MILES DAVIS, Magistrate Judge.
This case has been referred to the undersigned magistrate judge pursuant to the authority of 28 U.S.C. § 636(b) and Local Rules 72.1(A), 72.2(D) and 72.3 of this court relating to review of administrative determinations under the Social Security Act ("Act") and related statutes, 42 U.S.C. § 401, et seq. It is now before the court pursuant to 42 U.S.C. § 405(g) of the Act for review of a final determination of the Commissioner of Social Security ("Commissioner") denying Plaintiff Brooks' application for a period of disability and disability insurance benefits ("DIB") under Title II of the Act, 42 U.S.C. §§ 401-34.
Upon review of the record before this court, it is the opinion of the undersigned that the findings of fact and determinations of the Commissioner are supported by substantial evidence; thus, the decision of the Commissioner should be affirmed.
On March 2, 2012, Plaintiff, Christopher Maurice Brooks, filed an application for benefits, claiming an onset of disability as of March 2, 2012 (Tr. 23).
On April 11, 2014, (date of ALJ decision), the ALJ made several findings relative to the issues raised in this appeal (Tr. 23-35):
Review of the Commissioner's final decision is limited to determining whether the decision is supported by substantial evidence from the record and was a result of the application of proper legal standards. Carnes v. Sullivan, 936 F.2d 1215, 1218 (11th Cir. 1991) ("[T]his Court may reverse the decision of the [Commissioner] only when convinced that it is not supported by substantial evidence or that proper legal standards were not applied."); see also Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997); Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987). "A determination that is supported by substantial evidence may be meaningless . . . if it is coupled with or derived from faulty legal principles." Boyd v. Heckler, 704 F.2d 1207, 1209 (11th Cir. 1983), superseded by statute on other grounds as stated in Elam v. R.R. Ret. Bd., 921 F.2d 1210, 1214 (11th Cir. 1991). As long as proper legal standards were applied, the Commissioner's decision will not be disturbed if in light of the record as a whole the decision appears to be supported by substantial evidence. 42 U.S.C. § 405(g); Falge v. Apfel, 150 F.3d 1320, 1322 (11th Cir. 1998); Lewis, 125 F.3d at 1439; Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995). Substantial evidence is more than a scintilla, but not a preponderance; it is "such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 1427, 28 L. Ed. 2d 842 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 59 S.Ct. 206, 217, 83 L. Ed. 126 (1938)); Lewis, 125 F.3d at 1439. The court may not decide the facts anew, reweigh the evidence, or substitute its judgment for that of the Commissioner. Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990) (citations omitted). Even if the evidence preponderates against the Commissioner's decision, the decision must be affirmed if supported by substantial evidence. Sewell v. Bowen, 792 F.2d 1065, 1067 (11th Cir. 1986).
The Act defines a disability as an "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 which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A). To qualify as a disability the physical or mental impairment must be so severe that the claimant is not only unable to do her/his previous work, "but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." Id. § 423(d)(2)(A).
Pursuant to 20 C.F.R. § 404.1520(a)-(g), the Commissioner analyzes a disability claim in five steps:
1. If the claimant is performing substantial gainful activity, he is not disabled.
2. If the claimant is not performing substantial gainful activity, his impairments must be severe before he can be found disabled.
3. If the claimant is not performing substantial gainful activity and he has severe impairments that have lasted or are expected to last for a continuous period of at least twelve months, and if his impairments meet or medically equal the criteria of any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1, the claimant is presumed disabled without further inquiry.
4. If the claimant's impairments do not prevent him from doing his past relevant work, he is not disabled.
5. Even if the claimant's impairments prevent him from performing his past relevant work, if other work exists in significant numbers in the national economy that accommodates his residual functional capacity and vocational factors, he is not disabled.
The claimant bears the burden of establishing a severe impairment that keeps him from performing his past work. 20 C.F.R. § 404.1512. If the claimant establishes such an impairment, the burden shifts to the Commissioner at step five to show the existence of other jobs in the national economy which, given the claimant's impairments, the claimant can perform. MacGregor v. Bowen, 786 F.2d 1050, 1052 (11th Cir. 1986). If the Commissioner carries this burden, the claimant must then prove he cannot perform the work suggested by the Commissioner. Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987).
Dr. Jeffery English, a neurologist with the MS Center of Atlanta (Tr. 275), has treated Mr. Brooks for Multiple Sclerosis ("MS") since the early 2000's. (Tr. 320). Over the course of this extensive treating relationship, Dr. English has made voluminous notes regarding the cognitive decline he has observed in his patient. A December 10, 2004 MRI report showed "Abnormal Brain MRI study showing moderate lesion load demyelinating disease without active enchancement." (Tr. 319.) Mr. Brooks reported cognitive decline in April of 2005, stating that he was experiencing short term memory problems that had caused him to struggle in his classes. At that point, his wife had already taken over all the important household duties and he needed help at work. Dr. English noted "Memory is the biggest disabling factor." (Tr. 308).
Over the ensuing years Dr. English repeatedly noted cognitive decline, inadvisability to drive and subtle evidence of progression. His wife reported some increase in agitation and some decrease in memory." (Tr. 306.)
Dr. English felt that Mr. Brooks suffered from advancing cognitive decline: "He has been clinically and radiographically stable over the last year. He has some subtle changes which are progressing with his memory." (Tr. 291). Mr. Brooks' struggled with the symptoms of MS. He was repeating conversations, merging conversation, and having trouble multitasking. Later in 2007, Dr. English continued to note that "Mr. Brooks appears stable with the exception of noted memory decline by his family. He is repeating himself more." (Tr. 289-290).
On February 13, 2009, Dr. English noted that "Mr. Brooks actually looked better than I've seen him in quite some time." (Tr. 285). However, the treatment records for Mr. Brooks continue to relate the progressive decline of Mr. Brooks due to his MS: "Overall, he appears to be doing about the same. Besides the fatigue, his cognitive dysfunction is the biggest problem." (Tr. 283). Dr. English noted again 2010 that Mr. Brooks "continues to have memory decline according to his wife. Otherwise stable think he has been doing very well." (Tr. 280).
On April 12, 2012, Dr. English opined that Mr. Brooks suffered from MS and exhibited severe fatigue as a result of the illness. He also found that Mr. Brooks was capable of 5/5 grip strength and had 5/5 strength in his lower extremity. (Tr. 501).
On August 15, 2013, Dr. English filled out a questionnaire in which he opined that Mr. Brooks suffered from MS, which caused, "persistent disorganization of motor function in two extremities." (Tr. 575). He further felt Mr. Brooks suffered from a loss of cognitive abilities or affective changes that included short or long-term memory impairment, perceptual or thinking disturbances, and personality changes, and that those symptoms were accompanied by marked restriction of activities of daily living, marked difficulties in maintaining social functioning, marked difficulties in maintaining concentration, persistence, or pace, and repeated episodes of decompensation, each of extended duration. (Tr. 576). He indicated that Mr Brooks suffered from a medically documented history of an ongoing organic mental disorder that had lasted at least two years and had caused more than minimal limitation on Mr. Brooks' ability to do basic work activities, along with a current history of one or more years of being unable to function outside a highly supportive living arrangement, with an indication that Mr. Brooks was in continued need of the living arrangement. Mr. Brooks also suffered from significant, reproducible fatigue of motor function with substantial muscle weakness on repetitive activity, shown on physical examination, that resulted from neurological dysfunction in areas of the central nervous system known to be pathologically involved by the MS process. (Tr. 577).
The Department of Veterans Affairs ("VA") reviewed Mr. Brooks' medical issues and assigned a permanent 100% disability evaluation for [his] service connected disability. (Tr. 610).
Mr. Brooks was also examined by Michael Kasabian, D.O., at the request of the Commissioner, on May 3, 2012. Mr. Brooks reported that his speech was sometimes bad, his balance was off and his memory was poor, he had a history of asthma and sleep apnea, and that when he stood for more than five minutes his ankles started to hurt. On examination his speech and hearing were normal, there was no edema in his extremities and peripheral pulses were intact and equal x 4, deep tendon reflexes were 2/4 and muscle strength was 5/5 in all four extremities. He could stand on his heels and toes, grip strength was 5/5 bilaterally, he could handle fine objects without difficulty and could tie his shoes without assistance. He did not need a cane or other assistive device, and he had no limp. Dr. Kasabian's impression was history of MS, history of ankle pain, asthma, and sleep apnea. (Tr. 503-507).
Dr. Kasabian examined Mr. Brooks again on September 25, 2012. Mr. Brooks reported that his only MS symptom was left knee pain. His examination was again completely normal as to strength, gait, speech, dexterity and hearing, although the left knee was a little tender with range of motion testing. (Tr. 541-42).
Mr. Brooks was referred to Richard Doll, Ph.D., for a psychological evaluation on May 12, 2012. Dr. Doll indicated that Mr. Brooks' ability to do work related activities was guarded, but sustained concentration was fair; it was unclear whether he could handle stress in the work environment; and his social interaction was good. (Tr. 509-12).
On July 3, 2013, Mr. Brooks began treatment with Steve Hirshorn, Ph.D. for depression. His primary complaint was marital problems, and Dr. Hirshorn counseled him in that regard on four occasions through August 20, 2013 (Tr. 552-555)
Mr. Brooks presents five issues for the court's consideration, but the real issues in this case are (1) the ALJ's treatment of findings by the VA, and (2) whether the ALJ properly applied the law to the evidence. The issues will be discussed in that order.
Mr. Brooks is a veteran, and as such is entitled to medical care by the VA. Based on his physical condition and inability to work, the VA rated him 100% disabled as of March 24, 2012 (Tr. 610). The bases of his disability included weakness in all four extremities associated with MS, with sleep apnea and asthma. (Id.).
It is clear in the Eleventh Circuit that a disability rating by the Department of Veterans Affairs or Florida's Division of Workers Compensation is not binding on the Commissioner, but is entitled to great weight, and that it is error for the Commissioner to ignore it. Falcon v. Heckler, 732 F.2d 827 (11
The ALJ is not required, however, to examine each part of a veteran's disability documentation exhaustively, nor state that he gives the rating "great weight." Adams v. Comm'r of Soc. Sec., 542. The VA's rating is considered along with all relevant evidence, Kemp v. Astrue, 308 F. App'x 854, 857 (11
Here, the ALJ gave careful consideration to the VA's rating, but found it insufficient to force a finding of disabled based on the overall weight of the entire evidence. He also noted that the VA's definition of unemployability is different from the Commissioner's, and that the VA has a more deferential burden of persuasion than the Commissioner, meaning that a veteran is given the benefit of the doubt,
The ALJ did not err in not agreeing with the VA's disability rating, and Mr. Brooks is not entitled to reversal on this issue.
As noted above, this issue is the court's distillation of four separate but closely related claims that (a) the ALJ mischaracterized "progression" of Mr. Brooks' disease as "progress" in regaining his health, (b) the ALJ acted as his own expert, (c) the ALJ was guilty of picking and choosing among the medical evidence, and (d) the ALJ's rejection of the treating physician's opinion was error.
As to the alleged "mischaracterization," the ALJ stated: "Treatment notes from February of 2009 reflect that the claimant was having a steady progression with his memory and he was looking very good." (Tr. 29). This sentence appeared in a lengthy, comprehensive and accurate recitation of Mr. Brooks' MS history and condition. While the sentence, out of context, can be read as finding that Mr. Brooks' condition was improving (steady progression with his memory), it can likewise be read as stating exactly what Dr. English said. The progression with memory was progressing downward. The ALJ will not be reversed on such an ambiguity.
The ALJ did not act as his own expert and he was not guilty of picking and choosing among the medical evidence. Mr. Brooks contends that the ALJ rejected Dr. English's opinion without the input of any other expert, but this is not true. The examinations by Dr. Kasabian showed good strength and nothing more than mild tenderness on one knee. Dr. Doll was not entirely positive in his outlook, but did not rule out work.
Finally, Mr. Brooks contends that the ALJ erred in rejecting Dr. English's opinion. Absent good cause, the opinion of a claimant's treating physician must be accorded considerable or substantial weight by the Commissioner. Phillips v. Barnhart, 357 F.3d 1232, 1240-1241 (11
If a treating physician's opinion on the nature and severity of a claimant's impairments is well-supported by medically acceptable clinical and laboratory diagnostic techniques, and is not inconsistent with other substantial evidence in the record, the ALJ must give it controlling weight. 20 C.F.R. § 404.1527(d)(2). Where a treating physician has merely made conclusory statements, the ALJ may afford them such weight as is supported by clinical or laboratory findings and other consistent evidence of a claimant's impairments. See Wheeler v. Heckler, 784 F.2d 1073, 1075 (11
The opinion of a non-examining physician is entitled to little weight, and, if contrary to the opinion of a treating physician, is not good cause for disregarding the opinion of the treating physician, whose opinion generally carries greater weight. See 20 CFR § 404.1527(d)(1); Broughton v. Heckler, 776 F.2d 960, 962 (11
"When electing to disregard the opinion of a treating physician, the ALJ must clearly articulate its reasons." Phillips, 352 F.3d at 1241. Failure to do so is reversible error. Lewis, 125 F.3d at 1440 (citing MacGregor v. Bowen, 786 F.2d 1050, 1053 (11
The ALJ examined and considered the entire medical evidence. His comment on "progression" was ambiguous at worst, and was only the smallest part of his overall discussion of Mr. Brooks' condition. He specifically relied on the reports of Dr. Kasabian and Dr. Dol. He gave supported reasons for rejecting Dr. English's opinion. He noted Dr. Kasabian's finding that Mr. Brooks had full range of motion and normal muscle strength in his arms and legs, and complained only of left knee pain. He also noted Dr. Doll's findings of good recent and remote memory, providing a good personal history, good and coherent language and the ability to perform two-step commands (Tr. 31, 510-11). He further noted that in March 2012, Dr. English filled out a form that identified severe fatigue (but not sensory loss or motor loss) as Mr. Brooks' only symptom while finding full grip and leg strength (Tr. 30, 501).
"In determining whether substantial evidence supports a decision, we give great deference to the ALJ's factfindings." Hunter v. Social Security Administration, Commissioner., 808 F.3d 818, 822 (11
It is therefore respectfully
That the decision of the Commissioner be
It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant.