MARY PAT THYNGE, Magistrate Judge.
This action arises from the denial of Plaintiff's claim for Social Security benefits. On July 5, 2012, Plaintiff filed an application for Social Security Disability Insurance benefits ("DIB") under Title II of the Social Security Act.
Plaintiff was born on February 12, 1965.
Plaintiff allegedly suffers from a "myriad of issues," including:
The combination of the impairments is plaintiff's basis for concluding she is unable to perform any substantial gainful activity.
Dr. J. Kirkland Beebe, M.D. (hereinafter referred to as "Dr. Beebe") has been treating Plaintiff since November 28, 2011.
Plaintiff's arthritic pain traveled to her extremities and increased in her back over the next few years.
Most significantly, Dr. Beebe completed a Doctor's Certificate for the Delaware Department of Labor on November 20, 2012, wherein he diagnosed cervical radiculopathy and bilateral carpal tunnel syndrome, and concluded that Plaintiff was "disabled from all work indefinitely."
In an assessment of Plaintiff noted in a Multiple Impairment Questionnaire dated July 2, 2013, Dr. Beebe diagnosed cervical degenerative disc disease, osteoarthritis with bilateral cervical radiculopathy, bilateral carpal tunnel syndrome, and cubital carpal tunnel syndrome.
Dr. Beebe examined Plaintiff again on August 15, 2013.
Most significant to the issues at hand, Dr. Beebe wrote a "narrative report," dated February 18, 2014, concluding Plaintiff was "disabled due to her cervical and lumbar osteoarthritis, degenerative disk disease, bilateral carpal tunnel and bilateral cubital tunnel syndromes that have not responded to surgery, steroid injections, or physical therapy."
At the hearing on September 10, 2014, Plaintiff testified to her background, work history, and alleged disability.
Concerning her daily activities, Plaintiff describes difficulty standing or sitting for more than twenty to thirty minutes at a time.
Plaintiff also experiences daily headaches, that radiate from the back of her neck to the top of her head. According to plaintiff, "[t]ylenol doesn't touch it," and she uses a TENS unit,
Plaintiff describes constant burning and stinging sensation to her right palm and right wrist, which radiates to the right elbow into the fingers.
Additionally, plaintiff experiences gastrointestinal issues, which began in November 2013.
Plaintiff testified that she requires assistance with household tasks, including vacuuming, mopping floors and cleaning bathrooms.
Plaintiff testified that sitting or standing at a desk all day and moving her head is very difficult. In fact, she complained during the hearing of a large amount of pain with a "headache starting, [and] pressure" due to sitting, and verbalized the need to stand and move around.
During her testimony, the vocational expert, Beatty-Cody, was asked to consider a hypothetical individual of Plaintiff's age, education, and work history who could perform work at a "light exertional level," occasionally climb ladders, ropes, and scaffolds, occasionally crawl, frequently reach overhead with both arms, and was subject to frequent exposure to extreme cold and heat, humidity, vibration, fumes, odors, dust, gases, and poor ventilation.
Beatty-Cody was further requested to consider other versions of the hypothetical individual involving certain limitations. Regarding the limitation of difficulty reaching overhead, she concluded Plaintiff could perform her past work.
Beatty-Cody also considered the same hypothetical individual who needed to alternate standing and sitting every thirty minutes, specifically to stand ten minutes after sitting for thirty minutes, while remaining "on task,"
For the same individual working at a sedentary level, the expert concluded Plaintiff's past employment would be precluded, but the individual could be a "surveillance system monitor and telephone quotation clerk . . . ."
When asked to consider an individual at the light exertional level that was unable to reach overhead bilaterally, grasp/turn/twist objects, and use fingers and hands for fine manipulations, Beatty-Cody testified these limitations would preclude any type of work.
Conclusively, "[b]ased on the application for a period of disability and disability insurance benefits protectively filed on July 3, 2012, [Plaintiff] is not disabled under sections 216(i) and 223(d) of the Social Security Act." Further "[b]ased on the application for supplemental security income filed on September 27, 2013, [Plaintiff] is not disabled under section 1614(a)(3)(A) of the Social Security Act."
Both parties move for summary judgement. In determining the appropriateness of summary judgment, the court must "review the record as a whole, `draw[ing] all reasonable inferences in favor of the non-moving party[,]' but [refraining from] weighing the evidence or making credibility determinations." If "there is no genuine issue as to any material fact" and the movant is entitled to judgment as a matter of law, summary judgment is appropriate.
This standard does not change merely because there are cross-motions for summary judgment. Cross-motions for summary judgment:
"The filing of cross-motions for summary judgment does not require the court to grant summary judgment for either party."
Section 405(g) sets forth the standard of review of an All's decision. The court may reverse the Commissioner's final determination only if the ALJ did not apply the proper legal standards, or the record did not contain substantial evidence to support the decision. Factual findings are upheld if supported by substantial evidence. Substantial evidence means less than a preponderance, but more than a mere scintilla of evidence. As the United States Supreme Court has found, substantial evidence "does not mean a large or significant amount of evidence, but rather such relevant evidence as a reasonable mind might accept as adequate to support a conclusion."
In determining whether substantial evidence supports the Commissioner's findings, the court may not undertake a de novo review of the decision nor re-weigh the evidence of record. The court's review is limited to the evidence that was actually presented to the All. The Third Circuit has explained that a:
Thus, the inquiry is not whether the court would have made the same determination, but rather, whether the Commissioner's conclusion was reasonable. Even if the court would have decided the case differently, it must defer to and affirm the All, so long as the decision is supported by substantial evidence.
Where "review of an administrative determination is sought, the agency's decision cannot be affirmed on a ground other than that actually relied upon by the agency in making its decision." In SEC v. Chenery Corp., the Court found that a "reviewing court, in dealing with a determination or judgment which an administrative agency alone is authorized to make, must judge the propriety of such action solely by the grounds invoked by the agency." "If those grounds are inadequate or improper, the court is powerless to affirm the administrative action by substituting what it considers to be a more adequate or proper basis." The Third Circuit has recognized the applicability of this finding in the Social Security disability context. This court's review is limited to the four corners of the ALJ's decision. In Social Security cases, the substantial evidence standard applies to motions for summary judgment brought pursuant to FED. R. ay. P. 56.
The Supplemental Social Security Income (SSI) program was enacted in 1972 to assist "individuals who have attained the age of 65 or are blind or disabled" by setting a minimum income level for qualified individuals.
The Social Security Administration uses a five-step sequential claim evaluation process to determine whether an individual is disabled.
If the All determines that a claimant is disabled at any step in the sequence, the analysis stops.
"A cardinal principle guiding disability eligibility determinations is that the ALJ accord treating physicians' reports great weight."
The ALJ must consider medical findings supporting the treating physician's opinion that the claimant is disabled.
However, a statement by a treating source that a claimant is "disabled" is not a medical opinion: rather, it is an opinion on an issue reserved to the Ail because it is a finding that is dispositive of the case.
Statements about the symptoms
First, the ALJ must find a medically determinable impairment — proven with medically acceptable clinical and laboratory diagnostic data — that could reasonably be expected to produce the claimant's symptoms. Otherwise, the ALJ cannot find the applicant disabled, no matter how genuine the symptoms appear to be.
This step does not consider the intensity, persistence and limiting effects of the symptoms on the claimant: it only verifies whether a medical condition exists that could objectively cause the existence of the symptom.
Analysis stops at this step where the objectively determinable impairment meets or medically equals one listed in 20 CFR Part 404, Subpart P, Appendix 1, because the claimant is considered disabled per se.
At step two, the ALJ must determine the extent to which the symptoms limit the claimant's ability to do basic work activities. Therefore, he must determine the applicant's credibility.
At this step, the ALJ must consider the entire record, including medical signs, laboratory findings, the claimant's statements about symptoms, any other information provided by treating or examining physicians, psychiatrists and psychologists, and any other relevant evidence in the record, such as the claimant's account of how the symptoms affect her activities of daily living and ability to work.
Where more information is needed to assess a claimant's credibility, the AU must make every reasonable effort to obtain available information that would shed light on that issue. Therefore, the All must consider the following factors relevant to symptoms, only when such additional information is needed:
A claimant's statements and reports from medical sources and other persons with regard to the seven factors, noted above, along with any other relevant information in the record, provide the All with an overview of the subjective complaints, and are elements to the determination of credibility.
Consistency with the record, particularly medical findings, supports a claimant's credibility. Since the effects of symptoms can often be clinically observed, when present, they tend to lend credibility to a claimant's allegations. Therefore, the adjudicator should review and consider any available objective medical evidence concerning the intensity and persistence of pain or other symptoms in evaluating the claimant's statements.
Persistent attempts to obtain pain relief, increasing medications, trials of different types of treatment, referrals to specialists, or changing treatment sources may indicate that the symptoms are a source of distress and generally support a claimant's allegations. An applicant's claims, however, may be less credible if the level or frequency of treatment is inconsistent with the level of complaints, or if the medical reports or records show noncompliance with prescribed treatment.
Findings of fact by state agency medical and psychological consultants and other physicians and psychologists regarding the existence and severity of impairments and symptoms, and opinions of non-examining physicians and psychologist are also part of the analysis. Such opinions are not given controlling weight. However, the ALJ, although not bound by such findings, may not ignore them and must explain the weight afforded those opinions in his decision.
Credibility is one element in determining disability. The ALJ must apply his finding on credibility in step two of the five-step disability determination process, and may use it at each subsequent step.
The decision must clearly explain, that is, provide sufficiently specific reasons based on the record, to the claimant and any subsequent reviewers, regarding the weight afforded to the claimant's statements and the reasons therefore.
The law recognizes that the claimant's work history should be considered when evaluating the credibility of her testimony or statements.
The onset date of disability is determined from the medical records and reports and other similar evidence, which requires the ALJ to apply informed judgment.
Plaintiff argues the ALJ failed to properly weigh the medical opinion evidence and evaluate her credibility. She contends the ALJ erred by giving no weight to the limitations described by her treating physician, Dr. Beebe, and by giving significant weight to opinions from non-examining consultants.
To the contrary, Defendant maintains that substantial evidence supports the ALJ's evaluation of the medical source opinions, including appropriately giving no weight to an opinion of Dr. Beebe.
The issue determined by the ALJ was whether Plaintiff is disabled under sections 216(1), 223(d), and 1614(a)(3)(A). The present issue for the court is whether the ALJ properly applied the legal standards in making the determination; more specifically, whether "substantial evidence" supports the ALJ's decision.
As discussed throughout this opinion, Plaintiff's overarching contentions are the following: (1) the ALJ erred by giving no weight to the limitations described by her treating physician, and giving significant weight to opinions from non-examining consultants; and (2) the All mischaracterized the record by finding both Dr. Beebe and Plaintiff's opinions not credible. Therefore, this court's decision is based upon whether the ALJ's analyses of the disability determination standards, under the headings "Weight Given to Treating Physicians" and "Factors in Evaluating Credibility," were reasoned in a manner meeting the required standard.
Applying the aforementioned standards of procedure, although the ALJ finds Plaintiff's impairments do cause significant limitations, he concludes that such limitations do not constitute a disability under the Acts in question. He considered all of Plaintiff's symptoms, and the "extent to which they could reasonably be accepted as consistent with the objective medical evidence and other evidence, based on the requirements of 20 CFR 404.1529 and 416.929 and SSRs 96-4p and 96-7p . . . [and] opinion evidence in accordance with the requirements of 20 CFR 404.1527 and 416.927 and SSRs 96-2p, 96-6p and 06-3p."
Some of the impairments presented via medical documents and testimony are considered non-severe and cannot be found, even in combination with other impairments, to cause inability to do basic work. The gastrointestinal impairments are "stable," meaning they do not require ongoing treatment; therefore, they do not cause functional restrictions, and thus, are not "severe pursuant to SSR 96-4p."
After considering four broad functional areas set out in the disability regulations attributable to a determination of mental health of claimants, the ALJ made the following conclusions. In the first area, activities of daily living, Plaintiff has no limitation because she lives alone, performs personal care, and completes household chores. As to the second area, social functioning, Plaintiff has no limitation. Regarding the third element, concentration, Plaintiff has mild limitation because her concentration is affected by pain. Significantly, the Ail observed that, "Dr. Beebe consistently notes normal memory in his records."
Upon assessment of Plaintiff's residual functional capacity, the All concluded that Plaintiff does not have an impairment or combination thereof that is equivalent in severity to an accepted disability listed in the applicable regulation. In summary, Plaintiff's spinal impairments fail to meet testing criteria to indicate a compromise or compression of nerve roots or the spinal cord, or inability to ambulate. Her symptoms of asthma do not meet clinical criteria that would indicate severity to the level of an accepted disability under the Acts. Further, her problems with motor functioning of the upper extremities do not meet the definition of peripheral neuropathy, the neurological impairment listed in the regulation.
After considering the entire record, the All concluded that Plaintiff maintains the residual functional capacity to perform light work, with the exception of the following: she can only occasionally climb ladders, ropes or scaffolds, occasionally crawl, occasionally reach overhead with the bilateral upper extremities; occasionally handle, finger, and feel with her bilateral upper extremities; but may have frequent exposure to extreme cold, extreme heat, humidity, vibration, fumes, odors, dust, gas, and poor ventilation.
Although a treating physician's medical opinion should be given controlling weight, after considering all evidence of record in conjunction with his observations of Plaintiff and testimony at the hearing, the All afforded no weight to the opinion of her treating physician, Dr. Beebe. The ALJ's decision regarding weight did not turn on whether the nature and severity of her impairments were well supported by medically acceptable clinical and laboratory diagnostic techniques, but rather on whether the opinion was inconsistent with the other substantial evidence in the record. This court agrees with the ALJ that Dr. Beebe's opinion was inconsistent with other substantial evidence.
Specifically, no weight was given to either Dr. Beebe's written opinion that Plaintiff is disabled and is "very unlikely to be able to return to the workforce" or his opinion set forth in two Multiple Impairment Questionnaires, which appear inconsistent in the determination of the severity of Plaintiff's conditions.
The ALJ considered, as he must, the medical findings supporting Dr. Beebe's opinion that Plaintiff is disabled. His consideration was clearly indicated in the ALJ's November 3, 2014 decision, in which he pointed to specific inconsistences within Dr. Beebe's opinion and the record as a whole. For example, the ALJ noted that two separate Multiple Impairment Questionnaires indicate different severities of Plaintiff's condition. The ALJ rejected the treating physician's assessment, but did not make speculative inferences from medical reports; rather, his rejection was on the basis of contradictory medical evidence, including the vocational expert's testimony and medical reports of other physicians who treated and evaluated Plaintiff.
Notably, under the disability determination standard, a statement by a treating source that a claimant is disabled is not a medical opinion.
As stated above, a claimant's statements and reports from medical sources and other persons, along with any other relevant information in the record, provide the ALJ with an overview of the subjective complaints, and are elements to the determination of credibility. However, the key component in the assessment of Plaintiff's credibility is consistency between her testimony and the record. Plaintiff's claims may be less credible if the level or frequency of treatment is inconsistent with the degree of her complaints, or if the medical reports or records show noncompliance with prescribed treatment.
The ALJ concluded Plaintiff's testimony was not credible due to its inconsistency with other evidence in the record. For example, the ALJ states: "[a]Ithough the claimant testified she continues to experience severe right upper extremity limitations, the record indicates improvement with exercises and ability to go on a vacation less than a month post-surgery."
Further, proper application of the credibility standard requires the ALJ's decision to clearly explain the weight afforded to the claimant's statements and his reasoning, by including sufficiently specific reasons from the record. The examples cited herein of his reasoning, clearly delineated in his decision, suffice.
Plaintiff argues that the opinions of state agency medical consultants should not have been afforded great weight. However, findings of fact by state agency medical and psychological consultants, other psychologists and physicians, and the opinions of non-examining physicians regarding the existence and severity of impairments and symptoms are part of the analysis. The ALJ considered the vocational experts testimony, and also added limitations in Plaintiff's favor to that assessment, in making the final determination of disability. The ALJ did not give the vocational expert's opinion controlling weight, and therefore, did not err.
As stated above, in determining the appropriateness of summary judgment, the court is required to review the entire record and draw all reasonable inferences in favor of the non-moving party, but cannot weigh the evidence or make credibility determinations.
This court, consistent with the finding by the ALJ, determines that Dr. Beebe's opinion was inconsistent with other substantial evidence: therefore, the All did not err by affording no weight to his opinion regarding disability. Moreover, under the disability determination standard, a comment by a treating source that a claimant is disabled is not a medical opinion, and only the ALJ is authorized to decide the issue of disability, as when supported by substantial evidence in the record. Thus, this court has no bases to reverse or remand the ALJ's decision, since there is no indication that the ALJ acted beyond his regulatory authority.
The same analysis applies to the All's conclusion that Plaintiff lacked credibility. The ALJ found her testimony inconsistent with other evidence in the record, which was thoroughly explained throughout his written decision. For example, the ALJ noted that despite Plaintiff's testimony of continued severe right upper extremity limitations, the record contradicts her testimony and indicates improvement with exercises, with Plaintiff going on vacation within a month post-surgery.
Previously, in this decision, this court analyzed the propriety of the All's decision based solely on the grounds applied by the ALJ,
Plaintiff not only sought reversal of the final decision of the Commissioner denying her disability benefits, but alternatively, requests this matter be remanded for a new hearing on the issue of whether she is disabled. Because the his findings that Dr. Beebe's opinion was inconsistent with other substantial evidence are appropriately supported by the record, the ALJ did not err by affording no weight to Dr. Beebe's determination regarding disability. Since the ALJ applied the correct standards and properly evaluated the facts, which are supported by substantial evidence in the record, Plaintiff's motion for summary judgment is denied.
For the reasons contained herein, I recommend that:
1. Plaintiff's motion for summary judgement be denied.
2. Defendant's motion for summary judgement be granted.
This Report and Recommendation is filed pursuant to 28 U.S.C. § 636(b)(1)(B), FED. R. CIV. P. 72(b)(1), and D. DEL. LR 72.1. The parties may serve and file specific written objections within fourteen (14) days after being served with a copy of this Report and Recommendation.
The parties are directed to the Court's Standing Order in Non-Pro Se matters for Objections Filed under FED. R. CIV. P. 72, dated October 9, 2013, a copy of which is available on the Court's website, www.ded.uscourts.gov.
