MONTE C. RICHARDSON, Magistrate Judge.
This cause is before the Court on Plaintiff's appeal of an administrative decision denying her application for Social Security benefits. The Court has reviewed the record, the briefs, and the applicable law. For the reasons set forth herein, the Commissioner's decision is
Plaintiff filed an application for disability insurance benefits ("DIB") on July 9, 2007, alleging an inability to work since March 15, 2007. (Tr. 138-42). The Social Security Administration ("SSA") denied the application initially and upon reconsideration. (Tr. 69-75, 83-84). Plaintiff then requested and received a hearing before an Administrative Law Judge (the "ALJ") on January 21, 2010. (Tr. 11-25). On April 23, 2010, ALJ Davenport issued a decision finding Plaintiff not disabled.
Plaintiff claims to be disabled since March 15, 2007 due to a spinal injury, shoulder injury, and psychiatric impairments. (Doc 14, p. 3).
Plaintiff was 47 years of age on the date ALJ Davenport's decision was issued. (Tr. 37). She has a high school education and past relevant work experience as a motel cleaner and laundry worker. (Tr. 37, 51, 60). Plaintiff testified her high school degree was "special ed . . . like learning kindergarten all over again," but she could read and write well. (Tr. 52-53, 396, 404). Her medical history is detailed in the record and will be summarized here.
Plaintiff was a housekeeper at St. Vincent's Medical Center. (Tr. 146-48). She injured her cervical spine and shoulder while working there. (Doc. 14, p. 3). After the accident, Plaintiff saw Dr. Ero, an orthopedist, who diagnosed Plaintiff with degenerative disc disease with disc herniation. (Tr. 253). On August 11, 2005, Dr. Ero fused Plaintiff's C5-6 and C6-7 discs.
In September 2006, Plaintiff sustained her second cervical/shoulder injury at work. (Tr. 38, 654). She was referred to physical therapy, but did not regularly attend. (Tr. 654). Plaintiff was terminated from St. Vincent's on March 15, 2007, because St. Vincent's could no longer accommodate her condition. (Tr. 158-59). Plaintiff lost her worker's compensation case due to an insufficient showing of any connection between her neck injury and work place accident. (Tr. 42).
Diagnostic testing in July 2007 showed disc protrusions above the C5-7 fusion. (Tr. 652). In October 2007, Dr. Ero diagnosed adjacent segment disease. (Tr. 468). In February 2008, Dr. Ero opined Plaintiff could engage in light-duty work for thirty-one to forty hours a week and could lift up to twenty-five pounds. (Tr. 467, 470).
In March 2007, Dr. Karnani, Plaintiff's general physician, opined Plaintiff was disabled based on her back pain and depression. (Tr. 480). Dr. Karnani opined Plaintiff should lift no more than 10 pounds (Tr. 11), but Dr. Karnani did not reject Dr. Ero's conclusion that Plaintiff was capable of light-duty work and even deferred to Dr. Ero as the physician to be contacted for information regarding Plaintiff's condition. (Tr. 409).
In October 2007, Dr. Gnomic, a consultative examiner, opined Plaintiff only had "mild to moderate" limitations in prolonged sitting, standing, walking, climbing, and heavy lifting. (Tr. 427). During his examination of Plaintiff, Dr. Gnomic noted Plaintiff had decreased ranges of motion in the cervical and lumbar spine, but was able to squat, sit, and stand normally. (Tr. 424-30). Plaintiff also had intact finger and hand dexterity and grip strength.
In November 2007, Dr. Cater, a non-examining consultative doctor, suggested Plaintiff could lift 20 pounds occasionally. (Tr. 453). In April 2008, Dr. DeMiranda, another non-examining consultative doctor, opined Plaintiff could perform light-duty work. (Tr. 842-48). In June 2008, Dr. Jaminal, another of Plaintiff's treating physicians, suggested Plaintiff had no "limitation of motion of any joint" and "exaggerated/feigned tenderness" in her back during examination. (Tr. 942). An x-ray of Plaintiff's shoulder, examined by Dr. Jaminal, was normal in July 2008. (Tr. 947).
In October 2008, Dr. Smith, a consultative examiner, opined Plaintiff sustained a partial infraspinatous tendon tear in her right shoulder that had been overlooked by other physicians. (Tr. 858, 928, Doc. 14, p. 4). Dr. Smith did not give Plaintiff a disability rating, nor did he schedule a follow-up appointment. (Tr. 856-58).
In September 2009, Dr. Dehgan, a consultative examiner, opined Plaintiff had normal spinal alignment, slightly decreased range of motion, and normal strength of the upper and lower extremities. (Tr. 859-61). Dr. Dehgan reviewed the records of Dr. Gnomic, Dr. Smith, and Dr. Ero and opined Plaintiff could perform a full range of light-duty work. (Tr. 861). Dr. Dehgan suggested Plaintiff had no gross physical or neurological impairment and could return to work with no heavy lifting.
Plaintiff also suffered mental and psychiatric impairments. She was a victim of sexual abuse as a child and rape as an adult. (Tr. 879). Plaintiff began treatment for depression in the 1980s. (Tr. 882). She was hospitalized for suicidal thoughts and depression on several occasions. (Tr. 243, 249, 419, 882). Plaintiff responded positively to depression medication, but did not consistently take the prescribed amount. (Tr. 287, 325, 335, 478, 839).
In October 2007, Dr. Walls, a consultative examiner, described Plaintiff as "guarded." (Tr. 423). Dr. Walls noted Plaintiff was capable of understanding and following simple instructions and directions. (Tr. 422). Dr. Walls suggested Plaintiff was capable of performing simple tasks independently, maintaining attention and concentration for simple tasks, making appropriate routine decisions, and interacting appropriately with others.
In February 2008, Dr. Harris, a consultative examiner, opined Plaintiff suffered from a major depressive disorder. (Tr. 835). Dr. Harris opined Plaintiff would have moderate limitations understanding and remembering detailed instructions, carrying out detailed instructions, maintaining focus, concentrating for extended periods, and accepting criticisms from supervisors. (Tr. 837-38). In June 2008, Plaintiff denied any depression, anxiety, or memory loss. (Tr. 945).
In October 2009, Dr. Knox, another consultative examiner, opined Plaintiff suffered from major depression as well as post-traumatic stress disorder. (Tr. 882). Dr. Knox observed Plaintiff did not appear "overly guarded." (Tr. 881). Dr. Knox opined Plaintiff had moderate impairments in her ability to interact appropriately with the public and coworkers and marked impairments in her ability to respond appropriately to usual work situations and changes in routine work settings. (Tr. 885).
Plaintiff's hearing before ALJ Davenport was on January 21, 2010. (Tr. 31-65). At this hearing, Plaintiff testified pain and stress prevented her from working. (Tr. 41). As recently as July 2009, Plaintiff visited the Emergency Room for neck pain. (Tr. 40). Plaintiff suggested she "hurt all[] over" and became depressed when her nerves acted up. (Tr. 41). She testified that during the day she did "most hardly nothing" but, when asked about her previous day, suggested she took a walk and distributed information about the Bible. (Tr. 45). She attended church twice a week and attempted to read the Bible on her own. (Tr. 46). She did not have a driver's license and did not know how to drive. (Tr. 54-55).
Plaintiff suggested she struggled with the death of her mother, with whom she never had a close relationship. (Tr. 47-48). She also struggled with her childhood molestation and recent rape. (Tr. 48). Plaintiff admitted she considered suicide several times and was Baker Acted into the hospital several times as well. (Tr. 58). She testified she never sought mental counseling for these matters, other than from her "spiritual mother." (Tr. 49). Plaintiff cooked for herself, did her own housekeeping, cleaned her own laundry, and went shopping with her "spiritual mother." (Tr. 49-50). Plaintiff also relied on her "spiritual mother" to make her schedule and assist in financial matters. (Tr. 54). Plaintiff testified she was taking Tramadol, Darvocet, Lexapro, Lortab, Flexeril, Nexium, and Motrin. (Tr. 51).
A plaintiff is entitled to disability benefits when she is unable to engage in a substantial gainful activity by reason of any medically-determinable physical or mental impairment which can be expected to either result in death or last for a continuous period of not less than twelve (12) months. 42 U.S.C. §§ 416(i)(1), 423(d)(1)(A); 20 C.F.R. § 404.1505(a). The ALJ must follow five steps in evaluating a claim of disability.
In the instant case, the ALJ determined Plaintiff met the insured status requirements of the Social Security Act through December 31, 2011. (Tr. 13). At step one, the ALJ found Plaintiff had not engaged in substantial gainful activity since her alleged onset date, March 15, 2007.
At step three, the ALJ stated "the claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1." (Tr. 14). The ALJ found Plaintiff's "affective disorder cause[d] mild restrictions on her activities of daily living and social functioning" and "moderate limitations in maintaining concentration, persistence or pace."
(Tr. 15). In making this determination, the ALJ found Plaintiff's impairments could reasonably be expected to produce her alleged symptoms. (Tr. 17). However, the ALJ found Plaintiff's assertions "concerning the intensity, persistence, and limiting effects of the alleged symptoms [were] not credible to the extent they [were] inconsistent with the residual functional capacity assessment."
At step four, the ALJ determined Plaintiff was unable to perform her past relevant work as motel cleaner or laundry worker. (Tr. 24). However, "considering [Plaintiff's] age, education, work experience and residual functional capacity, there [were] jobs that exist[ed] in significant numbers in the national economy that [Plaintiff] [could] perform."
The scope of this Court's review is limited to determining whether the ALJ applied the correct legal standards,
Where the Commissioner's decision is supported by substantial evidence, the district court will affirm, even if the reviewer would have reached a contrary result as finder of fact, and even if the reviewer finds that the evidence preponderates against the Commissioner's decision.
Plaintiff argues the Commissioner's decision is not based on substantial evidence. Plaintiff's brief raises two main arguments
Plaintiff argues the ALJ erred by accepting Dr. Ero's opinions regarding Plaintiff's limitations even though Dr. Ero did not change his diagnosis between the two surgeries and failed to take into consideration Plaintiff's right shoulder tendon injury. (Doc. 14, pp. 7-8). After Plaintiff's first back surgery in August 2005, Dr. Ero placed Plaintiff on light-duty work restriction for four months. (Tr. 655-63). After Plaintiff's second work-place injury, Dr. Ero, in October 2007, again concluded Plaintiff was capable of returning to light-duty work. (Tr. 467-70). In February 2008, Dr. Ero saw Plaintiff for persistent neck pain, but no reference was made to Plaintiff's shoulder. (Tr. 467). An x-ray in July 2008 studied by Dr. Jaminal showed the shoulder to be normal. (Tr. 947). An MRI in October 2008 revealed to Dr. Smith a partial infraspinatus tendon injury in Plaintiff's shoulder. (Tr. 856-58). Dr. Ero did not examine Plaintiff after this MRI, but Dr. Smith opined the injury was from the accident two years prior to Dr. Smith's examination. (Tr. 858). Because Dr. Ero did not change Plaintiff's work restrictions during this time and because Dr. Ero did not factor into his opinion Plaintiff's tendon injury, Plaintiff suggests Dr. Ero's "unchanging opinions regarding [Plaintiff's] work status [are] illogical and [do] not constitute substantial evidence under the circumstances." (Doc. 14, p. 12).
It is understood that "[t]he mere diagnosis [of a condition] says nothing about the severity of the condition."
The focus of the Court's review of Plaintiff's claim should focus on the disabling effects of the impairment rather than on a physician's specific diagnosis. In other words, the pertinent issue in determining whether an individual is disabled is not any specific diagnosis, but rather, the limitations arising from the diagnosis.
Further, Dr. Ero's assessment is not inconsistent with the record. In February 2008, Dr. Ero opined Plaintiff could engage in light duty work for thirty-one to forty hours a week. (Tr. 467). Nearly one year after Dr. Smith diagnosed the tendon tear, Dr. Dehgan opined Plaintiff could "return to work, with no heavy lifting." (Tr. 861). Similarly, Plaintiff was discharged from Baptist Medical Center — Downtown Emergency Department with light-duty work restrictions on June 16, 2009, (Tr. 987), and without any work restrictions three other times in 2009. (Tr. 976, 1000, 1022). In July 2009, Plaintiff visited the Baptist Medical Center for shoulder pain, but the discharging physician suggested Plaintiff should "continue [the] light duty restrictions from [her] prior orthopedist." (Tr. 985-87). In Plaintiff's October 2009 visit to the Emergency Room, Plaintiff did not mention any shoulder pain and was discharged without any work restrictions. (Tr. 973-76). Thus, the ALJ did not err in considering Dr. Ero's determination of Plaintiff's RFC. The Court finds no reversible error in the ALJ's reliance on Dr. Ero's functional assessment.
Plaintiff argues the ALJ erred in rejecting Dr. Karnani's 10 pound lifting restriction even though Dr. Karnani had frequent and direct contact with Plaintiff. (Doc. 14, p. 12). Treating source opinions are generally entitled to increased weight. 20 C.F.R. § 404.1527(d)(2). Specifically, if the ALJ finds a treating source's opinion was "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case record, [he/she] will give it controlling weight."
Here, the ALJ gave sufficient reasoning for rejecting Dr. Karnani's opinions. The ALJ noted the inconsistency between Dr. Karnani's and Dr. Ero's assessments. (Tr. 18). Dr. Karnani suggested a 10 pound limit, but Dr. Ero put Plaintiff on light duty work with the ability to lift 25 pounds.
Next, the ALJ noted Dr. Karnani's deference to Dr. Ero's opinions.
Plaintiff next argues the ALJ's hypothetical to the VE did not consider or include the psychiatric restrictions recommended by the three consultative examiners, Drs. Knox, Harris, and Walls.
This Court assumes Plaintiff would argue the ALJ should have considered Dr. Knox's opinion that Plaintiff was depressed and had a moderate limitation in interacting with others, as well as marked limitations in responding to changes. Plaintiff may also argue the ALJ should have considered Dr. Walls's opinion that Plaintiff had difficulty attending to a schedule, learning new tasks, and dealing with stress. Finally, Plaintiff may rely on Dr. Harris's opinion that Plaintiff had moderate limitations as to social functioning and maintaining pace, persistence, or concentration.
Plaintiff is correct that case law in this circuit requires the ALJ to employ hypothetical questions which are accurate and supportable on the record and which include all limitations or restrictions of the particular claimant.
In the instant case, the ALJ asked the VE to assume a younger person with a high school degree in a simple, one or two step job, with occasional contact with the public, coworkers, and supervisors. (Tr. 61). The job was not to involve many changes and needed to be the same job day in and day out.
The ALJ found it significant that none of Plaintiff's mental health treatment providers suggested Plaintiff was unable to perform any work due to her mental impairments. (Tr. 23). However, the ALJ then considered and discussed the opinions of Dr. Knox, Dr. Harris, and Dr. Walls. Specifically, the ALJ noted that Dr. Knox diagnosed Plaintiff with major depression and post-traumatic stress disorder and opined Plaintiff had moderate impairments in her ability to interact appropriately with the public, supervisors, and coworkers. (Tr. 883, 885). Dr. Knox suggested Plaintiff also had marked impairments in her ability to respond appropriately to usual work situations and changes in routine.
Dr. Walls opined Plaintiff would have difficulty attending to a schedule, learning new tasks, and dealing with stress. (Tr. 421-23). The ALJ noted this opinion and properly discredited it, suggesting this part of Dr. Walls's opinion was "given little to no weight as there [was] not sufficient evidence other than [Plaintiff's] own subjective reporting that [Plaintiff] [was] incapable of keeping a schedule and/or routine." (Tr. 23). The ALJ also suggested Dr. Walls's opinions indicated Plaintiff "was only mildly to moderately limited in related tasks, but was capable of understanding, performing, and maintaining attention and concentration for simple tasks."
Finally, with respect to Dr. Harris, the ALJ discussed Dr. Harris's opinion that Plaintiff had mild limitations in the functional areas of daily activities, moderate limitations in social functioning, and moderate limitations in concentration, persistence, or pace. (Tr. 22). Specifically, Dr. Harris found Plaintiff was moderately limited in understanding, remembering, and performing detailed instructions.
In posing the hypothetical to the VE, the ALJ included these psychiatric RFC limitations. First, with respect to Plaintiff's problems with detailed instructions, the ALJ stressed Plaintiff was limited to performing simple tasks. Moreover, the ALJ included Plaintiff's limitations in her ability to respond appropriately to changes in work setting by stating Plaintiff's job should "not involve a lot of changes" and should be "the same one or two step job day in and day out." (Tr. 61). Additionally, the hypothetical included the restrictions regarding Plaintiff's ability to interact with others as Plaintiff was restricted to "occasional contact with the public, supervisors, and coworkers."
As noted above, Plaintiff contends the hypothetical presented to the VE did not include all of Plaintiff's psychiatric limitations, however, Plaintiff failed to specify any overlooked limitations. (Doc. 14). Plaintiff bears the burden of proving that she is disabled and is responsible for producing evidence in support of her claim. 20 C.F.R. §§ 404.1512(a), (c); 416.912(a), (c);
Based on the evidence of record and the doctors' opinions, the ALJ concluded Plaintiff could perform simple work tasks in a low stress environment and have limited contact with the public. (Tr. 23). The ALJ included the appropriate limitations in her hypothetical to the VE. As such, the undersigned finds the hypothetical question the ALJ submitted to the VE properly represented Plaintiff's abilities considering Plaintiff's physical and psychiatric limitations.
For the foregoing reasons, the decision of the Commissioner is