LEONARD T. STRAND, District Judge.
This case is before me on a Report and Recommendation (R&R) by the Honorable Jon Stuart Scoles, Chief United States Magistrate Judge. See Doc. No. 16. Judge Scoles recommends that I affirm the decision of the Commissioner of Social Security (the Commissioner) denying plaintiff Katherine Casson Social Security disability benefits (DIB) under Title II of the Social Security Act, 42 U.S.C. § 401 et seq. (Act). Casson filed timely objections (Doc. No. 17) to the R&R and the Commissioner filed a timely response (Doc. No. 18). The procedural history and relevant facts are set forth in the R&R and are repeated herein only to the extent necessary.
The Commissioner's decision must be affirmed "if it is supported by substantial evidence on the record as a whole." Pelkey v. Barnhart, 433 F.3d 575, 577 (8th Cir. 2006); see 42 U.S.C. § 405(g) ("The findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive . . . ."). "Substantial evidence is less than a preponderance, but enough that a reasonable mind might accept as adequate to support a conclusion." Lewis, 353 F.3d at 645. The Eighth Circuit explains the standard as "something less than the weight of the evidence and [that] allows for the possibility of drawing two inconsistent conclusions, thus it embodies a zone of choice within which the [Commissioner] may decide to grant or deny benefits without being subject to reversal on appeal." Culbertson v. Shalala, 30 F.3d 934, 939 (8th Cir. 1994).
In determining whether the Commissioner's decision meets this standard, the court considers "all of the evidence that was before the ALJ, but it [does] not re-weigh the evidence." Wester v. Barnhart, 416 F.3d 886, 889 (8th Cir. 2005). The court considers both evidence which supports the Commissioner's decision and evidence that detracts from it. Kluesner v. Astrue, 607 F.3d 533, 536 (8th Cir. 2010). The court must "search the record for evidence contradicting the [Commissioner's] decision and give that evidence appropriate weight when determining whether the overall evidence in support is substantial." Baldwin v. Barnhart, 349 F.3d 549, 555 (8th Cir. 2003) (citing Cline v. Sullivan, 939 F.2d 560, 564 (8th Cir. 1991)).
In evaluating the evidence in an appeal of a denial of benefits, the court must apply a balancing test to assess any contradictory evidence. Sobania v. Sec'y of Health & Human Servs., 879 F.2d 441, 444 (8th Cir. 1989). The court, however, does not "reweigh the evidence presented to the ALJ," Baldwin, 349 F.3d at 555 (citing Bates v. Chater, 54 F.3d 529, 532 (8th Cir. 1995)), or "review the factual record de novo." Roe v. Chater, 92 F.3d 672, 675 (8th Cir. 1996) (citing Naber v. Shalala, 22 F.3d 186, 188 (8th Cir. 1994)). Instead, if, after reviewing the evidence, the court finds it "possible to draw two inconsistent positions from the evidence and one of those positions represents the Commissioner's findings, [the court] must affirm the [Commissioner's] denial of benefits." Kluesner, 607 F.3d at 536 (quoting Finch v. Astrue, 547 F.3d 933, 935 (8th Cir. 2008)). This is true even if the court "might have weighed the evidence differently." Culbertson, 30 F.3d at 939 (quoting Browning v. Sullivan, 958 F.2d 817, 822 (8th Cir. 1992)). The court may not reverse the Commissioner's decision "merely because substantial evidence would have supported an opposite decision." Baker v. Heckler, 730 F.2d 1147, 1150 (8th Cir. 1984); see Goff v. Barnhart, 421 F.3d 785, 789 (8th Cir. 2005) ("[A]n administrative decision is not subject to reversal simply because some evidence may support the opposite conclusion.").
A district judge must review a magistrate judge's R&R under the following standards:
28 U.S.C. § 636(b)(1); see also Fed. R. Civ. P. 72(b). Thus, when a party objects to any portion of an R&R, the district judge must undertake a de novo review of that portion.
Any portions of an R&R to which no objections have been made must be reviewed under at least a "clearly erroneous" standard. See, e.g., Grinder v. Gammon, 73 F.3d 793, 795 (8th Cir. 1996) (noting that when no objections are filed "[the district court judge] would only have to review the findings of the magistrate judge for clear error"). As the Supreme Court has explained, "[a] finding is `clearly erroneous' when although there is evidence to support it, the reviewing court on the entire evidence is left with the definite and firm conviction that a mistake has been committed." Anderson v. City of Bessemer City, 470 U.S. 564, 573 74 (1985) (quoting United States v. U.S. Gypsum Co., 333 U.S. 364, 395 (1948)). However, a district judge may elect to review an R&R under a more-exacting standard even if no objections are filed:
Thomas v. Arn, 474 U.S. 140, 150 (1985).
Judge Scoles reviewed the ALJ's evaluation of the medical evidence, the ALJ's credibility determination and the ALJ's formulation of Casson's residual functional capacity (RFC). With regard to the medical evidence, Judge Scoles found:
Doc. No. 16 at 20.
Addressing Casson's argument that the ALJ improperly assessed her credibility, Judge Scoles described the applicable standards as follows:
Doc. No. 16 at 20-22. Judge Scoles noted that the ALJ pointed out inconsistencies between the objective medical evidence and Casson's allegations of disability. Id. at 22. Specifically, Judge Scoles quoted the portion of the ALJ's ruling in which the ALJ explained that Casson appeared to respond well to medicine and had activities of daily living, such as driving, that are inconsistent with the vision problems she described. Judge Scoles stated:
Doc. No. 16 at 23.
Finally, Judge Scoles set out the correct standard regarding the ALJ's duty to assess a claimant's RFC and, if needed, to develop the record further. Id. at 24. Judge Scoles reviewed the ALJ's finding that Casson could perform a full range of light work, and stated:
Doc. No. 16 at 26.
Casson objects to Judge's Scoles' findings regarding the medical evidence, Casson's credibility, and the ALJ's RFC.
Judge Scoles summarized the relevant medical evidence in his R&R. Doc. No. 16 at 5-10. I find no errors in his recitation of the medical history and it is therefore incorporated by reference. In short, it is undisputed that Casson suffers from myasthenia gravis. Among other things, myasthenia gravis can cause muscle weakness and eye problems.
In the course of her treatment, Casson regularly saw John Garred, Jr., M.D., a family practice physician, and James Case, M.D., a neurologist. Throughout the course of his treatment, Dr. Garred regularly made conclusory statements that Casson would be unable to return to work. See, e.g., AR 489 (treatment note from July 9, 2013, stating "She . . . probably is not ever going to be able to work again."). On July 11, 2013, Dr. Garred wrote a letter in which he stated that Casson:
AR 451-52. Dr. Garred provided a substantially-similar letter dated October 30, 2013. AR 531. Dr. Case opined similarly. AR 521.
However, on July 18, 2013, Casson was seen by Pariwat Thaisetthawatkul, M.D., and resident Sreekanth Koneru, M.D. Dr. Koneru observed that "her symptoms are well controlled except for [mono-ocular] blurry vision when she tries to read." AR 459. Dr. Thaisetthawatkul stated that "the ongoing problems she continues to have are likely NOT related to myasthenia gravis." AR 460 (emphasis in original). Dr. Thaisetthawatkul also stated that Casson's weakness and fatigue were likely caused by sleep issues.
Casson also saw Beth Bruening, M.D., regarding her eyesight. Dr. Bruening concluded that some of Casson's vision problems were unrelated to her myasthenia gravis. AR 537. Dr. Bruening suggested the issues could be corrected with a prescription adjustment. Id. Additionally, Dr. Garred's treatment notes conflict with his written assessments for third parties. Compare, e.g., AR 531 (Dr. Garred's letter stating Casson is unable to work) with AR 496-98 (his treatment notes from August 13, 2013, stating that he found Casson's neurological conditions to be "normal," that she suffered from unspecified muscle weakness and that her eyesight "may improve with more therapy.") Finally, on July 14, 2014, Dr. Case opined that Casson's myasthenia gravis seemed to be well-controlled and expressed doubt that Casson's fatigue was related to her primary condition. AR 719.
The ALJ stated:
AR 29. The ALJ found that Dr. Garred's conclusions were inconsistent with both his treatment notes and the conclusions of Dr. Thaisetthawatkul and Dr. Bruening. Thus, the ALJ stated: "I am unable to credit the opinions in the medical source statements issued by her treating sources since they all indicate exertional limitations that are not consistent with the record as a whole and, therefore, those opinions are given little weight." AR 30.
Casson argues that the ALJ improperly gave little weight to Dr. Garred's opinion. She contends that the opinion is entitled to controlling weight because Dr. Garred is a treating source and his findings are consistent with the medical record as a whole. Having carefully reviewed the record, I find that the ALJ provided good reasons, supported by substantial evidence, to discount Dr. Garred's opinion. See Michel v. Colvin, 640 F. App'x 585, 592-93 (8th Cir. 2016) ("[w]hen a treating physician's opinion is in conflict with other substantial medical evidence, then the ALJ may afford less weight to that physician's opinion.") (internal citations omitted).
I agree with Judge Scoles that the ALJ's decision includes a thorough and well-reasoned evaluation of the medical evidence, including Dr. Garred's treatment notes. The ALJ articulated specific reasons for discounting Dr. Garred's conclusory opinions, including the fact Dr. Garred often noted that Casson improved on medication, but then included a stock finding that she was unable to work. Additionally, and contrary to Casson's assertion, Dr. Garred's conclusions were contradicted by both Dr. Thaisetthawatkul and Dr. Bruening, as each found that Casson likely suffered from other, treatable, issues (sleep issues and cataracts) that caused some of her symptoms.
The ALJ considered and applied the appropriate factors regarding the evaluation of a treating source opinion. Based on my de novo review, I find that the ALJ's evaluation of the medical evidence is supported by substantial evidence in the record as a whole. I therefore overrule Casson's objection to that portion of the R&R.
Casson also argues that the ALJ's credibility assessment is not supported by substantial evidence. Specifically, she contends that the ALJ failed to consider her subjective complaints and failed to identify actual inconsistencies in the record.
Casson testified that she gets tired throughout the day. AR 46. She stated that she often has to sit and rest while doing routine chores, and normally has to lay down for an hour or more a day. Id. Casson also testified that she gets blurry vision while reading. Id. She stated that when she tries to focus her eyesight for a long period of time her muscles become weak, her vision blurs, and her eyes begin to twitch. Id. Casson also stated that she has a hard time carrying more than five pounds, bending, stooping or using stairs. AR 47-52.
The ALJ referenced the Polaski factors for considering a claimant's credibility and then provided reasons for concluding that Casson's allegations of disabling symptoms were not entirely credible. AR 24. Specifically, the ALJ found: (a) Casson's allegations are not supported by the medical record; (b) Casson engaged in activities that are not consistent with her alleged symptoms; and (c) Casson generally responded positively to treatment. AR 24-30.
Based on my de novo review, I conclude that the ALJ properly considered the Polaski factors and provided valid reasons, supported by substantial evidence, to discount Casson's allegation of debilitating symptoms. First, as discussed above, the medical evidence does not support Casson's allegations. While Dr. Garred (and to a lesser extent Dr. Case) made conclusory statements about the extent of Casson's disability, the actual treatment notes do not support Casson's allegations that she is unable to bend or use stairs and is so fatigued that she must lay down for an hour or more a day. While it is seems undisputed that Casson has issues with her eyesight and blurry vision, both the cause of those symptoms and their severity is uncertain. Additionally, there is little medical evidence directly linking fatigue and other physical ailments to Casson's severe impairments.
In addition, the ALJ was entitled to consider Casson's failure to follow up for medical testing. See, e.g., Wheeler v. Apfel, 224 F.3d 891, 895 (8th Cir. 2000). As set out in the ALJ's decision, both Dr. Thaisetthawatkul and Dr. Case suggested that Casson's fatigue may be caused by sleep apnea, but Casson declined to follow up on that issue. See, e.g., AR 579 (Dr. Case's note indicating that Casson's fatigue is likely a result of sleep apnea). Casson alleges no emotional or psychological reasons for her failure to follow up with regard to possible sleep apnea. Accordingly, the ALJ properly considered this failure in finding her subjective complaints not credible.
The ALJ also found that Casson's activities of daily living are not as restricted as might be expected in light of her subjective complaints. For example, the ALJ noted that Casson continues to drive, prepare meals and attend to her personal needs. It is generally true that a claimant's ability to engage in personal activities does not constitute substantial evidence that he or she has the functional capacity to engage in substantial gainful activity. See, e.g., Wagner v. Astrue, 499 F.3d 842, 851 (8th Cir. 2007). However, a claimant's ability to engage in a specific activity (in this case driving) that should be precluded by his or her alleged symptom (in this case vision issues) does cut against the claimant's credibility. See, e.g., Shannon v. Chater, 54 F.3d 484, 487 (8th Cir. 1995) (finding that the claimant's ability to engage in household chores was inconsistent with her allegation of disabling knee pain).
Finally, the ALJ noted that almost all of the medical records indicate that Casson responded well to treatment. This is another factor, appropriately cited by the ALJ, that weighs against Casson's subjective complaints of disabling symptoms. See, e.g., Kisling v. Chater, 105 F.3d 1255, 1257 (8th Cir. 1997) (holding that an impairment cannot be considered disabling if it can be controlled through treatment or medication). Thus, having carefully reviewed the record, I find that the ALJ appropriately considered the Polaski factors and provided good reasons for discrediting Casson's subjective complaints. As such, there is no basis for disturbing the ALJ's credibility determination. Johnson, 240 F.3d at 1148. Casson's objection to this portion of the R&R is overruled.
Casson also argues that the ALJ erred by discounting the opinions of state agency medical consultants and finding that Casson has the RFC to engage in light work. As Judge Scoles explained:
Doc. No. 16 at 23.
The ALJ stated:
AR 30. Based on this RFC, the ALJ determined that Casson could return to her past relevant work. AR 31.
I agree with Judge Scoles that ALJ's RFC is supported by substantial evidence. Casson's best argument is that the independent medical expert, Ronald Devere, M.D., limited her to sedentary work and the ALJ improperly discounted that opinion. However, while Dr. Devere recommended a restriction to sedentary work, he admitted that this restriction is not supported by the medical record. The exchange between the ALJ and Dr. Devere is illuminating:
AR 67-68. Thus, Dr. Devere did not testify that the medical evidence supports a finding that Casson is limited to sedentary work. Rather, Dr. Devere suggested such a finding as a result of giving Casson the "benefit of the doubt." The "benefit of the doubt" is not the correct standard for crafting the RFC. Instead, the ALJ's RFC evaluation must be based on all relevant evidence:
Julin v. Colvin, 826 F.3d 1082, 1089 (8th Cir. 2016). Here, the ALJ correctly considered all of the evidence, including the relevant medical evidence, in crafting the RFC. The ALJ specifically gave great weight to portions of the state medical agency opinions, other than the specific objection discussed above, as well as to Dr. Thaisetthawatkul's opinion. AR 30 (citing AR 457-61). Upon my de novo review, I find the ALJ crafted an RFC that is supported by substantial evidence in the record as a whole. Accordingly, Casson's objection to this portion of the R&R is overruled.
For the reasons set forth herein:
Doc. No. 14 at 14-15; see also Goff v. Barnhart, 421 F.3d 785, 793 (8th Cir. 2005) ("[T]here is no evidence Goff was ever denied medical treatment due to financial reasons. Without such evidence, Goff's failure to take pain medication is relevant to the credibility determination."). Similarly, in this case there is no evidence that Casson's financial constraints impaired her ability to seek examination and treatment for sleep apnea.
