MONTE C. RICHARDSON, District Judge.
This cause is before the Court on Plaintiff's appeal of an administrative decision denying his 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 a period of Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") on January 19, 2010, alleging May 3, 2007 as the onset date. (Tr. 152-57, 174). Plaintiff's claims were denied initially on March 15, 2010 and upon reconsideration on May 14, 2010. (Tr. 90-97,102-07). Thereafter, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"), which was conducted on April 8, 2011. (Tr. 32, 108-10). The ALJ ultimately found Plaintiff was not disabled in a decision dated May 26, 2011. (Tr. 13-25). Plaintiff requested review of the ALJ's decision, and the Appeals Council denied the request. (Tr. 1-3, 7-10). Plaintiff timely filed his complaint in this Court seeking judicial review of the Commissioner's decision finding him disabled. (Doc. 1).
Plaintiff claimed to be disabled since May 3, 2007, due to multiple gunshot wounds to his abdomen and postoperative complications. (Tr. 152-57, 173).
Plaintiff was fifty-one years old on the date of his hearing before the ALJ on May April 8, 2011. (Tr. 32, 43). Plaintiff has completed the eleventh grade, and has past relevant work experience as a resident care aide, maintenance worker, material handler, and stock clerk. (Tr. 43, 69-70). Plaintiff's medical history is discussed at length in the ALJ's decision and will be summarized herein.
In May and June of 2007, Plaintiff was treated for multiple gunshot wounds to the abdomen. (Tr. 261-82). In July 2008, a CT scan of Plaintiff's abdomen revealed a large anterior abdominal wall hernia. (Tr. 288-89). After receiving hernia surgery, Plaintiff's medical records indicate he was recovering well and suffered no ongoing pain. (Tr. 232-39). However, in April 2009, an updated CT scan indicated Plaintiff had developed another hernia, but a later assessment performed by Dr. Charles, M.D. Hultman showed it was simply a bulge. (Tr. 230-31, 283-84). Dr. Hultman re-examined Plaintiff in July 2009, and noted that if the bulge worsened or developed into a hernia, Plaintiff may need to undergo surgery. (Tr. 228-29).
In February 2010, Plaintiff visited Shands Jacksonville's emergency room, where he was diagnosed with a hernia in his stomach wall. (Tr. 343-44). Plaintiff was instructed to follow-up with the surgery clinic because a certain diagnosis was not possible in the emergency department. The record is devoid as to whether Plaintiff returned for his follow-up visit as instructed.
In March 2010, Dr. Susan Yandle, M.D., a consultive examiner, performed a consultative physical examination of Plaintiff. (Tr. 322-26). During the examination, Plaintiff complained of abdominal pain, which he described was a seven out of ten. Dr. Yandle noted that Plaintiff appeared to be in distress and diagnosed him with a large abdominal hernia. Dr. Yandle also opined that Plaintiff had a "moderate limitation for bending to the floor and marked limitation for lifting over twenty pounds from the floor." However, Dr. Yandle did not provide an opinion as to Plaintiff's RFC. At the time of the examination, Plaintiff noted his activities of daily living consisted of cleaning, cooking, shopping, laundry, bathing, dressing himself, listening to the radio, and reading. (Tr. 323).
In May 2010, after a review of the medical evidence, a state agency physician, Dr. Robert Steele, M.D., opined that Plaintiff could occasionally lift and/or carry twenty pounds, frequently lift and/or carry ten pounds, stand and/or walk about six hours in an eight-hour day, and had unlimited ability to push and/or pull. (Tr. 330-37).
In February 2011, Plaintiff again visited Shands Jacksonville's emergency room and reported complaints of stomach pain. (Tr. 339-69). Plaintiff was discharged and instructed that follow-up was necessary. (Tr. 342). Plaintiff returned for follow-up and the attending physician opined Plaintiff suffered mild tenderness to palpation of the abdomen with reducible hernia, and prescribed Lortab. (Tr. 342, 355-58).
At the hearing before the ALJ in April 2011, Plaintiff's activities of daily living were consistent with the activities listed in Dr. Yandle's report, but Plaintiff added that he could carry twenty pounds across the room and occasionally walk six blocks. (Tr. 54). Plaintiff also informed the ALJ that his surgery to remove the hernia was scheduled for April 28, 2011. (Tr. 72, 73). The ALJ indicated he would wait until after the surgery to render his decision, which all indications show he did because Plaintiff was discharged on May 13, 2011 and the ALJ's decision was signed on May 26, 2011. (Tr. 25, 396).
A claimant is entitled to disability benefits when he is unable to engage in 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 12 months. 42 U.S.C. §§ 416(i), 423(d)(1)(A); 20 C.F.R. § 404.1505. The ALJ must follow five steps in evaluating a claim of disability.
In the instant case, at step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since his alleged onset date of May 3, 2007. (Tr. 18). At step two, the ALJ found Plaintiff suffered from the severe impairment of hernia status post gunshot wound.
Based on the RFC, the ALJ found that at step four, Plaintiff was not able to perform any of his past relevant work. (Tr. 23). Therefore, the ALJ proceeded to step five where he sought the advice of a vocational expert ("VE") to determine whether Plaintiff's age, education, work experience, and RFC, along with any other additional limitations, shifted Plaintiff's condition into the disabled category. (Tr. 24, 67-72). The ALJ determined, with the assistance of the VE, that Plaintiff was not disabled because "there are jobs that exist in significant numbers in the national economy that the [Plaintiff] can perform." (Tr. 24).
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 following two issues on appeal: (1) whether the ALJ erred in discounting Dr. Yandle's opinion when determining Plaintiff's RFC (Doc. 16, pp. 7-13); and (2) whether the ALJ failed to properly evaluate Plaintiff's subjective complaints of pain. (Id. at p. 12).
Plaintiff contends that the ALJ erred by discounting Dr. Yandle's opinion when he determined Plaintiff's RFC. Specifically, Plaintiff argues that the medical evidence that the ALJ relied on when he rejected Dr. Yandle's opinion was not related to Plaintiff's abdomen; thus, his opinion was not properly rejected. (Doc. 16, pp. 7-13). In response, the Commissioner states that the ALJ relied on sufficient evidence when he rejected Dr. Yandle's opinion. (Doc. 17, pp. 6-7).
When examining the record to determine an individual's RFC, the examining physician's opinion is generally entitled to more weight than the opinion of a non-examining physician. 20 CFR § 404.1527(c)(1);
However, "the ALJ is free to reject the opinion of any physician when the evidence supports a contrary conclusion."
In Wainwright, the Eleventh Circuit considered whether substantial evidence supported the ALJ's decision to accord little weight to the opinion of a physician, who examined the claimant only once.
Similarly, in the instant case, the Court finds the ALJ's decision to accord little weight to the opinion of Dr. Yandle, a one-time examining physician, was within his authority, and he clearly articulated his reasons for doing so. Specifically, the ALJ noted he rejected the opinion of Dr. Yandle because he examined Plaintiff one-time, and his findings were inconsistent with the overall evidence of record, which included the "updated benign physical findings." (Tr. 23). In addition, the ALJ gave great weight to state agency physician Dr. Steele because: (1) he is a disability specialist and reviewed the bulk of the available evidence from treating and examining sources; (2) Plaintiff's testimony regarding his activities of daily living coincided with the his RFC assessment; and (3) the evidence of record supported the state agency physician, which are all facts the ALJ may consider when weighing various medical opinions.
In any event, the Court is not convinced that Dr. Yandle's assessment even contradicts the ALJ's RFC assessment. In fact, Dr. Yandle made no RFC determination and the medical source statement only indicates that Plaintiff had "moderate limitation for bending to the floor and marked limitation for lifting over 20 lb from the floor." (Tr. 326). From this, Plaintiff suggests that he would have difficulty with light duty work. (Doc. 16, p. 9). However, from a reading of Dr. Yandle's report, the Court finds very little that contradicts the ALJ's RFC, considering the fact that "light work," as defined by the Code of Federal Regulations, only includes lifting under 20 pounds. See 20 C.F.R. §§ 404.1567(b), 416.967(b).
The Court further notes Plaintiff's argument that the ALJ erred when he relied on Dr. Malave's recent "benign physical findings" because they were not related to Plaintiff's abdomen. (Doc. 16, pp. 10-11). Although Dr. Malave's benign findings may concern other areas of the body, Dr. Malave still examined Plaintiff's abdomen, which Plaintiff indicated had a minimal pain level at the time of his examination. (Tr. 371-72).
In light of the foregoing, the Court finds substantial evidence supports the ALJ's decision to accord little weight to Dr. Yandle's opinion.
Plaintiff argues the ALJ erred by failing to include his subjective complaints of pain in the hypothetical posed to the VE. (Doc. 16, p. 12). The Commissioner responds that the objective medical evidence does not support Plaintiff's complaints of pain. (Doc. 17, p. 10-13).
In order to prove a disability based on his testimony of pain, Plaintiff must satisfy two parts of the following test:
Here, the ALJ determined Plaintiff's underlying medical condition was hernia status post gunshot wound. (Tr. 18). In light of this determination, Plaintiff alleges his medical condition can reasonably be expected to give rise to the claimed pain. (Doc. 16, p. 12). As the ALJ noted, Plaintiff was diagnosed with a post-operative abdominal hernia in June 2008, which resulted from surgery to repair multiple gunshot wounds in 2007. (Tr. 243-44). At the time of his diagnosis, the examining physician noted that Plaintiff was not suffering from any abdominal pain. Plaintiff subsequently had the hernia repaired in July 2008 and underwent a follow-up visit, wherein Plaintiff continued to indicate he had no abdominal pain. (Tr. 237-42). Then, in August 2008, Plaintiff informed the physician that he was doing quite well and had no complaints of pain. (Tr. 234-35). Even as late as April and July 2009, the medical evidence fails to indicate Plaintiff was suffering from any abdominal pain. (Tr. 228-30). In fact, in April 2009, Plaintiff indicated that he was happy with his reconstruction.
Although Shands Jacksonville's emergency room diagnosed Plaintiff with a possible hernia in February 2010, the record is devoid as to whether Plaintiff returned for a follow-up visit to confirm this diagnosis. (Tr. 343-44). Indeed, the record indicates that Plaintiff sought no further treatment until February 2011. (Tr. 340-42). As late as March 17, 2011, Plaintiff's abdominal pain level was assessed as a two out of ten, despite his diagnosis of a ventral and recurrent incisional hernia. (Tr. 371-72).
In addition, as noted by the ALJ, Plaintiff's activities of daily living discredit Plaintiff's complaints of pain. Plaintiff testified that he takes care of himself, can walk six blocks, cleans, and could carry twenty pounds across the room, which is consistent with an ability to perform light work.
Therefore, considering all the evidence, this Court finds substantial evidence supports the ALJ's finding that Plaintiff's complaints concerning the intensity, persistence, and limiting effects of pain were not credible to the extent they were inconsistent with an ability to perform a full range of light work.
Upon due consideration, the Court finds the decision of the Commissioner was decided according to proper legal standards and is supported by substantial evidence. As neither reversal nor remand is warranted in this case, and for the aforementioned reasons, the decision of the ALJ is hereby