JOHN J. O'SULLIVAN, District Judge.
THIS MATTER is before the Court on the Plaintiff's Motion for Summary Judgment with Supporting Memorandum of Law (DE# 18, 11/06/2013) and the Defendant's Motion for Summary Judgment with Supporting Memorandum of Law (DE #23, 02/05/2014). The plaintiff seeks reversal of the Social Security Administration's denial of Supplemental Security Income (hereinafter "SSI") Benefits. In the alternative, the plaintiff requests a remand for further administrative proceedings. The complaint was filed pursuant to the Social Security Act, 42 U.S.C. §405(g) (hereinafter "Act"), and is properly before the Court for judicial review of a final decision of the Commissioner of the Social Security Administration (hereinafter "SSA"). This matter was referred to the undersigned by the Clerk's Notice of Magistrate Assignment (DE# 3, 06/07/13). Having carefully considered the filings and applicable law, the undersigned recommends that the Administrative Law Judge's (hereinafter "ALJ") decision be upheld, that the Defendant's Motion for Summary Judgment (DE# 23, 02/05/2014) be
On August 4, 2009, the plaintiff filed an application for Social Security Income (SSI). (Tr. 135-42). In her application, the plaintiff alleged disability beginning on March 1, 2009. (Tr. 135-42). The plaintiff's application was denied initially on September 24, 2009, and upon reconsideration on January 22, 2010. (Tr. 72-74, 79-80). An administrative hearing was held on June 10, 2011. (Tr. 44-59). The plaintiff testified at the hearing and was represented by counsel. (Tr. 45-54). Mr. Nicholas Fidanza, a vocational expert (hereinafter "VE"), also testified at the hearing. (Tr. 54-59). The ALJ found that the plaintiff was not disabled within the meaning of the Act. (Tr. 26-37). The ALJ's decision became final when the Appeals Council denied the plaintiff's request for review on April 16, 2013. (Tr. 1-8).
The plaintiff was born in Honduras on August 22, 1958. (Tr. 52-53, 135). The plaintiff is a naturalized U.S. citizen. (Tr. 52-53, 135). The plaintiff lives at home with her husband, two adult daughters and a grandchild. (Tr. 50). The plaintiff has an eighth grade education. (Tr. 48, 169). At the time of her administrative hearing, the plaintiff was fifty-two years old. (Tr. 48). The plaintiff does not smoke, drink alcohol or take drugs. (Tr. 317). The plaintiff has past relevant work as a self-employed street vendor selling perfumes and toys (Tr. 49, 165, 171-72). The plaintiff initially reported that she was a self-employed salesperson from 2000 to 2007, working eight hours per day, four days per week, and earning $150.00 per week income. (Tr. 165). The plaintiff later reported and testified that she was self-employed in 2009, working part-time, five hours per day for three or four days. (Tr. 32, 49-50, 357). The plaintiff testified that she stopped working in 2009 because she became depressed and had joint pain. (Tr. 49-51). The plaintiff alleged disability beginning March 1, 2009, but filed her disability claim on August 4, 2009. (Tr. 135-42, 164). The plaintiff has described her weekly activities as watching television, light cleaning, doing laundry, preparing daily meals, and occasionally socializing with friends and family. (Tr. 29, 179-84, 213-21, 313). The plaintiff also has the ability to care for her own personal hygiene and groom herself independently. (Tr. 29, 179-84, 213-21).
The plaintiff alleges disability, in part due to osteoarthritis and hypertension. (Pl.'s Motion for Summ. J. at 11). The plaintiff's counsel noted during the administrative hearing that the plaintiff did not receive medical treatment for osteoarthritis. (Tr. 48). On September 11, 2009, John J. Catano, M.D., conducted a physical consultative examination where the plaintiff gave a subjective complaint of join pain. (Tr. 316). At that medical exam, the plaintiff denied problems standing, walking, lifting, sitting, or communicating. (Tr. 316). A physical examination of the plaintiff's extremities and joints revealed that she had no clubbing, cyanosis or edema. (Tr. 317). The plaintiff's joints appeared normal, having a normal range of motion. (Tr. 317). Dr. Catano found no evidence of inflammatory or deforming arthritis or athropathy of any joint. (Tr. 317). Dr. Catano also observed that the plaintiff was able to button and unbutton her clothing. (Tr. 317). The plaintiff was also able to pick up coins. (Tr. 317). The plaintiff walked with normal gait, ambulated without any assistive device, and had a good grip on both hands. (Tr. 316-17). The plaintiff's speech was fluent and clear. (Tr. 316). There was no presence of atrophy. (Tr. 317). The plaintiff had no muscle spasm or tenderness on her neck with full range of motion. (Tr. 318). An examination of the plaintiff's lower back revealed that she had mild tenderness and spasm on the paraspinalis muscle. (Tr. 318). The range of motion of plaintiff's low back was to 70 degrees of anterior flexion. (Tr. 318). The plaintiff had no difficulty getting in and out of a chair and on and off the examining table by herself. (Tr. 318). Dr. Catano observed that the plaintiff could tandem walk and walk on her heels and toes with no difficulty. (Tr. 318).
On neurological examination, the plaintiff's cranial nerves II-XII and cerebella function were intact. (Tr. 318). Mentally, the plaintiff was oriented in three planes and had no psychotic features. (Tr. 318). The plaintiff's cognitive level and language skills were intact. (Tr. 318). Dr. Catano noted, however, that the plaintiff seemed depressed, and recommended that she have a thorough psychological evaluation. (Tr. 318). Dr. Catano's diagnostic impression is listed below:
(Tr. 318).
On September 21, 2009, Single Decisionmaker
On October 3, 2009, the plaintiff was taken to the emergency department at Hialeah Hospital for a headache and was admitted for monitoring. (Tr. 577-86). A CT scan of the head without contrast found no significant abnormalities. (Tr. 580). A neurological examination was negative for gait disturbance, syncope, and weakness. (Tr. 582). The exam was also negative for focal neurological deficits. (Tr. 583). The plaintiff had a blood pressure reading of 153/100, which improved with Clonidine medication. (Tr. 584). The plaintiff was discharged the next day in stable condition. (Tr. 584).
On October 5, 2009, Marlene Jalice, ARNP
On October 12, 2009, the plaintiff was readmitted to Palm Springs General Hospital and sent to the emergency room for a headache and nausea. (Tr. 357). Following a physical examination, where the plaintiff was found to have a good grip and steady gait, the plaintiff was released. (Tr. 373).
On December 29, 2009, State Agency physician Dr. Stanley determined that the plaintiff's physical conditions were not severe. (Tr. 405). Dr. Stanley noted that there was no physical worsening or new limits. (Tr. 405). On December 29, 2010, Marlene Jalice, ARNP of Citrus Health Network, issued a progress report for a follow-up, noting that the plaintiff had benign essential hypertension. (Tr. 521). The report indicated that the hypertension was well controlled when treated with medication. (Tr. 521).
The plaintiff alleges disability, in part due to depression. (Pl.'s Motion for Summ. J. at 2, 11). The plaintiff received treatment for depression at Citrus Health Network from April 2009 to May 2011. (Tr. 296-311, 376-82, 477-563). Berta M. Guerra, M.D., saw the plaintiff for medication management. (Tr. 306-09). Erika Pablos-Velez, M.A., was the plaintiff's psychotherapist. (Tr. 479-481). The plaintiff failed to show up for several appointments in the period from November 23, 2009, through February 8, 2011. (Tr. 378, 380, 477, 479, 481, 484-88, 490, 493, 495, 497, 504, 511). During this period of treatment, the plaintiff went through multiple medication changes. (Tr. 296-297, 482, 502, 512, 514-15, 534-35, 538-39). The plaintiff reported that she had variable sleep, an anxious mood, mood swings, and occasional racing thoughts. (Tr. 483, 487, 506, 512, 514, 554-55). The plaintiff's diagnosis remained bipolar disorder and psychotic disorder. (Tr. 563).
On July 7, 2009, the plaintiff was admitted for monitoring at Palmetto General Hospital after stating that she had overdosed on medication and was dealing with multiple stressors. (Tr. 255-56, 261, 285, 421-76). The plaintiff was Baker Acted secondary to death wishes and suicidal ideation. (Tr. 255-258). The plaintiff's toxicology screen was negative, and she reported no recent hospitalization. (Tr. 256). It was also reported that the plaintiff was not on any psychiatric medication. (Tr. 256). The plaintiff was diagnosed with major depressive disorder with psychotic features. (Tr. 268). The plaintiff was discharged the following day and given medication. (Tr. 254, 304-05). The plaintiff was also given instruction to follow up with Dr. Berta Guerra. (Tr. 254, 304-05 )
On September 9, 2009, the plaintiff underwent a psychological evaluation conducted by Mary D. DeCruise, Psy.D. (Tr. 312-15). Dr. DeCruise noted that the plaintiff was disheveled, fairly groomed and her hygiene appeared to be adequate (Tr. 313). The plaintiff was cooperative throughout the interview and was oriented to person, situation and time (Tr. 313). The plaintiff's rate of speech and tone were normal, while her eye contact was fair (Tr. 313). Dr. DeCruise also indicated that the plaintiff's thought process was relevant and coherent (Tr. 313). Throughout the evaluation, the plaintiff's abstract thinking, social judgment, insight and concentration were fair (Tr. 313). During the time of observation, the plaintiff's impulse control appeared to be intact (Tr. 313). The plaintiff denied experiencing any hallucinations or delusions during the evaluation. Furthermore, the plaintiff denied any current suicidal/homicidal ideation. (Tr. 313). The plaintiff was able to read, write, follow instructions and respond to questions (Tr. 313). The plaintiff also demonstrated a vocabulary and sentence structure within what is expected for those within her age group. (Tr. 313). Although the plaintiff performed poorly on Serial 7's
On September 21, 2009, the plaintiff's affective and anxiety-related disorders were found non-severe by psychologist David L. Kirk, Ph.D. (Tr. 323). On October 3, 2009, during an emergency room visit at Hialeah Hospital, the plaintiff denied suicidal/homicidal ideation, hallucinations, or delusions and was alert and awake. (Tr. 583).
On January 19, 2010, David Clay, Ph.D. found that the plaintiff's affective disorder did not meet the "B criteria" of the Listings
On May 23, 2010, the plaintiff was admitted to Hialeah Hospital due to complaints of slurred speech, general weakness, fainting, depression, and chest paints. (Tr. 569). The plaintiff's Brain CT scan was normal (Tr. 565). The plaintiff was given a preliminary diagnosis of having an altered level of consciousness. (Tr. 572). The plaintiff was then discharged and transferred to Palmetto General Hospital for a psychiatric evaluation. (Tr. 406-20, 567). Mark A. Hernandez, M.D. found that the patient was awake, alert, and oriented, but somewhat anxious and depressed (Tr. 413). The plaintiff denied any perceptual disturbances, and her thoughts seemed to be organized and logical. (Tr. 413). The plaintiff also denied any current suicidal or homicidal ideations. (Tr. 413). The plaintiff's diagnostic impression was bipolar disorder, depressed type; hypertension; and osteoporosis. (Tr. 413). Before being discharged, the plaintiff was instructed to follow up with Citrus Health Network. (Tr. 414).
On October 25, 2010, the plaintiff was admitted to Citrus Health Network for inpatient psychiatric treatment. (Tr. 452, 494, 541-52). The plaintiff had expressed suicidal ideation due to a feeling of hopelessness. (Tr. 494). The plaintiff also reported experiencing auditory hallucinations and a difficulty in controlling negative thoughts. (Tr. 494). The plaintiff was prescribed Norvasc, Doxepin and Geodon. (Tr. 542-43). On discharge, the plaintiff was in good and stable condition. (Tr. 541). The plaintiff left on her own and denied any suicidal or homicidal ideas. (Tr. 541).
On November 4, 2010, Dr. Berta Guerra noted that the plaintiff felt better after her hospitalization at Citrus Health Network (Tr. 491). The plaintiff's psychiatrist prescribed Zyprexa, Cogentin, Benadryl, and Paxil, increased her Geodon, and continued the plaintiff on Doxepin and Lithium Carbonate. (Tr. 535).
On November 15, 2010, the plaintiff denied suicidal/homicidal ideation and psychotic symptoms. (Tr. 489). The plaintiff also reported symptom relief since her hospitalization, stating that she felt more positive about the future. (Tr. 489). On January 10, 2011, Erika Pablos-Velez, M.A., noted that the plaintiff had an euthymic mood and stable affect. (Tr. 480). The plaintiff's mental status examination was within normal limits. (Tr. 480). Once more, the plaintiff denied suicidal/homicidal ideation and psychotic symptoms. (Tr. 480).
On April 5, 2011, the plaintiff reported having a better mood and being less depressed. (Tr. 555). The plaintiff again denied suicidal/homicidal ideation and psychotic symptoms. (Tr. 555). The plaintiff was diagnosed with bipolar disorder, NOS; psychotic disorder, NOS; post traumatic stress, DO and hypertension. (Tr. 563). On May 2, 2011, Dr. Berta Guerra indicated that the plaintiff was less depressed. (Tr. 553). The plaintiff denied hypomania or manic symptoms, and again denied any passive or active suicidal/homicidal ideation or psychotic symptoms. (Tr. 553). The plaintiff also mentioned that she was sleeping well. (Tr. 553).
A hearing was held before the ALJ on June 10, 2011. (Tr. 44). At the hearing, the plaintiff gave testimony about her personal history, work history, as well as her alleged physical and mental impairments. (Tr. 49-54). The plaintiff also gave testimony about her medications and the effect of those medications on her daily life. (Tr. 51-54).The plaintiff testified that she "spends days locked in [her] ... room" crying in the dark and sometimes falls into a "state of madness where [she] wants to take pills, and just die." (Tr. 50, 53). The plaintiff also testified that she took pills the day before the hearing. (Tr. 50). At the hearing, the VE classified the plaintiff's past work history under the general title of peddler, which consists of work with medium physical demand and SVP of 3. (Tr. 56). During the hearing, the ALJ proposed a hypothetical mirroring the plaintiff's age, education, and work experience. (Tr. 56). The ALJ added that the plaintiff could only perform the basic demands of unskilled work, carry out simple tasks and engage in occasional social interaction. (Tr. 56-57). Based on this hypothetical, the VE testified that such a person could not perform the plaintiff's past work as a peddler. (Tr. 57). The VE proposed that the plaintiff could be a general laborer, for which 1,000 jobs existed in the tri-county area; a hand packager, for which 1,000 jobs existed in the tri-county area; and a housekeeper, for which 2,000 jobs existed in the tri-county area. (Tr. 57).
"Disability" is defined as the "inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death, or has lasted or can last for a continuous period of not less than twelve months...." 42 U.S.C. §§ 416(I); 423(d)(1); C.F.R. § 404.1505 (2005). The impairment(s) must be severe, making the plaintiff "unable to do his previous work... or any other kind of substantial gainful work which exists in the national economy. ..." 42 U.S.C. § 423(d)(1); 20 C.F.R. § 404.1505-404. 1511 (2005).
To determine whether the plaintiff is entitled to disability benefits, the ALJ must apply a five-step analysis. 20 C.F.R. § 404.1520(a)-(f). The ALJ must first determine whether the plaintiff is presently employed or engaging in substantial gainful activity. If so, a finding of non-disability is made and the inquiry ends.
Second, the ALJ must determine whether the plaintiff suffers from a severe impairment or a combination of impairments. If the plaintiff does not, then a finding of non-disability is made and the inquiry ends.
Third, the ALJ compares the plaintiff's severe impairments to those in the listings of impairments located in Appendix I to Subpart 404 of the Code of Federal Regulations. 20 C.F.R. § 404.1520 (d), Subpart P, Appendix I. Certain impairments are so severe, whether considered alone or in conjunction with other impairments, that if such impairments are established, the regulations require a finding of disability without further inquiry into the plaintiff's ability to perform other work.
Fourth, the ALJ must determine whether the plaintiff has the "residual functional capacity" to perform his or her past relevant work. "Residual functional capacity" (hereinafter "RFC") is defined as "what you can do despite your limitations." 20 C.F.R. § 404.1545(a)(1). This determination takes into account "all relevant evidence," including medical evidence, the claimant's own testimony and the observations of others. Id. If the plaintiff is unable to perform his or her past relevant work, then a prima facie case of disability is established and the burden of proof shifts to the Commissioner to show at step five that there is other work available in the national economy which the plaintiff can perform. 20 C.F.R. § 404.1520(e);
Fifth, if the plaintiff cannot perform his or her past relevant work, the ALJ must decide if he or she is capable of performing any other work in the national economy.
In the instant case, at step one, the ALJ determined that the plaintiff was not employed, and thus not engaged in substantial gainful activity. (Tr. 28). This allowed the ALJ to move to step two to determine whether the plaintiff had a severe impairment or combination of impairments. The ALJ found that the plaintiff had bipolar disorder, depressed type, which was a severe impairment as defined in the regulations at 20 C.F.R. § 416.920(c) (2013). (Tr. 28). The ALJ found the plaintiff's alleged physical impairments, osteoarthritis and hypertension, as non-severe due to the lack of documentation in the medical record of "objective medically acceptable clinical and diagnostic techniques documenting the existence of an underlying impairment that would result in the pain." (Tr. 29). The ALJ's decision was further supported by the absence of documentation of the claimant receiving "consistent and ongoing treatment for these conditions" and the acknowledgment made by the plaintiff's representative that the plaintiff had not been treated for the alleged physical impairments. (Tr. 28).
At step three, the ALJ found that the plaintiff's medically determinable mental impairment of bipolar disorder, depressed type did not meet or equal the severity of one of the listed impairments located in Appendix I to Subpart 404 of the Code of Federal Regulations. 20 C.F.R. § 404.1520 (d), Subpart P, Appendix I. (Tr. 29.) In the decision, the ALJ assessed the four broad functional areas, the "paragraph B" criteria, as required by disability regulations, to determine whether the plaintiff's mental impairment of bipolar disorder, depression type was severe enough to satisfy the listed impairments. (Tr. 29). With regard to the activities of daily living and social functioning, the ALJ found that the plaintiff had no more than a mild restriction. (Tr. 29-30). The ALJ also concluded that the plaintiff had mild difficulties with respect to concentration, persistence or pace. (Tr. 30). In addition, the ALJ determined that the plaintiff had not experienced any episodes of decompensation of extended duration. (Tr. 30-31). In each of the four areas, the ALJ cited the plaintiff's testimony from the administrative hearing or information contained in medical records to support his finding. (Tr. 29-31). Moreover, the ALJ also considered whether the plaintiff's mental impairment satisfied the "paragraph C" criteria. The ALJ found that the plaintiff did not have "a medically documented history of chronic affective disorder of at least two years' duration that has caused more than a minimal limitation of ability to do basic work activities." (Tr. 31).
At step four, the ALJ determined that the plaintiff could not perform her past relevant work, but that the plaintiff had the residual functional capacity to perform a range of unskilled work. Based on the medical record, the ALJ concluded:
(Tr. 31).
At step five, the ALJ determined that there were jobs that existed in significant numbers in the national and local economy that the plaintiff could perform, including working as a general laborer, hand packager, and housekeeper. (Tr. 36-37). In making that determination, the ALJ considered all the medical records in the transcript and relied on the testimony of the VE, which the ALJ found was consistent with the information contained in the Dictionary of Occupational Titles. (Tr. 37).
The Court must determine if it is appropriate to grant either party's motion for summary judgment. Judicial review of the factual findings in disability cases is limited to determining whether the record contains substantial evidence to support the ALJ's findings and whether the correct legal standards were applied. 42 U.S.C. § 405(g) (2006);
The restrictive standard of review, however, applies only to findings of fact. No presumption of validity attaches to the Commissioner's conclusions of law, including the determination of the proper standard to be applied in reviewing claims.
The plaintiff objects to the ALJ's evaluation of the plaintiff's physical and mental conditions. (Pl.'s Motion for Summ. J. at 10). First, the plaintiff contends that the ALJ erred by applying the rules regarding `episodes of decompensation' too mechanically. (Pl.'s Motion for Summ. J. at 14-17). The plaintiff also asserts that the ALJ's RFC determination was erroneous because: (1) the ALJ's finding that the plaintiff had no physical functional limitations was contrary to the medical evidence; and (2) the ALJ did not properly consider the impact of medication side-effects or multiple medication changes on plaintiff's functionality. (Pl.'s Motion for Summ. J. at 10-14). Finally, the plaintiff further argues that the ALJ's mental RFC finding exceeded the mental demands of unskilled work and should have led to a finding of disability. (Pl.'s Motion for Summ. J. at 17-19). The undersigned finds that the ALJ's findings are substantially justified by the record and that the ALJ's decision should be affirmed. See Miles, 84 F.3d at 1400; see also Baker, 880 F.2d at 321.
The plaintiff asserts that the ALJ erred when she found that the plaintiff's bipolar disorder, depressed type did not meet or medically equal the severity of one of the listed impairments found in Appendix I of the Regulations. 20 C.F.R. §§ 404.1520(d), 416.920(d). (Pl.'s Motion for Summ. J. at 14-17). The plaintiff contends that the ALJ erred when she found that the plaintiff did not have any episode of decompensation, each of an extended period because Dr. Clay's evaluation indicated that the plaintiff had at least one or two and the record evidence shows that the plaintiff may have had more than two. (Pl.'s Motion for Summ. J. At 14-17).
To satisfy the "paragraph B criteria" of the medical listings, the mental impairment must result in at least two of the following: 1) marked restriction in activities of daily living; 2) marked difficulties in maintaining social functioning; 3) marked difficulties in maintaining concentration, persistence, or pace; or 4) repeated episodes of decompensation, each of extended duration.
The plaintiff argues that the ALJ rigidly applied the rules for episodes of decompensation, each of extended duration. In the listings, repeated episodes of decompensation, each of extended duration are either three episodes within one year, or an average of once every four months, each lasting for at least two weeks.
The ALJ found that the plaintiff's alleged hypertension and osteoarthritis were non-severe because there was no medical evidence of record documenting "the existence of an underlying impairment that would result in the pain of which the claimant complain...[and] no documentation that the claimant has received consistent and ongoing treatment for these conditions." (Tr. 29). The ALJ also determined that the plaintiff's alleged depression was severe because it "more than minimally [affected] her ability to perform basic work-related functions" (Tr. 28). However, after examining "the entire record", the ALJ concluded that the plaintiff had "no established exertional limitations and thus [had] the residual functional capacity to perform a full range of work at all exertional levels. ...", but with non-exertional limitations that leave the plaintiff mentally capable to meet the basic demands of unskilled work. (Tr. 31).
The ALJ's RFC determination is substantially justified and supported by the record because the medical evidence supports the assessment that the plaintiff lacked severe physical impairments that did not limit the claimant's ability to do basic work activities. Further, the ALJ's finding that the plaintiff's mental impairments did not significantly limit her functionality was based on the totality of all the relevant evidence.
The plaintiff contends that the ALJ did not comply with SSR 96-8p, 1996 WL 374184 (July 2, 1996) (hereinafter "SSR 96-8p"), because the plaintiff has always alleged her physical impairments and the record supports the determination that her physical impairments severely limit her functionality. (Pl.'s Motion for Summ. J. at 10-12). The plaintiff asserts that a finding that a claimant has no physical functional limitations is limited to circumstances where "there is no allegation of a physical or mental limitation or restriction of a specific functional capacity, and no information in the case record that there is such a limitation or restriction with respect to that functional capacity." SSR 96-8p. (Pl.'s Motion for Summ. J. at 11). However, contrary to the plaintiff's contention, SSR 96-8p does not state that an ALJ may only find that a claimant has no physical functional limitations when such circumstances exist, but "in fact uses that language to indicate the circumstances under which an adjudicator must find ... `no limitation or restriction' with respect to that functional capacity.'"
The ALJ's finding that the plaintiff's osteoarthritis and hypertension were non-severe and had no significant limit on the plaintiff's ability to do basic work activities is substantially justified by the record. "An impairment or combination of impairments is not severe if it does not significantly limit [one's] physical or mental ability to do basic work activities." 20 C.F.R. § 416.921(a). Some examples of basic work activities include walking, standing, sitting, pushing, pulling, reaching, and carrying.
The plaintiff has not met her burden. The ALJ substantially supported the determination with the established record evidence. The plaintiff's counsel noted during the administrative hearing that the plaintiff did not receive medical treatment for osteoarthritis. (Tr. 48). The plaintiff denied problems standing, walking, lifting, or sitting. (Tr. 316). Dr. Catano's consultative examination produced no evidence of inflammatory or deforming arthritis. (Tr. 317). Although Dr. Catano indicated that the plaintiff had some difficulty with her lower back, he noted that the plaintiff's examination was otherwise normal. (Tr. 318). The plaintiff admitted to being able to do light cleaning and being able to lift light things. (Tr. 183, 193). Multiple physical examinations documented that the plaintiff has a normal range of motion and a normal gait. (Tr. 317-18, 373-74, 582-83). After a visit to the hospital due to a headache, the plaintiff was discharged in stable condition. At the time of discharge, the plaintiff's high blood pressure had improved with medication. (Tr. 584). Moreover, Citrus Health Network reported that the plaintiff's benign essential hypertension was well controlled when treated with medication. (Tr. 521). Dr. Stanley determined that the plaintiff's physical conditions were not severe, and noted that there was no physical worsening or new limits. (Tr. 405). Single Decisionmaker Tiffany Gray indicated that the plaintiff could occasionally lift and/or carry 50 pounds and frequently lift and/or carry 25 pounds. (Tr. 65). Ms. Gray also noted that the plaintiff could stand, sit and/or walk for a total of about six hours in an eight-hour workday. (Tr. 65). The aforementioned evidence in the record substantially supports the ALJ's finding that the plaintiff was not significantly limited in her physical ability to perform basic work activities.
The plaintiff asserts that the ALJ's RFC finding did not properly consider the impact of medication side effects or multiple medication changes when assessing the plaintiff's mental impairments on her functionality. (Pl.'s Motion for Summ. J. at 12-14). When evaluating the intensity and persistence of a claimant's symptoms and determining the extent to which the claimant's symptoms limit the claimant's capacity for work, the ALJ must consider "all of the available evidence, including [one's] medical history, the medical signs and laboratory findings and statements about how [one's] symptoms affect them." 20 C.F.R. 416.929(a). Some relevant factors to an RFC determination include treatment, other than medication, that one can receive or has received for relief of one's pain or other symptoms and the type, dosage, effectiveness, and side effects of any medication one takes or has taken to alleviate one's pain or other symptoms. 20 C.F.R. 416.929(c)(3)(iv)-(v).
Substantial evidence supports the ALJ's findings because the record does not indicate that the plaintiff had additional functional limitations due to medication side effects. During the hearing, the ALJ solicited testimony regarding the effect of the plaintiff's prescribed medications upon her ability to work. (Tr. 51). The plaintiff testified that she experienced some debilitating side effects due to medication. (Tr. 51-54). As noted by the ALJ, the medical record, however, reveals that the medications had been readily effective in controlling and improving the claimant's symptoms (Tr. 35). The plaintiff's psychiatrist did make numerous medication changes in response to side effects such as anxiety, mood swings, sadness, and irritability, (Tr. 478, 499, 502, 506, 514, 515), but the plaintiff was not taking high levels of psychotropic medications. (Tr. 35, 534-36). While on medication, the plaintiff denied suicidal ideation/homicidal ideation and psychotic symptoms on multiple occasions. (Tr. 313, 413, 480, 489, 553, 555, 583). During the plaintiff's psychological evaluation with Dr. DeCruise, the plaintiff denied experiencing hallucinations or delusions. (Tr. 313). After the plaintiff's final hospitalization for suicidal ideation (Tr. 541-52), the evidence shows that the plaintiff had a marked improvement. During the plaintiff's last several follow-up visits at Citrus Health Network, the plaintiff felt more positive about the future, had an euthymic mood and stable affect, and was less depressed. (Tr. 480, 489, 491, 553, 555). The plaintiff's mental status examination conducted on January 10, 2011, was within normal limits. (Tr. 480). The most recent progress note from Citrus Health Network reported that the plaintiff was less anxious and less depressed. (Tr. 553). The plaintiff also mentioned that she was sleeping well and denied hypomania or manic symptoms. (Tr. 553). At the hearing, the plaintiff stated that she still experienced negative side effects due to medication, but admitted that the medication helped her. (Tr. 51). The ALJ considered all of the relevant evidence such as the objective medical findings and reports as well as the plaintiff's statements. The relevant evidence substantially supports a finding that the plaintiff's subjective complaints about the impact of her medications on her functionality were not fully credible because, even though the plaintiff experienced many medication changes due to side effects, the effectiveness of the plaintiff's psychiatric treatment and the objective medical evidence documented a steady improvement in her condition and demonstrated no functional limitations.
Substantial evidence supports the ALJ's determination that the plaintiff can make a successful adjustment to other work and is not disabled. The plaintiff contends that the ALJ's RFC determination should have led to a finding that the plaintiff was disabled because her limitations demonstrated that she was unable to perform other work. (Pl.'s Motion for Summ. J. at 17-19). The ALJ found that the plaintiff had the RFC to meet the basic demands of unskilled work (Tr. 31). The basic demands of unskilled work include the abilities to understand, carry out, and remember simple instructions; to respond appropriately to supervision, coworkers, and usual work situations; and to deal with changes in a routine work setting.
The plaintiff contends that the plaintiff's mental RFC prevented her from meeting the limitation to engage in simple, routine and repetitive tasks. (Pl.'s Motion for Summ. J. at 18). At step four, the ALJ found that the plaintiff was unable to perform any past relevant work. (Tr. 35). At step five, the ALJ bore the burden "to show the existence of other jobs in the national economy, which, given the plaintiff's impairments, the plaintiff can perform."
The plaintiff alleges that the plaintiff's limitation to relatively few work place changes and occasional public contact are significant non-exertional limitations. (Pl.'s Motion for Summ. J. at 18-19). Substantial evidence supports the determination that these limitations did not prevent the plaintiff from meeting the basic demands of unskilled work. Dr. DeCruise's psychological evaluation noted that the plaintiff's rate of speech and tone were normal while her eye contact was fair. (Tr. 313). Dr. DeCruise also reported that the plaintiff demonstrated an age appropriate vocabulary. (Tr. 313). Moreover, Dr. Clay indicated that the plaintiff could cooperate effectively with the others in completing simple tasks and transactions. (Tr. 399). Dr. Clay also reported that the plaintiff had moderate difficulties in maintaining social functioning and only a mild restriction in the activities of daily living. (Tr. 393). The ALJ's hypothetical to VE asked whether work existed in the national economy for a hypothetical person with the plaintiff's vocational profile and RFC, including the ability "to respond appropriately to changes in a routine work setting, interact appropriately with co-workers, and limited to jobs that do not require more than occasional interaction with the general public." (Tr. 56-57). The VE's testimony stated that, even with these limitations, the hypothetical person could work as a general laborer, hand packager, and housekeeper. (Tr. 36-37, 57). There is no indication in the record evidence or the VE's testimony that the plaintiff's limitation to relatively few work place changes and occasional public contact would significantly limit her ability to perform unskilled work.
Based on all the relevant evidence and the VE's testimony, the ALJ had substantial evidence to find that the plaintiff had the ability meet the basic demands of unskilled work and successfully adjust to other work that exists in significant numbers in the national economy. The undersigned finds that the ALJ's conclusion that the plaintiff was not disabled under the Act and therefore did not qualify for SSI is substantially justified by the record.
In accordance with the foregoing Report and Recommendation, it is
RESPECTFULLY SUBMITTED at the United States Courthouse, Miami, Florida this 15th day of August, 2014.
