ROBERT E. LARSEN, Magistrate Judge.
Plaintiff Jason Cook seeks review of the final decision of the Commissioner of Social Security denying plaintiff's application for disability benefits under Title II of the Social Security Act ("the Act"). Plaintiff argues that the ALJ erred in finding plaintiff's testimony regarding the effects of his impairments not entirely credible. I find that the substantial evidence in the record as a whole supports the ALJ's finding that plaintiff is not disabled. Therefore, plaintiff's motion for summary judgment will be denied and the decision of the Commissioner will be affirmed.
On October 10, 2012, plaintiff applied for disability benefits alleging that he had been disabled since March 1, 2008. He later amended his alleged onset date to August 17, 2012, the day he stopped working (Tr. at 29, 124). Plaintiff's disability stems from Crohn's disease, short bowel syndrome, fistula, chronic fatigue, abdominal pain with diarrhea and vomiting, possible colon cancer and malnutrition (Tr. at 50, 124). Plaintiff's application was denied on November 28, 2012. On March 4, 2014, a hearing was held before an Administrative Law Judge. On March 27, 2014, the ALJ found that plaintiff was not under a "disability" as defined in the Act. On May 7, 2015, the Appeals Council denied plaintiff's request for review. Therefore, the decision of the ALJ stands as the final decision of the Commissioner.
Section 205(g) of the Act, 42 U.S.C. § 405(g), provides for judicial review of a "final decision" of the Commissioner. The standard for judicial review by the federal district court is whether the decision of the Commissioner was supported by substantial evidence. 42 U.S.C. § 405(g);
Substantial evidence means "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion."
An individual claiming disability benefits has the burden of proving he is unable to return to past relevant work by reason of a medically-determinable physical or mental impairment which has lasted or can be expected to last for a continuous period of not less than twelve months. 42 U.S.C. § 423(d)(1)(A). If the plaintiff establishes that he is unable to return to past relevant work because of the disability, the burden of persuasion shifts to the Commissioner to establish that there is some other type of substantial gainful activity in the national economy that the plaintiff can perform.
The Social Security Administration has promulgated detailed regulations setting out a sequential evaluation process to determine whether a claimant is disabled. These regulations are codified at 20 C.F.R. §§ 404.1501,
1. Is the claimant performing substantial gainful activity?
2. Does the claimant have a severe impairment or a combination of impairments which significantly limits his ability to do basic work activities?
3. Does the impairment meet or equal a listed impairment in Appendix 1?
4. Does the impairment prevent the claimant from doing past relevant work?
5. Does the impairment prevent the claimant from doing any other work?
The record consists of the testimony of plaintiff and vocational expert Denise Weaver, in addition to documentary evidence admitted at the hearing.
The record contains the following administrative reports:
The record shows that plaintiff earned the following income from 2002 through 2011:
(Tr. at 117).
In a Function Report dated October 28, 2012, plaintiff reported that he watches television and does small things for his four-year-old daughter. He naps from noon until 3:00 p.m., then visits with his wife and children until he goes to bed around 9:00 or 10:00 p.m. (Tr. at 139). Plaintiff stays at home with his four-year-old and cares for her during the day (Tr. at 140). Plaintiff can care for his personal needs (Tr. at 140), and he prepares his own meals such as sandwiches, fresh meat, potatoes, vegetables, and grain products (Tr. at 141). His cooking depends on what hours his wife works; sometimes she prepares meals (Tr. at 141). When plaintiff cooks, it takes him 35 minutes to an hour (Tr. at 141).
Plaintiff can do laundry and do simple tasks around the house (Tr. at 141). He has to stay near a bathroom and his fatigue causes him to lie down every couple of hours (Tr. at 141). He does not drive because he does not have a driver's license (Tr. at 142). Plaintiff plays his guitar every day for about 20 minutes (Tr. at 143). Plaintiff only goes out to go to the doctor or to go next door to his mother's house (Tr. at 143).
Plaintiff's impairments affect his ability to lift, squat, bend, stand, reach, walk, sit, kneel, climb stairs, complete tasks, and use his hands (Tr. at 144). He can walk for 100 yards before needing to rest (Tr. at 144). He has to sit for an hour to build up energy after walking 100 yards (Tr. at 144). He can pay attention "as long as needed." (Tr. at 144). He finishes what he starts, and he can follow directions very well (Tr. at 144).
In this form, dated October 28, 2012, plaintiff reported that he plays video games, puzzles or uses a computer for 20 to 30 minutes at one sitting (Tr. at 148). He had a driver's license, but it was suspended (Tr. at 148). Plaintiff reported that he was not able to complete the form without help — his wife wrote his answers because his wrist causes him too much pain to write (Tr. at 149).
On August 17, 2012, plaintiff stopped working. This is his amended alleged onset date.
On August 20, 2012, plaintiff saw Carey Vaughan, D.O., to establish care (Tr. at 195-196). Plaintiff said he had had Crohn's disease
On August 24, 2012, plaintiff had a colonoscopy performed by Terry Nold, D.O., due to acute onset of diarrhea with transient bright red rectal bleeding (Tr. at 186). "Patient with prior diagnosis of Crohn's disease diagnosed at the University of Missouri. He has been placed on Azulfidine 1000 mg daily and he has done quite well until recently. He was feeling well and subsequently discontinued his medication." Plaintiff was assessed with acute proctocolitis (inflammation of the colon and rectum) with diffuse ulceration and granuloma formation. He was told to continue Asacol (non-steroidal anti-inflammatory), and he was prescribed Prednisone (steroid) daily for one week with a reduced dosage each week for six weeks. A repeat colonoscopy was recommended in 8 to 12 weeks.
On September 19, 2012, plaintiff saw Carey Vaughan, D.O., for a follow up (Tr. at 194). "Has been doing better since he was put on the steroids but he noticed more pain & D since his dose has been reduced. . . . Still having pain most days." Plaintiff weighed 190 pounds. His physical exam was normal. Plaintiff's dose of Prednisone was continued at 40 mg and he was told to begin to taper it in two weeks. "Advised to use bone broth and veggie rich soups, probiotics & anti-inflammatory nutrients to get stronger."
On October 10, 2012, plaintiff applied for disability benefits.
On November 15, 2012, plaintiff had a follow up with Carey Vaughan, D.O. (Tr. at 193, 261). Plaintiff reported still having a lot of pain caused by the fistula
On December 4, 2012, plaintiff saw Roxanne Lim, M.D., after having been referred by Dr. Vaughan (Tr. at 199-201). Plaintiff had last been seen in 2009 after having been diagnosed with Crohn's disease and rectal fistula in 2008. "He was started on Ciprofloxacin [antibiotic] and Flagyl [also called Metronidazole, an antibiotic] for his rectal fistula. He was also started on sulfasalazine for his Crohn's disease. The patient was then lost to follow up. The patient reported he has been doing well since then and discontinued his medications. Symptoms recurred in July 2012 when he started feeling tired as well as having joint pains, weight loss, nausea and vomiting. He has frequent bowel movements but they are nonbloody. He reports that he would also have feces coming out from his rectal fistula." Plaintiff was taking Prednisone and Sulfasalazine. "He reports some improvement in symptoms but continues to be tired. He has joint pains as well as the severe back pain." Plaintiff's Prednisone dose was 30 mg daily, and he had a prescription for Tramadol as needed for pain. Dr. Lim ordered lab work and renewed plaintiff's prescriptions. She also prescribed Flagyl for rectal fistula and ordered further tests.
On December 11, 2012, plaintiff had an MRI of his pelvis (Tr. at 213). Michael Aro, M.D., diagnosed left intersphincteric perianal fistula and small right-sided perianal intersphincteric abscess.
On January 8, 2013, plaintiff saw Jack Bragg, D.O., for a biopsy of the colon (Tr. at 203-212). Plaintiff weighed 175 pounds. He was diagnosed with chronic colitis with mild activity in the right colon, chronic colitis with moderate activity in the left colon, and no evidence of active colitis in the transverse colon (see diagram on page 8). No dysplasia
On January 13, 2013, plaintiff saw Jack Bragg, D.O., a gastroenterologist, for a follow up on his colonoscopy, blood work, MRI and biopsy (Tr. at 219-222). Plaintiff's tests showed intense erythema,
On February 19, 2013, plaintiff saw Jack Bragg, D.O., for a follow up (Tr. at 223-225). "He was last seen here in the clinic on January 15. At that time he was complaining of a lot of joint pain . . . We referred him to Dr. Wu, but he did not keep that appointment. . . . He stated that his bowel function was unchanged. Fistulas are not draining at the present time. He is not having any fever or chills, or abdominal pain at this time." Plaintiff also denied vomiting and denied any side effects from Prednisone. "He is not bleeding at this time." Under psychosocial history, the record states, "He is not a smoker. He does work." Plaintiff's physical exam was normal. Dr. Bragg refilled plaintiff's Tramadol as needed for pain. "I will try to get him to see Dr. Wu again."
On March 21, 2013, plaintiff saw Hazem Hammad, M.D., a gastroenterologist (Tr. at 226-228). "Jason has been on sulfasalazine 1 gram 4 times a day since his diagnosis in 2008. He has also required some pain medications intermittently for some peripheral joint pain and abdominal pain. Lately, he seems to be doing well." About a week earlier plaintiff thought he had the flu with some nausea and vomiting which had since resolved. "He currently has 2-3 soft bowel movements every day. No melena
On April 3, 2013, plaintiff saw Celso Velazquez, M.D., a rheumatologist, due to complaints of joint pain (Tr. at 215-218). Plaintiff said he had experienced joint pain since he was 16 years of age. "Notes discomfort in shoulders, elbows, wrists, left fingers (plays guitar), mid back, knees." Plaintiff's knee pain was aggravated by walking up stairs. Plaintiff rated his pain a 5 out of 10 in severity. On exam plaintiff had no swollen or tender joints, normal range of motion in all joints, no sacroiliac tenderness, good extension in his spine, he could bend over and touch his toes, and he had normal muscle strength in all limbs. He had crepitus
On May 1, 2013, plaintiff saw Jack Bragg, D.O., for a follow up (Tr. at 231-232). "Over the last several months his Crohn's has been going downhill." Plaintiff reported having had some nausea, vomiting and abdominal pain. Bowel movements were nonbloody and every day at least 3 times a day, mostly associated with food. "He maintains that sulfasalazine has stopped working for him right now." Plaintiff's exam was normal except he had mild tenderness on the left side of his abdomen. Dr. Bragg prescribed azathioprine
On May 29, 2013, plaintiff saw Jack Bragg, D.O., for a follow up (Tr. at 234-235). Since his last visit on May 1, 2013, plaintiff had had a C. difficile
On June 19, 2013, plaintiff saw Carey Vaughan, D.O., for a follow up (Tr. at 260). Plaintiff reported evening fevers, joint pain (for which another doctor had prescribed Meloxicam, a non-steroidal anti-inflammatory). Plaintiff had been out of Atenolol (for tachycardia). He weighed 158 pounds. His physical exam was normal. Plaintiff's Atenolol was refilled. X-rays were ordered and he was given a referral for a rheumatology consult.
On July 2, 2013, plaintiff saw Carey Vaughan, D.O. (Tr. at 259). Plaintiff reported decreased appetite. He had been staying in bed all the time, he had little energy, he was eating twice a day and denied diarrhea but had lost 10 pounds in two weeks. He weighed 148 pounds. His exam was normal except he was described as thin, pale, and ill appearing. He was assessed with uncontrolled Crohn's disease, intermittent fevers and weight lows. He was started on Prednisone.
On July 12, 2013, plaintiff saw Eston Schwartz, M.D., at Goldschmidt Cancer Center (Tr. at 254-256). Plaintiff stated that over the past few months he had lost a "huge amount of weight" and had lost over 100 pounds in the past year. "Jason comes in today stating he has gained about 15-20 pounds back since his visit to the resident clinic. He is feeling much better. His fever and chills have [gone] away. He is more active. He does not have any more diarrhea and his arthritis has improved." His performance status was noted to be, "No physically strenuous activity, but ambulatory and able to carry out light or sedentary work, (e.g., office work, light house work)." Plaintiff's physical exam was normal; he had normal range of motion in his extremities without obvious weakness. Plaintiff weighed 172 pounds. Plaintiff's platelet
On July 19, 2013, plaintiff saw Eston Schwartz, M.D., at Goldschmidt Cancer Center (Tr. at 251-253). "Jason comes in today for CBC and bone marrow biopsy. He states he is unable to stay for a bone marrow biopsy because he left his kids home alone. He has been feeling great. He has gained over 10 pounds since last week. His stools have normalized and he is quite active. He states he has no acute complaints." Plaintiff's exam was normal except edema in his legs. He weighed 181 pounds. He was assessed with Thrombocytosis secondary to Crohn's disease, anemia,
On August 16, 2013, plaintiff saw Eston Schwartz, M.D., at Goldschmidt Cancer Center (Tr. at 247-250). "Jason comes in today for follow up. We do continue to follow his fluctuating CBC. He states that he has been doing good and his weight has been up. However, he did not take his prednisone for about a week last week. He does feel more achy today with pain in his muscles and joints.. . . No more diarrhea at this time though." He reported joint and muscle pains and numbness on his left lateral quadriceps (outside of the thigh) associated with mid to lower back pain. His performance status was listed as, "No physically strenuous activity, but ambulatory and able to carry out light or sedentary work (e.g., office work, light house work)." On exam he had abdominal tenderness but his extremities were normal. He weighed 175 pounds. Dr. Schwartz assessed thrombocytosis secondary to Crohn's disease. He also assessed anemia and directed plaintiff to take over-the-counter iron daily and Folic acid daily, as plaintiff's sulfasalazine causes a decline in folic acid. "I was under the assumption that this prednisone was short term. However, if it is long term, I have suggested calcium and vitamin D as well as a bone density examination. He has been on it now for 7-8 months and it does not appear that he is coming off of it very quickly. I would be worried about vertebral fractures given the length of this prednisone and the dose."
On August 28, 2013, plaintiff saw Jack Bragg, D.O., for a follow up (Tr. at 237-239). "He currently denies any abdominal pain or diarrhea. Denies any hematochezia [see footnote 10 on page 12]. Has been tolerating all kinds of foods very well." Plaintiff's exam was normal. "As far as his symptoms of Crohn's go, he is doing well. It is hard to say whether his improvement in the symptoms is because of steroids or Imuran." Dr. Bragg recommended plaintiff taper off his prednisone slowly and continue with Imuran.
On September 13, 2013, plaintiff saw Eston Schwartz, M.D., at Goldschmidt Cancer Center (Tr. at 244-246). "Jason returns today for follow up. He does continue to taper his prednisone. He is feeling good and is gaining weight. He has gained about 15 pounds since our last visit. He states he is more active and energetic. He, however, is trying to get disability due to the fact that he was not able to work for so long. He does complain of continued muscle and bone pain at times and weakness in the leg joints." Plaintiff was noted to be "fully active, able to carry on all predisease activities without restrictions." In a review of systems, plaintiff denied nausea, vomiting, diarrhea, change in bowel habits, and GI bleeding. On exam he was found to have no tenderness in his abdomen or extremities. His exam was normal. He weighed 186 pounds. He was diagnosed with thrombocytosis secondary to Crohn's disease. His platelet count was nearly within normal limits. Although plaintiff was assessed with anemia, it was noted to be resolved. Dr. Schwartz recommended plaintiff begin taking iron and folic acid. He also recommended plaintiff start taking calcium and Vitamin D.
On September 9, 2013, plaintiff saw Carey Vaughan, D.O. (Tr. at 258). He had been out of prednisone for ten days. Plaintiff had gained 38 pounds with the prednisone. Plaintiff's physical exam was normal. His medications were refilled.
On December 6, 2013, plaintiff saw Eston Schwartz, M.D., at Goldschmidt Cancer Center (Tr. at 240-243). "Since our last visit, he did see the gastroenterologist at MU. They have him on Imuran, but he was not able to get in touch with them to refill his prescriptions. He states that they did check his blood work and they never called him back for refilling his Imuran. He thinks they want him to continue with that medicine. Other than that, he is having continued fatigue. He does not work and does not get out of his house. His wife states he rarely gets off the couch. He has no shortness of breath, no nausea, vomiting or diarrhea. No significant pain except in his abdomen." During a review of systems, plaintiff reported that he was not on treatment anymore for his gastrointestinal condition. He denied joint pain, and he had no decreased range of motion in any joints. He had no tenderness or weakness in his joints. Plaintiff weighed 185 pounds. Dr. Schwartz assessed, "Thrombocytosis secondary to Crohn's disease: Jason's platelet count [10.0] is slightly lower than it was last time, but stable. He is not on prednisone or Imuran. He is, however, having symptoms of worsening Crohn's with abdominal pain and diarrhea." Plaintiff was also assessed with anemia and Dr. Schwartz recommended plaintiff take iron supplements and folic acid. Dr. Schwartz refilled plaintiff's Imuran and recommended he follow up with his GI doctor. With regard to plaintiff's fatigue, Dr. Schwartz ordered blood work which was normal. "This is likely inactivity and I have told him that he needs to start becoming more active."
On January 29, 2014, plaintiff saw Carey Vaughan, D.O., for a follow up (Tr. at 257). Plaintiff reported aching all over, abdominal pain, and vomiting two to three times a week. Plaintiff's weight had been stable. "May get Medicaid soon and has disability hearing in March." Plaintiff weighed 184 pounds. His exam was normal. He was assessed with uncontrolled Crohn's disease. Lab work was ordered.
During the March 4, 2014, hearing, plaintiff testified; and Denise Weaver, a vocational expert, testified at the request of the ALJ.
At the time of the hearing plaintiff was 28 years of age (Tr. at 29). Plaintiff was living with his wife and three children, 11, 7 and almost 6 (Tr. at 29). Plaintiff has a high school education; he can read, write, and do simple math (Tr. at 29-30).
Plaintiff last worked at Aloha Watersports, his own company, in 2012 (Tr. at 30). Before that he was a dock manager at Aloha Boat (Tr. at 30). Because he was in the boat business, he worked other jobs in the winter (Tr. at 30). He did maintenance at Wal-Mart for a few months, mostly sweeping and doing janitorial work but also fixing shelves or doors (Tr. at 30-31). He worked at Millstone as a hired hand for cleaning sidewalks and "doing anything they needed done" (Tr. at 31). He worked as a sandwich maker at Quiznos (Tr. at 31).
Plaintiff used to weigh 270 pounds before he got sick (Tr. at 31). He has Crohn's disease and short bowel syndrome (Tr. at 31). He also has arthritis related to Crohn's disease (Tr. at 31). Although he testified that he takes Imuran for Crohn's, "some kind of heart medication" (Atenolol), and doxylamine for upset stomach (Tr. at 31), later when asked if he was taking any medication at all, he answered, "No, sir." (Tr. at 33). When asked about side effects, plaintiff said, "A lot of drowsiness, and not a lot of side effects that I'm aware of, sir." (Tr. at 33).
Plaintiff's Crohn's disease causes vomiting and diarrhea (Tr. at 32). He has a fistula which bothers him a lot when he uses the bathroom (Tr. at 32). He uses the restroom on average five times a day or more (Tr. at 32). After he eats, he has to use the bathroom about 10 or 15 minutes later (Tr. at 32). After he uses the restroom, he has to take a shower because the fistula drains (Tr. at 32). Sometimes he has incontinence; that occurred twice the previous week (Tr. at 32). Plaintiff has arthritis in his knees, elbows, shoulders, and lower back (Tr. at 32).
Plaintiff has not sought medical care in a while; "It's so far of a drive from where we're at, that I was trying to get a closer doctor, to either Lake of the Ozarks or Jefferson City. And insurance is a big deal, too. You know, there's a lot of stuff they would like to do, but haven't done." (Tr. at 34). He applied for Medicaid but was denied because he made too much money (Tr. at 35). Plaintiff was on Prednisone for six months at a time twice, but his doctor only puts him on Prednisone when he gets "really, really bad" (Tr. at 34-35). Dr. Schwartz wanted plaintiff to go to St. Louis for a possible PET scan because his blood work still shows that he has some sort of cancer (Tr. at 35). His doctor is not sure where the cancer is, so that scan would help figure out where the cancer could be (Tr. at 35-36).
Plaintiff has pain all the time, in his joints and on his left side (Tr. at 36). His fistula also causes pain (Tr. at 36). The only thing he does to relieve pain is go to the bathroom, and that is for the stomach cramps (Tr. at 36). Plaintiff only sleeps two or three hours at a time — he has night sweats and has to use the bathroom a lot during the night (Tr. at 36).
Plaintiff can walk 100 to 200 feet before needing to sit down (Tr. at 32-33). He can stand in one place for ten minutes at a time before needing to sit down (Tr. at 33). He has a lot of discomfort sitting because of the fistula; he can sit for about 45 minutes at a time (Tr. at 33).
Plaintiff can bathe and dress himself (Tr. at 33). He no longer drives (Tr. at 33-34). He cooks when his wife is working, but only if he has to (Tr. at 34). He stays in bed most of the day or sits on the couch (Tr. at 34). He watches television, usually situation comedies (Tr. at 34).
Vocational expert Denise Weaver testified at the request of the Administrative Law Judge. Plaintiff's past relevant work at Aloha Watersports is characterized as manager, hotel recreational facilities which includes marinas and water sport type facilities (Tr. at 38). The position is DOT 187.167-122, light, with an SVP of 7
The first hypothetical involved a person able to do light work with a sit/stand option allowing the person to alternate sitting and standing at will provided the person is not off task by 10% of the work period. The person could occasionally climb ladders, ropes, scaffolds, ramps or stairs; stoop; crouch; kneel or crawl. The person must avoid all use of hazardous machinery and all exposure to unprotected heights. Due to fatigue and pain, the person could only perform simple (SVP level 1 or 2), routine and repetitive tasks (Tr. at 38-39). The vocational expert testified that such a person could not perform any of plaintiff's past relevant work (Tr. at 39). Such a person could, however, work as a garment sorter, DOT 222.687-014, light, with an SVP of 2. There are 27,500 in the country, 715 in Missouri (Tr. at 39). The person could be a mail clerk, DOT 209.687-026, light with an SVP of 2. There are 51,250 in the country and 1,890 in Missouri (Tr. at 39-40). The person could work as a folding-machine operator in a clerical environment, DOT 208.685-014, light, with an SVP of 2. There are 75,500 jobs in the nation and 1,510 in Missouri (Tr. at 40).
The second hypothetical was the same as the first except the person would need two or more unscheduled or unexcused breaks in a workday (Tr. at 40). Such a necessity may "cause a problem with that individual's job" (Tr. at 40).
If the person were absent two or more times a month, he likely would not be retained (Tr. at 40).
Administrative Law Judge Raymond Souza entered his opinion on March 27, 2014 (Tr. at 12-22). Plaintiff's last insured date was June 30, 2014 (Tr. at 14).
Step one. Plaintiff has not engaged in substantial gainful activity since his amended alleged onset date (Tr. at 14).
Step two. Plaintiff has the following severe impairments: Crohn's disease, short bowel syndrome, irritable bowel syndrome, rectal fistula, ulcerative colitis, and patellofemoral syndrome (Tr. at 14).
Step three. Plaintiff's impairments do not meet or equal a listed impairment (Tr. at 14-15).
Step four. Plaintiff retains the residual functional capacity to perform light work except he must be able to alternate between sitting and standing at will provided he is not off task for more than 10% of the work period; he can occasionally climb ladders, ropes, scaffolds, ramps or stairs; stoop; crouch; kneel; or crawl. He must avoid all exposure to hazardous moving machinery and unprotected heights. He is limited to simple (SVP 1 or 2), routine, repetitive tasks due to fatigue and pain (Tr. at 15). With this residual functional capacity, plaintiff is unable to perform his past relevant work as a hotel manager, boat rigger, janitor, or sandwich maker (Tr. at 20).
Step five. Plaintiff is capable of working as garment sorter, mail clerk, or folding machine operator, all of which are available in significant numbers in the national economy (Tr. at 21). Therefore plaintiff is not disabled (Tr. at 21).
Plaintiff argues that the ALJ erred in finding that plaintiff's testimony was not credible.
(Plaintiff's brief, p. 8).
The credibility of a plaintiff's subjective testimony is primarily for the Commissioner to decide, not the courts.
In this case, I find that the ALJ's decision to discredit plaintiff's subjective complaints is supported by substantial evidence. Subjective complaints may not be evaluated solely on the basis of objective medical evidence or personal observations by the ALJ. In determining credibility, consideration must be given to all relevant factors, including plaintiff's prior work record and observations by third parties and treating and examining physicians relating to such matters as plaintiff's daily activities; the duration, frequency, and intensity of the symptoms; precipitating and aggravating factors; dosage, effectiveness, and side effects of medication; and functional restrictions.
The specific reasons listed by the ALJ for discrediting plaintiff's subjective complaints of disability are as follows:
(Tr. at 16-19).
Plaintiff stated he had problems with vomiting and diarrhea. His fistula drains, requiring him to shower five times a day after using the bathroom. He suffers from incontinence twice a week. Plaintiff stated he had arthritis in his joints, including his knees, elbows, shoulders, and lower back area. He thought he could walk 100 feet and stand for 10 minutes. Plaintiff had discomfort with his fistula so he could only sit for 45 minutes. Plaintiff stated he had drowsiness as a side effect of his medication but he was not currently taking any medications. He spends most of his day watching television.
Joint pains. Plaintiff's joint pains required nothing more than a low dose of a non-steroidal anti-inflammatory. Plaintiff never followed up on the recommended xrays, and none of his physical exams revealed anything abnormal beyond knee crepitus. His range of motion was always normal, strength was always normal, and every doctor to examine his joints noted no tenderness, no swelling, no weakness, no fluid.
Vomiting and diarrhea. According to the medical records, on December 4, 2012, plaintiff reported that symptoms including vomiting and diarrhea began in July 2012. He was put on medication and his symptoms improved. On February 19, 2013, plaintiff denied vomiting and said his bowel function was unchanged. On March 21, 2013, he reported some vomiting two weeks earlier due to the flu, but it had since resolved. He reported only 2 to 3 soft bowels movements a day, not diarrhea. On May 1, 2013, he reported some vomiting. He did not complain of diarrhea. On May 29, 2013, he denied vomiting, and he reported having 2 to 3 solid stools per day — not diarrhea. On September 13, 2013, he denied vomiting and diarrhea. On December 6, 2013, he denied vomiting and diarrhea. On January 29, 2014 — his last medical record — he reported vomiting 2 to 3 times a week.
Therefore, according to plaintiff's medical records, he was experiencing vomiting in July and August 2012, March 2013 (due to the flu, not his impairments), May 2013, and January 2014. He was experiencing diarrhea in July and August 2012 and December 2013. At all other times during the 18 months of medical records, plaintiff denied vomiting and diarrhea. This is inconsistent with his hearing testimony that vomiting and diarrhea impact his daily life and his ability to sleep at night. It is also inconsistent with an inability to perform any substantial gainful activity due to symptoms of vomiting and diarrhea.
Fistula. Plaintiff complained of pain from his fistula in November 2012. The following month he reported feces coming out of his rectal fistula. In January 2013, he continued to have draining from his fistula. However, by February 2013, Dr. Bragg noted that "fistulas are not draining". In March 2013, Dr. Hammad indicated that plaintiff's fistula was in remission. Plaintiff denied any pain or discharge from the fistula. There is no other mention of a fistula in any of plaintiff's medical records. Therefore, the symptoms from this condition lasted only a few months which is inconsistent with plaintiff's testimony that his fistula bothers him a lot and requires him to take a shower multiple times a day after using the bathroom due to draining.
Incontinence. Plaintiff testified that he suffers from bowel incontinence twice a week. Plaintiff never mentioned this condition to any of his doctors.
Although plaintiff testified that he did not seek medical treatment more frequently due to cost and lack of insurance, one can reasonably assume that on those rare occasions when he was able to see a doctor, he would have reported these disabling symptoms had they been occurring. Furthermore, the record contains no evidence that plaintiff was ever denied medical treatment due to financial reasons; and, as the ALJ noted, there was no evidence in the record that showed plaintiff explored all possible resources, such as clinics, charitable and public assistance agencies, etc. Without such evidence, the failure to seek treatment is a relevant credibility factor.
Plaintiff argues that the ALJ did not consider the fact that plaintiff's cannot drive. However, the record establishes that plaintiff does not drive because he does not have a driver's license — it was suspended (Tr. at 142, 148). This is not a limitation that is related to his impairment and the ALJ was not required to consider it.
As long as substantial evidence in the record supports the ALJ's findings, the court may not reverse the decision even if the case could have been decided differently.
Based on all of the above, I find that the substantial evidence in the record as a whole supports the ALJ's finding that plaintiff is not disabled. Therefore, it is
ORDERED that plaintiff's motion for summary judgment is denied. It is further
ORDERED that the decision of the Commissioner is affirmed.
SVP 1 — Short demonstration only
SVP 2 — Anything beyond short demonstration up to and including 1 month
SVP 3 — Over 1 month up to and including 3 months
SVP 4 — Over 3 months up to and including 6 months
SVP 5 — Over 6 months up to and including 1 year
SVP 6 — Over 1 year up to and including 2 years
SVP 7 — Over 2 years up to and including 4 years
