KENDALL J. NEWMAN, Magistrate Judge.
Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying plaintiff's applications for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under Titles II and XVI, respectively, of the Social Security Act ("Act").
For the reasons that follow, the court denies plaintiff's motion for summary judgment, grants the Commissioner's cross-motion for summary judgment, and enters judgment for the Commissioner.
Plaintiff was born on September 8, 1958, has a twelfth grade education, and previously worked as a truck driver, warehouse worker, heavy construction worker, lawn care worker, and home health aid/caregiver.
In a decision dated August 17, 2010, the ALJ determined that plaintiff had not been under a disability, as defined in the Act, from April 24, 2009, through the date of that decision. (AT 10-18.) The ALJ's decision became the final decision of the Commissioner when the Appeals Council denied plaintiff's request for review on February 3, 2012. (AT 1-6.) Thereafter, plaintiff filed this action in federal district court on April 4, 2012, to obtain judicial review of the Commissioner's final decision. (ECF No. 1.)
Plaintiff has raised the following issues: (1) whether the ALJ improperly discounted the opinion of plaintiff's treating physician; and (2) whether the ALJ improperly discounted plaintiff's testimony regarding his symptoms and functional limitations.
The court reviews the Commissioner's decision to determine whether (1) it is based on proper legal standards pursuant to 42 U.S.C. § 405(g), and (2) substantial evidence in the record as a whole supports it.
The ALJ evaluated plaintiff's entitlement to DIB and SSI pursuant to the Commissioner's standard five-step analytical framework.
Before proceeding to step four, the ALJ assessed plaintiff's residual functional capacity ("RFC") as follows:
(AT 13.)
At step four, the ALJ found that plaintiff was unable to perform any past relevant work. (AT 16.) However, at step five the ALJ determined that, in light of plaintiff's age (an individual closely approaching advanced age), education (high school education with ability to communicate in English), work experience, and RFC, there were jobs that existed in significant numbers in the national economy that plaintiff could perform. (AT 17.) Based on the vocational expert's testimony, the ALJ found that plaintiff could perform the following representative light occupations with a specific vocational profile ("SVP") of 2: (1) parking lot attendant, with 12,133 jobs in California and 73,102 jobs nationally; (2) outside deliverer with 7,717 jobs in California and 51,042 jobs nationally; and (3) lab sample carrier with 9,640 jobs in California and 90,040 jobs nationally. (
Accordingly, the ALJ concluded that plaintiff had not been under a disability, as defined in the Act, from April 24, 2009, through the date of the ALJ's decision. (AT 18.)
In this case, it is essentially undisputed that plaintiff suffers from chronic lower back pain attributable to degenerative disc disease. The primary issue is the extent of plaintiff's back pain and the degree of functional limitation resulting from his back condition. In this regard, plaintiff contends that the ALJ improperly discounted the opinion of his treating physician, Dr. Duane Worley.
The weight given to medical opinions depends in part on whether they are proffered by treating, examining, or non-examining professionals.
To evaluate whether an ALJ properly rejected a medical opinion, in addition to considering its source, the court considers whether (1) contradictory opinions are in the record; and (2) clinical findings support the opinions. An ALJ may reject an uncontradicted opinion of a treating or examining medical professional only for "clear and convincing" reasons.
On August 3, 2009, plaintiff's treating physician, Dr. Duane Worley, wrote a letter indicating that plaintiff had been his patient for the past four years, had experienced considerable health issues and a significant decline in physical function, but had persevered and continued to work despite Dr. Worley's suggestion to take time off to recuperate. (AT 284.) Dr. Worley stated that plaintiff had acute and severe lumbar stenosis with disabling back pain and radicular symptoms. (
On May 24, 2010, Dr. Worley completed a Physical Residual Functional Capacity Questionnaire. (AT 334-37.) In this questionnaire, Dr. Worley indicated that his frequency and length of contact with plaintiff was one year. (AT 334.) He diagnosed plaintiff with chronic lower back pain attributable to degenerative disc disease and status post a herniated lumbar disc surgery in 1982, and stated that plaintiff's prognosis was poor. (
Dr. Worley opined that plaintiff could walk for 3 blocks without rest or severe pain; could sit for 15-20 minutes at a time; could stand for 30-45 minutes at a time; could sit/stand/walk for less than 2 hours total in an 8-hour working day; had to walk around every 20-30 minutes for approximately 5-10 minutes at a time; required the option to shift between sitting, standing, and walking at will; needed to take unscheduled breaks lying down or sitting quietly every 30 minutes for approximately 10-15 minutes at a time; could only lift less than 10 pounds; could rarely twist and never stoop/bend, crouch/squat, climb ladders, or climb stairs; could only use his arms for reaching 70% during an 8-hour working day; and would likely be absent from work for more than four days per month. (AT 335-37.) Dr. Worley further stated that plaintiff's impairments lasted or could be expected to last at least twelve months. (AT 335.)
In discounting Dr. Worley's opinion, the ALJ primarily found that the opinion was inconsistent with the medical evidence of record. (AT 14, 16.) Indeed, Dr. Worley's severe limitations are not supported by the results of the objective radiology testing that was performed. A July 13, 2009 lumbar spine MRI confirmed that prior surgery had been performed at the L4-5 and L5-S1 levels (consistent with plaintiff's 1982 back surgery), but otherwise revealed only mild to moderate central canal stenosis and mild bilateral neural foraminal narrowing at the L4-5 level, and mild right neural foraminal narrowing at the L5-S1 level. (AT 14, 272.) A subsequent March 11, 2010 x-ray of the lumbar spine additionally showed only slight loss of height of L1, L4 and L5 vertebral bodies with marginal spurring noted at multiple levels. (AT 14, 384-85.) The ER provider who reviewed the x-ray found it to be essentially unremarkable with normal lumbar spine alignment. (AT 366.) Thus, as the ALJ reasonably observed, these mild to moderate objective findings are inconsistent with Dr. Worley's characterization of plaintiff's back problem in August 2009 as "acute and severe lumbar stenosis with disabling back pain." (AT 14, 284.)
Furthermore, although Dr. Worley's questionnaire assessed detailed restrictions and functional limitations, it included little analysis of the objective test results, medical evidence, and clinical findings pertaining to plaintiff's back condition to support such extreme limitations. (AT 334-37.) The few "objective signs," as summarized above, were all of the "check-the-box" variety, without any meaningful explanation or specifics. (AT 334.) Curiously, plaintiff's first documented complaint of back pain during the relevant period was on July 8, 2009, when plaintiff claimed he could not even adequately strain to have a bowel movement due to the intense pain. (AT 275-76.) At that time, the nurse practitioner ordered an MRI, but also, without apparently awaiting any MRI results, made a reference to "Disability paperwork — Last day of work April 24, 2009." (AT 276.) Notably, even though Dr. Worley's and his staff's treatment notes document plaintiff's subjective complaints, the treatment notes contain only minimal objective and clinical findings.
Moreover, as the ALJ noted, in October 2009, plaintiff's treating nurse practitioner, working in conjunction with Dr. Worley, issued plaintiff a note authorizing plaintiff to return to work as of October 5, 2009, upon plaintiff's request. (AT 15, 288.) Although this authorization appears to have been done somewhat reluctantly, it nonetheless undercuts Dr. Worley's opinion regarding disabling limitations, because a reasonable medical provider presumably would not authorize the issuance of a return-to-work note to a truly disabled patient, even if the patient requested it.
In light of the above, the court finds that the ALJ gave specific and legitimate reasons for discounting Dr. Worley's opinion.
On October 12, 2009, state agency physician Dr. Gilpeer reviewed plaintiff's medical records and opined that plaintiff could lift 20 pounds occasionally and 10 pounds frequently; stand and/or walk (with normal breaks) for a total of about 6 hours in an 8-hour workday; sit (with normal breaks) for a total of about 6 hours in an 8-hour workday; and only occasionally climb, balance, stoop, kneel, crouch, or crawl. (AT 290-95.) This assessment was affirmed by state agency physician Dr. Crowhurst on December 31, 2009. (AT 326-28.) As the Ninth Circuit has explained, although the opinion of a non-examining physician cannot by itself constitute substantial evidence, it may serve as substantial evidence when it is "consistent with independent clinical findings or other evidence in the record."
Therefore, the court finds that the ALJ gave specific and legitimate reasons for rejecting the opinion of plaintiff's treating physician, and that the ALJ's evaluation of the medical opinions was supported by substantial evidence.
In
"The ALJ must specifically identify what testimony is credible and what testimony undermines the claimant's complaints."
As an initial matter, the court notes that the ALJ did not entirely discredit plaintiff's allegations of back pain and associated limitations. Indeed, the ALJ limited plaintiff to light work with several postural limitations. (AT 13.) Nevertheless, to the extent that the ALJ discounted plaintiff's testimony regarding his symptoms and functional limitations, the ALJ provided several specific, clear, and convincing reasons for doing so.
The ALJ observed that the medical evidence did not support plaintiff's claims of disabling limitations to the degree alleged. (AT 14.) For the reasons discussed above, that finding was supported by substantial evidence. To be sure, "after a claimant produces objective medical evidence of an underlying impairment, an ALJ may not reject a claimant's subjective complaints based solely on a lack of medical evidence to fully corroborate the alleged severity of pain."
Moreover, the ALJ here also provided other reasons for discounting plaintiff's credibility. The ALJ pointed to several inconsistencies between plaintiff's statements and the record evidence. (AT 15.) For example, the ALJ noted that although plaintiff testified that he stopped working as a truck driver in April 2009 upon the recommendation of Dr. Worley, a July 8, 2009 treatment note reflects that plaintiff took a personal leave from work on April 24, 2009 to help his girlfriend recover from bunion surgery and because he had strained his back. (AT 15, 36-37, 275.) Indeed, as noted above, plaintiff's first complaint of back pain during the relevant period was only documented on July 8, 2009. (AT 275.) The ALJ also observed that plaintiff had been inconsistent in describing his daily activities. (AT 15.) At the administrative hearing, plaintiff testified that he was a home health aid/caregiver for his girlfriend through November 2009, which according to plaintiff involved vacuuming, light cooking, mopping, sweeping, taking her to the grocery store and to appointments, and generally assisting her around the house, and for which plaintiff was compensated by the state. (AT 29-33, 37-38.) However, in plaintiff's exertional activities questionnaire, executed in August 2009 and while still receiving compensation from the state as a caregiver for his girlfriend, plaintiff reported that he could do no chores because of his disabilities and that his girlfriend did all of them. (AT 16, 208-09.) An ALJ is permitted to draw an adverse inference concerning symptoms credibility from the claimant's general lack of candor.
Finally, the ALJ also reasoned that plaintiff sometimes failed to follow up on recommendations made by his treating providers, which suggested that plaintiff's symptoms may not have been as serious as he alleged. (AT 15.) For example, on March 11, 2010, plaintiff left the ER against medical advice, because he thought it was taking too long to get coverage for his deep vein thrombosis treatment approved. (AT 366-67.) Although plaintiff's brief argues that plaintiff was frustrated and that the physician refused to prescribe him medication for his back pain, the treatment notes from that incident indicate that the doctor could not prescribe him back pain medication, because he was not being properly discharged. (AT 367.) The ER physician did offer plaintiff back pain medication on site, but plaintiff apparently refused. (
In sum, the court finds that the ALJ provided specific, clear, and convincing reasons for discounting plaintiff's credibility as to his symptoms and functional limitations. Plaintiff's briefing before this court offers certain alternative views of the evidence; for example, plaintiff argues that his request to return to work in October 2009 is subject to a more favorable interpretation, i.e., that he essentially made a well-intentioned, but ultimately impracticable request to return to work. Although the evidence may also be susceptible to other interpretations, it is the function of the ALJ to resolve any ambiguities, and the court finds the ALJ's assessment to be reasonable and supported by substantial evidence.
For the foregoing reasons, IT IS HEREBY ORDERED that:
1. Plaintiff's motion for summary judgment (ECF No. 13) is DENIED.
2. The Commissioner's cross-motion for summary judgment (ECF No. 15) is GRANTED.
3. Judgment is entered for the Commissioner.
4. The Clerk of Court is directed to close this case and vacate all dates.
The claimant bears the burden of proof in the first four steps of the sequential evaluation process.