THOMAS B. SMITH, District Judge.
Plaintiff brings this action pursuant to the Social Security Act ("Act"), as amended, 42 U.S.C. § 405(g), to obtain judicial review of a final decision of Defendant, the Commissioner of the Social Security Administration (the "Commissioner") denying her claims for disability insurance benefits and Supplemental Security Income under the Act. Upon a review of the record and after due consideration, the Commissioner's final decision is
Plaintiff filed for benefits on September 3, 2014, alleging an onset date of January 1, 2013 (Tr. 25, 211-218). She claimed that she was disabled due to fibromyalgia, musculoskeletal pain from degenerative disc disease and cervical disc disease, depression and anxiety disorder (Tr. 46, 256, 287).
Plaintiff's application was denied initially and on reconsideration, and she requested and received a hearing before an administrative law judge ("ALJ") (Tr. 124, 128, 134, 140, 43-64). In a decision dated March 4, 2016, the ALJ found Plaintiff not disabled through the date of the decision (Tr. 22-42). The Appeals Council denied Plaintiff's request for review on July 6, 2016 (Tr.1-6). Accordingly, the ALJ's March 4, 2016 decision is the final decision of the Commissioner. Having exhausted the available administrative remedies, Plaintiff filed this action for judicial review (Doc. 1). The matter is fully briefed and ripe for resolution.
When determining whether an individual is disabled, the ALJ must follow the five-step sequential evaluation process established by the Social Security Administration and set forth in 20 C.F.R. §§ 404.1520(a)(4) and 416.920(a)(4). Specifically, the ALJ must determine whether the claimant: (1) is currently employed; (2) has a severe impairment; (3) has an impairment or combination of impairments that meets or medically equals an impairment listed at 20 C.F.R. Part 404, Subpart P, Appendix 1; (4) can perform past relevant work; and (5) retains the ability to perform any work in the national economy.
Here, the ALJ performed the required five-step sequential analysis. At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since her January 1, 2013 alleged disability onset date (Tr. 27). The ALJ found at step two that Plaintiff's severe impairments included degenerative disc disease of the cervical and lumbar spine, obesity, and fibromyalgia (Tr. 28). He found that other impairments, including depression and anxiety, were not severe impairments (Tr. 28-31). At step three, the ALJ determined that Plaintiff's impairments did not meet or equal any of the impairments listed in 20 CFR Part 404, Subpart P, Appendix 1 (Tr. 31). Next, the ALJ found that Plaintiff retained the residual functional capacity ("RFC") to:
(Tr. 31-32).
At step four, the ALJ determined that Plaintiff was unable to return to her past relevant work as a stock clerk and cashier, but, relying on the testimony from a vocational expert ("VE"), the ALJ found, at step five, that there are jobs that exist in significant numbers in the national economy that Plaintiff could perform (Tr. 35) and, therefore, found Plaintiff not disabled (Tr. 36).
The scope of the Court's review is limited to determining whether the ALJ applied the correct legal standards and whether the ALJ's findings are supported by substantial evidence.
When the Commissioner's decision is supported by substantial evidence the district court will affirm even if the reviewer would have reached a contrary result as finder of fact, and even if the reviewer finds that the preponderance of the evidence is against the Commissioner's decision.
Plaintiff urges reversal of the Commissioner's decision, contending that the ALJ failed to weigh the opinions of three treating physicians, failed to mention or weigh the opinions of the consultative mental examiners, and improperly gave great weight to the opinions of non-examining physicians. Plaintiff also claims that the Commissioner's findings regarding her mental impairments are not properly supported.
The Eleventh Circuit has held that whenever a physician offers a statement reflecting judgments about the nature and severity of a claimant's impairments, including symptoms, diagnosis, and prognosis, what the claimant can still do despite his or her impairments, and the claimant's physical and mental restrictions, the statement is an opinion requiring the ALJ to state with particularity the weight given to it and the reasons therefor.
Substantial weight must be given to the opinion, diagnosis and medical evidence of a treating physician unless there is good cause to do otherwise.
By contrast, a consultative examiner's opinion is not entitled to the deference normally given a treating source.
On November 14, 2012, prior to her alleged onset, Plaintiff started seeing Dr. Magdalena Beltre (Tr. 481). On examination, Dr. Beltre noted tenderness in Plaintiff's lower back, upper back, mid central back and over her spine. The doctor diagnosed Plaintiff with hypothyroidism, essential HTN,
On February 21, 2013, Plaintiff saw Dr. Beltre for a regular follow-up. She complained about anxiety and back pain. Dr. Beltre diagnosed HTN, myofascial syndrome and depression/anxiety. Plaintiff's musculoskeletal exam revealed full range of motion, no swelling or tenderness, and her neurological exam showed Plaintiff was fully oriented and had adequate mood and affect, with normal gait, symmetrical power, and sensation (Tr. 478).
On December 12, 2013, Plaintiff returned, complaining of muscle pain and back pain (Tr. 477). Dr. Beltre noted shoulder and lower back tenderness. The doctor diagnosed myofascial syndrome and HTN (
On January 14, 2014, Dr. Beltre reported to UNUM, Ms. Figueroa's short term and long term disability insurance carrier, that she could perform sedentary work, lifting up to ten pounds occasionally and frequently handling/fingering objects (Tr. 488-491). When asked about Plaintiff's limitations, Dr. Beltre indicated only "no heavy lifting." (Tr. 488).
On a September 24, 2014 visit, Plaintiff complained of swelling of her joints and pain in her back and legs (Tr. 475). She said she could not stay in the same position for over 15 minutes. Plaintiff had not been taking her medications because she had no insurance. Dr. Beltre's physical examination showed "WNL" (within normal limits) for all systems examined (Tr. 475). That same date, Dr. Beltre filled out a residual functional capacity questionnaire indicating that Plaintiff suffered from fibromyalgia and HTN (Tr. 483). Symptoms included body aches and anxiety. Dr. Beltre stated that Ms. Figueroa could sit for 20 minutes at a time and stand and walk for 20 minutes at a time. She could sit for a total of one hour in an eight hour workday, and stand/walk not even one hour in an eight hour workday. She would need unscheduled breaks every fifteen to twenty minutes. She could only occasionally lift less than ten pounds. She would miss work more than four times a month (Tr. 483-84).
On December 8, 2014, Plaintiff presented to Dr. Heidy Ormeno-Lopez at Orlando Family Physicians (Tr. 620). Dr. Ormeno-Lopez diagnosed HTN; fibromyalgia; depression, major, recurrent; joint pain and acute sinusitis. However, on physical examination, Dr. Ormeno-Lopez noted Plaintiff was in no acute distress and, while she noted tenderness in both knees, Dr. Ormeno-Lopez observed no other musculoskeletal or mental problems and Plaintiff had full strength in both upper and lower extremities (
On March 5, 2015, Dr. Ormeno-Lopez filled out a residual functional capacity questionnaire regarding Plaintiff (Tr. 656-657). Diagnoses were fibromyalgia, and cervical and lumbar herniated discs. The doctor opined that Plaintiff's prognosis was guarded. Her symptoms included constant muscle pain, back pain, and fatigue. It was felt that Plaintiff could sit for 60 minutes at a time and stand/walk for 20 minutes at a time. She could sit for a total of one hour in an eight hour workday, and stand/walk for not even one hour in an eight hour workday. She would need four extra fifteen minute breaks per day. Plaintiff could never lift, and could only use her hands for 50% of the day for grasping, turning, twisting objects, and fine manipulation (
Dr. Ormeno-Lopez saw Plaintiff again on April 2, 2015 at which time her diagnoses included only hypothyroidism, benign essential HTN, vitamin D deficiency, and hypertriglyceridemia (Tr. 720-21). The doctor's examination mentioned no musculoskeletal or mental problems and the doctor noted that Plaintiff was in no acute distress and was "feeling well today."
On June 8, 2015, Plaintiff returned, complaining of anxiety, muscle aches, and headache (Tr. 717-18). When Dr. Ormeno-Lopez examined Plaintiff, she identified no musculoskeletal problems other than left thoracic wall tenderness, no psychological problems, and Plaintiff was in no acute distress (
On September 3, 2015, Plaintiff saw Dr. Felix Lopez, also at Orlando Family Physicians (Tr. 710-12). Dr. Lopez diagnosed HTN, fibromyalgia, lumbar herniated disc, cervical herniated disc, and colonic polyp. However, Plaintiff denied any painful or swollen joints, weakness, depression, or anxiety, and Dr. Lopez' exam revealed only normal findings, including a full range of motion in the neck, no clubbing or swelling in the extremities, normal strength in the all extremities, and cognitive function intact (
On October 6, 2015 return visit, Dr. Lopez noted impaired glucose metabolism and abnormal liver enzymes (Tr. 703). He diagnosed impaired glucose metabolism, abnormal liver enzymes, hypothyroidism, multilevel degenerative disc disease, HTN, and cholelithiasis. However, upon examination, Plaintiff denied any painful joints or weakness and denied any depression or anxiety, and Dr. Lopez found Plaintiff in no acute distress, with normal strength in all extremities and no identified psychological issues (Tr. 703-04).
On January 4, 2016, Plaintiff saw Dr. Lopez for follow up (Tr. 814). Depression screening indicated moderately severe depression. The doctor diagnosed HTN, impaired fasting glucose, lumbar radiculopathy, major depression, fibromyalgia, hypothyroidism, and insomnia. Physical examination showed normal strength in all of Plaintiff's extremities (Tr. 815).
On January 21, 2016, Dr. Lopez filled out a physical assessment, giving Plaintiff a diagnosis of advanced degenerative joint disease, cervical radiculopathy, lumbar radiculopathy, hypertension and hyperthyroidism (Tr. 800-02). The doctor opined that Plaintiff's symptoms would frequently interfere with her attention and concentration and that the side effects of her medication included drowsiness. Dr. Lopez stated that Plaintiff could sit for a total of one hour in an eight hour workday, and stand/walk for a total of one hour in an eight hour workday. She could frequently lift less than ten pounds (Tr. 801). Dr. Lopez opined that Plaintiff would miss work three or four times a month (Tr. 802).
In the administrative decision, the ALJ noted the treatment records of these physicians and weighed their opinions, stating:
(Tr. 34). Plaintiff challenges these findings, contending that "neither of these reasons are valid" as objective medical evidence supports the opinions of limitations and normal findings are not inconsistent with fibromyalgia. I am not persuaded.
As is evident from the treatment records and the records of other examiners and practitioners summarized by the ALJ and the Commissioner, the record does indeed, include "repeatedly normal physical examinations with only some tenderness findings." (
I am also not persuaded that Plaintiff's diagnosis of fibromyalgia means that the ALJ erred in considering the normal physical examinations. The Eleventh Circuit has recognized that fibromyalgia "often lacks medical or laboratory signs, and is generally diagnosed mostly on an individual's described symptoms," and that the "hallmark" of fibromyalgia is therefore "a lack of objective evidence."
Social Security Ruling ("SSR") 12-2p, cited by the ALJ, discusses what an individual must show to establish her fibromyalgia ("FM") constitutes a medically determinable impairment ("MDI").
In evaluating a person's statements about his or her symptoms and functional limitations, the Commissioner follows a two-step process:
Here, the ALJ acknowledged the diagnosis of fibromyalgia, but did not find it disabling, noting:
(Tr. 33). Thus, the ALJ found the lack of objective evidence to substantiate the disabling limitations alleged and then proceeded to evaluate all of the evidence, including Plaintiff's activities, to determine the extent to which the symptoms limited her capacity for work. In doing so, he complied with the requirements of the SSR. As his conclusions are supported by substantial evidence, I see no error.
Plaintiff next contends that the ALJ did not properly consider the opinions of the consultative mental examiners. On December 10, 2014, Plaintiff presented for a psychological consultative examination with Drs. William Austin, Psy.D., and Charles McFall, Psy.D. (Tr. 837-839). Reported "Activities of Daily Living" included:
Mental status examination revealed:
(Tr. 838 — emphasis added). Based on her reported symptoms, Drs. Austin and McFall diagnosed Major Depressive Disorder, Moderate, Recurrent; and PTSD. They assigned a GAF score of 53 (Tr. 839). Plaintiff claims that it was error for the ALJ to fail to mention or consider the consultative mental examiner's opinions, including the GAF score. I agree that this examination should have been discussed, but conclude that any error is harmless.
The ALJ discussed Plaintiff's allegations of depression and anxiety at length in his decision (Tr. 29-34). The ALJ determined that Plaintiff had mild limitation in her activities of daily living, mild limitation in social functioning, and mild limitation in concentration, persistence or pace (Tr. 29-30). These findings are not shown to be inconsistent with the mental status examination findings conducted by Drs. Austin and McFall. As such, any error is harmless.
Plaintiff's contention that it was an error for the ALJ to give great weight to the opinions of non-examining physicians is also off the mark. Although the Eleventh Circuit has held that "the opinions of non-examining reviewing physicians are entitled to little weight and, taken alone, do not constitute substantial evidence to support an administrative decision,"
Plaintiff contends that the ALJ's findings that her mental impairments were not severe and caused no work related limitations are not supported by substantial evidence. An impairment or combination of impairments is "severe" within the meaning of the regulations if it significantly limits an individual's ability to perform basic work activities. 20 C.F.R. § 404.1521.
The claimant has the burden of proof to provide substantial evidence establishing that a physical or mental impairment has more than a minimal effect on her ability to perform basic work activities. An impairment is not severe only if the abnormality is so slight and its effect so minimal that it would clearly not be expected to interfere with the individual's ability to work, irrespective of age, education, or work experience.
In her decision, the ALJ acknowledged that Plaintiff had medically determinable mental impairments of depressive disorder and anxiety but concluded that they "do not cause more than minimal limitation in the claimant's ability to perform basic mental work activities and is therefore nonsevere." (Tr. 29). In objecting to this conclusion, Plaintiff cites to the ALJ's "finding" at page "21" of the record, regarding treatment notes from the Health Department at Tr. 368 and 370 (Doc. 19 at 31-32). On review, no such finding appears in the administrative decision; nor has Plaintiff properly characterized the treatment records she cites.
On review, I find that the administrative decision was made in accordance with proper legal standards and is supported by substantial evidence.
Upon consideration of the foregoing:
1. The Commissioner's final decision in this case is
2. The Clerk is directed to enter judgment accordingly and