JOI ELIZABETH PEAKE, Magistrate Judge.
Plaintiff David Tickle ("Plaintiff") brought this action pursuant to Sections 205(g) and 1631(c)(3) of the Social Security Act (the "Act"), as amended (42 U.S.C. §§ 405(g) and 1383(c)(3)), to obtain judicial review of a final decision of the Commissioner of Social Security denying his claims for Disability Insurance Benefits and Supplemental Security Income under, respectively, Titles II and XVI of the Act. The parties have filed cross-motions for judgment, and the administrative record has been certified to the Court for review.
Plaintiff protectively filed his applications for Disability Insurance Benefits and Supplemental Security Income Benefits on March 8, 2013, alleging a disability onset date of January 1, 2008. (Tr. at 13, 240-52.)
Following the hearings, the ALJ concluded that Plaintiff was disabled within the meaning of the Act from December 1, 2012 through December 31, 2014. (Tr. at 17.) He further found that, beginning January 1, 2015, medical improvement occurred such that Plaintiff no longer met the requirements of the Act. (Tr. at 21.) On January 16, 2016, the Appeals Council denied Plaintiff's request for review of the decision, thereby making the ALJ's conclusion the Commissioner's final decision for purposes of judicial review. (Tr. at 1-5.)
Federal law "authorizes judicial review of the Social Security Commissioner's denial of social security benefits."
"Substantial evidence means `such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'"
"In reviewing for substantial evidence, the court should not undertake to re-weigh conflicting evidence, make credibility determinations, or substitute its judgment for that of the [ALJ]."
In undertaking this limited review, the Court notes that in administrative proceedings, "[a] claimant for disability benefits bears the burden of proving a disability."
"The Commissioner uses a five-step process to evaluate disability claims."
A finding adverse to the claimant at any of several points in this five-step sequence forecloses a disability designation and ends the inquiry. For example, "[t]he first step determines whether the claimant is engaged in `substantial gainful activity.' If the claimant is working, benefits are denied. The second step determines if the claimant is `severely' disabled. If not, benefits are denied."
On the other hand, if a claimant carries his or her burden at each of the first two steps, and establishes at step three that the impairment "equals or exceeds in severity one or more of the impairments listed in Appendix I of the regulations," then "the claimant is disabled."
When determining whether a claimant who has previously been found to be disabled continues to be disabled, the ALJ uses an eight-step sequential evaluation process. This eight-step process provides that: (1) if the claimant is engaging in substantial gainful activity, disability ends; (2) if the claimant has an impairment or combination of impairments that meets or medically equals a listing, disability continues; (3) if the claimant does not meet or equal a listing, the ALJ will determine whether "medical improvement" has occurred;
In the present case, the ALJ found that Plaintiff had not engaged in "substantial gainful activity" since his alleged onset date. Plaintiff therefore met his burden at step one of the sequential evaluation process. At step two, the ALJ further determined that, from December 1, 2012 to December 31, 2014, Plaintiff suffered from the following severe impairments:
(Tr. at 17.) The ALJ found at step three that Plaintiff's left knee and right ankle impairments met the requirements of 20 C.F.R., Part 404, Subpt. P, Appx. 1, §§ 1.02(A) (hereinafter "Listing 1.02(A)") between December 1, 2012 and December 31, 2014. (Tr. at 18-20.) Therefore, Plaintiff was under a disability, as defined by the Act, during that period. (Tr. at 21.)
The ALJ further determined that, beginning January 1, 2015, Plaintiff's disability ended, in light of his improvement following his knee replacement surgery. (Tr. at 21-22.) The ALJ therefore followed the eight-step sequential evaluation process outlined above, and found that as of January 1, 2015, Plaintiff had not developed any new impairments, so his impairments remained the same. (Tr. at 16-17, 21.) The ALJ then found that as of January 1, 2015, Plaintiff's impairments did not meet or equal a Listing. (Tr. at 21.) The ALJ further found that medical improvement had occurred as of January 1, 2015, and that the improvement related to Plaintiff's ability to work.
(Tr. at 22.) The ALJ found that all of Plaintiff's past relevant work exceeded his RFC (Tr. at 24), but determined that, given Plaintiff's age, education, work experience, and RFC, along with the vocational expert's testimony as to these factors, Plaintiff could perform other jobs available in the national economy beginning January 1, 2015. (Tr. at 25-26.) Therefore, the ALJ concluded that Plaintiff was no longer disabled under the Act as of that date. (Tr. at 26.)
In the present appeal, Plaintiff contends that "[t]he ALJ inadequately explained his finding that Plaintiff was no longer disabled as of January 1, 2015 due to medical improvement and this finding is not supported by the evidence." (Pl.'s Br. [Doc #12] at 4.) In addition, Plaintiff contends that the Appeals Council erred by failing to remand the case to the ALJ in light of a new medical opinion from Plaintiff's treating orthopedic surgeon. (
In finding that Plaintiff was entitled to a closed period of disability, the ALJ in the present case determined that from December 1, 2012 to December 31, 2014, Plaintiff met Listing 1.02(A), which deals with the lower extremities and requires "[i]nvolvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively, as defined in 1.00B2b." 20 C.F.R., Part 404, Subpt. P, Appx. 1, § 1.02(A); (Tr. at 18-20). "Inability to ambulate effectively means an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual's ability to independently initiate, sustain, or complete activities. Ineffective ambulation is defined generally as having insufficient lower extremity functioning (see 1.00J) to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities." 20 C.F.R., Part 404, Subpt. P, Appx. 1, § 1.00(B)(2)(b)(1).
At Plaintiff's supplemental hearing, the impartial orthopedic medical expert, Dr. Schosheim, testified that, "due to the claimant's severe arthritic condition of his left knee and arthritis of his right ankle and his limitations in his right upper extremity, the claimant equaled Listings 1.02(A)(B) [sic] from December 1, 2012, until January 1, 2015." (Tr. at 19, 42-43, 45.) At step three of the sequential analysis, the ALJ adopted Dr. Schosheim's opinion, concluding that Plaintiff met Listing 1.02(A). (Tr. at 18-20.) Dr. Schosheim went on to testify that, beginning in December 2014, approximately six months after Plaintiff's total left knee replacement, Plaintiff "had gone from a walker to a cane, [his] range of motion had improved, and that at that point [Plaintiff] was having much less discomfort in his knee." (Tr. at 43, 19.) Based on his review of medical records to this effect, Dr. Schosheim opined that from January 2015 forward, Plaintiff "no longer equaled a listing." (Tr. at 43, 19, 21.) Again, the ALJ adopted Dr. Schosheim's opinion in concluding that medical improvement occurred as of January 1, 2015, in that Plaintiff "no longer ha[d] an impairment or combination of impairments that me[t] or medically equal[ed] the severity" of a listed impairment. (Tr. at 21, 19.) In making this finding that ALJ explained that,
(Tr. at 21.) Citing Plaintiff's treatment notes from December 2014, the ALJ further noted that Plaintiff "had responded well regarding his left knee, was walking with a non-antalgic gait, and his range of motion improved . . . [He] went from a walker to a cane and was getting off the cane." (Tr. at 19, 552-53.)
Plaintiff contends that the ALJ's determination is not supported by substantial evidence. Plaintiff contends that he "did not experience significant pain relief," and that his ongoing pain is reflected in his testimony and in the treatment notes from his May 2015 examination. (Pl.'s Br. at 5.) However, the ALJ considered Plaintiff's testimony and the treatment records at length. (Tr. at 19, 22.) The ALJ noted that:
(Tr. at 22, 552-53.) The ALJ further considered the May 2015 notes by Plaintiff's treating orthopedist, Dr. Del Gaizo, noting that:
(Tr. at 22, 562-63). Thus, the ALJ considered the medical evidence at length, including the evidence from May 2015, and concluded that Plaintiff no longer met Listing 1.02A. This conclusion was sufficiently explained to permit judicial review, and was supported by substantial evidence, including the medical evidence and the opinion of the medical expert.
Plaintiff also contends that the ALJ failed to consider the evidence of his worsening pain in his right knee. However, the ALJ considered the evidence regarding Plaintiff's right knee, and noted that:
(Tr. at 17-18.) The May 2015 imaging records were characterized by Dr. Del Gaizo as reflecting "moderate degenerative joint disease with mild varus deformity but not bone on bone articulation." (Tr. at 563.) At the May 2015 appointment, Dr. Del Gaizo assessed Plaintiff as having "moderate right knee arthritis." (Tr. at 563.) Dr. Del Gaizo administered a steroid injection in Plaintiff's right knee, and Plaintiff "felt near immediate pain relief." (Tr. at 563.) Dr. Del Gaizo advised Plaintiff to follow-up with him in two years. (Tr. at 563.) In addition, although the ALJ found that Plaintiff's right knee was not a severe impairment at step two of the sequential evaluation, the ALJ still considered the evidence regarding Plaintiff's right knee in formulating the RFC. The ALJ considered Plaintiff's right knee at length at both hearings, and conveyed the imaging results from May 2015 to the medical expert at the supplemental hearing, for consideration as part of the RFC evaluation. (Tr. at 46-50, 58-59, 87-89, 92-93.) The ALJ also noted Plaintiff's testimony regarding his right knee as part of the RFC determination (Tr. at 22), and in setting the RFC the ALJ relied upon the opinion of the medical expert after they had discussed Plaintiff's right knee issues at the hearing and after the medical expert had reviewed the May 2015 treatment records. Thus, the ALJ did not fail to consider the evidence in the record regarding Plaintiff's right knee.
Plaintiff also contends that the ALJ failed to evaluate the effect of Plaintiff's pain on his ability to function and failed to incorporate Plaintiff's pain into the RFC. However, the ALJ specifically discussed and accounted for Plaintiff's pain. (Tr. at 23-24.) In discussing the testimony of the vocational expert, the ALJ made reference to the vocational expert's testimony that for a person to engage in unskilled competitive work, the person would need to perform at least at 85% productivity during an eight-hour workday. (Tr. at 25, 65-66.) The ALJ concluded that it would be too speculative to determine a specific percent of time that Plaintiff would be unproductive or off task due to pain, but that he would be within the limits provided by the vocational expert in light of the other limitations included in the RFC to reflect Plaintiff's limitations as a result of pain. (Tr. at 25.) Thus, the ALJ clearly evaluated Plaintiff's pain and the effect of that pain on his ability to function, and addressed those limitations in formulating the RFC and presenting hypotheticals to the vocational expert.
Plaintiff also contends that the ALJ failed to adequately explain his decision, and in particular failed to explain why his RFC determination did not include all of the limitations noted by Plaintiff's treating physician, Dr. Del Gaizo. Plaintiff notes that Dr. Del Gaizo opined that Plaintiff must periodically alternate between sitting and standing and also opined that Plaintiff could stand and/or walk less than 2 hours in an 8 hour work day. (Tr. 568-69.) However, the ALJ gave significant weight to Dr. Del Gaizo's opinion as Plaintiff's treating physician, and adopted most of Dr. Del Gaizo's recommended limitations. (Tr. at 22-23.) To the extent he did not completely adopt Dr. Del Gaizo's opinion, the ALJ specifically addressed Dr. Del Gaizo's opinion as follows:
(Tr. at 23.) Thus, the ALJ specifically addressed the conflict between Dr. Del Gaizo's opinion and the RFC, and declined to credit Dr. Del Gaizo's "check box" answers to the extent that they did not provide sufficient explanation or rationale. The ALJ further found that the medical expert was also a specialist, that his opinions were consistent with the medical record, and that:
(Tr. at 23.)
Ultimately, the ALJ made a determination based on the evidence presented, and it is not the function of this Court to re-weigh the evidence or reconsider the ALJ's determinations if they are supported by substantial evidence. As noted above, "[w]here conflicting evidence allows reasonable minds to differ as to whether a claimant is disabled, the responsibility for that decision falls on the ALJ."
Plaintiff also contends that the Appeals Council erred by failing to remand the case based on a letter submitted as part of the Appeals Council review in this case. (Pl.'s Br. at 8.) After the ALJ's decision was issued on October 30, 2015, Plaintiff returned to see Dr. Del Gaizo on December 9, 2015. Following that appointment, Dr. Del Gaizo provided a letter, which states:
(Tr. at 577.)
The Appeals Council considered the letter but concluded that it did not provide a basis for changing the ALJ's decision in this case. (Tr. at 1-5.) Plaintiff contends that the letter shows that Plaintiff continued to suffer from right knee pain and that his arthritis in his right knee was progressively worsening, and had worsened to the point that Plaintiff met Listing 1.02A for his right knee.
In cases where the Appeals Council has considered evidence submitted by the claimant but denied review, on appeal the Court must "`review the record as a whole' including any new evidence that the Appeals Council `specifically incorporated . . . into the administrative record.'"
In this case, as discussed above, the ALJ considered and addressed the evidence regarding Plaintiff's right knee pain. Even with Dr. Del Gaizo's December 2015 letter included, the ALJ's determination is still supported by substantial evidence, considering the record as a whole. In reaching this conclusion, the Court notes first that Dr. Del Gaizo's cursory statement that Plaintiff's right knee meets the criteria for Listing 1.02A does not provide any substantive basis or analysis that undermines the ALJ's determination in this case, and the letter is not much more than a conclusory assertion on an issue reserved to the Commissioner. Even more importantly, Dr. Del Gaizo's letter does not compete with the evidence underlying the ALJ's decision because Dr. Del Gaizo's letter reflects only that Plaintiff "meets" the criteria as of December 2015, while the ALJ's decision considers the period only through the date of that decision, October 30, 2015. Notably, the fact that Plaintiff's right knee continued to worsen is not unexpected and does not conflict with the ALJ's determination as of October 30, 2015. Indeed, it is entirely possible that Plaintiff's right knee worsened more quickly than anticipated and that medical records from December 2015 would reflect that by December, Plaintiff met Listing 1.02A for his right knee. Plaintiff remains free to submit a new claim with respect to his right knee based on alleged worsening of his condition that may be reflected in those later records. However, that is a separate determination not before this Court, and the Court concludes that Dr. Del Gaizo's December 2015 statement does not require remand, where the letter does not conflict with or compete with the evidence underlying the ALJ's decision, and where the letter does not render the ALJ's decision of October 30, 2015 unsupported by substantial evidence.
IT IS THEREFORE RECOMMENDED that the Commissioner's decision finding no disability be AFFIRMED, that Plaintiff's Motion to Reverse the Decision of the Commissioner [Doc. #11] be DENIED, that Defendant's Motion for Judgment on the Pleadings [Doc. #14] be GRANTED, and that this action be DISMISSED with prejudice.