BRIAN K. EPPS, Magistrate Judge.
Joyce Elaine Whitaker appeals the decision of the Commissioner of Social Security denying her application for Disability Insurance Benefits ("DIB") under the Social Security Act. Upon consideration of the briefs submitted by both parties, the record evidence, and the relevant statutory and case law, the Court
Plaintiff applied for DIB on March 5, 2014, alleging a disability onset date of January 1, 2011. Tr. ("R."), pp. 13, 155-161. Plaintiff's last insured date for purposes of the DIB application is March 31, 2013. R. 14. Plaintiff was fifty-seven years old on her alleged disability onset date. R. 57, 155. Plaintiff applied for benefits based on allegations of hypothyroidism, congestive heart failure with dilate cardiomyopathy, plural effusion, coronary artery disease ("CAD"), type 2 diabetes, and "non-viable heart." R. 190. Plaintiff has a high school education and completed two years of college in 1974. R. 191. Prior to her alleged disability, Plaintiff had accrued relevant work history as a licensed vocational nurse for both a hospital and assisted living facility. R. 22, 33, 196-98.
The Social Security Administration denied Plaintiff's applications initially, R. 57-63, and on reconsideration, R. 64-71. Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"), R. 83-84, and the ALJ held a hearing on February 17, 2017. R. 28-56. At the hearing, the ALJ heard testimony from Plaintiff, who was represented by Andrew S. Youngman and Elliot Durham, as well as from Robert E. Brabham, Jr., a Vocational Expert ("VE").
Applying the sequential process required by 20 C.F.R. § 404.1520, the ALJ found:
R. 15-23.
When the Appeals Council ("AC") denied Plaintiff's request for review, R. 1-3, the Commissioner's decision became "final" for the purpose of judicial review. 42 U.S.C. § 405(g). Plaintiff then filed this civil action requesting reversal and remand of that adverse decision. Plaintiff argues the Commissioner's decision is not supported by substantial evidence because the ALJ failed to properly develop the record to determine the onset date of Plaintiff's chronic, disabling cardiac conditions.
Judicial review of social security cases is narrow and limited to the following questions: (1) whether the Commissioner's findings are supported by substantial evidence, and (2) whether the Commissioner applied the correct legal standards.
The Commissioner's factual findings should be affirmed if there is substantial evidence to support them.
The deference accorded the Commissioner's findings of fact does not extend to her conclusions of law, which enjoy no presumption of validity.
Plaintiff argues the ALJ's decision is not supported by substantial evidence because the ALJ failed to properly develop the record to determine the onset date of Plaintiff's chronic, disabling cardiac conditions by giving little weight to the opinion of treating cardiologist Dr. Michael A. Odle and failing to call either Dr. Odle to clarify his opinion of the onset date or some other medical expert to give an opinion. Pl.'s Br., pp. 9-15. Conversely, Defendant argues the ALJ properly discounted Dr. Odle's opinion and did not need to seek further evidence on the onset date of Plaintiff's cardiac conditions. Comm'r's Br. pp. 3-12. As explained below, the ALJ (1) properly considered Dr. Odle's medical opinion, giving it little weight, and (2) had sufficient information to render an informed decision about the onset date of Plaintiff's cardiac conditions. Therefore, Plaintiff's argument does not form a valid basis for reversal or remand.
In the Eleventh Circuit, a treating physician's opinion must be given substantial weight.
The Commissioner, however, is not obligated to agree with a medical opinion if the evidence tends toward a contrary conclusion.
When considering how much weight to give a medical opinion, the ALJ must consider a number of factors:
Lastly, under SSR 96-5p, the determination of disability regarding a Social Security claim is reserved to the Commissioner and treating and other medical source opinions on issues reserved to the Commissioner are never entitled to controlling weight or special significance. SSR 96-5p, 1996 WL 374183, at *1, 2 (July 2, 1996);
Plaintiff argues the ALJ erred by rejecting Dr Odle's opinion Plaintiff's cardiac conditions began in 2012, prior to the date last insured of March 31, 2013. Pl.'s Br., pp. 9-15. Dr. Odle is a board-certified cardiologist and the Chief of Cardiac Services at Army Medical Center in Fort Gordon, Georgia. R. 405. In his Treating Source Statement dated December 6, 2016, Dr. Odle listed the severe cardiac conditions for which he treated Plaintiff, then answered the year 2012 in response to the question "When did the symptoms and limitations in this questionnaire first appear, to the best of your knowledge?" R. 402-05. Dr. Odle also stated he had treated Plaintiff for the past five years and six months. R. 402.
The ALJ gave little weight to Dr. Odle's opinion in the treating source statement, and instead found Plaintiff's cardiac conditions were not present on the date last insured of March 31, 2013. R. 21. In support of his finding, the ALJ reasoned Dr. Odle's opinion was rendered three and half years after the date last insured, there was no mention of any cardiac symptoms in the medical record prior to June 28, 2013, and his opinion of Plaintiff's physical ability was significantly more restrictive than Plaintiff described herself at the hearing on February 17, 2017. R. 20-21. The state agency medical consultants, assigned some weight by the ALJ, R. 20, found there was insufficient evidence to establish Plaintiff's cardiac conditions existed prior to the date last insured, and this finding is supported by substantial medical evidence.
There is no medical evidence supporting Dr. Odle's opinion Plaintiff's cardiac symptoms and limitations began in 2012 or Plaintiff's physical limitations were as he stated prior to March 31, 2013, the date last insured. The medical evidence shows examinations of Plaintiff's heart were normal and she denied any heart irregularity or difficulty breathing prior to the date last insured. R. 241-43. As of June 2012, Plaintiff's medical records do not include any mention of cardiac related conditions and only report facial swelling from oral surgery and a possibility of diabetes. R. 355-61. As of October 2012, the medical records continue to not mention any cardiac conditions. R. 353-54. During her June 28, 2013 appointment, Plaintiff reported increased abdominal swelling and shortness of breath beginning at most two to four weeks prior to the appointment. R. 348. These symptoms were the first signs of Plaintiff's cardiac symptoms in the medical records, which by Plaintiff's own description she did not begin experiencing until early June 2013. R. 17, 348.
Dr. Odle's opinion did not reference any medical documentation or evidence showing Plaintiff's cardiac symptoms and limitations began prior to the date last insured, and Plaintiff has not pointed to any either. When asked to identify particular medical findings supporting his assessment in his opinion, Dr. Odle only stated heart failure and dyspnea. R. 402-05. There is no further reference to dates indicating when Plaintiff's cardiac symptoms and limitations began.
Plaintiff argues she could not have developed such a severe cardiac condition overnight, and a reasonable inference can be made these conditions existed on March 31, 2016 since she first reported the symptoms that led to her cardiac diagnoses just three months later on June 28, 2013. Pl.'s Br., p. 13. This contention overlooks her admission, during the June 28, 2013 appointment, her symptoms had just begun two to four weeks ago. Furthermore, the question for purposes of disability insurance is not when Plaintiff's cardiac condition first began to form, but instead when the condition produced symptoms rendering Plaintiff disabled. The answer here is no earlier than the beginning of June, when Plaintiff stated she first noticed the symptoms that led to diagnoses of her cardiac conditions.
For all of these reasons, the ALJ's decision to give Dr. Odle's opinion little weight is supported by substantial evidence.
Plaintiff argues the ALJ failed to develop the record by contacting Dr. Odle about his opinion, seeking another treating source statement, or ordering a consultative examination to determine the onset date of Plaintiff's cardiac conditions. Pl.'s Br., pp. 14-15. A claimant has the burden of proving his disability and is responsible for providing evidence in support of his claim.
The ALJ did not need to obtain additional information by ordering a consultative examination or seeking a medical source statement from another treating physician to render an informed decision about the onset date of Plaintiff's cardiac conditions. The record consists of more than 1,000 pages and years of Plaintiff's medical treatment notes. None of the sources describe symptoms supporting the level of limitations found in Dr. Odle's opinion prior to the date last insured, including Plaintiff herself. Further, SSR 83-20, which Plaintiff cites, does not suggest the ALJ should have sought additional information to clarify the date last insured. This ruling only requires an ALJ to inquire further about the disability onset date when there is ambiguity in the record. There is no error in failing to make further inquiry where, as here, "the ALJ found that [Plaintiff] was not disabled prior to the date last insured based on ample, unambiguous medical evidence from both before and after the date last insured"
For the reasons set forth above, the Court
SO REPORTED and RECOMMENDED.