PATRICIA D. BARKSDALE, Magistrate Judge.
This is a case under 42 U.S.C. §§ 405(g) and 1383(c)(3) to review a final decision of the Acting Commissioner of Social Security denying Jacquelyn Spivey-Adams's
Spivey-Adams was born in 1984. Tr. 188. She completed one year of college and has experience as a dance instructor, receptionist, restaurant hostess and server, and sales associate. Tr. 224-25. She alleges she became disabled in June 2006 from kidney problems, Crohn's disease, endometriosis, degenerative disc disease, depression, anxiety, sleep problems, panic attacks, gall bladder removal, acid reflux, a hiatal hernia, migraine headaches, TMJ, and vision loss. Tr. 223. She proceeded through the administrative process, failing at each level. Tr. 1-4, 14-36, 82-125, 128-39, 142-51. This case followed. Doc. 1.
This order adopts the summaries of evidence in the ALJ's decision, Tr. 23-29, and the parties' briefs, Doc. 15 at 17-25; Doc. 17 at 5-7, 11-13, 15-20, 22-24. Some evidence pertinent to the arguments is also summarized below.
In January 2013, Robert Steele, M.D., a state-agency consulting physician, evaluated Spivey-Adams's residual functional capacity ("RFC") and provided the following opinions. Tr. 118-19. In an 8-hour workday, she can occasionally lift and carry 20 pounds, frequently lift 10 pounds, stand or walk more than 6 hours, and sit more than 6 hours. Tr. 118. She can frequently climb ramps or stairs, balance, stoop, kneel, crouch, and crawl and occasionally climb ladders, ropes, or scaffolds. Tr. 119. She has no manipulative, visual, communicative, or environmental limitations. Tr. 119.
In December 2013, Dr. Parghi completed a physical RFC questionnaire. Tr. 790-92. He stated he had seen Spivey-Adams for more than 8 years; diagnosed her with neck pain, back pain, recurrent urinary tract infections, depression, and anxiety; opined her prognosis was fair; and identified "tenderness on [palpation] of lumbar and cervical spine" as the clinical findings and objective signs supporting his opinions. Tr. 790. He provided the following opinions on her functional limitations. During a typical workday, her pain or other symptoms will occasionally be severe enough to interfere with attention and concentration necessary to perform even simple work tasks. Tr. 790. She can walk one block without rest or severe pain, sit for one hour at a time before needing to get up, and stand for 45 minutes at a time before needing to sit down or walk around. Tr. 791. In an 8-hour workday, she can sit for 4 hours and stand or walk for less than 2 hours. Tr. 791. In an 8-hour workday, she would need unscheduled 15-minute breaks about every 2 hours. Tr. 791. She need not elevate her legs while sitting or use an assistive device while standing or walking. Tr. 791. She can frequently lift less than 10 pounds, occasionally lift 10 pounds, rarely lift 20 pounds, and never lift 50 pounds. Tr. 791. She does not have significant limitations in reaching, handling, or fingering. Tr. 792. In an 8-hour workday, she can grasp 75 percent of the time, perform fine manipulations 60 percent of the time, and reach 50 percent of the time with both hands. Tr. 792. Her impairments are likely to produce good days and bad days. Tr. 792. She is likely to be absent from work more than 4 days a month on average because of impairments or treatment. Tr. 792. She needs to lie down for about an hour during an 8-hour time period. Tr. 792.
In February 2014, a kinesiotherapist
Tr. 819 (errors in original). Under a section titled, "MUSCULOSKELETAL SCREEN (COMMENTS)," the evaluator stated:
Tr. 821.
In February 2014, Dr. Arcila completed a physical RFC questionnaire. Tr. 800. She stated she sees Spivey-Adams once a month; diagnosed her with lumbar disc displacement, lumbago, post-laminectomy syndrome, chronic pain syndrome, and Crohn's disease; and identified the functional capacity evaluation as the objective evidence supporting her opinions. Tr. 800. She provided the following opinions. During a typical workday, Spivey-Adams's pain or other symptoms will constantly be severe enough to interfere with attention and concentration necessary to perform even simple work tasks. Tr. 800. She can walk 3 to 4 blocks without rest or severe pain and stand for 30 minutes at a time before needing to sit down or walk around. Tr. 801. In an 8-hour workday, she can sit for 3 to 4 hours and stand or walk for 2 to 3 hours. Tr. 801. In an 8-hour workday, she would need unscheduled breaks consistent with the findings in the functional capacity evaluation. Tr. 801. She need not elevate her legs while sitting or use an assistive device while standing or walking. Tr. 801. She can frequently lift less than 10 pounds but never more. Tr. 801. She has no significant limitations with reaching, handling, or fingering. Tr. 802. In an 8-hour workday, she has no limitations in grasping or performing fine manipulation and can reach 67 to 100 percent of the time with both hands. Tr. 802. Her impairments are likely to produce good days and bad days. Tr. 802. She is likely to be absent from work more than 4 days a month on average because of impairments or treatment. Tr. 802. She needs to lie down for 2 to 3 hours during an 8-hour time period. Tr. 802.
In August 2014, Dr. Hussain provided the following answers to interrogatories (he answered yes or no to most questions posed). Tr. 822-23. He has been treating Spivey-Adams since January 2014 for impairments including post-laminectomy syndrome, lumbar disc displacement, lumbosacral spondylosis, lumbago, and chronic pain syndrome. Tr. 822. He is familiar with and has access to the medical records from the Institute of Pain Management from before then. Tr. 822. He reviewed the February 2014 functional capacity evaluation and Dr. Arcila's physical RFC questionnaire, and the findings and opinions in them are consistent with treatment records from the Institute of Pain Management and his examination findings and accurately reflect Spivey-Adams's work capabilities. Tr. 822-23. Spivey-Adams's reports of significant pain limiting her ability to engage in prolonged sitting, standing, walking, or lifting and restricting her to part-time work and limited activities of daily living are consistent with her impairments, his examination results, and his clinical and objective findings. Tr. 823. Under "COMMENTS," he wrote:
Tr. 823.
At a 2014 hearing, Spivey-Adams testified as follows.
She attended some college in 2005 or 2006. Tr. 43. Medical records indicating she attended college classes in late 2011 are wrong. Tr. 43-45, 62-63. She has tried looking for low-cost health care options but has found none she can afford. Tr. 45-46. She works as a server at a restaurant for 3- to 4-hour shifts about 4 days a week. Tr. 48-49. She frequently lifts up to 15 pounds. Tr. 49. She does not believe she can work full time because she has difficulty standing for more than 2 hours because of severe back pain. Tr. 49-50. The last time she worked full time (in 2004 or 2005), she got "very sick" after about two months and experienced pain and exhaustion. Tr. 50.
She sees a pain-management physician once a month, a primary-care doctor about once every three months, and recently returned to Dr. Arnold Graham Smith (a neurosurgeon) to have him review an MRI. Tr. 50, 64. He indicated the image was not clear enough for him to "see what he needed to see." Tr. 64. He suggested additional tests, but she did not pursue them because she has no insurance. Tr. 64. She last saw Dr. Smith several years earlier, when she had back surgery. Tr. 50-51, 63. The surgery did not resolve her back pain, so she continued to follow up with him to improve her back pain until she moved to pain management. Tr. 51, 68. She saw Dr. Arcila for a couple of years at the Institute of Pain Management, and Dr. Arcila "probably knows the most" about her conditions. Tr. 67. She recently began seeing Dr. Hussain because Dr. Arcila left. Tr. 67.
She takes Oxycodone and uses a Fentanyl patch, which she wears all the time and changes every 2 days. Tr. 64. She has been receiving medication through her pain-management doctor since before she underwent back surgery. Tr. 52. She is "kind of used to" most of the side effects because she has been taking medication for so long. Tr. 52. She also has received "different kinds of injections" in her back. Tr. 67-68.
She smokes less than half a pack of cigarettes a day. Tr. 53. She either "borrow[s] a couple [cigarettes] from people" or buys a pack whenever she has some extra money from work. Tr. 53-54.
She can lift at most 5 to 10 pounds frequently but would be in pain afterward. Tr. 54. She can sit for 30 to 45 minutes at a time and stand for about 2 hours at a time before needing to move around or take a break, but she would be in pain afterward. Tr. 54-55. She can walk 15 to 20 minutes a time before sitting down or taking a break. Tr. 55. She has difficulty using stairs. Tr. 55. Since using a walker during her recovery from back surgery, she has not been prescribed an assistive device for walking. Tr. 55. Besides back pain, she has Crohn's disease, experiences stomach cramps and nausea, and occasionally gets kidney stones. Tr. 66-67.
She lives alone in a one-story house that her mother owns. Tr. 55, 58. In a typical workday, she wakes up by 9:30 a.m., showers quickly, and gets dressed. Tr. 56. She leaves for work at about 10:15 a.m., arrives by 11:00 a.m., and begins working at about 11:30 a.m. Tr. 56. She can occasionally lean against a wall or sit down for short periods of time while at work. Tr. 66. She works until 2:30 or 3:00 p.m. Tr. 56. She then returns home and lies down for the rest of the day. Tr. 56. She feels "extremely" tired and sore after working. Tr. 65. She called in sick once after working a night shift longer than her usual shift, and she has been sent home twice because she was in a lot of pain, felt nauseous and exhausted, and "looked sickly." Tr. 65-66. On a nonwork day, she tries to "rest up and save [her] energy for when [she] ha[s] to work." Tr. 56. She does "small things around the house" throughout the day but usually returns to lying down or reclining. Tr. 56. She tries to do small chores such as sweeping a room or cleaning a few dishes and rest in between. Tr. 56-57.
She can dress and bathe herself. Tr. 57. She can prepare simple meals but cannot stand to cook for more than a couple of minutes. Tr. 57. She shops for groceries with help from others. Tr. 57. She typically gathers her laundry and drives to her mother's house, and her mother does the laundry for her. Tr. 57-58. If she is cannot finish dishes, she will have her mother or a friend come over to help. Tr. 58. She must call someone for maintenance issues around the house, and her mother hires people to do yard work. Tr. 58. She leaves the house for no more than a couple of hours to get food or run errands. Tr. 59. She rarely does other activities with friends or family but will occasionally have someone over or go to someone's house to watch a movie. Tr. 59. She does not belong to a group or club. Tr. 59-60. She reads a lot and enjoys doing small crafts such as making bead bracelets or other small jewelry. Tr. 60.
She weighs 118 pounds but used to weigh 196 pounds about a year and a half ago. Tr. 60-61. She knows of no reason for the significant decrease but assumes it is mostly attributable to a healthier diet. Tr. 61-62. She saw her doctor about every month after she began losing weight, and he was unsure if it was attributable to Crohn's disease or something else. Tr. 61. Her weight continued to drop even after she stopped trying to lose weight. Tr. 61. She "[m]ostly" agrees with medical records indicating she had begun exercising more; she does some stretching and tries to walk her dog around her neighborhood. Tr. 61.
The ALJ asked a vocational expert ("VE") to consider a hypothetical person the same age as Spivey-Adams and with her education, work experience, and the following limitations:
Tr. 71-22. The VE testified that person could perform Spivey-Adams's past work as a waitress and could also perform other jobs available in the national economy (cashier II, ticket seller, ticket taker). Tr. 72.
The ALJ asked the VE to consider a person with the same limitations as in the first hypothetical but with the following additional limitations:
Tr. 73. The VE testified that person could not perform Spivey-Adams's past work but could perform other jobs available in the national economy (a reduced number of ticket-taker jobs and collator/operator). Tr. 73-74.
The ALJ asked the VE to consider a person with the same limitations as the second hypothetical but who was limited to sedentary work, "defined as lifting up to ten pounds occasional. Standing and walking for about two hours, and sitting for up to six hours in an eight hour work day with normal breaks." Tr. 74. The VE testified that person could perform jobs available in the national economy (addresser; cutter and paster, press clippings; waxer). Tr. 74-75.
The VE testified three or more unexcused or unscheduled absences or late arrivals "would be considered excessive and result in termination." Tr. 75. The VE testified typically the jobs identified allow for two 15-minute breaks and a 30-minute lunch break. Tr. 75. The VE testified an employee who was off-task for more than 10 percent of a workday "would be unable to sustain competitive employment." Tr. 76.
Spivey-Adams's counsel asked the VE to consider a hypothetical person the same age as Spivey-Adams and with her education and work experience who could "sit for a total of four hours in an eight hour day, . . . stand and walk for less than two hours," and "lift ten pounds occasionally and 20 pounds rarely." Tr. 78. The VE testified those limitations would "eliminate all work." Tr. 78. Counsel asked the VE to consider a hypothetical person who could "sit for three up to four hours in an eight hour day, . . . stand and walk for two to three hours," and "frequently lift up to nine pounds, but never more than nine pounds." Tr. 79. The VE testified those limitations would eliminate all work. Tr. 79.
At step one,
At step two, the ALJ found Spivey-Adams suffers from severe impairments of degenerative disc disease status post-surgery, a history of Crohn's disease, irritable bowel syndrome, and post-laminectomy syndrome. Tr. 20.
At step three, the ALJ found Spivey-Adams has no impairment or combination of impairments that meets or medically equals the severity of any listed impairment in 20 C.F.R. Part 404, Subpart P, Appendix 1. Tr. 21.
After stating she had considered the entire record, the ALJ found Spivey-Adams has the RFC to perform light work as defined in 20 C.F.R. § 416.967(b)
Tr. 21.
The ALJ discussed Spivey-Adams's activities of daily living:
Tr. 26.
The ALJ gave little weight to Dr. Parghi's opinions, explaining:
Tr. 27. She gave little weight to Dr. Hussain's opinions, explaining "the opined severity is also inconsistent with the objective evidence of record, treatment notes[,] and activities of daily living since the alleged onset date." Tr. 27. She relied on the same evidence discussed in evaluating Dr. Parghi's opinions and added:
Tr. 27-28. She gave little weight to Dr. Arcila's opinions, again relying on progress notes from January through October 2013 showing "essentially unremarkable" examination findings and Spivey-Adams's decision to decline lumbar injections. Tr. 28. She added:
Tr. 28. She gave substantial weight to Dr. Steele's opinions because she found them "generally consistent with the overall evidence discussed" in the decision. Tr. 29. She explained she included additional or more restrictive limitations than Dr. Steele found "in an abundance of caution" to address Spivey-Adams's "pain complaints and fatigue complaints, noting her narcotic pain regimen." Tr. 29.
At step four, the ALJ found Spivey-Adams can perform her past relevant work as a waitress. Tr. 29-30. Alternatively, at step five, the ALJ found Spivey-Adams can perform jobs the VE identified (cashier II, ticket seller, and ticket taker) and those jobs exist in significant numbers in the national economy. Tr. 30-31. She therefore found no disability. Tr. 31.
A court's review of an ALJ's decision is limited to determining whether the ALJ applied the correct legal standards and whether substantial evidence supports his findings. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). Substantial evidence is "less than a preponderance"; it is "such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Id. A court may not decide facts anew, reweigh evidence, make credibility determinations, or substitute its judgment for the Commissioner's judgment. Id. A court must affirm the ALJ's decision if substantial evidence supports it, even if the evidence preponderates against the factual findings. Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990).
Spivey-Adams argues substantial evidence does not support the ALJ's decision to give little weight to her treating physicians' opinions because (1) the ALJ did not discuss all factors relevant to evaluation of medical opinions, (2) substantial evidence does not support the finding that the opinions are inconsistent with other medical evidence, (3) substantial evidence does not support the finding that the opinions are inconsistent with her reported activities of daily living and work history, and (4) substantial evidence does not support the finding that Dr. Hussain based his opinions primarily on her subjective complaints. Doc. 15 at 9-17. She argues the ALJ inadequately discussed Dr. Hussain's opinions, giving them at most "cursory" treatment. Doc. 15 at 11. And she argues that, in rejecting her treating physicians' opinions, the ALJ improperly substituted her lay opinions for those of medical experts. Doc. 15 at 17.
The Commissioner responds: (1) Spivey-Adams's arguments are contrary to the standard of review because she points to evidence supporting her claims without acknowledging substantial evidence supports the ALJ's findings; (2) the ALJ considered all factors in evaluating the opinions and was not required to expressly discuss each; (3) substantial evidence supports the findings that the opinions were inconsistent with other medical evidence and Spivey-Adams's activities and were based largely on subjective complaints; (4) the ALJ was not required to compare medical opinions or find a claimant disabled based on the number of consistent medical opinions; (5) the ALJ adequately discussed Dr. Hussain's opinions; (6) the state-agency medical consultants' opinions support the ALJ's decision; and (7) substantial evidence supports the ALJ's evaluation of Spivey-Adams's subjective complaints. Doc. 17 at 4-27.
To be eligible for benefits, a claimant must demonstrate she is disabled. 20 C.F.R. § 416.912(a). A claimant is disabled if "unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." 42 U.S.C. § 1382c(a)(3)(A). The claimant has the burden of persuasion through step four. Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987).
In making a disability determination, an ALJ must consider all relevant record evidence. 20 C.F.R. § 416.920(a)(3). "[T]here is no rigid requirement that the ALJ specifically refer to every piece of evidence in his decision, so long as the ALJ's decision . . . is not a broad rejection which is not enough to enable [the Court] to conclude that [the ALJ] considered [the claimant's] medical condition as a whole." Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005) (internal quotation marks omitted). "[T]he burden of showing that an error is harmful normally falls upon the party attacking the agency's determination." Shinseki v. Sanders, 556 U.S. 396, 409 (2009).
A claimant's RFC is the most she can still do despite her limitations. 20 C.F.R. § 416.945(a)(1). The Social Security Administration uses the RFC at step four to decide if she can perform any past relevant work and, if not, at step five with other factors to decide if there are other jobs in significant numbers in the national economy she can perform. 20 C.F.R. § 416.945(a)(5). The "mere existence" of an impairment does not reveal its effect on a claimant's ability to work or undermine RFC findings. Moore v. Barnhart, 405 F.3d 1208, 1213 n.6 (11th Cir. 2005).
Regardless of its source, the Social Security Administration "will evaluate every medical opinion" it receives. 20 C.F.R. § 416.927(c). "Medical opinions are statements from acceptable medical sources that reflect judgments about the nature and severity of . . . impairment(s), including . . . symptoms, diagnosis and prognosis, what [one] can still do despite impairment(s), and . . . physical or mental restrictions. 20 C.F.R. § 416.927(a). Opinions on issues that are dispositive of a case, such as whether a claimant is disabled or able to work, are not medical opinions because they are opinions on issues reserved to the Commissioner. 20 C.F.R. § 416.927(d)(1).
An ALJ "must state with particularity the weight given to different medical opinions and the reasons therefor." Winschel v. Comm'r of Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011). "In the absence of such a statement, it is impossible for a reviewing court to determine whether the ultimate decision on the merits of a claim is rational and supported by substantial evidence." Id. "Unless [an ALJ] has analyzed all evidence and has sufficiently explained the weight he has given to obviously probative exhibits, to say that his decision is supported by substantial evidence approaches an abdication of the court's duty to scrutinize the record as a whole to determine whether the conclusions reached are rational." Cowart v. Schweiker, 662 F.2d 731, 735 (11th Cir. 1981) (internal quotation marks omitted). If an ALJ does not "state with at least some measure of clarity the grounds for his decision," a court will not affirm simply because some rationale might have supported it. Winschel, 631 F.3d at 1179.
The Social Security Administration generally will give more weight to the medical opinions of treating sources
To be entitled to controlling weight, a treating source's medical opinion must be "well-supported by medically acceptable clinical and laboratory diagnostic techniques and . . . not inconsistent with the other substantial evidence in your case record. 20 C.F.R. § 416.927(c)(2). The term "not inconsistent" means
Social Security Ruling ("SSR") 96-2p, 1996 WL 374188 (July 2, 1996).
Unless the Social Security Administration gives a treating source's opinion controlling weight, it will consider several factors to decide the weight to give a medical opinion: examining relationship, treatment relationship, supportability, consistency, specialization, and any other relevant factor. 20 C.F.R. § 416.927(c). An ALJ need not explicitly address each factor. Lawton v. Comm'r of Soc. Sec., 431 F. App'x 830, 833 (11th Cir. 2011). Some factors, like the treatment relationship, may "sometimes take precedence over other factors, but at other times will not." POMS DI 24515.003(B).
When a claim is before an ALJ, the ALJ assesses a claimant's RFC. 20 C.F.R. § 416.946(c). She need not defer to any medical opinion concerning a claimant's RFC. See 20 C.F.R. § 416.927(d)(3). An ALJ does not "play doctor" when evaluating a claimant's RFC, Castle v. Colvin, 557 F. App'x 849, 853-54 (11th Cir. 2014), even absent a medical opinion concerning the claimant's limitations, cf. Green v. Soc. Sec. Admin., 223 F. App'x 915, 923-24 (11th Cir. 2007) (finding substantial evidence supported ALJ's RFC finding even after he discredited only medical evaluation in record because he relied on office visit records).
Spivey-Adams contends the ALJ failed to consider several factors relevant in evaluating medical opinions, including their consistency with each other and other medical evidence, the nature and length of the treating and examining relationships of the doctors, and their areas of specialization. Doc. 15 at 9-11. Though the ALJ had to consider those factors, she was not required to explicitly address all of them in her decision. See Lawton, 431 F. App'x at 833. Her decision demonstrates she knew and considered that Drs. Parghi, Arcila, and Hussain were Spivey-Adams's treating physicians who had examined her on several occasions.
Substantial evidence supports the ALJ's finding that the opinions are inconsistent with treatment records. As the ALJ observed, several records—including a significant number of treatment records from Drs. Parghi and Arcila—show normal gait and station, normal range of motion, full strength, other mild or normal examination findings and diagnostic imaging, reports that Spivey-Adams's pain medication was at least moderately effective, or less frequent flare-ups of Crohn's disease. Tr. 438-39, 638-41, 644-47, 649-52, 654-57, 660-63, 665-68, 670-73, 675-78, 682, 685-88, 690-93, 695-96, 698-99, 702-04, 706-08, 729, 733-34, 736-37, 739-40, 742-43, 745-46, 748-49, 754, 759, 764-65, 770, 775-76, 778, 783, 789. Records also show Spivey-Adams reported she lost weight through exercise, reported functioning without difficulty, and declined steroid injections despite being offered them. Tr. 675, 733, 736, 742, 754, 764-65, 770, 775, 777, 789.
Citing SSR 96-2p, Spivey-Adams argues that "[t]o find that a medical opinion is `consistent' with the record does not require the utter absence of any inconsistency." Doc. 15 at 11-12 (emphasis in original). And she points to other records showing decreased range of motion, reports of pain and other symptoms and descriptions of the quality of pain, continued treatment for pain, and at least one record purportedly showing she requested and received steroid injections. Doc. 15 at 13-14. Though SSR 96-2p states a medical opinion need not be consistent with all other evidence, it also says this is true only "as long as there is no other substantial evidence in the case record that contradicts or conflicts with the opinion." SSR 96-2p at *3. Multiple normal or mild examination findings over an extended time and Spivey-Adams's activities conflict with the doctors' opinions finding disabling limitations. Spivey-Adams's reliance on other records with different findings
Substantial evidence supports the ALJ's finding that the doctors' opinions were inconsistent with Spivey-Adams's daily activities and work history. The ALJ observed, and the record supports, that Spivey-Adams reported attending college, worked part-time as a server, lived independently, lost weight through exercise, and visited friends. Tr. 48-49, 237-41, 676, 681, 686, 691, 733, 736, 742. Those activities suggest a greater level of functioning than her doctors found.
Spivey-Adams argues her activities and work history are limited and are insufficient to show she can work full-time or overcome medical evidence supporting disability. Doc. 15 at 14-16. The ALJ found Spivey-Adams's subjective complaints not entirely credible, and Spivey-Adams does not challenge that finding. See generally Doc. 15. In any event, Spivey-Adams's activities are not "sporadic or transitory" as she contends, see Doc. 15 at 15, and the ALJ properly found that participation in a variety of activities is inconsistent with medical opinions that Spivey-Adams is incapable of any level of sustained physical activity.
Substantial evidence supports the ALJ's finding that Dr. Hussain's opinions were based primarily on Spivey-Adams's subjective complaints. The functional capacity evaluation, though mentioning some "limited" functional testing, includes virtually no test results aside from grip-strength testing. See Tr. 819-21. Without those, it is impossible to assess the opinions against those findings or determine whether his opinions were based on testing. See 20 C.F.R. § 416.927(c)(3) ("The more a medical source presents relevant evidence to support a medical opinion, particularly medical signs and laboratory findings, the more weight we will give that medical opinion. The better an explanation a source provides for a medical opinion, the more weight we will give that medical opinion."). The evaluation primarily references her subjective reports and does not indicate which limitations, if any, are based on objective functional testing. See Tr. 819-21. Though Dr. Hussain later indicated through interrogatory answers that the limitations were consistent with his treatment and examination of Spivey-Adams, see Tr. 822-23, he provides no specific information. Spivey-Adams points to no treatment records from Dr. Hussain to support his opinions. Though Dr. Hussain stated he reviewed other treatment records from the Institute of Pain Management, as the ALJ observes, they also do not support the extreme limitations reflected in the functional capacity evaluation.
Spivey-Adams argues it is improper for an ALJ to reject a medical opinion as based on subjective complaints where there is nothing suggesting the doctor relied more on subjective complaints than on objective findings. Doc. 15 at 16. Unlike the cases she cites, here there is evidence suggesting Dr. Hussain and the examiner who completed the functional capacity evaluation relied more on subjective complaints. As discussed, the evaluation contains virtually no objective findings and repeatedly references Spivey-Adams's subjective reports of pain.
Spivey-Adams contends the ALJ's discussion of the functional capacity evaluation was "utterly abysmal," asserting the ALJ "only briefly noted it in a parenthetical with reference to its exhibit number . . . without reference to the specific limitations found upon examination." Doc. 15 at 11. Contrary to that assertion, the ALJ specifically referenced the evaluation and the interrogatory answers and described their content in some detail. Tr. 27. On the functional limitations in the evaluation, she observed:
Tr. 27. The ALJ's discussion of those documents demonstrates she adequately considered them. She was not required to list every detail in her decision. Cf. Dyer, 395 F.3d at 1211 ("[T]here is no rigid requirement that the ALJ specifically refer to every piece of evidence in his decision, so long as the ALJ's decision . . . is not a broad rejection which is not enough to enable [the Court] to conclude that [the ALJ] considered [the claimant's] medical condition as a whole.").
Finally, the ALJ did not impermissibly substitute her own lay opinion for those of medical experts. Instead, she fulfilled her duty under the regulations to assess Spivey-Adams's RFC in light of all the evidence in the record. She provided good reasons supported by substantial evidence for giving little weight to Spivey-Adams's treating physicians' opinions.
The Court
The Commissioner substantially revised regulations on the consideration of medical evidence for claims filed on or after March 27, 2017. See 82 Fed. Reg. 5844-01, 5844 (Jan. 18, 2017). Because Spivey-Adams filed her claim before that date, all citations are to the regulations in effect on the date of the ALJ's decision.