BRIAN M. COGAN, District Judge.
Plaintiff commenced this action pursuant to 2 U.S.C. § 405(g), seeking review of a decision of the Commissioner of Social Security (the "Commissioner"), denying his application for disability insurance benefits. Although the Administrative Law Judge ("ALJ") found that plaintiff has severe impairments that impose more than minimal functional limitations and that he can no longer work in his previous professions, the ALJ determined that he had the residual functional capacity to perform sedentary work. Following the ALJ's decision, plaintiff submitted additional medical evidence to the Appeals Council and has submitted yet additional medical evidence to this Court.
This action is before me on the Commissioner's and plaintiff's cross-motions for judgment on the pleadings. For the following reasons, I affirm the decision of the ALJ.
Plaintiff applied for disability insurance benefits, citing meniscus tears and torn cartilage in his left knee, a calcaneus fracture of his right ankle, and multiple bulging discs in his back as his disability. The application was denied, and he requested a hearing before an ALJ. During the hearing, plaintiff stated that certain medical records were outstanding. The ALJ subsequently subpoenaed additional medical records, thereafter issuing a decision where he found plaintiff not disabled. Plaintiff sought review with the Appeals Council and provided the Council additional medical records as they became available.
Plaintiff was born in June 1969 and has his GED. In the years preceding the onset of his alleged disability, plaintiff worked as an assistant store manager at a pharmacy, as an operations manager at a retail store, and in construction through self-employment. He reported that he had stopped working due to his conditions on June 10, 2014. Plaintiff reported that due to back and knee pain, he was limited in standing, walking, running, lifting, and bending. Plaintiff stated in a function report that during the day he mostly would lie down or sit with his leg elevated and compresses on his lower back and knee. He further said that sharp shooting pains in his knee and back affected his sleep.
Notwithstanding these conditions, plaintiff stated that he was able to take care of his personal needs without assistance, although his condition affected his ability to bend and stand for long periods. Plaintiff said that he made simple meals on a daily basis, but that he could not stand to make full course meals because of the pain and pressure he felt. He stated that he could do household chores like light dusting. Plaintiff reported being able to drive and shop monthly in stores for one hour. Plaintiff said he socialized with others regularly. He noted that his hobby was watching television. Plaintiff stated that he could walk one and one-half blocks before having to rest for ten minutes. He said he used crutches, a cane, and a brace/splint "all the time."
Plaintiff visited Paul Leva, M.D., an internist, for a routine medical examination during which he reported that his left knee had started locking, that he was unable to bend, and that he had back pain. An MRI showed a mild sprain and/or mucoid degeneration of the anterior cruciate ligament ("ACL"); suspicion of a low grade oblique tear; minimal hypertrophic lipping without significant cartilage thinning; and no significant joint effusion. X-rays of the lumbar spine taken that day showed lumbar straightening with mild degenerative changes at the L3 vertebrae. Dr. Leva referred plaintiff for physical therapy.
Plaintiff later reported to Dr. Leva that physical therapy had not improved his back or knee pain. After a second examination, Dr. Leva administered a trigger point lidocaine injection to the lumbar spine and prescribed Voltaren gel and physical therapy for his back and knee. Dr. Leva also recommended no heavy lifting, exercises, weight loss, and a limitation on prolonged sitting and standing. During a subsequent visit, plaintiff reported continued pain and a limp, and Dr. Leva prescribed Tizandine and Lidocaine ointment, as needed, as well as possible laser therapy of the back.
Shortly thereafter, Sandra Iannotti, M.D., an orthopedic surgeon, evaluated plaintiff and found no acute distress, a non-antalgic gait, full range of motion, and pain with squatting. Dr. Iannotti diagnosed a medial meniscal tear and recommended a left knee arthroscopy and partial medial meniscectomy. Dr. Iannotti performed the surgery, after which plaintiff reported that he was not doing well. On examination, Dr. Iannotti found that plaintiff had a minimally antalgic gait and a good range of motion with pain and recommended physical therapy. Physical therapist Anthony Corso assessed plaintiff and noted that he required skilled physical therapy to restore his prior level of functioning.
At a subsequent follow-up with Dr. Iannotti, plaintiff complained of pain after physical therapy, and Dr. Iannotti's examination of the left knee showed, among other things, excellent range of motion, full extension, and flexion to 135 degrees, and good stability. Dr. Iannotti recommended temporarily halting physical therapy, increased the dosage of Ibuprofen, and ordered a repeat MRI. After reviewing the MRI, Dr. Iannotti prescribed Ibuprofen three times per day and core strengthening for the back. Plaintiff returned to Dr. Leva, reporting lower back and left knee pain and difficulty walking and climbing stairs. Plaintiff returned to Dr. Iannotti, as well, and reported that he felt continued left knee pain, that he had stopped physical therapy, and that he was taking Ibuprofen. Dr. Iannotti urged him to return to physical therapy. Plaintiff later saw Dr. Leva to have a disability form completed, during which he repeated his earlier complaints. Dr. Leva, although diagnosing back and limb pain, opined that plaintiff could walk, stand, sit, push, pull, and bend for one to two hours each, lift five pounds, and not use public transportation.
Plaintiff returned to Dr. Iannotti, who recommended a repeat knee arthroscopy and partial lateral meniscectomy after examining him. She performed the second knee surgery, after which plaintiff reported "tremendous" anterior knee pain and difficulty straightening, bending, and walking. Dr. Iannotti prescribed Vicodin, advised that he use ice and heat, and recommended physical therapy. Sometime after, plaintiff reported slowly getting better, using crutches and a cane intermittently, and taking Vicodin occasionally. He had not yet started physical therapy, and Dr. Iannotti urged him to do stretching exercises. About a month later, plaintiff reported to Dr. Iannotti that he had sharp and throbbing pain in his left knee when walking, standing, and bending. On examination, Dr. Iannotti stated that she did not think that the meniscus had anything to do with plaintiff's pain, as it looked "beautiful" arthroscopically and all his pain was not typical meniscal. She stated that the MRI was equivocal as to the cause of his pain and that it seemed to be chronic regional pain syndrome ("CRPS"). Dr. Iannotti recommended that plaintiff be examined by a CRPS specialist or a neurologist.
Around the same time, Dr. Leva completed a disability questionnaire, opining that plaintiff could sit, stand, and walk for less than one hour each per day. He further opined that plaintiff had to move from a seated position every few hours for a few minutes' duration and that he did not need to elevate his legs while sitting. Dr. Leva also opined that plaintiff could not lift or carry any weight, but that he had no significant limitations in using his arms, hands, or fingers for reaching, handling, or manipulating. Dr. Leva did say that plaintiff's pain symptoms would increase if he had to sit for long periods of time and that he would likely be absent from work more than three times a month.
Dr. Iannotti also completed a disability questionnaire, opining that plaintiff could stand, sit, and push/pull/bend for one-to-two hours each per day, but that he could not walk. She opined that he could lift ten pounds occasionally.
Charles Bleifeld, M.D., an orthopedist in Dr. Iannotti's practice, provided a second opinion about plaintiff's left knee. On examination, Dr. Bleifeld found that plaintiff walked with a flexed knee gait, but was able to bear full weight without difficulty. He opined that plaintiff was having a problem managing his pain and noted that plaintiff had not been going to physical therapy because he felt it made the pain worse. Among other things, Dr. Bleifeld recommended formal physical therapy as necessary to get rid of his flexion contracture.
Matthew Tavroff, D.P.M., a podiatrist, also evaluated plaintiff around this time in connection with plaintiff's complaints of right heel pain. Plaintiff reported having a calcaneal fracture in 2008, but more recently experiencing pain for the preceding six months. Dr. Tavroff diagnosed foot pain and edema and advised soaking the right foot in Epsom salts. Plaintiff returned to Dr. Tavroff complaining of right heel pain, and Dr. Tavroff's examination revealed the same diagnoses. In a subsequent visit, Dr. Tavroff administered a lidocaine injection, which plaintiff stated had helped for two days.
Plaintiff thereafter returned to Dr. Iannotti, again complaining of pain in the left anterior knee. Plaintiff reported trying to go back to work for two weeks using a Dynasplint, which he said he could tolerate for about a day. He was using a cane to walk and reported only using Ibuprofen because of withdrawal symptoms related to the other pain medications, including Vicodin and Percocet. Dr. Iannotti highly recommended, as did the Hospital for Special Surgeries, which plaintiff also visited, that plaintiff do formal physical therapy to improve his flexion contracture. Dr. Iannotti stated that, "he remains out of work, total disability, unable to stand or walk for significant periods of time."
Plaintiff subsequently followed-up with Dr. Tavroff for right heel and ankle pain, and Dr. Tavroff recommended wider shoes to accommodate an ankle brace, follow-up with the doctor who previously treated his foot in 2008, and physical therapy as advised by his orthopedist. Dr. Tavroff also provided an assessment for the Suffolk County Department of Social Services, where he opined that plaintiff could walk, stand, and sit for one-to-two hours each per day and that he could lift ten pounds occasionally. He also contraindicated standing, walking, and bending. Around the same time, Dr. Iannotti also completed an employability assessment, opining that plaintiff could walk and stand for one-to-two hours each, and sit for more than four hours (or no evidence of limitation). She also opined that he could push/pull/bend for more than four hours and that he was unlimited in using his hands.
Plaintiff began physical therapy, and a progress report from physical therapist Venise Mulé Glass noted that plaintiff had made "some progress" in the seven times she had seen him for his left knee. Ms. Glass rated his endurance as fair and stated that his function was limited due to severe pain and pressure; she advised him that he continue physical therapy. Ms. Glass also provided an assessment, opining that plaintiff could stand, walk, and push/pull/bend for twoto-four hours each, sit more than four hours (or no evidence of limitation), and lift 20 pounds occasionally and ten pounds frequently. She also stated that squatting and climbing were contraindicated. She opined that plaintiff was capable of working part-time.
The Suffolk County Department of Social Services exempted plaintiff from participating in temporary work activities due to orthopedic barriers.
During the proceedings before the ALJ, plaintiff testified regarding his impairments. Plaintiff testified that it was harder to stand than to sit, but that he could not stand for any length of time because it put pressure on his knee and foot. He further testified that he could not sit at all because of the pressure in his knee, feelings of pins and needles, and numbness. Plaintiff also testified regarding problems climbing stairs and bending. He stated that he did no housework, had no hobbies, and did not drive due to his knee impairment.
Further, Edna F. Clark testified as an independent vocational expert at the ALJ hearing. The ALJ provided Ms. Clark a hypothetical of an individual with the following profile: An individual limited to sedentary work with occasional climbing, bending, balancing, stooping, kneeling, crouching, and crawling, who required use of a cane and one-minute repositioning breaks after sitting for one-half hour. Ms. Clark stated that the individual could not perform work that was light and medium in exertion, which was plaintiff's previous work.
However, Ms. Clark stated that the individual could perform the following sedentary
The ALJ found that plaintiff's severe impairments, consisting of "status post-arthroscopic repair of the medial and lateral menisci, right ankle tendonitis (peroneus longus and peroneus brevis), right subtalar joint arthritis, [and] degenerative disc disease of the lumbar spine," do not meet or equal the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. The ALJ then found that plaintiff has the residual functional capacity to perform sedentary work, except that he must be permitted a one-minute repositioning break every half hour, that he can occasionally bend, balance, stoop, kneel, climb, and crawl, and that he must use a cane for walking.
In forming this opinion, the ALJ gave great weight to Dr. Iannotti's most recent assessment, considering her previous assessments as temporary, because she is a specialist in the relevant field and plaintiff's treating orthopedic surgeon and because her assessment was consistent with the most recent MRI, Dr. Bleifeld's findings, and the current conservative course of treatment. The ALJ gave Ms. Glass's opinion good weight because she had seen the plaintiff seven times, and her opinion was consistent with his documented improvement. The ALJ gave Dr. Leva's opinion little weight because, even though Dr. Leva was plaintiff's treating physician, he is not a specialist like Dr. Iannotti. He also gave it less weight because Dr. Leva's opinion and review of the MRI was inconsistent with his examination findings. The ALJ also gave Dr. Tavroff's opinion limited weight because he provided no objective basis for his restrictions on sitting.
In reviewing a final decision by the Commissioner under 42 U.S.C. § 405, the Court does not determine de novo whether a plaintiff is disabled. See 42 U.S.C. §§ 405(g), 1383(c)(3);
If supported by substantial evidence, the Commissioner's factual determinations are conclusive, and the Court is not permitted to substitute its analysis of the evidence.
To be found disabled, a claimant must furnish medical and other evidence to establish the existence of his disability.
The Commissioner uses a five-step analysis in determining whether a claimant is disabled. See 20 C.F.R. § 404.1520. First, the Commissioner determines if the claimant is working; if he is engaging in substantial gainful activity, the claim will be denied without consideration of the medical evidence.
If the claimant's severe impairments are not per se disabling, the fourth inquiry requires the Commissioner to determine the claimant's residual functional capacity ("RFC"), which is the most he can do despite his impairment.
Plaintiff argues that the ALJ failed to properly weigh the medical opinion evidence, thereby failing to properly determine plaintiff's RFC at step four. As background, at step one, the ALJ found that plaintiff was not working. The ALJ found at step two that plaintiff had the following severe impairments: status post-arthroscopic repair of the medial and lateral menisci, right ankle tendonitis, right subtalar joint arthritis, and degenerative disc disease of the lumbar spine. Next, at step three, the ALJ found that plaintiff did not have an impairment or combination of impairments that met or equaled the severity of one of the impairments in the listings set forth at 20 C.F.R. Part 404, Subpart P, Appendix 1. Then, on step four, the ALJ considered all of the evidence before him and concluded that plaintiff retained the RFC to perform sedentary work as defined in 20 CFR 404.1567(a), except that he required a one-minute repositioning break every half hour. He also determined that plaintiff could occasionally bend, balance, stoop, kneel, climb, and crawl, and that he needed a cane for walking. The ALJ further determined that plaintiff could not perform his past relevant work as a retail manager, assistant store manager, or operations manager. Finally turning to step five, the ALJ, considering the testimony of the vocational expert, found that sedentary jobs matching plaintiff's RFC were available to plaintiff in the national economy, including surveillance system monitor, final assembler, and bench assembly worker. In so finding, the ALJ determined that plaintiff was not disabled.
I find that the ALJ's analysis was supported by the medical evidence before him and utilized the correct legal analysis. The "RFC is an administrative assessment of the extent to which an individual's medically determinable impairments(s), including any related symptoms, such as pain, may cause physical or mental limitations or restrictions that may affect his or her capacity to do work-related physical and mental activities." SSR 96-8P, 1996 WL 374184, *2. The assessment takes into consideration the limiting effects of all of a plaintiff's impairments, severe and non-severe, and the determination sets forth the most a plaintiff can do.
A claimant's RFC is assessed based on all relevant evidence of record and takes into consideration the limiting effects of all impairments.
Plaintiff unpersuasively argues that the ALJ substituted his own interpretation of the medical evidence for that of certain of his physicians. However, the ALJ did not substitute his interpretation; rather, the ALJ confronted several inconsistencies among the medical records and resolved them considering the record as a whole. It is well within the ALJ's discretion and authority to weigh the available medical opinions and resolve any conflicts to determine a claimant's RFC.
Here, the ALJ evaluated every medical opinion in the record, as he was required to do.
The ALJ here acted reasonably in assigning great weight to the most recent opinion of Dr. Iannotti, plaintiff's orthopedic surgeon. Dr. Iannotti opined that in an eight-hour workday, plaintiff could sit for more than four hours (or, no evidence of limitation), push/pull/bend for more than four hours, walk and stand for one-to-two hours, and lift ten pounds occasionally. She further opined that he could not stand or walk for long periods of time, nor could he climb, but that he had no limitation in using his hands. The ALJ assigned this great weight given its consistency with other evidence in the record and given Dr. Iannotti's specialization in the relevant field and the fact that she was his treating surgeon. Dr. Iannotti's opinion supported the ALJ's finding of an RFC limited to sedentary work with additional limitations on climbing and the need to use a cane.
The ALJ also assigned good weight to the opinion of Ms. Glass, plaintiff's most recent physical therapist, who opined that, after seeing plaintiff on seven occasions, plaintiff could stand, walk, and push/pull/bend for two-to-four hours each, sit more than four hours (or no evidence of limitation), and lift 20 pounds occasionally and ten pounds frequently. She also stated that squatting and climbing were contraindicated. Ms. Glass's opinion, though not one of a treating physician, is the opinion of an individual who saw plaintiff seven times and saw him improve, and whose opinion is consistent with his treating orthopedic surgeon Dr. Iannotti and an RFC of sedentary work with additional limits on climbing and squatting. I similarly find that the opinion of Ms. Glass supported the ALJ's factual finding.
Plaintiff argues that the ALJ's determination is improper because Dr. Iannotti's and Ms. Glass's indication that he could sit for "more than 4 hours" in an eight-hour day does not lend itself to finding that plaintiff can hold a sedentary job. However, a review of their assessments shows that "more than 4 hours" corresponds to the column indicating "no evidence of limitation." All of the other options that either could circle were those indicating sitting for fewer hours than four and representing some level of limitation. Moreover, neither Ms. Glass nor Dr. Iannotti included additional written comments regarding limitations for sitting.
And contrary to plaintiffs' argument, this absence of additional comments did not mean that the ALJ was required to contact these sources to inquire affirmatively about any sitting limitations.
Plaintiff also argues that the ALJ erred in assigning limited weight to the opinion of Dr. Leva, his treating physician; however, I find that the ALJ acted properly in declining to give controlling weight to the opinion of Dr. Leva, who opined that plaintiff was limited to sitting and walking less than one hour each in a workday. The ALJ is required to give a treating physician's opinion controlling weight, but only if it is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record."
The regulations list factors the ALJ should consider when evaluating the appropriate weight to assign to medical opinions, including a treating source's opinion that is not assigned controlling weight.
Here, the ALJ explained why he was not giving Dr. Leva controlling weight. First, Dr. Leva's opinion was inconsistent with the opinion evidence of Dr. Iannotti and Ms. Glass.
Further, the ALJ noted that Dr. Leva is not a specialist, and Dr. Iannotti, the specialized orthopedic surgeon, was the better source for an assessment of the knee impairment.
Additionally, it appears that the ALJ attributed little weight to Dr. Leva's opinion because the opinion was internally inconsistent with Dr. Leva's own examination notes, which indicated "a full range of motion in the lumbar, negative straight leg raising, and normal motor strength and sensation in the lower extremities." I also note that Dr. Leva's opinion pre-dates Dr. Iannotti's and Ms. Glass's opinions by six and seven months, respectively, which is to say, even if Dr. Leva's were not even internally inconsistent, Dr. Leva's opinions do not account for the improvement that plaintiff experienced when he began physical therapy as he had been recommended to do on several occasions.
Finally, I find that the ALJ properly considered the opinion of Dr. Tavroff, plaintiff's treating podiatrist, when he accorded little weight to his opinion. Dr. Tavroff opined that plaintiff could sit for only one to two hours per day, but he failed to provide any objective basis for this opinion, as the ALJ noted. The ALJ even pointed out Dr. Tavroff contraindicated only standing, walking, and bending in his notes, and therefore, the ALJ acted consistently with the other evidence of record in according Dr. Tavroff's opinion little weight.
Plaintiff's argument that the ALJ applied an incorrect legal standard in assessing his testimony is also unpersuasive. An ALJ assesses a plaintiff's subjective symptoms using a twostep process.
Here, the ALJ first determined that the objective medical evidence and plaintiff's function report did not corroborate plaintiff's subjective claims of disabling pain.
Moreover, an ALJ may find a claimant's statements less credible "if the level or frequency of treatment is inconsistent with the level of complaints, or if the medical reports or records show that the individual is not following the treatment as prescribed and there are no good reasons for this failure." SSR 96-7P, 1996 WL 374186, at *7. First, while plaintiff complained of severe pain, the medical records indicate that plaintiff limited his pain management to Ibuprofen. Yet, to qualify as a disability, pain must be so severe as to preclude any substantial gainful activity.
In sum, the ALJ's decision to limit his reliance on plaintiff's testimony because of issues of credibility is supported by the face of the function report and the evidence of record as a whole. That plaintiff would have weighed the evidence differently ignores the review standard, which guides courts to affirm an ALJ's determination where substantial evidence supports the ALJ's determination, even where other evidence may support the plaintiff.
Plaintiff's motion for judgment on the pleadings is denied, and the Commissioner's cross-motion for judgment on the pleadings is granted. The Clerk is directed to enter judgment accordingly.