affect the individual's ability to do basic work activities. This requires the adjudicator to make a finding about the credibility of the individual's statements about the symptom(s) and its functional effects.
3. Because symptoms, such as pain, sometimes suggest a greater severity of impairment than can be shown by objective medical evidence alone, the adjudicator must carefully consider the individual's statements about symptoms with the rest of the relevant evidence in the case record in reaching a conclusion about the credibility of the individual's statements if a disability determination or decision that is fully favorable to the individual cannot be made solely on the basis of objective medical evidence.
4. In determining the credibility of the individual's statements, the adjudicator must consider the entire case record, including the objective medical evidence, the individual's own statements about symptoms, statements and other information provided by treating or examining physicians or psychologists and other persons about the symptoms and how they affect the individual, and any other relevant evidence in the case record. An individual's statements about the intensity and persistence of pain or other symptoms or about the effect the symptoms have on his or her ability to work may not be disregarded solely because they are not substantiated by objective medical evidence." Id.
