ALLISON CLAIRE, Magistrate Judge.
Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner"), denying his application for disability insurance benefits ("DIB") under Title II of the Social Security Act, 42 U.S.C. §§ 42 U.S.C. §§ 401-34, and for Supplemental Security Income ("SSI") under Title XVI of the Social Security Act ("the Act"), 42 U.S.C. §§ 1381-1383f. DIB is paid to disabled persons who have contributed to the Disability Insurance Program, and who suffer from a mental or physical disability. 42 U.S.C. § 423(a)(1);
Plaintiff applied for DIB on March 16, 2010. Administrative Record ("AR") 15.
In a decision dated January 16, 2013, the ALJ issued an unfavorable decision, finding plaintiff "not disabled" under Sections 216(i) and 223(d) of the Act (Title II), 42 U.S.C. §§ 416(i), 423(d), and Section 1614(a)(3)(A) of the Act (Title XVI), 42 U.S.C. § 1382c(a)(3)(A). AR 15-27 (decision and exhibit list).
Plaintiff asked the Appeals Council ("Council") to review the ALJ's decision. AR 10. On July 2, 2014, the Appeals Council denied review, leaving the ALJ's decision as the final decision of the Commissioner of Social Security. AR 1-3. Plaintiff filed this action on July 31, 2014. ECF No. 1;
For the reasons that follow, the court will deny plaintiff's motion for summary judgment, and will grant the Commissioner's cross-motion for summary judgment.
Plaintiff was born on December 13, 1965, and was 44 years old on the alleged onset date of his disabilities, January 21, 2010. AR 22. Plaintiff has a high school education and can communicate in English. AR 22. Plaintiff is not a U.S. citizen, but is a lawful permanent resident in possession of a "green card." AR 34.
The Commissioner's decision that a claimant is not disabled will be upheld "if it is supported by substantial evidence and if the Commissioner applied the correct legal standards."
Substantial evidence is "more than a mere scintilla," but "may be less than a preponderance."
"The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and resolving ambiguities."
The court will not reverse the Commissioner's decision if it is based on harmless error, which exists only when it is "clear from the record that an ALJ's error was `inconsequential to the ultimate nondisability determination.'"
Disability Insurance Benefits and Supplemental Security Income are available for every eligible individual who is "disabled." 42 U.S.C. §§ 423(a)(1)(E) (DIB), 1381a (SSI). Plaintiff is "disabled" if he is "`unable to engage in substantial gainful activity due to a medically determinable physical or mental impairment. . . .'"
The Commissioner uses a five-step sequential evaluation process to determine whether an applicant is disabled and entitled to benefits. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4);
20 C.F.R. §§ 404.1520(a)(4)(i), (b) and 416.920(a)(4)(i), (b).
The claimant bears the burden of proof in the first four steps of the sequential evaluation process. 20 C.F.R. §§ 404.1512(a) ("In general, you have to prove to us that you are blind or disabled"), 416.912(a) (same);
The ALJ made the following findings:
AR 17-22.
Plaintiff argues that the ALJ erred by: (1) failing to make findings at Steps 2 and 3 regarding plaintiff's vision impairments; (2) failing to evaluate properly the opinion of Dr. Reed, an examining physician; (3) improperly discrediting plaintiff's subjective complaints and asserted limitations; (4) failing to support with substantial evidence, his finding that plaintiff could perform light exertion work; and (5) relying solely on the Medical-Vocational Guidelines to find that plaintiff was not disabled.
At Step 2 of the sequential analysis, the ALJ was required to determine if plaintiff has medically determinable impairments that are "severe" enough to significantly limit plaintiff's ability to perform basic work activities. 20 C.F.R. §§ 404.1520(c), 416.920(c). "Basic work activities" include "seeing." 20 C.F.R. §§ 404.1521(b)(2) ("basic work activities" includes "[c]apacities for seeing"), 416.921(b)(2) (same).
Plaintiff argues that the ALJ erred by failing to make findings regarding his alleged vision impairments at Step 2. See Memorandum in Support of Plaintiff's Motion for Summary Judgment (ECF No. 13-1) ("Plaintiff's Motion") at 10-11. Defendant asserts that the ALJ
Plaintiff is correct that the ALJ did not make any express finding regarding plaintiff's alleged vision impairments at Step 2. At Step 2, the ALJ found that plaintiff's gout, diabetes mellitus and seizures were "severe," and that his high blood pressure and high cholesterol, were "not severe." AR 17. Contrary to defendant's assertion, the ALJ did not find that plaintiff's vision impairment was not severe; there is simply no mention of it. The ALJ did find at Step 2 that plaintiff has the severe impairment of diabetes mellitus. AR 17. However, if defendant means to argue that every mention of "diabetes" in the decision is also a reference to the visual complications arising from the disease, the court rejects the argument. The complications the ALJ mentions as arising from diabetes, or that plaintiff testified to, are numbness and tingling in the arms and legs, AR 19, 46, and dizziness, AR 47, in addition to retinopathy, AR 48. Defendant seems to be arguing that the ALJ did not err because he must have found that plaintiff had no severe vision impairment, because if he did not so find, then that would be error. This is just circular reasoning; it is not an acceptable legal argument.
Nevertheless, the ALJ's failure to make the required Step 2 finding regarding plaintiff's alleged severe vision impairment is harmless error in this case, because, as discussed below, plaintiff presented no acceptable medical evidence that he had a severe vision impairment.
A Step 2 severe mental or physical impairment "must result from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques." 20 C.F.R. §§ 404.1508, 416.908. It must be established "by medical evidence consisting of signs, symptoms, and laboratory findings," and not only by plaintiff's "statement of symptoms."
The record contains medical evidence of plaintiff's vision disorder from four sources. Plaintiff's treating optometrist, Thomas A. Flynn, O.D., examined plaintiff on March 12, 2012. Dr. Flynn, in his "Examination Record" diagnosed plaintiff with "Presbyopia,"
Dr. Flynn reported plaintiff's "unaided acuity" for distance ("DVA") to be 20/30 in both eyes. AR 397. He reported plaintiff's unaided near visual acuity ("NVA") to be "HM," or hand-motion-only.
There is no statement or other indication in Dr. Flynn's report that plaintiff's vision acuity — whether corrected or unaided — was such as to significantly limit plaintiff's ability to see, or to carry out any other basic work activity. To the contrary, plaintiff does not argue that his apparently corrected vision of "20/25+" and "20/30" for both eyes, near and distance vision, is limiting in any way.
On April 2, 2012, an examining physician, Dr. John E. Stabel (Stabel Eye Clinic), diagnosed plaintiff with "moderate" non-proliferating diabetic retinopathy. AR 439 (Exh. 19F). Dr. Stabel also found "Scattered Macular Dot/Blot Hemorrhage," AR 440, which is a "feature" of diabetic retinopathy. See Stedmans Medical Dictionary 779660. Dr. Stabel reported plaintiff's "vision" to be 20/20 in the right eye, and 20/40 in the left. AR 441. However, the court is unable to tell if this refers to plaintiff's unaided vision or his corrected vision, or to his distance or near vision, and neither party offers any guidance on this.
On July 31, 2012, Dr. Stabel again examined plaintiff. AR 433-38 (Exh. 19F). Dr. Stabel again diagnosed plaintiff with "moderate" non-proliferating diabetic retinopathy. AR 434. This time, Dr. Stabel found "cotton wool spots" on both eyes, and "some hemorrhage and exudate" on the right eye. AR 435. As noted, these signs are "features" of diabetic retinopathy. See Stedmans Medical Dictionary 779660. Dr. Stabel reported plaintiff's vision on this examination to be 20/60 in both eyes, and stated that plaintiff's vision "has decreased in the last four months." AR 434, 436. Plaintiff argues that these findings are "consistent with plaintiff's report that his glasses did not help anymore." See Plaintiff's Motion at 12. However, the court is again unable to determine if the reported vision is unaided or corrected, near or distance.
There is no statement or other indication in either of Dr. Stabel's reports of what plaintiff's corrected vision is. However, even if the "20/60" report refers to plaintiff's corrected vision, there is no statement or indication that it was such as to significantly limit plaintiff's ability to see, or to carry out any other basic work activity. It might well be a reasonable lay conclusion that corrected vision of 20/60 in both eyes would impair the ability to see. However, it is plaintiff's burden to present acceptable medical evidence of the claimed severe impairment. It is not enough to simply present a measurement and leave it to the court — which is not authorized to "play doctor" — to conclude that the cited measurement is severe enough to limit plaintiff's ability to conduct basic work activities.
Plaintiff does point to his own statement that he sometimes gets "blurred vision," and that glasses were not helping. Even if these statements were evidence of a severe vision impairment, the only evidence supporting such a claim of impairment is plaintiff's own statement, which is not enough to establish such an impairment.
After noting the deterioration in plaintiff's sight, Dr. Stabel referred plaintiff to J. Brian Reed, M.D., of Retinal Consultants Medical Group, Inc. On August 14, 2012, plaintiff was examined by Dr. Reed. AR 427-32 (Exh. 18F). Dr. Reed's "Impression" was that plaintiff had "[s]evere" non-proliferative diabetic retinopathy, as well as "Hypertensive retinopathy." AR 428.
Dr. Reed found that plaintiff's vision was 20/25 in the right eye, and 20/30 in the left. AR 428, 430. Once again, the court is unable to determine if this refers to plaintiff's corrected or unaided vision, or his near or distance vision.
This is the only report of plaintiff's vision that is specifically mentioned in the ALJ's decision. Like the prior reports, Dr. Reed's contains no statement or indication that plaintiff's vision was such as to significantly limit plaintiff's ability to see, or to carry out any other basic work activity.
Finally, on November 9, 2012, plaintiff was examined by John Tendall, M.D., of MDSI Physician Services. AR 452-57 (Exh. 20F). Although Dr. Tendall acknowledges the report from Dr. Reed, he alone among the four examining or treating doctors does not diagnose plaintiff with any visual disorder.
Dr. Tendall found plaintiff's corrected distance vision to be 20/40 in both eyes. AR 455.
As discussed above, plaintiff has identified no evidence in the record showing that he has a vision impairment, even a non-severe vision impairment. Plaintiff argues that he has established that he has a medically determinable impairment because he has shown that he has severe nonproliferative diabetic retinopathy. AR 10. However, the existence of a visual
The Commissioner's regulations, and the cases applying them, expressly distinguish between visual disorders and the limitations those disorders may cause:
Listings ¶ 2.00A(1);
For example, Dr. Flynn, plaintiff's treating optometrist, diagnosed plaintiff with the very disorders that plaintiff argues establish his impairment, namely presbyopia, myopia, diabetes with ocular involvement, and mild non-proliferative diabetic retinopathy. AR 398. Yet Dr. Flynn also apparently prescribed corrective lenses that would leave plaintiff's corrected vision at a combined "20/20-" for distance, and "20/25" for near vision. AR 397. Plaintiff offers no explanation for why plaintiff's ability to see, as measured by these clinical findings, or to perform any other basic work function, is impaired in any way by his presbyopia, myopia, diabetes with ocular involvement, or retinopathy.
Even if the court accepts plaintiff's worst clinical findings — 20/60 vision in both eyes, and "severe" non-proliferative retinopathy together with the various noted features of the retinopathy — none of the medical records explain what functional impairment plaintiff suffers as a result of those conditions. The court is not authorized to substitute its own lay view of what level of vision would significantly affect plaintiff's ability to work. Instead, the court looks to medical evidence of impairment. Plaintiff has provided none.
Plaintiff argues that the ALJ erred by not fully and fairly developing the record once plaintiff established the existence of his visual disorder, namely, severe non-proliferative diabetic retinopathy, citing
"An ALJ's duty to develop the record further is triggered only when there is ambiguous evidence or when the record is inadequate to allow for proper evaluation of the evidence."
Here, the evidence is not ambiguous. While the medical evidence is undisputed that plaintiff has diabetic retinopathy, there is no medical evidence that this disorder limits plaintiff's ability to perform basic work functions. However, the question of possible "inadequacy" is more complex. The Commissioner's regulations describe "visual disorders" as "abnormalities of the eye . . . that may cause a loss of visual acuity. . . ." Listings ¶ 2.00A(1). As discussed above, non-proliferative diabetic retinopathy is such a visual disorder. Moreover, notwithstanding the general principle that it is plaintiff's burden to prove that he is disabled, the Commissioner's regulations regarding vision disorders state: "If your visual disorder does not satisfy the criteria in 2.02, 2.03, or 2.04, we will request a description of how your visual disorder affects your ability to function." Listings ¶ 2.00A(4). Here, plaintiff has a visual disorder that plainly does not satisfy the specified criteria, potentially triggering the Commissioner's obligation to seek further information about plaintiff's ability to function.
The ALJ did, however, have an assessment of how plaintiff's visual disorder affected his ability to function: Dr. Tendall's assessment. As noted above, Dr. Tendall apparently did not conduct a funduscopic examination of plaintiff. However, he did specifically acknowledge plaintiff's diagnosis of "severe nonproliferative diabetic retinopathy with hypertensive retinopathy," made by an examining physician, Dr. Reed. AR 452. Accordingly, Dr. Tendall's subsequent functional assessment can fairly be said to be based upon clinical medical findings, even though they are not all his own. Dr. Tendall's functional assessment concluded that plaintiff was not impaired in any way related to his vision. Specifically, he concluded that plaintiff could "avoid ordinary hazards in the workplace," "read very small print," "read ordinary newspaper or book print," "view a computer screen," and "determine differences in shape and color of small objects such as screws, nuts or bolts." AR 449.
Accordingly, the court finds that the ALJ's failure to specifically mention "vision impairment" at Step 2 was, at worst, harmless error, since there was no medical evidence to support any level of such impairment.
Plaintiff argues that the ALJ "disregarded" Dr. Reed's and Dr. Stabel's clinical findings. Plaintiff's Motion at 12. That is not correct. First, as far as can be gleaned from the administrative record, the reports of both doctors
Second, none of the clinical findings that the ALJ allegedly disregarded shows that the plaintiff had a visual impairment that limited his ability to perform basic work activities, including "seeing." Rather, they tended only to show, as discussed above, that plaintiff had a visual disorder, namely, diabetic retinopathy.
Plaintiff alleges that there are clinical findings that plaintiff's vision is getting worse and cannot be helped with glasses. Plaintiff's Motion at 12. However, the clinical findings, other than Dr. Reed's, do not specify whether the reported worsening vision is unaided or corrected, and therefore the court has no way to interpret the differing visual acuity findings.
Plaintiff argues that there is a conflict between the findings of Dr. Reed and Dr. Stabel, who found "that plaintiff had severe non-proliferative diabetic retinopathy," and the opinions of Dr. Tendall and Dr. Estrin, who found that plaintiff had "no visual impairment limitations." Plaintiff's Motion at 12. There is no conflict, as the findings are entirely consistent. Dr. Reed and Dr. Stabel found that plaintiff had a visual disorder, namely, non-proliferative diabetic retinopathy ("severe" in Dr. Reed's diagnosis, and "moderate" in Dr. Stabel's). AR 428 (Reed), 434 (Stabel, July 31, 2012), 439 (Stabel, April 2, 2012). Dr. Estrin and Dr. Tendall found that that plaintiff did not have any visual functional limitations. AR 253 (Estrin), 449 (Tendall). There is no conflict between finding that a visual disorder exists, on the one hand, and finding that no visual functional limitation exists, on the other.
As discussed above, Dr. Tendall expressly acknowledged that plaintiff had the visual disorder of severe non-proliferative diabetic retinopathy, as Dr. Reed found. AR 452. Dr. Tendall then went on to find that there was no visual impairment. AR 449. Dr. Estrin also found that there was no visual functional impairment (although he did not mention any visual disorders). AR 253. There is no conflict between Dr. Reed and Dr. Stabel on the one hand, and Dr. Kendall and Dr. Estrin on the other, because they reported conclusions about different things: visual disorders on the one hand, and visual functional limitations on the other.
Because there is no evidence of a vision impairment, the ALJ had no basis for considering the severity or effects of any "vision impairment" at Step 3. That is because the requirement to look at the Listings at Step 3 only exists if there exists a severe, medically determinable impairment.
Plaintiff argues that the medical evidence meets "the first prong of the
The court finds that it is undisputed that plaintiff meets the first part of the
The second part of the pain analysis is "an analysis of the credibility of the claimant's testimony regarding the severity of [his] symptoms."
Here, the ALJ found that "the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely credible for the reasons explained in this decision," and that "the claimant's subject complaints and allegations regarding his functional limitations are not fully credible." AR 20, 21. The court finds that there is specific, clear and convincing evidence in the record for the ALJ not to credit plaintiff's assertions of pain regarding his right foot.
Harchentan Singh Sandhu, M.D., examined plaintiff on October 1, 2009, "for an urgent evaluation of gout." AR 223 (Exh. 1F). Dr. Sandhu noted that he had seen plaintiff recently for an "acute onset of right-sided flare-up in the midfoot region," but that the medication prescribed "has helped him a lot," and indeed the swelling and tenderness "is significantly improved."
Plaintiff does not point to any testimony or medical evidence regarding what he says is plaintiff's "allegations of having severe pain and limitations in his right foot." See Plaintiff's Motion at 14. Equally important, plaintiff does not identify any evidence that this alleged severe pain — even if evidence of it could be found somewhere in the record — is not ameliorated by medication. Specifically, he does not identify any such evidence sufficient to overcome the evidence cited by the ALJ that the pain was ameliorated by medication.
Plaintiff's hearing testimony regarding the pain in his shoulder appears at AR 50-51. The court finds that there is specific, clear and convincing evidence in the record to support the ALJ's decision not to credit plaintiff's pain and limitations testimony regarding his shoulder.
Dr. Sandhu found "no synovitis present" in the shoulders. AR 218, 223. Edward Kazel, M.D., examined plaintiff on September 30, 2010. AR 321. In light of plaintiff's complaints of shoulder pain, Dr. Kazel ordered "x-rays for his cervical spine, x-ray of the right shoulder."
Plaintiff seems to argue that the ALJ erred in relying on the cervical spine x-rays, because a later x-ray, dated 5-23-12, revealed:
Plaintiff's Motion at 14. However, plaintiff does not explain the meaning or consequences of these latter x-ray results — which are presented as a string of unexplained terms — nor how they should affect the ALJ's (or this court's) view of plaintiff's alleged shoulder pain and limitations.
Plaintiff argues that because of plaintiff's alleged vision impairment, it was inappropriate for the ALJ to rely on the Medical-Vocational Guidelines.
For the reasons set forth above, 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. 18), is GRANTED; and
3. The Clerk of the Court shall enter judgment for defendant, and close this case.