DAVID R. GRAND, Magistrate Judge.
Plaintiff Steven M. O'Beirne ("O'Beirne") brings this action pursuant to 42 U.S.C. §405(g), challenging a final decision of Defendant Commissioner of Social Security ("Commissioner") denying his application for Disability Insurance Benefits ("DIB") under the Social Security Act (the "Act"). Both parties have filed summary judgment motions [8, 14], which have been referred to this court for a Report and Recommendation pursuant to 28 U.S.C. §636(b)(1)(B).
For the reasons set forth below, the court finds that substantial evidence supports the Administrative Law Judge's ("ALJ") assessment that O'Beirne is not disabled under the Act. Accordingly, the court recommends that the Commissioner's Motion for Summary Judgment [14] be GRANTED, O'Beirne's Motion for Summary Judgment [8] be DENIED, and that, pursuant to sentence four of 42 U.S.C. §405(g), the Commissioner's decision be AFFIRMED.
On February 2, 2009, O'Beirne filed an application for DIB, alleging disability beginning on May 2, 2008. (Tr. 115-21). The claim was denied initially on June 17, 2009. (Tr. 50-54). Thereafter, O'Beirne filed a timely request for an administrative hearing, which was held on February 3, 2010, before ALJ William Thompson, Jr. (Tr. 27-47). O'Beirne (represented by attorney Joseph Houle) testified at the hearing, as did vocational expert ("VE") Stephen B. Schmidt. (Tr. 31-46). On March 4, 2010, the ALJ found that O'Beirne was not disabled. (Tr. 12-20). On March 31, 2011, the Appeals Council denied review. (Tr. 1-4). O'Beirne filed for judicial review of the final decision on May 10, 2011 [1].
In a February 26, 2009 disability field office report, O'Beirne reported that his alleged onset date was May 2, 2008. (Tr. 135). The claims examiner noted that O'Beirne's "behavior over the phone was normal." (Tr. 136).
In a function report dated March 14, 2009, O'Beirne reported that he lives in a house with his family. (Tr. 150). He indicated that he spends most of his time each day reading, preferably with his legs up to "prevent feelings of syncop[e],"
When asked to identify functions impacted by his condition, O'Beirne checked lifting, squatting, bending, standing, walking, sitting, talking, stair climbing, memory, and concentration. (Tr. 155). He further explained that the syncope is triggered by sitting, coughing, and physical exertion, and that his depression medications affect his mind. (Id.). He claimed he could walk about one block before needing to stop and rest for an hour. (Id.). His ability to pay attention has declined, perhaps because of the medication, but he can follow written and spoken instructions, and he gets along well with authority figures. (Tr. 155-56).
In an undated disability report, O'Beirne indicated that his ability to work is limited by coronary artery disease, neurocardiogenic syncope, depression, and panic attacks. (Tr. 159). When asked how these conditions limit his ability to work, O'Beirne stated:
(Id.). O'Beirne reported that these conditions first interfered with his ability to work in December 2007, but that he continued to work (albeit fewer hours per week and with less travel) until May 2, 2008. (Tr. 159-60). At that point, having exhausted his FMLA and disability leave, and still unable to perform the duties of his job, he was told by his employer that there was no work for him. (Tr. 160).
O'Beirne completed high school and one year of college. (Tr. 170). He also received training on Primavera Systems Project Management Software in 1989. (Id.). Prior to stopping work, O'Beirne worked as a Senior Mechanical Project Engineer, earning $38.00 per hour. (Tr. 161). In that job, he developed engineering designs and otherwise provided general project supervision and onsite management. (Id.). He was required to sit five hours per day; walk, stand, and climb one hour per day; and write, type or handle small objects eight hours per day. (Tr. 161-62). He was frequently required to lift less than ten pounds, and supervised between five and fifty people. (Tr. 162).
O'Beirne reported being seen by several doctors regarding his medical conditions. (Tr. 162-68). He also reported taking Aspirin and Plavix (as blood thinners), Atenolol and Midodrine (to regulate his blood pressure and syncope), Clonazepam (for muscle spasms), Nitroglycerine (as needed for chest pain), Omeprazole (for stomach issues), Paxil (for depression and panic attacks), Simvistatin (to lower lipids), and a Vitamin D supplement. (Tr. 168-69). All of these medications have side effects, ranging from nausea to bruising to drowsiness to lightheadedness and difficulty concentrating. (Id.). He further reported that he has had the following medical tests: blood tests, breathing tests, cardiac catheterizations, EEGs, EKGs, MRI/CT scans, treadmill (exercise) tests, and chest x-rays. (Tr. 169-70).
In a third party function report dated March 13, 2009, O'Beirne's wife, Jennifer, reported that O'Beirne's inability to drive and travel out of state, along with the effects of his medications, render him unable to perform his job. (Tr. 188). She confirmed that O'Beirne spends most of his days in bed, with his legs elevated, "to eliminate the feelings of syncope." (Id.). O'Beirne is unable to sleep for long stretches of time, unable to perform indoor and outdoor chores, and unable to socialize. (Tr. 189). He needs reminders to take his medicine. (Tr. 190). And, although O'Beirne loves to cook, he no longer prepares meals because it is difficult for him to stand for long periods of time. (Id.). She confirmed that O'Beirne cannot drive and does not go out of the house alone. (Tr. 191). Because of the stress and depression induced by his syncope, O'Beirne is no longer able to handle the family's finances. (Tr. 191-92). He does not socialize with others, but has no problems getting along with family, friends, or neighbors. (Tr. 192-93). He has become "withdrawn" and "fearful" and feels physically worse each day. (Tr. 193). O'Beirne's wife confirmed his difficulty lifting, bending, standing, walking, sitting, stair climbing, and with memory, completing tasks, and concentration, saying that any changes in movement affect his blood pressure, which makes him pass out. (Id.). In his wife's words:
(Tr. 195).
In an undated disability appeals report, O'Beirne reported that, beginning on approximately June 15, 2009, his syncope events increased to 5-6 events per week. (Tr. 200). In addition, on May 30, 2009, he was diagnosed with sleep apnea, requiring him to sleep with a full face mask at night. (Id.). Since the time of his last report, he had undergone a sleep study and was placed on a CPAP machine. (Tr. 201). He was continuing to take Aspirin and Plavix, Atenolol and Midodrine, Clonazepam, and a Vitamin D supplement. (Tr. 202). In addition, he had added Alprazolam (for depression and anxiety), Fludrocortisone (for syncope), Paroxetine (for depression and syncope), and Simudstatin (for lipids). (Id.). He reported that his conditions caused him to be "very forgetful, can not drive, unexpected passing out, loss of energy, depression." (Tr. 203). In conclusion, he indicated that syncope is now occurring more often as a result of a sneeze or coughing. (Tr. 204).
At the February 3, 2010 hearing before the ALJ, O'Beirne testified that he graduated from high school and took college classes for a few months. (Tr. 31-32). He worked full-time as a mechanical engineer until October 28, 2008, when he went off work as a result of his neurocardiogenic syncope. (Tr. 32-33, 35). Since that time, he has attempted to do some work from home, but his syncope makes it difficult to sustain any employment. (Tr. 33). In his job as a mechanical engineer, the amount of time he spent standing and walking varied by project; some days, he was "continuously walking" and lifting up to 40 or 50 pounds. (Id.).
O'Beirne further testified that he is unable to work because of the frequency of his syncope events. (Tr. 35). He testified that these events, which occur three or four times per week, and last between 30 and 60 seconds, render him "completely wiped out afterwards," and he needs a full night's sleep to recover. (Id.). O'Beirne testified that he believes the frequency of these events render him a danger to himself and to others, and employers are unwilling to risk the liability associated with hiring him. (Tr. 41).
On a typical day, O'Beirne does some light house work (starting the laundry, loading and unloading the dishwasher), and he might try to do some exercise. (Tr. 36). On occasion, he goes grocery shopping with his wife. (Tr. 40). On average, though, he spends six to seven hours a day lying down in an effort to raise his blood pressure. (Tr. 36). On a good day, he can walk 100-200 yards before he has to stop because of lightheadedness, shortness of breath, and fatigue. (Tr. 38). He can only stand still for two to three minutes or sit for 10-15 minutes; after that, he needs to put his legs up in the air, or the blood pooling in his arms and legs triggers syncope. (Tr. 39). As a result, he can no longer drive. (Id.). O'Beirne testified that he can lift a gallon of milk and that he can bathe and dress without assistance. (Tr. 40).
O'Beirne testified that he sees Dr. Kurt Holland and Dr. Timothy Shinn at Michigan Heart regarding his syncope. (Tr. 37). He has tried several medications for blood pressure and for the autonomic nervous system, but they produce side effects, and his physicians are still adjusting prescriptions and doses. (Tr. 37, 42). At the time of the hearing, O'Beirne said that he was on the waiting list to see a specialist who is "one of the best." (Tr. 37-38, 41). With respect to his coronary artery disease, O'Beirne testified that he suffered two heart attacks, one in September 2004 and one in March 2008. (Tr. 38). As a result, he changed his eating habits, and he continues to take blood pressure and cholesterol medication. (Id.).
The record contains a substantial amount of medical documentation regarding O'Beirne's coronary artery disease, neurocardiogenic syncope, anxiety and depression. Relevant aspects of O'Beirne's medical history will be discussed in chronological order.
O'Beirne suffered a heart attack on September 13, 2004 and had stents placed in his right coronary and left anterior descending arteries. (Tr. 355). On September 22, 2004, he was seen by Dr. E.N. Papasifakis at Midwest Cardiology Associates ("MCA") in follow-up, where his cardiac examination was normal. (Tr. 381-82). On October 13, 2004, he had a normal exercise stress echocardiogram. (Tr. 323). On October 19, 2004, he was seen again at MCA for a follow-up visit, where he stated that he had "no cardiac symptoms." (Tr. 380).
On April 28, 2005, O'Beirne presented at MCA "without cardiac related symptoms." (Tr. 379). No problems were noted, and he was advised to return in six months. (Id.). On August 1, 2005, O'Beirne was seen at MCA for complaints of increasing chest discomfort over the prior two months. (Tr. 373). Although his clinical examination was mostly "unremarkable," he was scheduled for an exercise stress test, the results of which were "entirely normal." (Tr. 373-75). The examining physician concluded that his symptoms most likely were not cardiac in etiology, and he was advised to return in six months. (Tr. 375-76). On November 7, 2005, O'Beirne returned for a "cardiovascular reevaluation." (Tr. 371). At that point, he stated that he was "running a couple of miles a day and his symptoms of chest discomfort have completely resolved." (Id.).
On March 13, 2006, O'Beirne was again seen at MCA with complaints of worsening chest pain. (Tr. 369). It was recommended that he obtain a stress echocardiogram. (Id.). However, when O'Beirne returned to MCA on July 6, 2006, it was noted that he had not undergone this test. (Tr. 366). The examining physician noted that his "symptoms do not sound to be cardiac." (Tr. 367). On June 26, 2006, O'Beirne underwent an angiogram at Beaumont Hospital, which showed no abnormality. (Tr. 389). And, on July 17, 2006, he had a normal exercise stress test at MCA. (Tr. 321).
On August 13, 2007, O'Beirne went to Oakwood Hospital with chest pain and palpitations. (Tr. 385). All of his cardiac tests — including a chest x-ray, an EKG, and an exercise stress test — came back normal. (Tr. 317, 385). At a visit with his cardiologist on September 12, 2007, it was noted that he had been experiencing chest pain since 2004, but that it had "not been considered cardiac," and that all of his cardiac testing had come back negative. (Tr. 361).
On September 19, 2007, O'Beirne went to the emergency room at St. Mary Mercy Hospital in Livonia ("St. Mary's") with complaints of chest pain. (Tr. 594). He had a normal EKG and chest x-ray but was transferred to Oakwood Hospital, where he underwent a left heart catheterization to rule out stenosis. (Tr. 383-84, 764). The results of this test showed no significant in-stent re-stenosis. (Tr. 405).
On September 26, 2007, O'Beirne was seen at MCA for evaluation. It was noted that his coronary artery disease was "stable." (Tr. 359). On October 8, 2007, O'Beirne returned to the Oakwood Hospital emergency room with complaints of chest pain. (Tr. 428). On November 15, 2007, Dr. Papasifakis examined O'Beirne, noting that although he was "chronically anxious," he was in "no acute distress" and had "no cardiovascular issues at this time." (Tr. 357). On November 24, 2007, O'Beirne went to the St. Mary's emergency room with chest pain. (Tr. 758). All of the objective tests administered came back negative, however. (Tr. 759).
On November 26, 2007, O'Beirne saw his primary care physician, Dr. Talanki Viswanath, complaining of chest and abdominal pain. (Tr. 787). He had recently stopped one prescribed medication (Vytorin). (Id.). Although anti-depressant therapy was discussed, O'Beirne stated that he was not depressed and wanted to wait on this. (Tr. 788).
On November 27, 2007, he was again seen in the St. Mary's emergency room, this time for heart palpitations and dizziness. (Tr. 750). All of his tests — including lab work, an ECG, a head CT, and a chest x-ray — were negative. (Tr. 752-57). He admitted that he had not been taking his prescribed medications, saying that he thought they were contributing to his symptoms. (Tr. 750). Ultimately, because all of the objective tests came back negative, the physician concluded that his spells sounded anxiety-related, possibility with some element of hyperventilation. (Tr. 752).
On December 14, 2007, O'Beirne went to the emergency room at Beaumont with palpitations and tunnel vision. (Tr. 225). He had an exercise stress test and a chest x-ray performed, both of which were normal. (Tr. 225-26, 238).
On December 28, 2007, O'Beirne presented to the emergency room at St. Mary's with "very vague" symptoms, including chest pain. (Tr. 567-69, 737). He had a chest x-ray and a chest CT scan, both of which were normal. (Tr. 742, 744). He was placed on Lopressor and Cardizem for suspected cardiospasm and known coronary artery disease, but he refused to take both medications. (Id.). He indicated that he was supposed to be taking an anti-depressant, but that he had discontinued the medication after only one dose. (Tr. 582, 731). Indeed, he indicated that he had not taken any medications in 3-4 weeks. (Tr. 729). He refused antidepressants in the hospital, stating that he believed his problems were not related to depression, but he was advised to see a psychiatrist. (Tr. 729).
On January 6, 2008, O'Beirne was seen in the emergency room at St. Mary's for abdominal pain and difficulty breathing. (Tr. 740). He had a normal ECG, blood test, chest xray, and chest CT scan. (Tr. 741). On January 8, 2008, O'Beirne saw Dr. Viswanath, complaining of "pleurisy" and feeling like he could not get enough air. (Tr. 779). Dr. Viswanath referred him to a cardiologist, a pulmonologist, and a psychiatrist. (Id.). On January 9, 2008, O'Beirne went to the emergency room at Beaumont, complaining of shortness of breath. (Tr. 235-37). He had a normal chest x-ray and a normal abdominal ultrasound. (Id.).
On January 12, 2008, O'Beirne again went to the St. Mary's emergency room, this time with spasms in his neck and an inability to swallow. (Tr. 726). He denied any chest pain and adamantly refused a chest pain workup. (Id.). The emergency room physician likened O'Beirne's condition to hyperventilation and ultimately diagnosed him with throat pain. (Tr. 727). On March 20, 2008, O'Beirne underwent a heart catheterization at Beaumont Hospital, which showed "severe focal stenosis," and he had another stent placed. (Tr. 221-22).
On April 14, 2008, O'Beirne saw Dr. Thomas Sisson at the outpatient Pulmonary Clinic at the University of Michigan regarding his recurrent complaints of chest pain and dizziness. (Tr. 532-34). Dr. Sisson suspected that O'Beirne "may have some neurologic condition," so he scheduled him for a swallow study and a cardiopulmonary exercise test.
On May 12, 2008, O'Beirne called an ambulance for himself and was taken to the St. Mary's emergency room for chest pain and muscle spasms. (Tr. 574). He had a chest x-ray, which showed no significant abnormalities, and an EEG (which was normal). (Tr. 716, 722). No diagnosis was given, and he was advised to follow up with neurology. (Tr. 721). Later that same day, O'Beirne saw Dr. Punitha Vijayakumar, a neurologist, regarding his spasms. (Tr. 969-70). Dr. Vijayakumar noted that O'Beirne had been prescribed Xanax and Ativan, but he did not want to take these medications because he did not believe they were helping. (Tr. 969). O'Beirne was advised to have some vasculitis workup, an EEG, a swallow study, and MRIs (once he was sufficiently far removed from his cardiac catheterization). (Tr. 970). On May 13, 2008, O'Beirne had an electroencephalogram (EEG) to rule out seizures, the results of which were normal. (Tr. 485).
On May 22, 2008, O'Beirne returned to see Dr. Vijayakumar regarding the body spasms he was experiencing. He had had an MRI of his C-spine, which found no abnormal problem in the spinal cord, as well as an MRI of his brain, which "showed no significant abnormalities." (Tr. 499, 712-14). On June 4, 2008, O'Beirne saw Dr. Vijayakumar again for a follow-up visit regarding continued body spasms. (Tr. 492). He had undergone a spinal tap that day to rule out "stiff man syndrome," but had then passed out three times, and his wife was concerned. (Id.). On June 7, 2008, O'Beirne returned to the St. Mary's emergency room with a post-spinal tap headache. (Tr. 570). On June 24, 2008, he had a normal echocardiogram. (Tr. 489). On June 26, 2008, he had a negative stress EKG. (Tr. 488).
On July 2, 2008, O'Beirne saw Dr. Timothy Shinn at Michigan Heart for symptoms of syncope, which he stated had begun after he had a stent re-implanted in March 2008. (Tr. 513). Dr. Shinn noted that O'Beirne's syncope was unique in that it happened in many different positions, including when he was at rest and/or supine. (Id.). At Dr. Shinn's recommendation, O'Beirne underwent a "head-up tilt table test," which was positive and consistent with a vasodepressor syndrome. (Tr. 523). He also underwent an electrophysiology study, the results of which were normal. (Tr. 512). On July 9, 2008, Dr. Shinn advised O'Beirne that he could return to work. (Tr. 601). He was reminded, however, that Michigan state law prohibited him from driving until he had been syncope-free for six months. (Id.).
On July 17, 2008, O'Beirne returned to Michigan Heart for follow up. (Tr. 555). It was noted that although Dr. Shinn had recommended that O'Beirne take midodrine, he "took it for three days and felt poorly with it" so he "discontinued it at this point in time." (Id.). The examining physician, Dr. Kurt Holland, "strongly urged Mr. O'Beirne to give the midodrine another attempt." (Id.).
On July 24, 2008, O'Beirne saw Dr. Viswanath for complaints of heart disease and episodes of dizziness and passing out. (Tr. 774). Dr. Viswanath suggested that O'Beirne take Lexapro (which would help both the depression and the syncope), but O'Beirne was "not sure yet." (Id.).
On August 22, 2008, O'Beirne returned to Michigan Heart for an electrophysiology follow-up. (Tr. 553). O'Beirne reported that after resuming the midodrine, he had had no recurrences of syncope. (Id.). It was also noted, however, that "he has stopped multiple medications because they were making him feel poorly." (Id.).
On August 26, 2008, O'Beirne returned to see Dr. Sisson at the University of Michigan. (Tr. 535). Dr. Sisson noted that O'Beirne had been diagnosed with neurogenic syncope and was being treated with atenolol and midodrine, which "resulted in a significant improvement of his syncope," as well as his other symptoms of muscle spasm. (Id.). Overall, O'Beirne reported that he was "feeling much better." (Id.).
On February 16, 2009, O'Beirne was again seen at St. Mary's with complaints of chest discomfort. (Tr. 549). O'Beirne reported that he was having syncope three times per week, and it was noted that he "seems complacent about this." (Tr. 550). He had unilaterally decreased his dose of Paxil and completely stopped taking the midodrine. (Id.). Between February 16 and 17, 2009, he had a stress thallium test (negative), a troponin I 3X test (negative), and a myocardial perfusion imaging scan (negative). (Tr. 685). A 30-day event monitor was recommended (to evaluate the syncope events). (Tr. 552).
On March 2, 2009, O'Beirne saw Dr. Viswanath with complaints of a rash on his face and hands following his February hospital admission. (Tr. 772). He also complained of "occasional episodes of palpitation and diaphoresis" and said that he was thinking of seeking another opinion at the Cleveland Clinic because the objective tests had revealed no underlying medical problems. (Id.).
On April 6, 2009, O'Beirne was seen at Michigan Heart for a six-month follow-up. (Tr. 979). He reported that his "last true syncopal episode was a couple of weeks ago." (Id.). He was switched from midodrine to Florinef, and "no further evaluation [was] recommended for his episodes of chest discomfort in the face of a negative stress test." (Tr. 980). In addition, a 30day monitor was to be performed, although the attending physician specifically stated: "I have a low suspicion for an arrhythmogenic etiology for his symptoms." (Id.).
On April 30, 2009, O'Beirne went to the emergency room at St. Mary's with complaints of chest pain. (Tr. 919). Again, however, he had a negative chest x-ray, and the examination was otherwise unremarkable. (Tr. 922).
On May 14, 2009, O'Beirne returned to see Dr. Holland at Michigan Heart, complaining of extreme fatigue and difficulty sleeping. (Tr. 982). He had been having some atypical chest pain, but a recent Cardiolite test showed no evidence for ischemia. (Id.). He reported that he had had one recent syncopal episode; however, he stated "that since increasing his Florinef . . . he is doing much better and has had no recurrent episodes." (Id.). Dr. Holland suggested a sleep study to determine if O'Beirne was suffering from sleep apnea. (Id.).
On July 31, 2009, O'Beirne saw Dr. Vijayakumar for the first time in about a year. (Tr. 978). O'Beirne reported that he had "had maybe three [syncope] episodes recently." (Id.). Dr. Vijayakumar noted that, in the intervening period between visits, O'Beirne had had a sleep study, which showed that he suffered from sleep apnea, and he was then sleeping with a CPAP machine. (Id.). After examining O'Beirne, Dr. Vijayakumar concluded that he suffered from obstructive sleep apnea and, possibly, acid reflux disease. He was advised to take antacids and "have good sleep habits." (Id.).
On September 2, 2009, O'Beirne again went to the St. Mary's emergency room with chest pain. (Tr. 933). His serial troponins were done, which were negative, ruling out an acute myocardial infarction. (Id.). At discharge, he was advised to "get counseling regarding his anxiety depression as he has multiple triggers for his neurocardiogenic syncope." (Tr. 934).
On October 7, 2009, O'Beirne was again seen at Michigan Heart. (Tr. 985). At that time, he reported that while taking Florinef, he was still having syncopal episodes "3-4 times a week for about the last year and a half" and that "over the last 3 weeks, they have increased in frequency to about 7-10 times a week." (Id.). O'Beirne reported that "he has not been driving lately, although he has been driving in the last year and a half." (Id.). He had recently been asked to increase his Florinef, but he reduced it on his own instead because it was giving him a headache. (Id.). O'Beirne was advised to switch back to midodrine, to increase his daily water and dietary sodium intake, and to follow up with Dr. Blair Grub at the University of Toledo regarding the recurrent syncope. (Id.). At the time of the February 3, 2010 hearing, O'Beirne had not seen Dr. Grub. (Tr. 37-38).
On December 10, 2009, O'Beirne saw Dr. Viswanath with complaints of dizziness. (Tr. 945). He indicated that he had discontinued two of his medications, Paxil and Zetia, because he did not believe the Paxil was helping his depression and he "had problems" with the Zetia. (Id.). Dr. Viswanath recommended several follow-up tests, including a lipid profile, chemistry profile, and ultrasound of O'Beirne's gallbladder. (Tr. 946). The record does not indicate whether O'Beirne underwent these tests.
On May 11, 2009, a physical residual functional capacity ("RFC") assessment was conducted. (Tr. 873-80). Dr. Donald Kuiper, a state agency medical consultant, examined O'Beirne's medical records and concluded that he retained the ability to occasionally lift 20 pounds, frequently lift 10 pounds, stand and/or walk for 6 hours in an 8-hour work day, and sit for 6 hours in an 8-hour workday. (Tr. 874). He further concluded that O'Beirne could occasionally climb ramps or stairs, kneel, crouch, and crawl and could frequently balance and stoop, but could never climb ladders, ropes or scaffolds, and had to avoid concentrated exposure to hazards (such as unprotected heights and large and dangerous moving machines). (Tr. 875, 877).
On June 13, 2009, a mental RFC assessment was conducted by Dr. Valerie Domino. (Tr. 881-98). After examining O'Beirne's records, Dr. Domino concluded that he did not meet or medically equal the criteria for Listing 12.04 (affective disorders) or Listing 12.06 (anxiety related disorders). (Tr. 885). This was because he had only mild limitations in his activities of daily living, moderate limitations in maintaining social functioning and concentration, persistence or pace, and no episodes of decompensation. (Tr. 895). Dr. Domino further concluded that O'Beirne could do simple, repetitive tasks and could work casually with the general public, co-workers, and supervisors, although he might occasionally need extra breaks due to psychiatric symptoms. (Tr. 883).
On May 21, 2009, O'Beirne was examined by Dr. Leonard Lachover, a state agency examining psychiatrist, for purposes of a psychiatric evaluation. (Tr. 899-901). Dr. Lachover noted that O'Beirne was not seeing a psychiatrist (although he had seen a therapist on one hospital visit). (Tr. 899). O'Beirne stated that his depression had worsened when he had his second heart attack, and he began feeling "low-esteem, sadness, more anxiety, decreased selfesteem, with periodic crying spells." (Id.). Dr. Lachover noted that O'Beirne was "pleasant and cooperative," and that his speech was "goal oriented and goal directed." (Tr. 899-900). Dr. Lachover further noted that O'Beirne's Global Assessment of Functioning (GAF) score was 40, and opined that: "Because of his psychiatric symptomatology, he is prone to relapses. It would be anticipated that work would be a stress that could lead to deterioration in his current condition." (Tr. 900).
Steven B. Schmidt testified as an independent vocational expert ("VE"). (Tr. 42-46). The VE testified that O'Beirne's past relevant work as a mechanical engineering project manager was skilled in nature, and at a light level of exertion. (Tr. 43). O'Beirne's other past relevant work as a computer systems manager was skilled in nature, and at a sedentary level of exertion. (Id.). The ALJ asked the VE to imagine a claimant of O'Beirne's age, education, and work experience, who would be limited as follows:
(Tr. 43). The VE testified that the hypothetical individual would be capable of working in light, unskilled jobs, such as packer (15,000 jobs in Michigan), assembly (4,600 jobs in Michigan), and laundry worker (3,000 jobs in Michigan). (Tr. 43-44). He further testified that these jobs are low-stress and involve essentially repetitive, simple tasks. (Tr. 45). However, the VE also testified that, if the hypothetical individual were required by a medical condition to lie down for four to six hours during daylight hours, there are no jobs in the national economy that he could perform. (Tr. 44).
Under the Act, DIB are available only for those who have a "disability." See Colvin v. Barnhart, 475 F.3d 727, 730 (6
42 U.S.C. §1382c(a)(3)(A). The Commissioner's regulations provide that a disability is to be determined through the application of a five-step sequential analysis:
Scheuneman v. Comm'r of Soc. Sec., 2011 WL 6937331 (E.D. Mich. Dec. 6, 2011), citing 20 C.F.R. §§404.1520, 416.920; see also Heston v. Comm'r of Soc. Sec., 245 F.3d 528, 534 (6
Following the five-step sequential analysis, the ALJ found that O'Beirne is not disabled under the Act. At Step One, the ALJ found that O'Beirne has not engaged in substantial gainful activity since May 2, 2008, his alleged onset date. (Tr. 14). At Step Two, the ALJ found that O'Beirne has the severe impairments of neurocardiogenic syncope, history of coronary artery disease, mood disorder, and anxiety disorder. (Id.).
At Step Three, the ALJ found that none of O'Beirne's severe impairments meet or medically equal a listed impairment. (Tr. 14-15). Specifically, with respect to O'Beirne's mental impairments, the ALJ considered Listings 12.04 (for affective disorders) and 12.06 (for anxiety disorders) and found that O'Beirne's impairments, considered singly and in combination, did not meet or medically equal the criteria of either of these Listings. (Id.).
The ALJ then assessed O'Beirne's residual functional capacity ("RFC"), considering the degree of limitation found in the mental function analysis, and concluded that O'Beirne is capable of performing light work, as defined in 20 C.F.R. §416.1567(b), except as follows: he can lift and carry 20 pounds occasionally and 10 pounds frequently; he can sit, stand, and walk for a total of 6 hours in an 8-hour workday; he cannot climb ladders, ropes or scaffolding and cannot work around heights or moving machinery; he is limited to work involving simple instructions; he must have relatively restricted contact with the public; and he must have restricted contact with coworkers in the sense that he cannot be part of a work team or cooperative work process. (Tr. 16). At Step Four, the ALJ determined that O'Beirne cannot do his past relevant work as a mechanical engineer or computer project manager, both of which were skilled in nature. (Tr. 18). At Step Five, the ALJ concluded, based in part on the VE's testimony, that O'Beirne is capable of performing a significant number of jobs that exist in the national economy. (Tr. 19). As a result, the ALJ concluded that O'Beirne is not disabled under the Act. (Id.).
The District Court has jurisdiction to review the Commissioner's final administrative decision pursuant to 42 U.S.C. §405(g). Judicial review under this statute is limited in that the court "must affirm the Commissioner's conclusions absent a determination that the Commissioner has failed to apply the correct legal standard or has made findings of fact unsupported by substantial evidence in the record." Longworth v. Comm'r of Soc. Sec., 402 F.3d 591, 595 (6
When reviewing the Commissioner's factual findings for substantial evidence, the court is limited to an examination of the record and must consider the record as a whole. Bass, 499 F.3d at 512-13; Wyatt v. Sec'y of Health & Human Servs., 974 F.2d 680, 683 (6
O'Beirne argues that, in concluding that he was capable of performing certain light, unskilled jobs, the ALJ failed to adequately assess the credibility of his subjective complaints. (Doc. #8 at 8-12). Specifically, O'Beirne alleges that in concluding that his complaints of disabling symptoms and limitations were not credible, the ALJ both mischaracterized the record evidence and "
As the Sixth Circuit has held, determinations of credibility related to subjective complaints of pain rest with the ALJ because "the ALJ's opportunity to observe the demeanor of the claimant `is invaluable, and should not be discarded lightly.'" Kirk v. Secretary of Health & Human Servs., 667 F.2d 524, 538 (6
With respect to O'Beirne's allegations that his anxiety and depression render him disabled, substantial evidence supports the ALJ's conclusion that this is not the case. The ALJ did largely accept O'Beirne's allegations regarding his mental health, and he incorporated these limitations into his RFC findings by limiting O'Beirne to work involving simple instructions and restricted contact with the public and co-workers. (Tr. 16). As the ALJ correctly noted, however, there is no indication that O'Beirne's anxiety and depression were disabling. O'Beirne was not undergoing regular mental health treatment.
With respect to O'Beirne's history of coronary artery disease, the medical evidence in the record supports the ALJ's conclusion that this condition does not preclude all work. As the ALJ recognized, treatment notes consistently indicate that O'Beirne was in no acute distress during his examinations. (Tr. 17; see, e.g., Tr. 380 ("no cardiac symptoms"), 379 (presented "without cardiac related symptoms"), 371 ("symptoms of chest discomfort have completely resolved"), 359 (coronary artery disease was "stable")). Moreover, between the time of his first heart attack (in September 2004) and the hearing before the ALJ (in early 2010), O'Beirne had numerous objective cardiac tests performed — including exercise stress tests, stress echocardiograms, angiograms, chest x-rays, chest CT scans, ECGs, EKGs, a stress thallium test, a troponin I 3X test, and a myocardial perfusion imaging scan — all of which were entirely normal. (Tr. 225-26, 238, 317, 321, 323, 373-75, 385, 389, 685, 716, 722, 742, 744, 752-59, 922). O'Beirne concedes that although he underwent numerous medical tests, "many of these tests [were] negative." (Doc. #8 at 8). Lastly, as the ALJ noted, O'Beirne worked after both of his heart attacks — in September 2004 and March 2008 — and he does not allege that his coronary artery disease worsened after that period of time, which suggests that this condition would not currently prevent him from working. (Tr. 17).
As for O'Beirne's neurocardiogenic syncope, it is this condition that he claims most prevents him from working. (Tr. 35). As the ALJ noted in his opinion, however, the medical evidence contained in the record simply does not support O'Beirne's allegation that this condition renders him completely disabled. The ALJ noted that O'Beirne's treatment for this condition has been "essentially routine and conservative in nature."
Moreover, there is substantial evidence in the record supporting the ALJ's conclusion that O'Beirne has not been entirely compliant in taking prescribed medications. (Tr. 17). For example, at November and December 2007 emergency room visits, O'Beirne admitted that he had not been taking his prescribed medications. (Tr. 729, 750). In May of 2008, O'Beirne's neurologist, Dr. Vijayakumar, noted that O'Beirne had been prescribed Xanax and Ativan, but he did not want to take these because he did not believe they helped. (Tr. 969). In June of 2008, Dr. Viswanath "re-suggested" that O'Beirne take a beta-blocker, but he "refused." (Tr. 776). On July 17, 2008, O'Beirne told Dr. Shinn at Michigan Heart that although he had been prescribed midodrine for his syncope, he "took it for three days and felt poorly with it," so he discontinued it. (Tr. 555). After re-starting on that medication, O'Beirne again stopped, even though it appeared to be working well for him. (Tr. 535, 553); supra at 13. And, as the ALJ noted, Dr. Viswanath
Additionally, the medical evidence in the record strongly suggests that O'Beirne's allegations regarding the limiting effects of his syncope are not fully credible. Neurologic testing done by Dr. Vijayakumar in 2008 was negative for any neurologic etiology.
In addition, as the ALJ noted, O'Beirne's reported daily activities are not consistent with the degree of limitation he alleges. (Tr. 17). He cares for animals at home, takes care of his personal hygiene, rides in a car
In other words, then, the ALJ recognized the duty imposed upon him by the regulations and, in addition to O'Beirne's own subjective complaints, he considered the objective medical evidence, as well as O'Beirne's daily activities, during the relevant time period in assessing O'Beirne's credibility. For the reasons discussed above, the ALJ's credibility determination is reasonable and supported by substantial evidence in the record.
O'Beirne also argues that the ALJ's supposed failure to address the majority of over 750 pages of medical records "in and of itself demonstrates the ALJ failed to make his credibility finding
Finally, O'Beirne argues that the ALJ erred in giving "little weight" to Dr. Viswanath's September 22, 2009 physical medical source statement, which opined that O'Beirne had completely work preclusive limitations. (Doc. #8 at 15). O'Beirne also argues that the ALJ erred in rejecting Dr. Lachover's conclusion that he is "prone to relapses and that work would likely be a stress that could lead to deterioration in his current condition."
The ALJ gave "little weight" to Dr. Lachover's opinion because it was inconsistent with O'Beirne's mental health treatment history and his activities of daily living. (Tr. 18). Similarly, the ALJ gave "little weight" to Dr. Viswanath's opinion regarding O'Beirne's lifting and postural limitations, as well as his opinion that O'Beirne is "unable to return to work" because these opinions were "quite conclusory," because Dr. Viswanath provided very little explanation of the evidence relied on in reaching his conclusions, and because he stated an opinion on an issue reserved to the commissioner. (Id.). The ALJ's determinations in these respects are supported by substantial evidence. See 20 C.F.R. §404.1527(e)(1), (e)(3).
In evaluating the medical opinions of various physicians in this case, the ALJ thoroughly considered their bases, in light of the other evidence in the record. As a result, the ALJ gave Dr. Kuiper's opinion substantial weight because it was consistent with both the medical evidence and O'Beirne's activities of daily living. (Tr. 17). Similarly, the ALJ gave substantial weight to the opinion of Dr. Domino, the state agency psychological consultant, who stated that O'Beirne can do simple, repetitive tasks for 40 hours per week and work casually with the general public, coworkers and supervisors, finding that this opinion was consistent with O'Beirne's statements that he gets along well with authority figures and follows written and spoken instructions well. (Tr. 17).
In sum, the ALJ's evaluation of the various medical opinions and O'Beirne's credibility, as well as his conclusions regarding O'Beirne's RFC, are supported by substantial evidence and should not be disturbed.
For the foregoing reasons, the court RECOMMENDS that O'Beirne's Motion for Summary Judgment [8] be DENIED, the Commissioner's Motion for Summary Judgment [11] be GRANTED, and this case be AFFIRMED.
The parties to this action may object to and seek review of this Report and Recommendation, but are required to act within fourteen (14) days of service of a copy hereof as provided for in 28 U.S.C. §636(b)(1) and Fed. R. Civ. P. 72(b)(2). Failure to file specific objections constitutes a waiver of any further right of appeal. See Thomas v. Arn, 474 U.S. 140 (1985); Howard v. Secretary of HHS, 932 F.2d 505, 508 (6
