NANCY A. VECCHIARELLI, Magistrate Judge.
Plaintiff, John P. Holbrook, Sr. ("Plaintiff"), challenges the final decision of Defendant, Michael J. Astrue, Commissioner of Social Security ("the Commissioner"), denying Plaintiff's application for Supplemental Security Income ("SSI") under Title XVI of the Social Security Act,
On April 22, 2008, Plaintiff filed an application for SSI and alleged a disability onset date of May 3, 1996. (Tr. 40.) The application was denied initially and upon reconsideration, so Plaintiff requested a hearing before an administrative law judge ("ALJ"). (Tr. 40.) On January 6, 2010, an ALJ held Plaintiff's hearing. (Tr. 40.) Plaintiff appeared, was represented by counsel, and testified. (Tr. 40.) A vocational expert ("VE") also appeared and testified. (Tr. 40.)
On April 8, 2010, the ALJ found Plaintiff not disabled. (Tr. 49.) On April 13, 2011, the Appeals Council declined to review the ALJ's decision, so the ALJ's decision became the Commissioner's final decision. (Tr. 1.) On May 21, 2011, Plaintiff filed his complaint to challenge the Commissioner's final decision. (Doc. No. 1.)
On November 7, 2011, Plaintiff filed his Brief on the Merits. (Doc. No. 16.) On December 22, 2011, the Commissioner filed his Brief on the Merits. (Doc. No. 17.) Plaintiff did not file a Reply Brief.
Plaintiff asserts two assignments of error: (1) the ALJ improperly assessed the credibility of Plaintiff's subjective complaints of pain; and (2) the ALJ improperly assessed Plaintiff's orthopedic impairments in his step three determination of whether those impairments, either singly or in combination, met or medically equaled an impairment in
Plaintiff was 42 years old on the date he filed his application for SSI. (Tr. 46.) He has a limited education and is able to communicate in English. (Tr. 47.) He does not have past relevant work experience. (Tr. 47.)
Plaintiff's assignments of error relate to only his orthopedic impairments; accordingly, the following summary of the medical evidence will related to only Plaintiff's orthopedic impairments.
On September 19, 2001, an x-ray of Plaintiff's left knee revealed "moderate to marked degenerative changes." (Tr. 270.)
On August 7, 2002, Plaintiff was involved in a motor vehicle accident. (Tr. 258.) The emergency services personnel reported that Plaintiff complained of pain in his neck, back, and ankle. (Tr. 258.) He was diagnosed with a cervical sprain, lumbar sprain, and right ankle contusion; and he was provided with a crutch. (Tr. 253.)
On February 12, 2003, Plaintiff presented to Forum Health Trumbull Memorial Hospital because he allegedly "overdosed." (Tr. 261.) Dr. Edward C. Pierson, M.D., attended to Plaintiff and reported the following. (Tr. 261.) Plaintiff has a history of a fractured knee, as well as back and shoulder "difficulties." (Tr. 261.) Plaintiff reported that chronic pain in his knee, back, and shoulder interfered with his sleep and inhibited his appetite. (Tr. 261.)
On August 30, 2005, an x-ray of Plaintiff's left knee revealed significant degenerative changes involving the medial and, to a lesser extent, lateral tibiofemoral compartments, as well as the patellar femoral compartment. (Tr. 291.) The radiologist's impression was that Plaintiff had moderately severe spondylotic changes in his left knee. (Tr. 291.) An x-ray of Plaintiff's lumbar spine also taken that day was negative. (Tr. 292.)
On March 12, 2007, Plaintiff presented to Dr. Mary-Helene Massullo
Plaintiff injured his back 15 years prior when he was hit head-on by a tow motor and was thrown into a brick wall. (Tr. 338.) An x-ray of his back shortly thereafter revealed a dislocated vertebra and disc. (Tr. 338.) Subsequent bed rest and physical therapy had not helped him. (Tr. 338.) An x-ray four years later revealed a crushed disc. (Tr. 338.) He suffered pain at the L1 region of his back that radiated bilaterally down his lower extremities. (Tr. 338.)
Plaintiff attributed his neck pain to the same tow motor accident that allegedly caused his back pain. (Tr. 339.) He suffered discomfort in the C7 to T1 region of his neck and back and numbness in his hands. (Tr. 339.)
Plaintiff also dislocated his left knee 10 years prior during a football game. (Tr. 338.) Initially, he had his knee drained and placed in a brace. (Tr. 338.) He thereafter underwent arthroscopic surgery, whereupon his knee was cleaned and drained. (Tr. 338.) Two years later, he underwent another arthroscopic surgery, whereupon his bone marrow was drained and his knee was debrided. (Tr. 338.) The results of both surgeries were "bad." (Tr. 338-39.) A year later, he presented to a specialist and underwent another arthroscopic surgery whereupon his ACL was repaired. (See Tr. 339.) The results of the third surgery were "pretty good," although Plaintiff continued to suffer pain in his left knee. (Tr. 339.)
Dr. Massullo further indicated that Plaintiff reported having "a hard time keeping a job" because of his back and chronic headaches, but that he did not use an assistive ambulatory device. (Tr. 338.) Dr. Massullo noted that Plaintiff first stated he could walk for only one yard but thereafter stated that he could walk for 100 yards; and that he could ascend and descend stairs with the use of a railing. (Tr. 339.)
Upon physical examination, Dr. Massullo reported the following. Plaintiff exhibited an abnormal gait with a slight limp favoring the left lower extremity. (Tr. 342.) Range of motion testing, however, was unreliable because it was "very inconsistent," as Plaintiff's range "went from minimal to normal" and Plaintiff was able to move within in a range that he often claimed he could not move. (Tr. 341.) Plaintiff had chronic changes in his left knee, and his left knee deviated outward laterally as compared to the right knee. (Tr. 341, 342.) Plaintiff also had diminished sensation in his left lower extremity. (Tr. 342.) Dr. Massullo also indicated, pursuant to Plaintiff's subjective reports, that Plaintiff had chronic low back pain, chronic arthralgia in the left knee, and chronic cervical pain. (Tr. 342.)
An x-ray of Plaintiff's left knee revealed "severe medial joint space narrowing along with alignment offset/subluxation of the tibial and femoral cortex." (Tr. 347.) An x-ray of Plaintiff's lumbar spine revealed only "[m]ild scattered facet hypertrophy and disc space narrowing [at] multiple levels . . . greatest at L4-L5 and L5-S1"; and no fractures, dislocations, bony destruction, lysis or listhesis, compression sites or free bone fragments, or blastic or lytic processes. (Tr. 347.)
Dr. Massullo concluded that Plaintiff would be "compromised" in any occupation that would require prolonged walking or traveling using his lower extremities, and bending or squatting using his left lower extremity. (Tr. 342.)
On May 15, 2007, Plaintiff presented to the emergency department with a complaint of moderate to severe pain in his left knee. (Tr. 402.) An x-ray of Plaintiff's left knee revealed advanced tricompartmental osteoarthritis and small joint effusion. (Tr. 459.)
On May 22, 2007, state agency reviewing physician James Gahman, M.D., assessed Plaintiff's physical residual functional capacity ("RFC") as follows. (Tr. 372-79.) Plaintiff could lift and carry 20 pounds occasionally and 10 pounds frequently; and sit, stand, and walk for about 6 hours in an 8-hour workday with normal breaks. (Tr. 373.) His ability to push and pull were unlimited except to the extent that he was limited in his ability to lift and carry. (Tr. 373.) He could frequently climb ramps and stairs but never climb ladders, ropes or scaffolds; frequently balance and stoop; and occasionally kneel, crouch, and crawl. (Tr. 374.) He had no manipulative, visual, communicative, or environmental limitations. (Tr. 375-76.) Dr. Gahman found that Plaintiff's subjective statements of the extent to which he was limited were not fully credible because "the claimant gave inconsistent effort during [Dr. Massullo's] evaluation."
On May 23, 2007, an MRI of Plaintiff's left knee revealed "[e]xtremely advanced degenerative osteoarthritic changes" and "moderate knee joint effusion." (Tr. 458.)
On July 22, 2007, Plaintiff presented to the emergency department with a complaint of intermittent numbness and tingling in both of his hands that radiated up his arms. (Tr. 404-05.) Dr. M. Savino, D.O., attended to Plaintiff and indicated that Plaintiff reported he had fallen off his roof a week prior. (Tr. 404.) Dr. Savino reported the following. X-rays of Plaintiff's cervical spine and left hand were negative. (Tr. 404.) Upon physical examination, Plaintiff exhibited full range of motion and no tenderness in his neck or spine. (Tr. 404.) Dr. Savino diagnosed Plaintiff with peripheral neuropathy and discharged Plaintiff in an improved condition with instructions to follow up with "Dr. Malvasi" or return to the emergency department if his condition worsened. (Tr. 405.)
On August 30, 2007, Plaintiff presented to the emergency department with a complaint of pain in his hands, wrists, and elbows. (Tr. 406.) The attending physician was of the impression that Plaintiff suffered cervical radiculopathy. (Tr. 407.)
On September 4, 2007, Plaintiff presented to the emergency department with a complaint of headaches and paresthesias. (Tr. 408.) Dr. Alisa Roberts, D.O., attended to Plaintiff and diagnosed Plaintiff with cervical disc disease. (Tr. 409.)
On February 11, 2008, Plaintiff presented to the emergency department with a complaint of mild to moderate neck pain. (Tr. 410.) The attending physician was of the impression that Plaintiff suffered cervical disc disease per Plaintiff's history. (Tr. 411.)
On April 22, 2008, Plaintiff presented to the emergency department with a complaint of mild neck pain. (Tr. 412.) The attending physician was of the impression that Plaintiff suffered degenerative joint disease in the cervical spine. (Tr. 413.)
On May 12, 2008, Plaintiff returned to Dr. Massullo for another physical examination at the request of the Bureau of Disability Determination. (Tr. 419.) Dr. Massullo indicated that Plaintiff reported he was unable to walk, bend, or lift. (Tr. 419.)
Dr. Massullo reported the following upon physical examination. Plaintiff's gait was abnormal with a limp that favored the left lower extremity. (Tr. 422.) Plaintiff wore a knee brace, but he did not appear to need an assistive ambulatory device. (Tr. 422.) He was able to grasp and manipulate with both hands. (Tr. 422.) His joints did not present heat, redness, thickening, or swelling. (Tr. 422.) The range of motion in his left knee was restricted in full flexion, and he was unable to walk on his toes on the left side. (Tr. 422.) Further, there was atrophy in his lower left extremity. (Tr. 422.)
Dr. Massullo concluded that, in light of Plaintiff's limp, atrophy, and history of surgical intervention on the left knee, "[a]ny occupation that would require prolonged kneeling, standing, traveling, using [the] lower extremities, [and] walking may be slightly compromised." (Tr. 423.)
On July 9, 2008, state agency reviewing physician Ronald Cantor, M.D., assessed Plaintiff's physical RFC. (Tr. 449-56.) Dr. Cantor's findings were consistent with state agency reviewing physician Dr. Gahman's opinions dated May 22, 2007, except that he found Plaintiff could occasionally climb ramps, stairs, ladders, ropes, and scaffolds; balance; stoop; kneel; crouch; and crawl. (Tr. 451.)
On August 6, 2008, an MRI of Plaintiff's left knee revealed "[v]ery severe arthritic changes in all 3 compartments particularly medial." (Tr. 460.) Further, the "ACL graft [did] not appear intact"; there was "[a]bnormal bowing and signal within the posterior cruciate ligament; and there were "[i]ntra articular loose bodies associated with joint effusion and popliteal cyst." (Tr. 460.)
On September 29, 2008, Plaintiff presented to Dr. Michael A. Jones, D.O., for an evaluation of his left knee pain. (Tr. 510.) Dr. Jones reported that Plaintiff had ACL reconstruction surgery 18 years prior followed by several arthroscopic surgeries that provided Plaintiff with only temporary relief; Plaintiff had been taking Percocet and Valium for the past month for the pain in his knee; and Plaintiff wore an ACL deterioration brace but continued to suffer pain and instability in his knee. (Tr. 510.) Dr. Jones reported upon physical evaluation that Plaintiff had 5- to 10-degree flexion contracture; limited flexion to about 125 degrees; minor increased anterior translation to drawer testing; crepitation in the patellofemoral joint with range of motion; and no significant effusion. (Tr. 510.) Dr. Jones indicated that x-rays of Plaintiff's left knee revealed significant osteophyte formation and complete loss of medial cartilage height; erosion of the posteriomedial tibial plateau from arthritis; subchondral bone cysts; and about 15 degrees of varus alignment radiographically. (Tr. 510.) In short, Dr. Jones found that Plaintiff suffered end-stage degenerative joint disease in the left knee. (Tr. 510.) Dr. Jones reported that he explained at length the various treatment options for Plaintiff's knee, and that Plaintiff requested a total knee replacement because all conservative measures had failed. (Tr. 510.)
On November 5, 2008, Plaintiff underwent a total left knee replacement performed by Dr. Jones. (Tr. 542, 554.)
On November 13, 2008, Plaintiff presented to Dr. Neuendorf to follow up on the results of an MRI of his lumbar spine and an EMG of his lower extremities. (Tr. 516.) Dr. Neuendorf reported the following. Plaintiff presented with dressings on his left knee; walked with a limp; and used a crutch. (Tr. 516.) However, he complained that most of his pain was in his neck, and that the pain radiated down both arms into his hands. (Tr. 516.) Plaintiff also complained of pain in his lower left lumbar region and in both of his feet. (Tr. 516.) The EMG was negative for any radiculopathy. (Tr. 516.) The MRI revealed degenerative discs at L3-L4 with minimal bulging discs, and degenerative discs disease at L4-L5 with spur formation and a broad protruding disc. (Tr. 516; see also Tr. 579-80.) Upon physical examination, Plaintiff's neck and lumbar areas revealed spasms, tenderness, and decreased range of motion. (Tr. 516.) Dr. Neuendorf diagnosed Plaintiff with neuropathic pain syndrome; lumbar radiculopathy; cervical radiculopathy; degenerative disc disease at C6-C7; and a protruding disc with degenerative disc disease at L4-L5. (Tr. 516.)
Plaintiff testified at his hearing as follows. Plaintiff lives by himself, but on the same street as the rest of his family. (Tr. 22.) His family and friends help him take care of his house and go shopping for him. (Tr. 22.) He does not have a driver's license. (Tr. 22.) He is unable to lift his grandchildren, who are four and six years old. (Tr. 21.) His arms are weak; he has bone spurs in his neck; and he suffers muscle deterioration. (Tr. 21.) He cannot lift 20 pounds. (See Tr. 21.) His pain and worries interfere with his ability to sleep. (Tr. 24.) However, his medications do not cause him problems. (Tr. 21.)
The ALJ posed the following hypothetical to the VE:
(Tr. 29.) The VE testified that such a person could perform other work as a surveillance system monitor/alarm monitor (for which there were 350,000 jobs in the national economy), and assembler (for which there were 200,000 jobs in the national economy). (Tr. 30-31.)
Plaintiff counsel then asked whether such a person who additionally would be off task between 15 and 20 percent of the time because of pain and psychological symptoms could perform other work. (Tr. 31.) The VE responded that such a person would not be able to perform other work. (Tr. 31.)
A claimant is entitled to receive benefits under the Social Security Act when she establishes disability within the meaning of the Act.
The Commissioner reaches a determination as to whether a claimant is disabled by way of a five-stage process.
The ALJ made the following findings of fact and conclusions of law:
(Tr. 42-47.)
Judicial review of the Commissioner's decision is limited to determining whether the Commissioner's decision is supported by substantial evidence and was made pursuant to proper legal standards.
The Commissioner's conclusions must be affirmed absent a determination that the ALJ failed to apply the correct legal standards or made findings of fact unsupported by substantial evidence in the record.
Plaintiff contends that the ALJ's credibility assessment of his subjective complaints of pain "was made without using the appropriate legal standards for evaluating [his] pain." For the following reasons, this assignment of error is not well taken.
Pain alone, if caused by a medical impairment, may be severe enough to constitute a disability. See Kirk v. Sec'y of Health & Human Servs., 667 F.2d 524, 538
The Duncan Test does not require objective evidence of the alleged pain itself.
See
Here, the ALJ found that Plaintiff suffered medically determinable impairments that could cause Plaintiff's alleged pain—namely, Plaintiff's degenerative disc disease and degenerative joint disease. Further, a review of the ALJ's decision reveals that the ALJ discussed most, if not all, of the relevant factors in his assessment of Plaintiff's RFC. (See Tr. 44-45.) The ALJ recognized that Plaintiff complained he could not sustain lifting, bending, sitting, or walking because of chronic back and lower extremity pain with limited range of motion. (Tr. 44.) However, the ALJ found that evidence supported the conclusion that Plaintiff's subjective complaints of pain were not fully credible. Plaintiff's activities of daily living were pain-limited but nevertheless functional, as Plaintiff was independent in self-care and could prepare simple meals, shop, and perform light household chores. (Tr. 44-45.) Some of Plaintiff's statements in the record were inconsistent, and some test results upon physical examination were inconsistent and unreliable. (Tr. 45.) Although images of Plaintiff's lumbar and cervical spine showed degenerative changes, there was no evidence of a herniated disc. (Tr. 45.) Plaintiff underwent a total left knee replacement, but post-surgical imaging showed good alignment with no acute findings, and Plaintiff was given pain medication. (Tr. 45.) Plaintiff was neurologically intact and exhibited normal strength, sensation, and reflexes during one examination; and the examining physician opined that Plaintiff did not require an assistive ambulatory device. (Tr. 45.)
Plaintiff has provided absolutely no explanation of how the ALJ's assessment of his credibility was deficient. Instead, Plaintiff merely recites the legal principals as set forth in
Plaintiff contends that the ALJ erroneously assessed him under the Listings in four ways: (1) the ALJ's discussion of Plaintiff's back impairments was cursory; (2) the ALJ failed to discuss Plaintiff's knee impairment and consider whether it met or medically equaled
The ALJ stated that "[t]he claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in" the Listings. (Tr. 42.) The ALJ then discussed Plaintiff's physical impairments as follows:
(Tr. 42.) Plaintiff contends that "this summary . . . does not provide a sufficient analysis of [his] back impairment under the [L]istings." (Pl.'s Br. 11.) Plaintiff does not, however, cite case law in support of this contention, and the regulations "do[] not state that the ALJ must articulate, at length, the analysis of the medical equivalency issue."
Plaintiff also contends that the ALJ failed to address his left knee impairment and consider it under
Plaintiff further contends that the ALJ failed to consider his back and knee impairments in combination. But the ALJ considered Plaintiff's back impairment and "other musculoskeletal impairments"; found that Plaintiff's other musculoskeletal impairments "likewise" did not result in an inability to ambulate effectively as defined in the Listings; stated that Plaintiff's impairments, in combination, did not meet or medically equal an impairment in the Listings; and discussed the evidence of both Plaintiff's back and knee impairments in his RFC assessment. Accordingly, the Court is not persuaded that the ALJ failed to consider Plaintiff's back and knee impairments in combination. See
Finally, Plaintiff contends that substantial evidence supports the conclusion that he meets or medically equals
For the foregoing reasons, the Commissioner's final decision is AFFIRMED.
