KATHERINE MENENDEZ, Magistrate Judge.
In this case, Megan Krick appeals the denial of her application for disability benefits by the Commissioner of Social Security.
On May 2, 2012,
[AR 82.]
Ms. Krick has had four shoulder surgeries, two on each shoulder, and she had surgery on her right knee. [AR 46.] She has received injections in her shoulders, her back, and her knee. [AR 47.]
In her testimony at the hearing and documents submitted in support of her claim, Ms. Krick explained that she experiences constant pain. She cannot stand, sit, or walk for more than 30 minutes at a time and the only position in which she feels comfortable for extended periods is lying down. As a result, she spends most of the day on the couch. She needs help with household chores and grocery shopping because she is unable to carry bags of groceries. At night, she wakes up constantly from pain when she tries to sleep. She also has trouble cooking and getting dressed. [AR 224-31, 239; see also id. at 38-42 (describing experiences of chronic pain, knee swelling, and other issues precluding work).]
Jordan Garelick, an ALJ with the Social Security Administration, held a hearing on Ms. Krick's claim. ALJ Garelick denied her claim and his decision now operates as the final decision of the Commissioner subject to review in this proceeding. [AR 8-17 (ALJ's decision).] The ALJ determined that Ms. Krick had the following medically determinable, severe impairments: disorders of muscle ligament fascia; degenerative joint disease; irritable bowel syndrome; and asthma. [AR 10-12.] As is most relevant to the issues presented here, ALJ Garelick determined Ms. Krick's residual functional capacity ("RFC"), which is the most she is capable of doing based on the limitations caused by all of her impairments. He found that despite her impairments, Ms. Krick retains the ability to do sedentary work with additional restrictions. Specifically, ALJ Garelick placed restrictions on: climbing; balancing; reaching overhead; exposure to cold, heat, and humidity; use of moving machinery; and exposure to unprotected heights. [AR 12-15.] The ALJ also found that Ms. Krick would need to be off task less than 10% of the work day. [AR 12.]
ALJ Garelick specifically determined that Ms. Krick's "medically determinable impairments could reasonably be expected to cause [her] alleged symptoms; however, [her] statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely credible . . . ." [AR 14.] Particularly relevant here, the ALJ found that despite Ms. Krick's statements about her limitations:
[AR 14.]
The ALJ also considered the opinion of Ms. Krick's primary care physician, Dr. Sara Nolan. [AR 15.] Dr. Nolan, who had treated Ms. Krick over several years, completed an RFC questionnaire stating: (1) pain would interfere with Ms. Krick's ability to pay attention and concentrate at work on a consistent basis; (2) Ms. Krick would have marked limitation in dealing with the normal stress of competitive employment; (3) she would need to lie down for nearly 6 hours out of an 8-hour work day, shift positions at will, and elevate her legs while sitting; (4) should never lift more than ten pounds; and (5) would need to miss work more than three times per month. [AR 793-96.] Dr. Nolan also explained that Ms. Krick "has constant pain." [AR 796.] In giving this opinion little weight, the ALJ wrote:
[AR 15.]
In reviewing the Commissioner's denial of Ms. Krick's application for benefits the Court determines whether the decision is supported by substantial evidence on the record as a whole or results from an error of law. Gann v. Berryhill, 864 F.3d 947, 950 (8th Cir. 2017); Miller v. Colvin, 784 F.3d 472, 477 (8th Cir. 2015); 42 U.S.C. § 405(g). "Substantial evidence is less than a preponderance of the evidence, but is such relevant evidence as a reasonable mind would find adequate to support the Commissioner's conclusion." Blackburn v. Colvin, 761 F.3d 853, 858 (8th Cir. 2014) (internal citations and quotation marks omitted). In considering whether there is substantial evidence on the record as a whole, the Court not only examines the record to determine if substantial evidence supports the Commissioner's decision, but also takes into account the evidence in the record that "fairly detracts from that decision." Reed v. Barnhart, 399 F.3d 917, 920 (8th Cir. 2005). However, the Court does not reverse the Commissioner's decision merely because substantial evidence also supports a contrary outcome or the record might support a different conclusion. Gann, 864 F.3d at 950; Reed, 399 F.3d at 920. The Court reverses the Commissioner's decision only where it falls outside "the available zone of choice," meaning that the Commissioner's findings is not among the possible positions that can be drawn from the evidence in the record. See Buckner v. Astrue, 646 F.3d 549, 556 (8th Cir. 2011) (quoting Bradley v. Astrue, 528 F.3d 1113, 1115 (8th Cir. 2008).
Ms. Krick seeks reversal of the Commissioner's decision for three reasons. First, she argues that the ALJ ignored evidence, including information related to her Ehlers-Danlos Syndrome and the fact of her obesity. She contends such evidence supports her claim that she is more severely limited than the RFC finding reflects. [Pl.'s Mem. at 9-13, ECF No. 19.] Second, Ms. Krick argues that the ALJ erroneously concluded that Dr. Nolan's opinion was inconsistent with her own treatment notes and other evidence in the record, and this error caused the ALJ to improperly discount Dr. Nolan's conclusions. [Pl.'s Mem. at 13-17.] Finally, Ms. Krick asserts that the ALJ erred in applying 20 C.F.R. § 404.1529(c)(3). That regulation requires consideration of several factors to assess the intensity, persistence and limited effects of an individual's symptoms, and Ms. Krick asserts that the ALJ analyzed some factors inappropriately and ignored others implicated by record evidence. [Pl.'s Mem. at 17-20.]
Ms. Krick first argues that the ALJ's decision must be reversed because the RFC finding was based on an analysis of the record that ignored several pieces of evidence, mischaracterized the record, or incorrectly evaluated the evidence.
Ms. Krick contends that ALJ Garelick ignored her Ehlers-Danlos Syndrome ("EDS"). The Court disagrees. ALJ Garelick specifically discussed Ms. Krick's EDS impairment, correctly acknowledging that it "manifested in overly-flexible joints, with [Ms. Krick] having undergone associated surgeries . . . ." [AR 13.] ALJ Garelick also cited several pieces of evidence that accurately characterize the relevant medical records, including: (1) several rotator cuff repairs and an arthroscopic knee procedure; and (2) physical therapy records that showed Ms. Krick progressed well during her various post-surgical physical therapy programs.
Ms. Krick also appears to suggest that the ALJ misunderstood how her EDS impairment affects her because the ALJ's opinion references an imaging study of her cervical spine where the record does not suggest that any spinal issue results from her EDS. [See Pl.'s Mem. at 10.] In ALJ Garelick's written decision, he mentions a February 2015 cervical spine imaging result among a list of other MRIs and X-rays that relate to other joints. [AR 13.] Its inclusion in a list of tests that more precisely substantiate Ms. Krick's EDS is, at most, a de minimis mistake. And it does nothing to undermine the ALJ's otherwise accurate discussion of the syndrome. In the same paragraph, the ALJ expressly found that Ms. Krick's EDS manifests itself in overlyflexible joints, which accurately characterizes the medical evidence in the record. Given that the ALJ correctly understood how Ms. Krick's EDS affects her joints, the inclusion of the February 2015spinal imaging study in that list had no bearing on the outcome. See Hepp v. Astrue, 511 F.3d 798, 806 (8th Cir. 2008) ("[A]n arguable deficiency in opinion-writing technique does not require us to set aside an administrative finding when that deficiency had no bearing on the outcome.") (internal quotation marks omitted).
Mr. Krick also contends that the ALJ erred by ignoring evidence of her obesity and failed to discuss the condition at all. [Pl.'s Mem. at 12-13.] Relying on records which assign Ms. Krick a body mass index above 30
In a Social Security appeal such as this, an error by the ALJ is not harmless when a claimant provides "some indication that the ALJ would have decided differently if the error had not occurred." Byes v. Astrue, 687 F.3d 913, 917 (8th Cir. 2012). Here, there is no indication that ALJ Garelick should have included additional restrictions in Ms. Krick's RFC due to her weight. Most importantly, the medical evidence does not reflect any link between Ms. Krick's functional impairments to her weight. See SSR 02-1p, 2002 WL 34686281, at *6 (explaining that in the RFC evaluation "[o]besity can cause limitation of function"). For example, Dr. Nolan's RFC questionnaire does not attribute any of Ms. Krick's limitations to her weight. And the medical records from June and December of 2014 showing Ms. Krick's BMI was slightly over the obesity cutoff do not list obesity as a diagnosis or connect her weight to any functional limits. [AR 933-, 970-78.] For these reasons, the Court concludes that the ALJ would not have reached a different outcome if he had discussed her obesity, and any error in failing to do so is harmless. McNamara v. Astrue, 590 F.3d 607, 611 (8th Cir. 2010) ("Nothing in McNamara's medical records indicates that a physician ever placed physical limitations on McNamara's ability to perform work-related functions because of her obesity.").
Ms. Krick argues that the ALJ should have connected her neck pain to her fibromyalgia diagnosis and a history of motor vehicle accidents. Because fibromyalgia would not show up on an MRI, she asserts that the ALJ erred in relying on an unremarkable cervical spine imaging result from February 2015. [Pl.'s Mem. at 10-11.] Again, the Court finds no error in the ALJ's reference to the February 2015 MRI or the handling of her diagnosis of fibromyalgia. Dr. Nolan did not list fibromyalgia among the diagnoses that led to her more restrictive opinion reflected in the RFC questionnaire she completed. Instead, Dr. Nolan focused on Ms. Krick's EDS as the basis for her opinions. [AR 793.] Ms. Krick points to medical records from January and July of 2012 showing fibromyalgia diagnoses. These diagnoses were based on positive trigger point tests, including her neck. [See AR 349-51, 467-68.] However, these records do not suggest greater functional limitations than those reflected in the ALJ's ultimate sedentary RFC.
Moreover, based on the Court's review of the record as a whole, the ALJ appropriately cited medical records indicating that Ms. Krick regularly demonstrated "normal muscle bulk, tone, and power in her upper and lower extremities as well as normal strength, sensation, reflexes, gait and station."
Turning to the opinion evidence, Ms. Krick argues that the ALJ erred in discounting Dr. Nolan's opinion. [Pl.'s Mem. at 13-17.] There is no dispute that Dr. Nolan is a treating physician and that her January 23, 2015 assessment is a treating physician's opinion. Such an opinion is entitled to controlling weight where it is "`well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in [the] record.'" Pirtle v. Astrue, 479 F.3d 931, 933 (8th Cir. 2007) (quoting Prosch v. Apfel, 201 F.3d 1010, 1012-13 (8th Cir. 2000) (quoting 20 C.F.R. § 404.1527(d)(2))). Even where the treating physician's opinion is not entitled to controlling weight, it should not ordinarily be disregarded and is entitled to substantial weight. Papesh v. Colvin, 786 F.3d 1126, 1132 (8th Cir. 2015). If the treating source's opinion is not given controlling weight, an ALJ must evaluate it based on the length of the treating relationship, the frequency of examinations, the nature and extent of the treatment relationship, the support for the opinion in the medical evidence, consistency of the opinion with the record as a whole, and any specialization of the treating physician. Id.; 20 C.F.R. § 404.1527(c). "When an ALJ discounts a treating [source's] opinion, he should give good reasons for doing so." Davidson v. Astrue, 501 F.3d 987, 990 (8th Cir. 2007).
ALJ Garelick gave "little weight" to Dr. Nolan's opinion. [AR 15.] He reasoned that "the extreme degree of limitation cited in [the RFC questionnaire] form is not consistent with either the objective evidence of record (including that documented in Dr. Nolan's own treatment notes) or the information provided about the claimant's functional level of activity as discussed above [in the ALJ's opinion]." [AR 15.]
Because these observations are supported by substantial evidence on the record as a whole, they are "good reasons" supporting the ALJ's decision to discount Dr. Nolan's opinion. ALJ Garelick essentially found that Dr. Nolan's RFC opinion was inconsistent with her own treatment notes, which do not themselves reflect significant restrictions, and in fact contained frequent encouragement for Ms. Krick to get more exercise.
Because substantial evidence on the record as a whole supported the reasons the ALJ provided for discounting Dr. Nolan's RFC opinion, the ALJ did not commit reversible error in assigning that opinion little weight.
Ms. Krick next contends that the ALJ erred in assessing the factors listed in 20 C.F.R. § 404.1529(c)(3) and SSR 96-7p.
Here, the Court finds no error in the ALJ's observation that "the objective evidence does not support the degree of debilitation alleged," [AR 14], is supported by substantial evidence on the record as a whole. As noted above, the ALJ appropriately found that Ms. Krick's medical records show that she has "consistently recovered from surgery without complication and then done well in physical therapy." [AR 14]; see, e.g., records cited, supra, in footnotes 6 & 9.
Ms. Krick argues that the ALJ improperly evaluated her activities of daily living in discounting her subjective complaints of pain. [Pl.'s Mem. at 18-19.] There is no question that Ms. Krick's treatment records document consistent complaints of pain. However, this is not a case where the ALJ completely disregarded Ms. Krick's complaints of pain based on her daily activities, but rather observed that records show she has a greater degree of daily functioning than alleged. The ALJ observed that Ms. Krick
[AR 14.] Though it is true that a claimant need not be bedridden to prove an inability to engage in full-time work, see Reed v. Barnhart, 399 F.3d 917, 923 (8th Cir. 2005), the Eighth Circuit has also found that a claimant's shopping, driving short distances, attending church, and visiting relatives were inconsistent with the assertion of disabling pain, Edwards v. Barnhart, 314 F.3d 964, 966 (8th Cir. 2003). ALJ Garelick considered Ms. Krick's daily activities in assessing her statements about the limiting effects of her symptoms, and his conclusion has substantial evidentiary support, which places his assessment on this issue within the zone of choice permitted by the record as a whole. [See, e.g., AR 33 (testifying that she was able to driver herself to the hearing, though she stopped at one point); AR 53-54 (describing walking around a Target and stating that she is able to lift a gallon of milk); AR 59 (describing self-care activities as well as doing dishes and laundry, though limited); AR 379 (indicating Ms. Krick is able "to climb one flight of stairs and perform yard work, household cleaning, grocery shopping, etc. without trouble"); AR 601 (indicating Ms. Krick is able to walk 1-2 miles").]
Finally, Ms. Krick argues that the ALJ did not properly analyze the side effects from her medications. [Pl.'s Mem. at 19.] However, based on the Court's review of the record as a whole, there is no error in the ALJ's observation that the "treatment notes do not contain contemporaneous documentation of ongoing complaints of significant negative side effects." [AR 14.] Ms. Krick's ability to point to discrete medical records addressing side effects does not demonstrate the ALJ's finding was unsupported by substantial evidence. Ms. Krick cites a record from September 2013 following her right knee surgery where she was temporarily taking Oxycontin and Oxycodone. [AR 880.] A physician's assistant noted that Ms. Krick's nausea was related to her pain medications, which could be switched, but Ms. Krick did not want to switch her medications. [AR 880.] But this was not an ongoing issue. Ms. Krick also cites a May 2012 treatment record with Dr. Nolan where she presented for a sleep problem and noted that Nortriptyline made her feel "wired." [AR 368-70.] Dr. Nolan recommended that she follow up with her mental health provider for her sleep issues, but did not discontinue her medication. [AR 370.] These records do not support reversal of the ALJ's decision.
For the reasons stated above,
1. Plaintiff's Motion for Summary Judgment
2. Defendant's Motion for Summary Judgment
3. This matter is
Phelan v. Colvin, No. 15-5195, 2017 WL 586366, at *1 n.2 (W.D. Ark. Jan. 18, 2017) (quoting 3 Java O. Solis, Ehlers-Danlos Syndrome, in The Gale Encyclopedia Of Medicine 1674-78 (Jacqueline L. Longe ed., 5th ed. 2015)). Ms. Krick described hypermobility in her joints. [See AR 47-48.]