JAMES R. KLINDT, Magistrate Judge.
James W. Winton ("Plaintiff") is appealing the Commissioner of the Social Security Administration's final decision denying his claim for disability insurance benefits ("DIB") and supplemental security income ("SSI"). Plaintiff's alleged inability to work is the result of "[m]ajor heart attacks," "bad back," "shoulder," "neck," "carpal tunnel," and "[d]iabetes."
On June 26, 2013, an Administrative Law Judge ("ALJ") held a hearing at which the ALJ heard testimony from Plaintiff, who was present with a non-attorney representative, and a vocational expert ("VE"). Tr. at 310-25. At the time of the hearing, Plaintiff was forty-nine (49) years old. Tr. at 313. On August 21, 2013, the ALJ issued a Decision finding Plaintiff not disabled from April 2, 2003 through the date of the Decision. Tr. at 15-28. Plaintiff then requested review by the Appeals Council, Tr. at 10-11, and submitted evidence to the Council in the form of a brief authored by his representative, Tr. at 7;
Plaintiff makes four arguments on appeal: (1) that the ALJ "failed to apply the correct legal standards to the opinion of [Plaintiff's] treating physician, Dr. [Suhas] Kulkarni"; (2) that the ALJ "failed to apply the correct legal standards to the opinion of [examining physician,] Dr. [Donald J.] Tindall"; (3) that the ALJ "failed to apply the correct legal standards to the opinion of [psychiatric consultant,] Dr. [Aroon] Suansilppongse"; and (4) that the ALJ "failed to apply the correct legal standards to [Plaintiff's] testimony." Plaintiff's Brief (Doc. No. 18; "Pl.'s Br."), filed March 3, 2015, at 2, 9-18. Defendant filed a Memorandum in Support of the Commissioner's Decision (Doc. No. 19; "Def.'s Mem.") on May 15, 2015. After a thorough review of the entire record and the parties' respective memoranda, the undersigned finds that the Commissioner's final decision is due to be affirmed for the reasons stated herein.
When determining whether an individual is disabled,
Here, the ALJ followed the five-step sequential inquiry.
The ALJ determined that Plaintiff has the following residual functional capacity ("RFC"):
Tr. at 20 (emphasis and citations omitted). At step four, the ALJ found Plaintiff "is unable to perform any past relevant work" as a "structural steel worker," "sawmill operator," "construction worker I," or "dairy farm laborer." Tr. at 26 (some emphasis and citation omitted). At step five, after considering Plaintiff's age ("39 years old . . . on the alleged disability onset date"), education ("limited"), work experience, and RFC, the ALJ found, with the assistance of testimony from the VE, that "there are jobs that exist in significant numbers in the national economy that [Plaintiff] can perform," Tr. at 26 (emphasis and citations omitted), including representative occupations such as "label coder," "router," and "collator operator," Tr. at 27.
This Court reviews the Commissioner's final decision as to disability pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Although no deference is given to the ALJ's conclusions of law, findings of fact "are conclusive if . . . supported by `substantial evidence.'"
As indicated above, Plaintiff raises four issues before this Court. The first three concern the ALJ's handling of medical opinions and are addressed together. The fourth issue concerns the ALJ's credibility finding. A discussion follows.
Regarding his treating physician, Dr. Kulkarni, Plaintiff argues "[t]he ALJ purportedly gave Dr. Kulkarni's opinion `significant weight' but she then disregarded the functional limitations he assigned." Pl.'s Br. at 12. Plaintiff next claims error in the ALJ's "cit[ation] to MRIs from April and May 2004 to disregard Dr. Tindall's opinion that was rendered nine years later [in 2013]."
The Regulations establish a "hierarchy" among medical opinions
With regard to a treating physician or psychiatrist,
If an ALJ concludes the medical opinion of a treating physician or psychiatrist should be given less than substantial or considerable weight, he or she must clearly articulate reasons showing "good cause" for discounting it.
An ALJ is required to consider every medical opinion.
Plaintiff first treated with Dr. Kulkarni on April 22, 2004, following a motor vehicle accident. Tr. at 198-99. Dr. Kulkarni diagnosed Plaintiff with "[p]osttraumatic cervical spine sprain/strain"; "[p]osttraumatic thoracic spine sprain/strain"; "[p]osttraumatic lumbar spine sprain/strain with radicular symptoms"; "[m]yofacial pain syndrome involving paravertebral muscles"; "[p]osttraumatic right shoulder rotator cuff impingement syndrome"; and "[p]osttraumatic bilateral hand carpal tunnel syndrome." Tr. at 199.
Plaintiff next saw Dr. Kulkarni on April 30, 2004, for electrodiagnostic study of both upper extremities. Tr. at 207. The study revealed "[m]oderate median nerve motor/sensory neuropathy across left and right wrist/hand" and "[m]oderate median nerve motor neuropathy across left proximal forearm." Tr. at 207.
On May 12, 2004, Plaintiff presented to Dr. Kulkarni with complaints of neck pain radiating into fingertips, upper and lower back pain, and shoulder pain. Tr. at 206. Upon examination, Dr. Kulkarni noted:
Tr. at 206. Dr. Kulkarni intended to "order MRI of cervical spine to rule out any disc herniation" and "an orthopedic surgery consult because of carpal tunnel syndrome in both hands." Tr. at 206. Plaintiff was given a prescription for "wrist splints to be used on both sides while awake." Tr. at 206. A May 28, 2004 MRI of the cervical spine showed "no evidence of disc bulge or herniation." Tr. at 208.
On July 7, 2004, Plaintiff saw Dr. Kulkarni for complaints of "neck pains graded 6[,] upper and lower back pains graded 5[,]" and "numbness in his hands." Tr. at 205. Dr. Kulkarni noted that Plaintiff was seen by orthopedic surgeon, Dr. Sullivan, who gave Plaintiff an injection in his right wrist.
Plaintiff next saw Dr. Kulkarni on August 4, 2004, with continued complaints of neck, upper back, and lower back pain with "pins and needle-like feeling in both hands." Tr. at 204. Plaintiff's pain medications were refilled, and he was to continue using wrist splints. Tr. at 204.
On August 25, 2004, Plaintiff saw Dr. Kulkarni, who opined that Plaintiff had reached maximum medical improvement with a "26% whole person impairment." Tr. at 201-03. Dr. Kulkarni noted the following permanent restrictions: "no lifting, carrying, pulling or pushing of weights over 20 pounds, no frequent bending forwards and no prolonged sitting, standing or walking over one hour at a time without a five minute break." Tr. at 203. He further recommended Plaintiff "avoid repetitive flexion extension movement at both wrists and to avoid exposure to vibration to the wrists." Tr. at 203. Dr. Kulkarni stated, "Will follow up on an as-needed basis." Tr. at 203. There are no other records of treatment with Dr. Kulkarni in the administrative transcript.
Plaintiff saw Dr. Tindall on June 20, 2013, for a one-time independent medical evaluation. Tr. at 301-304. Dr. Tindall noted Plaintiff was involved in a motor vehicle accident in 2004 in which Plaintiff injured his low back, left shoulder, right and left wrist, and left hand and forearm. Tr. at 301. It was further noted that Plaintiff experienced an acute myocardial infarction in November 2011 that was treated by angioplasty and stenting and followed six to eight hours later with a second acute myocardial infarction that was similarly treated. Tr. at 301.
On physical examination, Plaintiff appeared "[a]lert and oriented times three." Tr. at 302. Plaintiff's gait was normal but he walked and stood with his "back held stiffly," and he had "a moderate amount of difficulty getting in and out of [a] chair." Tr. at 302. Plaintiff's grip strength was noted as "4+/5 bilaterally"; his "[r]ight and left wrist and elbow flexors and extensions [were] 5/5"; his "[r]ght shoulder abductors [were] 5/5"; and his "[l]eft shoulder abductors [gave] way secondary to pain." Tr. at 302. Plaintiff's range of motion was limited in the thoracolumbar spine and left shoulder. Tr. at 302-03. Dr. Tindall made the following diagnoses and conclusions:
Tr. at 303-04.
Dr. Tindall discussed Plaintiff's activities of daily living and documented that Plaintiff can "drive for short periods of time"; "he needs assistance with showering and dressing"; and his "[h]ands can be used for bathing, eating, dressing, and, with the dominant right hand, combing hair, brushing teeth, turning a door knob, and doing a very limited amount of writing." Tr. at 302. Dr. Tindall completed a Medical Source Statement of Ability to Do Work-Related Activities (Physical) form on June 20, 2013. Tr. at 297-99. Dr. Tindall opined that Plaintiff can stand or walk less than two hours and sit for less than six hours in an 8-hour workday and must periodically alternate sitting and standing to relieve pain or discomfort. Tr. at 297-98. According to Dr. Tindall, Plaintiff should never climb, balance, kneel, crouch, or crawl. Tr. at 298. Plaintiff is limited in both upper and lower extremities in pushing and/or pulling and can only lift/carry less than ten pounds. Tr. at 297-98. Plaintiff is limited in reaching in all directions, handling, fingering and feeling. Tr. at 298. Dr. Tindall opined that Plaintiff's prognosis is guarded and medical improvement is not expected. Tr. at 299.
On August 20, 2012, non-examining state agency consultant, Dr. Suansilppongse, reviewed Plaintiff's records. Tr. at 278-91. Pertinent to Plaintiff's arguments, in completing the Mental RFC Assessment, Dr. Suansilppongse noted that Plaintiff is moderately limited in his ability to interact appropriately with the general public and in his ability to accept instructions and respond appropriately to criticism from supervisors. Tr. at 290. Dr. Suansilppongse concluded that Plaintiff's "anxiety and depression reaction and alleged pain would interfere with his ability for sustained concentration and persistence or for task completion. However, [Plaintiff] would be able to complete tasks at an acceptable pace." Tr. at 291. The doctor further found that Plaintiff's "social avoidance and anxiety reaction would interfere with his ability for appropriate interaction with supervisors, coworkers or the public." Tr. at 291. Dr. Suansilppongse diagnosed "Mood Disorder NOS r/o Dysthymic Disorder." Tr. at 281, 291.
In discussing Dr. Kulkarni's opinion, together with two other doctors,
Tr. at 23-24 (citations omitted).
Plaintiff argues that despite giving Dr. Kulkarni's opinions significant weight, she did not account in her RFC assessment for Plaintiff's need for a five-minute break every hour between sitting, standing or walking, nor did she include limitations for the wrist. Pl.'s Br. at 11-12. Defendant responds that "[t]he ALJ was not `required to adopt wholesale Plaintiff's treating physicians' own determinations as to [his] ability to work if substantial evidence in the record supports the ALJ's contrary RFC finding.'" Def.'s Mem. at 7 (purporting to quote
The RFC assessment "is the most [a claimant] can still do despite [his or her] limitations." 20 C.F.R. § 404.1545(a)(1). It is used at step four to determine whether a claimant can return to his or her past relevant work, and if necessary, it is also used at step five to determine whether the claimant can perform any other work that exists in significant numbers in the national economy. 20 C.F.R. § 404.1545(a)(5). In assessing a claimant's RFC, the ALJ "must consider limitations and restrictions imposed by all of an individual's impairments, even those that are not `severe.'" SSR 96-8P, 1996 WL 374184 at *5;
Here, the ALJ considered and specifically discussed the medical evidence of record and gave significant weight to Dr. Kulkarni's opinion to the extent consistent with the record as a whole given Plaintiff's limited treatment and the findings on physical examination. Tr. at 24. The ALJ also gave significant weight to the opinions of Drs. Patty and Singth, neither of whom opined that Plaintiff required a break every hour between sitting, standing and/or walking, nor opined that Plaintiff must avoid all vibration at the wrists. Tr. at 23-24. To the extent that Dr. Kulkarni's limitations were not adopted in total, the ALJ pointed to support in the record regarding the normal physical findings, including Plaintiff's normal gait, his ability to squat and heel-to-toe walk and walk without an assistive device, and his grip strength being only mildly reduced. Tr. at 24. The ALJ also noted Plaintiff's minimal treatment since 2004. Tr. at 24. Notably, Plaintiff has not directed the Court to other objective medical evidence that supports limitations greater than those assessed by the ALJ's RFC. Upon review of the ALJ's Decision and the record as a whole, the undersigned finds no error in the ALJ's handling of the opinion of treating physician, Dr. Kulkarni.
As for the opinion of independent evaluator, Dr. Tindall, the ALJ "accorded little weight because Dr. Tindall's opinion was inconsistent with the imaging reports and findings on physical examination." Tr. at 24. Specifically, the ALJ noted:
Tr. at 24 (citations omitted).
Plaintiff contends that the ALJ erred in affording Dr. Tindall's opinions little weight because the ALJ was comparing Dr. Tindall's 2013 opinion with medical evidence from nine years prior. Pl.'s Br. at 14. Plaintiff argues that "[i]t is very reasonable to infer that [Plaintiff's] condition had worsened over a nine[-]year period."
Plaintiff also argues that Dr. Tindall diagnosed Dupuytren's disease, but the ALJ "failed to even consider the functional limitations arising from this impairment." Pl.'s Br. at 15. As a preliminary matter, the ALJ did acknowledge Dr. Tindall's diagnosis. Tr. at 23. A diagnosis, however, says nothing about the severity of the condition or the limiting effect of an impairment.
The ALJ properly considered Dr. Tindall's opinion and stated reasons supported by substantial evidence for discounting the doctor's opinion, and thus the Decision is due to be affirmed on this issue.
Plaintiff next challenges the ALJ's handling of the opinion of non-examining psychological consultant, Dr. Suansilppongse, who diagnosed Plaintiff with mood disorder not otherwise specified. Pl.'s Br. at 15-16 (referring to Tr. at 291). In discussing Dr. Suansilppongse's opinion, the ALJ stated as follows:
Tr. at 25 (citations omitted). Relevant to the analysis of Dr. Suansilppongse's opinion, the ALJ also attributed significant weight to State agency mental health consultant, Thomas Conger, Ph.D., and summarized Dr. Conger's opinion that Plaintiff's "condition may result in some social difficulties but he shows the ability to relate effectively in general[]." Tr. at 25 (referring to Tr. at 253-70);
Plaintiff argues that because Dr. Suansilppongse concluded that Plaintiff's social avoidance and anxiety would interfere with his ability for appropriate interaction with supervisors, coworkers or the public, the ALJ erred in failing to account in the RFC for Plaintiff's "limited ability to appropriately interact with supervisors or co-workers." Pl.'s Br. at 16. In making her RFC assessment, the ALJ noted that Plaintiff "can perform simple tasks with only occasional interaction with the public," Tr. at 20, but the ALJ did not otherwise limit Plaintiff's interaction with supervisors or co-workers.
Although the ALJ did not adopt in the RFC finding all limitations identified by Dr. Suansilppongse, in light of the evidence of record, the undersigned finds no error in the ALJ's handling of Dr. Suansilppongse's opinion. As discussed above, in addition to attributing significant weight to the opinions of Dr. Suansilppongse, the ALJ also attributed significant weight to Dr. Conger's opinion that Plaintiff is able to relate effectively in general. Tr. at 25;
Plaintiff argues that the ALJ erred in making her credibility finding because she "failed to apply the correct legal standards to significant medical evidence." Pl.'s Br. at 18. Specifically, Plaintiff contends that the ALJ's failure to properly weigh the opinions of Drs. Kulkarni, Tindall, and Suansilppongse, whose opinions supported Plaintiff's testimony, resulted in the ALJ improperly discrediting Plaintiff.
To establish a disability based on testimony of pain or other subjective symptoms, a claimant must satisfy two parts of a three-part test showing: (1) evidence of any underlying medical condition; and (2) either (a) objective medical evidence confirming the severity of the alleged subjective symptoms; or (b) that the objectively determined medical condition can reasonably be expected to give rise to the claimed subjective symptoms.
"[C]redibility determinations are the province of the ALJ."
Here, the ALJ found that Plaintiff's "medically determinable impairments could reasonably be expected to cause the alleged symptoms," but the ALJ found that Plaintiff's "statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely credible." Tr. at. 23. After discussing the medical evidence, the ALJ elaborated on her credibility assessment stating:
Tr. at 23 (citations omitted).
In discussing Plaintiff's activities of daily living, the ALJ noted that in a Function Report dated May 2, 2012, Plaintiff "indicated he bathed and dressed independently, microwaved meals, swept, put away laundry, made the bed, and drove alone." Tr. at 18 (referring to Tr. at 165-72);
Based on a thorough review of the administrative transcript, and upon consideration of the respective arguments of the parties, the Court finds that the ALJ's Decision is supported by substantial evidence.
In accordance with the foregoing, it is hereby
1. The Clerk of Court is directed to enter judgment pursuant to sentence four of 42 U.S.C. § 405(g), and pursuant to § 1383(c)(3),
2. The Clerk is directed to close the file.
Tr. at 23-24 (citations omitted).