SAM A. CROW, Senior District Judge.
On March 13, 2015, plaintiff filed an application for social security disability insurance benefits. Plaintiff alleged a disability onset date of July 6, 2012. The application was denied initially and on reconsideration. An administrative hearing was conducted on May 16, 2017. The administrative law judge (ALJ) considered the evidence and decided on September 8, 2017 that plaintiff was not qualified to receive benefits. This decision has been adopted by defendant. This case is now before the court upon plaintiff's request to reverse and remand the decision to deny plaintiff's application for benefits.
To qualify for disability benefits, a claimant must establish that he or she was "disabled" under the Social Security Act, 42 U.S.C. § 423(a)(1)(E), during the time when the claimant had "insured status" under the Social Security program. See
The court must affirm the ALJ's decision if it is supported by substantial evidence and if the ALJ applied the proper legal standards. See
There is a five-step evaluation process followed in these cases which is described in the ALJ's decision. (Tr. 14-15). First, it is determined whether the claimant is engaging in substantial gainful activity. Second, the ALJ decides whether the claimant has a medically determinable impairment that is "severe" or a combination of impairments which are "severe." At step three, the ALJ decides whether the claimant's impairments or combination of impairments meet or medically equal the criteria of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Next, the ALJ determines the claimant's residual functional capacity and then decides whether the claimant has the residual functional capacity to perform the requirements of his or her past relevant work. Finally, at the last step of the sequential evaluation process, the ALJ determines whether the claimant is able to do any other work considering his or her residual functional capacity, age, education and work experience.
In steps one through four the burden is on the claimant to prove a disability that prevents performance of past relevant work.
The ALJ made the following specific findings in his decision. First, plaintiff meets the insured status requirements for Social Security benefits through March 31, 2018. Second, plaintiff has not engaged in substantial gainful activity since July 6, 2012. Third, plaintiff has the following severe impairments: anxiety; post-traumatic stress disorder (PTSD); adjustment disorder; paranoid personality disorder traits; and obsessive-compulsive disorder (OCD). Fourth, plaintiff does not have an impairment or combination of impairments that meet or medically equal the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. Fifth, plaintiff has the residual functional capacity to perform a full range of work at all exertional levels but with the following non-exertional limitations: plaintiff is limited to simple, routine, repetitive tasks with occasional interaction with coworkers and no interaction with the general public, but plaintiff retains the ability to accept supervision on a basic level. Finally, the ALJ determined that, although plaintiff cannot perform any past relevant work, he could perform such jobs as laboratory equipment cleaner, order filler, and laundry worker. The ALJ further found that these jobs exist in significant numbers in the national and state economy.
Plaintiff's claim for benefits is based upon his mental health and his irritable bowel syndrome (IBS) which seems connected to his mental health. Plaintiff alleges that the mental or emotional stress of work causes his IBS symptoms and that his IBS symptoms exacerbate the mental or emotional stress of work. The record contains opinions from treating sources who discuss the functional limitations caused by plaintiff's IBS. The ALJ mostly agreed with the psychological diagnoses of these sources, but he disagreed with their conclusions regarding the work limitations caused by plaintiff's IBS and mental health conditions. In fact, the ALJ concluded, based upon his review of the medical evidence, that IBS was not a severe impairment for plaintiff and he referenced this conclusion in giving only partial weight to the treating sources' opinions. Plaintiff contends that this conclusion is not supported by substantial evidence.
Plaintiff's first argument to reverse the decision to deny benefits concerns the ALJ's analysis of two treating sources: Dr. Elizabeth Hatcher, plaintiff's treating psychiatrist, and Tyrus Petty, plaintiff's therapist. Part of the ALJ's critique of their opinions was based upon his determination that plaintiff's alleged IBS was not a severe impairment. Plaintiff contends that this conclusion is not supported by substantial evidence.
Plaintiff asserts that the ALJ's analysis of the evidence ignores the interplay between plaintiff's mental or emotional status and his IBS symptoms, i.e., that job stress or anxiety cause his IBS symptoms and his IBS symptoms cause plaintiff job stress and anxiety, and that the combination creates a severe work impairment. Instead of ignoring this possibility, the ALJ's decision addresses it as follows:
(Tr. 17). Before stating this conclusion, the ALJ reviewed the findings contained in numerous medical records and noted plaintiff's testimony that plaintiff does not take medication for IBS and that, after plaintiff stopped working, his IBS symptoms did not improve. (Tr. 16).
So, the court rejects the claim that the ALJ did not consider the combination or interplay of mental and physical impairments in his analysis. The ALJ concluded that he would reject plaintiff's claim for benefits even if he had found that plaintiff's IBS was a "severe" physical impairment. And, as discussed below, the court finds that the ALJ reasonably discounted treating source opinions of plaintiff's functional limitations based upon his consideration of the record, including the severity of plaintiff's IBS symptoms.
In considering a treating physician's opinion, an ALJ must either give it controlling weight or "`articulate[] specific, legitimate reasons for his decision, finding, for example, the opinion unsupported by medically acceptable clinical and laboratory diagnostic techniques or inconsistent with other substantial evidence in the record.'"
Dr. Hatcher completed two medical source statements. In a statement dated January 6, 2016 (Tr. 999-1000), she opined that plaintiff was
Dr. Hatcher's statement dated March 28, 2017 (Tr. 1058-1059) was somewhat different. In the areas marked with an asterisk above, plaintiff was not listed as moderately limited. In the areas marked with two asterisks, plaintiff was listed as markedly limited, at least on bad days. Plaintiff's rating remained moderately or markedly limited in those areas not marked with an asterisk. Plaintiff's ability to carry out detailed instructions and to sustain an ordinary routine without special supervision were listed as moderately to markedly limited, although they were rated as only mildly limited on the January 6, 2016 form.
Both statements from Dr. Hatcher estimated that plaintiff would miss work or leave prematurely at least four days per month. (Tr. 999, 1058).
The ALJ reviewed the notes of plaintiff's examinations by Dr. Hatcher and concluded they showed "no significant abnormalities, other than a tendency to `meander' over many topics." (Tr. 20). He said the examinations showed: full orientation; intact reality; alertness; ability to follow conversations; ability to engage in abstraction; articulate speech; loquacious language; an animated mood/affect; intact memory; pleasant demeanor; and intact attention.
Plaintiff contends that the ALJ's analysis ignores that a visit to Dr. Hatcher might not produce the kind of work stress that plaintiff alleges exacerbated his symptoms. But, plaintiff has testified that his IBS symptoms are no better since he has stopped working. (Tr. 49). This is a "weight of the evidence" issue which the ALJ has the discretion to decide.
The ALJ further noted that, while Dr. Hatcher's mental status examinations were consistent with the consultative examination and conclusions of Dr. Melvin Berg (a consultative examining source), the extreme limitations in Dr. Hatcher's medical source statements were inconsistent with Dr. Berg's report. (Tr. 21). During his visit with plaintiff, Dr. Berg found that plaintiff was outgoing, friendly and lively, and also extremely tense, and nervous and jittery. (Tr. 868). Dr. Berg observed that plaintiff lived alone independently; demonstrated average to superior intellectual ability; logical, coherent, reality-based thinking; good concentration; and adequate memory function. (Tr. 868-870). He found that plaintiff socializes with his parents and church members. (Tr. 869). He determined that plaintiff is able to process simple information, retain and execute simple instructions, persist at simple tasks, and learn and retain new information.
Plaintiff argues that Dr. Berg's report is consistent with Dr. Hatcher's "opinion." Doc. No. 11, p. 19. The ALJ did find consistencies between Dr. Berg's report and Dr. Hatcher's examination findings. (Tr. 22). But, the ALJ was reasonable in concluding that Dr. Berg's report was inconsistent with the "extreme limitations" noted in Dr. Hatcher's medical source statements. (Tr. 21).
The ALJ also commented that notes from Dr. Michael Engelken, a personal physician and treating source, indicated that plaintiff "exhibited no psychiatric abnormalities, with an appropriate and pleasant demeanor, good eye contact, no overt signs of anxiety or depression, and normal speech." (Tr. 17).
The ALJ discounted Dr. Hatcher's assessments, in addition, because they relied "substantially" upon plaintiff's own self-reports. (Tr. 21). Plaintiff contends that the ALJ was being overly speculative and that, in any event, Dr. Hatcher was within her right to rely upon the subjective and objective symptoms she deemed credible.
This is not a persuasive argument to overturn the decision to deny benefits. An ALJ may legitimately consider whether a treating source's opinion relied upon subjective self-reports. See
On June 8, 2015, Mr. Tyrus Petty, LSCSW, submitted a report answering questions regarding plaintiff. (Tr. 961-967). The report indicates that Petty was plaintiff's therapist for three and one-half years beginning in December 2010, while plaintiff was working at a public library. Mr. Petty opines that plaintiff's situation with IBS has worsened so that plaintiff cannot rely upon a symptom-free time or environment. He describes plaintiff's case as involving the interaction of IBS and mental disorders in a manner that has created a "toxic closed loop phenomenon." (Tr. 967). "The IBS attacks cause a severe spike in his mental and emotional state. In turn, an increase in his anxiety will directly ignite an IBS response."
The ALJ gave Mr. Petty's opinion "partial weight." (Tr. 22). He discounted the opinion to the extent it was inconsistent with the medical evidence from physical examinations (which are summarized at Tr. 16, 17 and 23) and relied substantially or overwhelmingly on the claimant's subjective allegations.
As additional support for his decision, the ALJ discussed the breadth of plaintiff's activities of daily living and the reports of three non-examining, non-treating consultants. (Tr. 23-24). Two of the consultants considered plaintiff's mental health symptoms; one considered plaintiff's physical symptoms.
The court finds that the ALJ pointed to sufficient evidence and argumentation to support his evaluation of Mr. Petty's opinion, Dr. Hatcher's opinion, and the ALJ's determination of plaintiff's RFC. The ALJ's decision may not be the only reasonable opinion which may be drawn from the record, but it is a reasonable opinion. IV. DR. BERG'S OPINION VIS-À-VIS PLAINTIFF'S RFC.
Plaintiff's last argument is that the ALJ erred when he gave Dr. Berg's opinion "significant weight" (Tr. 22), but failed to include the limitations suggested in that opinion in his determination of plaintiff's RFC.
To reiterate, the RFC formulated by the ALJ limits plaintiff to simple, routine, repetitive tasks with occasional interaction with coworkers and no interaction with the general public, but plaintiff retains the ability to accept supervision on a basic level. (Tr. 19). Dr. Berg stated that plaintiff "is inconsistent in his ability to accommodate to the demands of superficial interpersonal interaction," although "he can present himself in a very effective manner, as during the consultation and probably in other superficial contacts." (Tr. 870).
The court disagrees with plaintiff's argument for the following reasons. First, the ALJ gave Dr. Berg's opinion "significant weight." He did not declare he was adopting its conclusions verbatim; nor was he required to do so. See
Second, the court finds that the ALJ did incorporate the restrictions discussed in Dr. Berg's report when in the RFC the ALJ limited plaintiff to "occasional interaction with co-workers," "no interaction with the general public," and "supervision on a basic level." This finding is supported by the results in the following cases. In
The court also draws support from:
Plaintiff also contends that the alleged error in incorporating Dr. Berg's opinion in the RFC formulation is not harmless because the vocational expert testified that there would be no work available for plaintiff given the limits suggested by Dr. Berg's report. Again, the court disagrees.
The ALJ asked the vocational expert two similar questions. First, he asked:
(Tr. 57). The expert answered this question "no." But, the expert identified three jobs which could be performed by such an individual. This answer supports the ALJ's finding that plaintiff could perform work present in substantial numbers in the economy.
The other similar question posed by the ALJ was:
(Tr. 58). This question was answered "no" by the vocational expert. The court agrees with plaintiff that it is unclear whether the expert's answer is based upon the inability to interact consistently with supervisors and others, or the absenteeism and punctuality issue, or both. It is also noteworthy to the court that this question does not ask the expert to assume that the individual could accept supervision on a basic level.
While this part of the testimony is not clear, the answer to the first question provides sufficient evidence to support the ALJ's conclusions. Therefore, the court rejects plaintiff's second grounds to reverse the denial of benefits.
For the above-stated reasons, the court denies plaintiff's action to reverse defendant's decision refusing plaintiff's application for social security benefits.