ELIZABETH M. TIMOTHY, Magistrate Judge.
This case has been referred to the undersigned magistrate judge for disposition pursuant to the authority of 28 U.S.C. § 636(c) and Fed. R. Civ. P. 73, based on the parties' consent to magistrate judge jurisdiction (see docs. 10, 11). It is now before the court pursuant to 42 U.S.C. § 405(g) of the Social Security Act ("the Act"), for review of a final decision of the Commissioner of the Social Security Administration ("the Commissioner of the SSA") denying Plaintiff's applications for disability insurance benefits ("DIB") under Title II of the Act, 42 U.S.C. §§ 401-34, and supplemental security income ("SSI") under Title XVI of the Act, 42 U.S.C. §§ 1381-83.
Upon review of the record, the court concludes that the findings of fact and determinations of the Commissioner are supported by substantial evidence and comport with proper legal principles; thus, the decision of the Commissioner is affirmed.
On November 10, 2008, Plaintiff filed applications for DIB and SSI, and in each application she alleged disability beginning October 16, 2007 (tr. 21).
In denying Plaintiff's claims, the ALJ made the following relevant findings (see tr. 21-33):
(a) Plaintiff meets the insured status requirements of the Act through December 31, 2010.
(b) Plaintiff has not engaged in substantial gainful activity since October 16, 2007, the alleged onset date.
(c) Plaintiff has the following severe combination of impairments: human immunodeficiency virus ("HIV"), obesity, myofascial pain, knee pain, hypertension, headaches, status post alcohol abuse, and depression. Plaintiff's asthma is a nonsevere impairment.
(d) Plaintiff does not have an impairment or combination of impairments that meets or medically equals one of the impairments included in 20 C.F.R. Part 404, Subpart P, Appendix 1.
(e) Plaintiff has the residual functional capacity ("RFC") to perform light work,
(f) Plaintiff is capable of performing her past relevant work as a customer service representative, which work does not require the performance of activities precluded by her RFC. Alternatively, based on the testimony of the VE and in light of Plaintiff's age, education and work experience, there are other jobs existing in significant numbers in the national economy that Plaintiff can perform, specifically, the jobs of non-postal mail clerk and usher.
(g) Plaintiff has not been under a disability, as defined in the Act, from October 16, 2007, through the date of the decision.
Review of the Commissioner's final decision is limited to determining whether the decision is supported by substantial evidence from the record and was a result of the application of proper legal standards.
The Act defines a disability as an "inability 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 12 months." 42 U.S.C. § 423(d)(1)(A). To qualify as a disability the physical or mental impairment must be so severe that the claimant is not only unable to do her previous work, "but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." Id. § 423(d)(2)(A). Pursuant to 20 C.F.R. § 404.1520(a)-(g),
1. If the claimant is performing substantial gainful activity, she is not disabled.
2. If the claimant is not performing substantial gainful activity, her impairments must be severe before she can be found disabled.
3. If the claimant is not performing substantial gainful activity and she has severe impairments that have lasted or are expected to last for a continuous period of at least twelve months, and if her impairments meet or medically equal the criteria of any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1, the claimant is presumed disabled without further inquiry.
4. If the claimant's impairments do not prevent her from doing her past relevant work, she is not disabled.
5. Even if the claimant's impairments prevent her from performing her past relevant work, if other work exists in significant numbers in the national economy that accommodates her RFC and vocational factors, she is not disabled.
The claimant bears the burden of establishing a severe impairment that keeps her from performing her past work. 20 C.F.R. § 404.1512. If the claimant establishes such an impairment, the burden shifts to the Commissioner at step five to show the existence of other jobs in the national economy which, given the claimant's impairments, the claimant can perform.
Plaintiff asserts that the decision denying benefits should be reversed because (1) the opinions of treating physicians Michelle Brandhorst, M.D., and Lokaranjit Chalasani, M.D., were not given great weight; and (2) the ALJ failed to resolve a conflict between the VE's testimony and the Dictionary of Occupational Titles ("DOT").
Under what is known as the "treating physician's rule," substantial weight must be given to the opinion, diagnosis, and medical evidence of a treating physician unless there is good cause to do otherwise. See
In this case, the ALJ stated that he found Dr. Brandhorst's August 31, 2010, clinical assessment of pain ("CAP") form to be inconsistent with her treatment notes and thus that it was entitled to "no weight"
First, the cases Plaintiff cites in support of this argument are from district courts in the Eleventh Circuit, not the Eleventh Circuit Court of Appeals. Thus the cases are not binding Eleventh Circuit precedent.
The ALJ discussed at length the records concerning Plaintiff's high blood pressure and related headache complaints, including the records from Dr. Brandhorst that referenced these conditions (tr. 26-27). He found that the degree and frequency of, as well as the treatment for, these conditions to have been inconsistent and limited (id., citing tr. 876-987). Dr. Brandhorst's medical records also refer to Plaintiff's complaints of and treatment for insomnia (tr. 912-14), moderate asthma (tr. 889-90, 901-02), chest wall pain (tr. 887-88), and moderate arthritis (tr. 882-83, 891-92), although the ALJ did not specifically discuss this information. Especially in a medical record the size of the instant one, that the ALJ did not discuss in detail all of Dr. Brandhorst's findings is not surprising. Nor does it mean that the ALJ did not consider all of Dr. Brandhorst's findings. See
Next, the court addresses Plaintiff's claim that Dr. Chalasani's assessment of her mental impairments was wrongly rejected. The ALJ found that "[n]o evidentiary weight can be given to the opinion [rendered by Dr. Chalasani on July 1, 2010]"
A social security claimant generally is permitted to present new evidence at each stage of the administrative process. See 20 C.F.R. § 404.900(b); see also
The evidence Plaintiff submitted to the Appeals Council consists of four Medication Management notes evidently prepared by (but not bearing the signature of) Dr. Chalasani and an unsigned Formal Treatment Plan Review note prepared by an unidentified source. The earliest of Dr. Chalasani's Medication Management notes is dated August 31, 2009 (tr. 1036-37). With respect to the objective portion of the examination, Dr. Chalasani noted that Plaintiff appeared to be alert, oriented times three, calm, cooperative, and well-groomed with "good ADLs [activities of daily living]" (tr. 1036). Her speech was within normal limits and her thought process was goal-directed, but her mood was dysphoric and her affect was blunt (id.). There were no overt psychotic symptoms, and Plaintiff denied homicidal or suicidal ideation, intent, or plan. Plaintiff displayed fair cognitive ability, insight, and judgment (id.). Dr. Chalasani's diagnoses were depressive disorder, not otherwise specified ("NOS"), and mood disorder, secondary to general medical condition (id.). Plaintiff's global assessment of functioning ("GAF") score was 55 (id.).
Dr. Chalasani's next Medication Treatment note is dated March 18, 2010 (tr. 1034-35), or more than six months after her prior reported visit on August 31, 2009. Plaintiff reported that she continued to be "at baseline with very minimal response to the medication" for her mood symptoms (tr. 1034). She again refused individual therapy (id.). Dr. Chalasani's objective observations, diagnoses, and estimate of Plaintiff's GAF score were similar to those he made in his August 2009 report (id.). Dr. Chalasani continued Plaintiff's medications and advised her to return in three months for follow-up (id.). Dr. Chalasani next saw Plaintiff on June 22, 2010, when she reported that her mood "`was a little better'" (tr. 1033). Dr. Chalasani noted that "[o]verall, the patient appears to be maintaining treatment gains and tolerating the medication well. The patient denies any exacerbation of her mood or anxiety symptoms" (id.). Dr. Chalasani's objective observations, diagnoses, and estimate of Plaintiff's GAF score were similar to those he made in his August 2009 and March 2010 reports (id.). Plaintiff's medications were continued, and she was advised to return in three months (id.).
Dr. Chalasani's final treatment note is dated September 22, 2010 (tr. 1031), or about three months after her prior visit. Plaintiff reported that she continued to feel depressed "at times" and had trouble with her energy level and fatigue (id.). Plaintiff had some difficulty sleeping, but she denied any medication side effects (id.) Dr. Chalasani's objective observations, diagnoses, and estimate of Plaintiff's GAF score were similar to those he made in his three prior reports (id.). Dr. Chalasani adjusted Plaintiff's medications and advised her to return in four to six weeks to monitor her progress and also to check for side effects (id.). Also on September 22, 2010, a Formal Treatment Plan Review was completed (tr. 1030). The Review indicates that, with respect to Plaintiff's progress toward goals, her "depression has decreased some since she was last seen in July" (id.). She talked more with her friends and family, but her mood swings remained the same (id.). It was noted that Plaintiff wished to continue to receive services at Lakeview Center; she was encouraged to continue her medications as prescribed and informed of counseling services (id.).
In this case, because Plaintiff submitted the evidence to the Appeals Council, the court must consider whether remand under sentence four is warranted. The court concludes it is not, as Plaintiff has not made the requisite showing. While the additional records Plaintiff submitted to the Appeals Council may be said to establish her treating relationship with Dr. Chalasani, they do not support the numerous "marked[ly]" severe findings made in his July 2010 psychological assessment (tr. 860-62). Importantly, the GAF scores Dr. Chalasani assessed were consistently in the mid "moderate" range (tr. 1031, 1033, 1034, 1036). Also, Plaintiff's reports to Dr. Chalasani suggest that her medications were helping and her symptoms were somewhat better. For example, on June 22, 2010, or fewer than ten days prior to Dr. Chalasani's July 1, 2010, assessment, Plaintiff reported that her mood "`was a little better,'" and Dr. Chalasani noted that "[o]verall, the patient appears to be maintaining treatment gains and tolerating the medication well. The patient denies any exacerbation of her mood or anxiety symptoms" (tr. 1033). Moreover, Dr. Chalasani's Medication Management notes do not reflect that he conducted any objective standardized tests, other formal tests, or in-depth evaluations or treatments. In short, Dr. Chalasani's notes simply do not contain enough findings to support his opinion that Plaintiff had a "marked" inability to ask simple questions or request assistance; get along with co-workers or peers; understand, remember and carry out complex instructions; maintain attention and concentration for extended periods; perform activities within a schedule, maintain regular attendance and be punctual within customary tolerances; sustain a routine without special supervision; or complete a normal workday and workweek without interruptions from psychologically based symptoms and perform at a consistent pace without an unreasonable number and length of rest periods. Dr. Chalasani's Medication Management notes also are insufficient to show that Plaintiff suffered a "marked" constriction of interests or deterioration in personal habits. The court also observes that the Medication Management notes reflect that although Plaintiff presented to Dr. Chalasani in order to obtain medications, Plaintiff repeatedly declined to accept therapy—the psychological records for which, if she had agreed to participate, might have adequately documented the level of impairment in the areas of Dr. Chalasani's psychological assessment. In any event, without sufficient documentation from a treating source—which, as noted, is not provided by Dr. Chalasani's Medication Management Notes or the Formal Treatment Plan Review—Dr. Chalasani's July 2010 psychological assessment reflecting "marked" impairment in nine of nineteen areas lacks adequate support.
In sum, the information contained in Dr. Chalasani's four reports from August 2009 and March, June, and September 2010 (and the September 22, 2010, Formal Treatment Plan Review) is not sufficient to support Dr. Chalasani's July 2010 psychological assessment. These records therefore do not render the ALJ's actions, findings, or conclusions contrary to the weight of the evidence of record, and they do not render the denial of benefits erroneous. 20 C.F.R. § 404.970(b). Thus, a remand pursuant to sentence four of § 405(g) based on the additional evidence Plaintiff submitted to the Appeals Council is not warranted.
Plaintiff also argues that if the ALJ had "misgivings" about her treating relationship with Dr. Chalasani, he should have recontacted Dr. Chalasani to seek additional information so that he could make an informed decision as to the weight Dr. Chalasani's opinion should be given (doc. 19 at 12).
"[A] hearing before an ALJ is not an adversarial proceeding" and "the ALJ has a basic obligation to develop a full and fair record."
In this case, the court concludes that the medical evidence concerning Plaintiff's alleged mental impairment was sufficient for the ALJ to decide the case. As previously noted, the records from Lakeview Center, which span the period before and after the date Plaintiff alleges disability, do not support a finding of disability. See n.16, supra. The ALJ also reviewed evidence from Frank A. Brown, Ph.D., a psychologist who examined Plaintiff at the request of the State agency in February 2009. Dr. Brown assessed Plaintiff with depression of mild to moderate severity and a GAF score of 60, which indicated only mild symptoms (tr. 577). Additionally, State agency psychologist Robert Schilling, Ph.D., a non-examining consultant, examined Plaintiff's records and opined in February 2009 that Plaintiff had depression of mild to moderate severity (tr. 590) and anxiety disorder, NOS (tr. 592). Rating Plaintiff's functional limitations, Dr. Schilling estimated that Plaintiff had a mild degree of limitation with respect to the restrictions of activities of daily living and difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, persistence, or pace; and no episodes of decompensation (tr. 597). On a mental RFC Assessment, Dr. Schilling found that Plaintiff had no "marked" limitations and was "moderately" limited in four of twenty domains; in the remaining sixteen domains Plaintiff was "not significantly limited" (tr. 601-02). Similarly, although not identically, non-examining consultant Robert Stainback, Ph.D., found in a mental RFC that Plaintiff had no "marked" limitations and was "moderately" limited in four of twenty domains; in the remaining sixteen domains Plaintiff was "not significantly limited" (tr. 745-46). Dr. Stainback also estimated that Plaintiff had no functional limitations with respect to restrictions of activities of daily living; mild difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, persistence, or pace; and no episodes of decompensation (tr. 741).
In short, the court concludes that the record was sufficient for the ALJ to make a decision without the need to recontact Dr. Chalasani merely because the ALJ decided to reject Dr. Chalasani's July 2010 opinion. In light of the substantial evidence in the record, the ALJ had the necessary information to determine Plaintiff's mental impairment and associated functional limitations. Moreover, Plaintiff has not alleged, much less shown, that she suffered prejudice as a result of any failure of the ALJ to recontact Dr. Chalasani. There is no allegation or evidence the ALJ's decision would have changed in light of any additional information. Indeed, the court has concluded the contrary with respect to the additional records that were submitted to the Appeals Council. Consequently, the ALJ did not err by failing to recontact Dr. Chalasani.
Plaintiff also contends that the Commissioner's decision should be reversed because the ALJ failed to resolve a conflict between the VE's testimony and the DOT, as required by Social Security Ruling ("SSR") 00-4p.
The court first notes that Plaintiff cites not even one case in support of her contention that having the mental RFC to perform only "simple, routine tasks" and retaining the ability to understand, remember, and carry out only very short and simple instructions limits her "to a Reasoning Development level of 1" (doc. 19 at 19). In any event, contrary to Plaintiff's assertion, the court notes that "[m]ost courts which have addressed this issue have held that the requirement of Reasoning Level 2 or 3 is not inconsistent with the ability to perform only simple tasks."
In the instant case, the court concludes that, even if Plaintiff has the mental RFC to perform only "simple, routine tasks" and retains the ability to understand, remember, and carry out only very short and simple instructions, these capacities are consistent with a reasoning level of two or three, not a reasoning level of one as posited by Plaintiff. As no conflict exists between the VE's testimony and the DOT concerning Plaintiff's ability to work as a customer service representative or non-postal mail clerk [requiring a reasoning development level of three], or concerning her ability to work as an usher [requiring a reasoning development level of two], the ALJ committed no error.
Additionally, in a recent unpublished case from the Eleventh Circuit,
Finally, even if there was an actual conflict between any part of the VE's testimony and the DOT, in the Eleventh Circuit the VE's testimony trumps the DOT.
For the foregoing reasons, the Commissioner's decision is supported by substantial evidence and should not be disturbed. 42 U.S.C. § 405(g);
Accordingly, it is
1. That the docket shall reflect that Carolyn W. Colvin, the Acting Commissioner of Social Security, is the Defendant in this case.
2. That the decision of the Commissioner is
In her memorandum, Plaintiff cites the record in some detail with respect to the procedural aspects of the case, as well as with respect to the testimony that was given at the administrative hearing. Plaintiff does not, however, provide a detailed analysis of the extensive medical record in this case, and she offers very few citations to the medical record in support of her factual contentions. While the court has conducted a review of the relevant medical record in this case, it is not obliged to scour the record in order to locate support for Plaintiff's claims. Accordingly, as the Scheduling Order cautions, to the extent Plaintiff has failed to support her factual contentions with accurate, precise citations to the record, those contentions may be disregarded for lack of proper development.