JOHN D. EARLY, Magistrate Judge.
Plaintiff Isidro G. ("Plaintiff") filed a Complaint on May 21, 2018 seeking review of the Commissioner's denial of his application for disability insurance benefits ("DIB"). On March 4, 2019, the parties filed a Joint Submission ("Jt. Stip.") regarding the issues in dispute. The matter now is ready for decision.
Plaintiff filed an application for DIB on July 7, 2014, alleging disability commencing on October 4, 2013. Administrative Record ("AR") 163-66. After his application was denied initially (AR 79-81), Plaintiff requested an administrative hearing (AR 82), which was held on December 22, 2014. AR 37-65. Plaintiff, represented by an attorney, appeared and testified before an Administrative Law Judge ("ALJ").
On February 8, 2017, the ALJ issued a written decision finding Plaintiff was not disabled. AR 15-32. The ALJ found Plaintiff had not engaged in substantial gainful employment since October 4, 2013 and suffered from the severe impairments of: cervical disc disorder with herniation; spinal stenosis and myelopathy; status post decompression and fusion; neuropathy; lumbar disc disorder with bulges and protrusions; lumbosacral sciatic syndrome; bilateral shoulder impingement and sprains; diffuse arthralgia; right knee sprain; bilateral ankle sprains; and obesity. AR 23. The ALJ found Plaintiff did not have an impairment or combination of impairments that met or medically equaled a listed impairment. AR 26. The ALJ also found Plaintiff had the residual functional capacity ("RFC") to perform the demands of light work as defined in 20 C.F.R. § 404.1567(b) with the following limitations (AR 26):
The ALJ found Plaintiff was unable to perform any past relevant work, but, considering his age, education, work experience, and RFC, the ALJ found other jobs existed in significant numbers in the national economy that Plaintiff could perform. AR 30-31. Accordingly, the ALJ concluded Plaintiff was not under a "disability," as defined in the Social Security Act, from October 4, 2013 through the date of the ALJ's decision. AR 32.
On March 27, 2018, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the Commissioner's final decision. AR 1-8. This action followed.
Under 42 U.S.C. § 405(g), a district court may review the Commissioner's decision to deny benefits. The ALJ's findings and decision should be upheld if they are free from legal error and supported by substantial evidence based on the record as a whole.
Lastly, even if an ALJ errs, the decision will be affirmed where such error is harmless (
When the claimant's case has proceeded to consideration by an ALJ, the ALJ conducts a five-step sequential evaluation to determine at each step if the claimant is or is not disabled.
First, the ALJ considers whether the claimant currently works at a job that meets the criteria for "substantial gainful activity."
After determining the claimant's RFC, the ALJ proceeds to the fourth step and determines whether the claimant has the RFC to perform his past relevant work, either as he "actually" performed it when he worked in the past, or as that same job is "generally" performed in the national economy.
The claimant generally bears the burden at each of steps one through four to show he is disabled, or he meets the requirements to proceed to the next step; and the claimant bears the ultimate burden to show he is disabled.
The parties present two disputed issues (Jt. Stip. at 4):
With respect to Issue No. 1, Plaintiff contends the ALJ failed to provide "specific and legitimate reasons" for rejecting limitations from Phillip J. Kanter, M.D. ("Dr. Kanter"), an examining physician.
In determining a claimant's RFC, an ALJ must consider all relevant evidence in the record, including medical records, lay evidence, and "the effects of symptoms, including pain, that are reasonably attributable to the medical condition."
"There are three types of medical opinions in social security cases: those from treating physicians, examining physicians, and non-examining physicians."
"[T]he ALJ may only reject a treating or examining physician's uncontradicted medical opinion based on clear and convincing reasons" supported by substantial evidence in the record.
In his Agreed Medical Evaluation report, Dr. Kanter provided work restrictions for Plaintiff's cervical spine, stating, "[Plaintiff] is precluded from prolonged posturing, repetitive flexion-extension, and heavy lifting, pushing, and pulling at the should level or above." AR 346. Dr. Kanter provided no work restrictions for Plaintiff's lumbosacral spine, right knee, right ankle/foot, and left ankle/foot. AR 346.
The ALJ provided "great weight" to the opinion of Dr. Kanter because his opinions were "consistent" with the medical evidence. AR 29. The ALJ found Dr. Kanter's opinions were "generally consistent" with consultative examiner Rocely Ella-Tamayo, M.D. The ALJ also gave Plaintiff "the benefit of the doubt" and provided postural, environmental, and upper extremity limitations beyond what was recommended by Dr. Ella-Tamayo given the combination of Plaintiff's severe impairments. AR 29. As noted, the ALJ found Plaintiff had the RFC to perform the demands of light work as defined in 20 CFR 404.1567(b) with the following additional physical limitations: "[Plaintiff] can occasionally climb ramps and stairs, but can never climb ladders, ropes or scaffolds. He can occasionally balance, stoop, kneel, crouch, and crawl. He is unable to use the bilateral upper extremities for above shoulder level work, including overhead reaching. He is unable to work around unprotected heights." AR 26.
Plaintiff contends Dr. Kanter "set forth greater functional restrictions than what the ALJ's RFC assessed" by precluding Plaintiff from "prolonged posturing of his cervical spine; repetitive flexion-extension; and pushing/pulling at or above shoulder level." Jt. Stip. at 5. Plaintiff argues Dr. Kanter's "greater functional restrictions" necessitate "neck-specific restrictions" in the RFC, but the ALJ did not provide any neck-specific restrictions in the RFC.
The Court finds Plaintiff has not shown the ALJ erred in his RFC assessment and has not convincingly shown that the RFC limitations do not already incorporate Dr. Kanter's "greater functional restrictions" regarding "prolonged posturing of [the] cervical spine, repetitive flexion-extension, and pushing/pulling at or above the shoulder level."
First, the ALJ specifically included a limitation incorporating Dr. Kanter's restriction of "heavy lifting, pushing, and pulling at the shoulder level or above" by including in the RFC that Plaintiff is "unable to use the bilateral upper extremities for above shoulder level work." AR 26.
Second, with respect to the other two limitations set forth by Dr. Kanter, "prolonged posturing of [the] cervical spine" and "repetitive flexion-extension," the RFC limits Plaintiff to "light work" with further restrictions on balancing, climbing, stooping, crawling, kneeling, crouching, lifting, standing, walking, sitting, and reaching overhead. AR 26. Plaintiff has not shown that these restrictions fail to account for limitations set forth by Dr. Kanter. Further, in finding the RFC's restrictions as they related to Plaintiff's cervical limitations "reasonable in light of the objective medical evidence," the ALJ cited to: (1) the positive results following Plaintiff's October 2013 surgery; (2) Plaintiff's limited, post-surgical conservative treatment relating to his neck area; and (3) Dr. Ella-Tamayo's assessment, which took place after the issuance of Dr. Kanter's opinion and found Plaintiff "would be capable of a light [RFC] and would not have any limitations in the neck or upper extremities." AR 27 (citing AR 312);
The RFC determination is an "administrative finding" specifically reserved for the Commissioner.
In Issue No. 2, Plaintiff argues the ALJ did not state clear and convincing reasons for rejecting Plaintiff's symptom testimony. Jt. Stip. at 18-22.
Where a disability claimant produces objective medical evidence of an underlying impairment that could reasonably be expected to produce the pain or other symptoms alleged, absent evidence of malingering, the ALJ must provide "specific, clear and convincing reasons for rejecting the claimant's testimony regarding the severity of the claimant's symptoms."
The ALJ's findings "must be sufficiently specific to allow a reviewing court to conclude that the [ALJ] rejected [the] claimant's testimony on permissible grounds and did not arbitrarily discredit the claimant's testimony."
However, if the ALJ's assessment of the claimant's testimony is reasonable and is supported by substantial evidence, it is not the Court's role to "second-guess" it.
During the 2016 hearing, Plaintiff testified he could not perform a job that required him to perform twenty pounds of lifting for about two and a half hours a day. AR 51-52. Plaintiff also stated it would be "very difficult" for him to perform at a job where he would have to stand and walk for more than four hours in a day, and he testified that he would was "not sure" if he could use his hands for handling or fingers for fingering for about five hours a day at a job because it would "give [him] problems." AR 52. In a psychiatric report from September 30, 2014, Plaintiff reported he could care for his personal hygiene, cook, shop, and carry out other housekeeping chores. AR 296-97.
The ALJ found Plaintiff's medically determinable impairments could reasonably be expected to cause the alleged symptoms, but his statements "concerning the intensity, persistence[,] and limiting effects of these symptoms [were] not entirely consistent with the medical evidence and other evidence," (AR 27) because Plaintiff's subjective symptom testimony was inconsistent with: (1) the objective evidence; (2) his conservative treatment; and (3) his activities of daily living. AR 29-30. As explained below, the ALJ provided legally sufficient reasons for discounting Plaintiff's subjective symptom testimony.
First, the ALJ discounted Plaintiff's symptom testimony because it was not supported by objective medical evidence. AR 28-31. "Although lack of medical evidence cannot form the sole basis for discounting pain testimony, it is a factor that the ALJ can consider in his credibility analysis."
Second, the ALJ discounted Plaintiff's symptom testimony because he had only received conservative treatment post-surgery. AR 27-30. Treatment, especially when conservative, is a legitimate consideration in a credibility finding.
The ALJ noted Plaintiff's medical records documented "conservative treatment for his conditions after his cervical fusion." AR 28. Plaintiff's record documents he managed his allegedly disabling pain with only "mild" pain medication, post-surgery. AR 27. Plaintiff alleged disability beginning on October 4, 2013 and underwent a cervical spine discectomy and fusion surgery five days later. AR 21, 240. In June of 2014, Plaintiff was only taking muscle relaxers and ibuprofen "as needed" to address his cervical spine, and his doctors' recommendations throughout the relevant period were only for bone growth stimulation, home exercise, and physical therapy. AR 27-28, 347-48, 369, 371-72. Thus, the ALJ's finding regarding post-surgery conservative treatment was a clear and convincing reason to discount Plaintiff's statements of a disabling impairment.
Third, the ALJ also discounted Plaintiff's subjective symptom testimony based on his reported daily activities, specifically, his ability to care for his personal hygiene, cook, shop, and carry out other housekeeping chores. AR 30. The Ninth Circuit has "repeatedly warned that ALJs must be especially cautious in concluding that daily activities are inconsistent with testimony about pain, because impairments that would unquestionably preclude work and all the pressures of a workplace environment will often be consistent with doing more than merely resting in bed all day."
Here, without reaching the issue, even if the ALJ erred in relying on Plaintiff's activities of daily living as a basis for discounting his symptom testimony, as long as there remains "substantial evidence supporting the ALJ's conclusions" and the error "does not negate the validity of the ALJ's ultimate [credibility] conclusion," the error is deemed harmless and does not warrant reversal.
The Court finds the ALJ provided sufficiently specific, clear, and convincing reasons for discounting Plaintiff's symptom testimony, specifically, the conflict with the objective medical evidence and Plaintiff's conservative treatment post-surgery. Those grounds, together, are sufficient to affirm the ALJ's findings with respect to Plaintiff's symptom testimony.
IT THEREFORE IS ORDERED that Judgment be entered affirming the decision of the Commissioner and dismissing this action with prejudice.