JAMES R. KLINDT, Magistrate Judge.
Christopher Barbera ("Plaintiff") is appealing the Commissioner of the Social Security Administration's final decision denying his claim for disability insurance benefits ("DIB"). Plaintiff's alleged inability to work is a result of "scoliosis and spinal problems," "left knee," and "anxiety." Transcript of Administrative Proceedings (Doc. No. 10; "Tr." or "administrative transcript"), filed February 10, 2015, at 229 (emphasis and capitalization omitted). On March 10, 2011, Plaintiff protectively filed an application for DIB, alleging an onset disability date of February 25, 2011. Tr. at 151-52. Plaintiff's "protective filing date" is listed elsewhere in the administrative transcript as March 7, 2011.
On November 8, 2012, an Administrative Law Judge ("ALJ") held a hearing during which the ALJ heard testimony from Plaintiff, who was represented by counsel. Tr. at 40-77. On April 26, 2013, the ALJ issued a Decision finding Plaintiff not disabled and denying Plaintiff's claim. Tr. at 26-34. Plaintiff then requested review by the Appeals Council, Tr. at 15, and submitted evidence to the Council in the form of a brief authored by his attorney representative and some additional medical evidence. Tr. at 6-8;
Plaintiff raises two issues on appeal:
Pl.'s Brief (Doc. No. 15; "Pl.'s Br."), filed May 7, 2015, at 1, 8-21. Defendant filed a Memorandum in Support of the Commissioner's Decision (Doc. No. 19; "Def.'s Mem.") on July 14, 2015. After a thorough review of the entire record and the parties' respective memoranda, the undersigned finds that the Commissioner's final decision is due to be affirmed for the reasons stated herein.
When determining whether an individual is disabled,
Here, the ALJ followed the five-step sequential inquiry.
The ALJ determined that Plaintiff has the residual functional capacity ("RFC") "to perform the full range of light work." Tr. at 31 (emphasis omitted). At step four, the ALJ found that Plaintiff is "capable of performing past relevant work in real estate . . [as] [t]his work does not require the performance of work-related activities precluded by [Plaintiff's RFC]." Tr. at 33 (emphasis and citations omitted).
Although the ALJ concluded at step four that Plaintiff was capable of performing his past relevant work, the ALJ made alternative findings at step five of the sequential evaluation process. Tr. at 33. The ALJ considered Plaintiff's RFC, age, education, and work experience, in conjunction with the Medical-Vocational Guidelines, 20 C.F.R. Part 404, Subpart P, Appendix 2 ("Grids"), and determined that "there are other jobs that exist in significant numbers in the national economy that [Plaintiff] also can perform." Tr. at 34 (citations omitted). Accordingly, the ALJ concluded that Plaintiff "has not been under a disability . . . from February 25, 2011, through the date of th[e] [D]ecision." Tr. at 34 (emphasis and citation omitted).
This Court reviews the Commissioner's final decision as to disability pursuant to 42 U.S.C. §§ 405(g). Although no deference is given to the ALJ's conclusions of law, findings of fact "are conclusive if . . . supported by `substantial evidence.'"
Plaintiff makes two arguments before this Court. Plaintiff first argues the ALJ "failed to articulate good cause for not crediting the opinions of Dr. Casanova, [Plaintiff's] treating internal medicine specialist." Pl.'s Br. at 8-16. Plaintiff's second argument essentially challenges the ALJ's credibility finding as it relates to Plaintiff's upper extremity limitations, complaints of pain, and mental impairment symptoms.
Plaintiff submits that he had been treating with Dr. Casanova intermittently since April 2007, that the doctor's opinions were based upon Plaintiff's complicated medical history, and that the doctor's opinions should have been afforded substantial weight.
The Regulations establish a "hierarchy" among medical opinions
With regard to a treating physician or psychiatrist,
If an ALJ concludes the medical opinion of a treating physician or psychiatrist should be given less than substantial or considerable weight, he or she must clearly articulate reasons showing "good cause" for discounting it.
(2) the evidence supports a contrary finding; or (3) the opinion is conclusory or inconsistent with the treating physician's or psychiatrist's own medical records.
An ALJ is required to consider every medical opinion.
Plaintiff's date of alleged onset of disability is February 25, 2011. Tr. at 151. However, Plaintiff's low back problems date back to 1991.
Plaintiff was seen again by Dr. Casanova on March 15, 2011, with similar complaints of "[p]ain to the lower lumbar spine radiating down both legs." Tr. at 381. Dr. Casanova noted "tightness . . . on the area of the lumbar spine." Tr. at 382. Plaintiff's strength was noted as "[5/5] in the upper and lower extremities." Tr. at 382. Assessment at that time was noted to be "[c]ervical [r]adiculitis," [l]umbosacaral [r]adiculitis," and "[a]nxiety, [g]eneralized disorder." Tr. at 382.
On June 14, 2011, Dr. Casanova authored a note stating that Plaintiff "can no longer do the line of work he was previously in. [Plaintiff] should avoid operation of heavy machinery or any activity that requires concentration due [to] medications that he is currently on." Tr. at 397-98. This note was apparently not written in conjunction with an appointment with Dr. Casanova for treatment.
Plaintiff next saw Dr. Casanova on March 15, 2012, with a complaint of "[p]ain to the lower lumbar spine radiating down both legs. . . . [Plaintiff] described the severity of the injury as severe [and] [t]he timing is sudden onset." Tr. at 413. Dr. Casanova noted Plaintiff "[s]uffers from cervical radiculopathy affecting the left upper extremity since 2011; report weakness on the left hand." Tr. at 413. However, upon neurological exam, Plaintiff had "[m]otor strength [5/5] in the upper and lower extremities." Tr. at 414.
Following the March 15, 2012 visit, Dr. Casanova completed on March 28, 2012, a Medical Source Statement Concerning the Nature and Severity of an Individual's Physical Impairment form on behalf of the Plaintiff. Tr. at 399-404. Dr. Casanova opined Plaintiff is unable to sit or stand/walk more than two hours in an eight-hour day. Tr. at 403. Additionally, he limited Plaintiff to lifting rarely less than ten pounds, no stooping, pushing, kneeling, pulling, or bending. Tr. at 402-03. Dr. Casanova further indicated Plaintiff is significantly limited in his ability to do repetitive reaching, handling, fingering or lifting. Tr. at 403. Fatigue as a side effect of Plaintiff's medication was noted. Tr. at 401. Dr. Casanova opined that "[Plaintiff] has a very poor prognosis due to these conditions" and would be expected to be absent from work as a result of his impairments or treatment "[m]ore than 3 times per month." Tr. at 400.
In October 2012, Dr. Casanova completed a Mental Residual Functional Capacity Form rating Plaintiff's "[m]ental abilities to function independently, appropriately, effectively and on a sustained basis." Tr. at 416. For the most part, Dr. Casanova opined that Plaintiff would only have the mental ability to engage in most of the activities outlined on the form about twenty-five percent of the time. Tr. at 416. As for interacting with the general public and coworkers and in maintaining socially appropriate behavior, Dr. Casanova opined Plaintiff would only be able to do these activities fifteen percent of the time. Tr. at 416.
Plaintiff saw Dr. Casanova on November 6, 2012, for among other things, complaints of "[p]ain . . . radiating down both legs . . . [and] located on the neck radiating down both arms (worse on the left side)." Tr. at 437. The pain was noted as severe, of constant duration and gradual onset. Tr. at 437. Dr. Casanova noted that "[r]ecent MRI of the Cervical Spine showed multiple areas of disk disease and facet disease. Findings progressively worse when compared to study in 2006." Tr. at 437. Plaintiff's motor strength was indicated as "[5/5] on the right side, [4/5] on the left side [and] [w]eak left hand grip." Tr. at 438. Dr. Casanova commented that Plaintiff's "muscle atrophy identified on the left arm is significant, his left side is weaker." Tr. at 438. Dr. Casanova recommended Plaintiff stay on the current medical regimen. Tr. at 438.
In discussing Dr. Casanova's opinions, the ALJ stated as follows:
Tr. at 33 (citations omitted).
The Regulations generally require that the opinions of examining physicians are given more weight than those of non-examining physicians.
Here, the ALJ considered and discussed the opinions of Dr. Casanova. In affording this doctor's opinions "little weight," the ALJ articulated his reasons for doing so. Plaintiff acknowledges that the ALJ provided reasons for discrediting Dr. Casanova's opinions, but he urges that the reasons were inadequate. Pl.'s Br. at 10.
In discounting Dr. Casanova's opinions, the ALJ referenced Plaintiff's "inconsistent and intermittent treatment." Tr. at 33. Additionally, the ALJ noted Plaintiff "has not sought treatment from an orthopedist, surgeon, or back specialist, or sought physical therapy and other conservative modalities in addition to narcotic pain medications." Tr. at 32. According to the ALJ, this "suggests that [Plaintiff] is not as limited as alleged." Tr. at 32. In that regard, in each of Plaintiff's visits to Dr. Casanova, the recommendation was always the same regarding diet ("Encourage to stay on a balance[d] diet"), medication instructions ("Take medications as prescribed"), and lifestyle comments ("Encourage to walk as tolerated" or "Encourage to stay active as tolerated"). Tr. at 382, 384, 414, 438. There were no referrals to specialists or physical therapy.
The ALJ also noted that "the limitations expressed are not supported by the objective medical evidence which shows relatively stable mild to moderate disc degeneration and stenosis over the last several years." Tr. at 33. Plaintiff argues that his condition did significantly change from 2006 to 2012, and he submits that the ALJ's characterization otherwise is inaccurate. Pl.'s Br. at 10. A review of the MRI reports, however, does not support the significant changes suggested by Plaintiff.
The impression from the 2005 lumbar spine MRI revealed "mild stenosis at L3-4 from a diffuse disc bulge and facet joint arthropathy with facet joint hypertrophy also resulting in bilateral moderate to severe foraminal narrowing, worse on the right." Tr. at 429. Impressions also included "[a]symmetric broad based disc bulges . . . at L4-5 and L5-S1 with bilateral moderate neural foraminal narrowing, worse on the left[;] [s]pondylosis . . . throughout the lumbar spine. No compression fractures[; and s]evere scoliosis, convex to the left." Tr. at 431.
The impression of the MRI of the lumbar spine dated March 5, 2007, was "[s]coliosis and degenerative disease with resulting mild stenosis at L3-4. There is no severe stenosis at any level, and no disc herniation." Tr. at 314;
The impression of the MRI of the lumbar spine dated October 18, 2012 revealed "[g]eneralized scoliosis and degenerative disease [and] [m]oderate stenosis in the subarticular recesses bilaterally at the L3-4 level." Tr. 410. It was noted that there was [n]o herniated dis[c]." Tr. at 410.
As for the MRIs of the cervical spine, the impression from the April 18, 2006, MRI was as follows:
Tr. at 433.
The MRI of the cervical spine dated October 17, 2012, revealed the following impression:
Tr. at 412.
Although the report of the 2012 cervical MRI noted that the findings have "progressed since the exam dating back to 2006," Tr. at 412, a comparison of the findings from the 2005, 2007, and 2012 lumbar and cervical spine MRIs referenced above do not necessarily demonstrate a significant change in Plaintiff's condition warranting greater limitations than those assessed by the ALJ's RFC. Moreover, simply having a problem or impairment does not automatically translate into work-related functions that an ALJ must include in an RFC.
Plaintiff's daily activities are also relevant in assessing the ALJ's treatment of Dr. Casanova's opinions. As the ALJ noted in his Decision, Plaintiff engages in "regular cleaning, cooking, reading, and personal care within his physical tolerances on a daily and consistent basis." Tr. 30.
Accordingly, the undersigned finds that the ALJ appropriately considered the opinions of Dr. Casanova, along with the other evidence of record, and stated adequate reasons for discounting Dr. Casanova's opinions.
In his second argument, Plaintiff contends that "[t]he ALJ failed to properly explain why he was not crediting [Plaintiff's] upper extremity limitations, despite his diagnosis of cervical radiculopathy, his positive cervical MRI findings, and examination findings including muscle atrophy, weakness, and reduced reflexes." Pl.'s Br. at 16. Plaintiff goes on to state that he "suffers from impairment in concentration due to the extent of his pain and other symptoms."
To establish a disability based on testimony of pain or other subjective symptoms, a claimant must satisfy two parts of a three-part test showing: (1) evidence of any underlying medical condition; and (2) either (a) objective medical evidence confirming the severity of the alleged subjective symptoms; or (b) that the objectively determined medical condition can reasonably be expected to give rise to the claimed subjective symptoms.
"[C]redibility determinations are the province of the ALJ."
In reaching his credibility finding, the ALJ noted that since Plaintiff's alleged onset date of February 2011, Plaintiff has sought treatment on only a few occasions from his primary care physician, Dr. Casanova, and from the emergency room. Tr. at 32. The ALJ stated that "such intermittent and irregular treatment . . . suggests that he is not as limited as alleged." Tr. at 32. Plaintiff complains that the ALJ should have found greater upper extremity limitations. Pl.'s Br. at 16-21. However, a review of the Decision reveals the ALJ considered the medical evidence and Plaintiff's testimony, and the ALJ concluded the limitations were not as limiting as Plaintiff alleged. Tr. at 30-33. And, as noted by Defendant, Plaintiff's conservative treatment undermines his allegations of disabling limitations and provides support for the ALJ's credibility determination. Def.'s Mem. at 12 (citing 20 C.F.R. § 404.1529(c)(3)(iv-v); SSR 96-7p;
Thus, the ALJ articulated adequate reasons for finding Plaintiff's statements not entirely credible, and the ALJ's credibility determination is supported by substantial evidence. Accordingly, the ALJ's Decision is due to be affirmed on this issue.
Based on a thorough review of the administrative transcript, and upon consideration of the respective arguments of the parties, the Court finds that the ALJ's Decision is supported by substantial evidence.
In accordance with the foregoing, it is hereby
1. The Clerk of Court is directed to enter judgment pursuant to sentence four of 42 U.S.C. § 405(g)
2. The Clerk is directed to close the file.