LOUISE W. FLANAGAN, District Judge.
This matter is before the court on the parties' cross motions for judgment on the pleadings. (DE 22, 31). Pursuant to 28 U.S.C. § 636(b)(1) and Federal Rule of Civil Procedure 72(b), United States Magistrate Judge James E. Gates entered a memorandum and recommendation ("M&R"), wherein it is recommended that the court deny plaintiff's motion, grant defendant's motion, and affirm defendant's decision. Plaintiff timely filed objections to the M&R, and defendant did not respond. Thus, the issues raised are ripe for ruling. For the reasons that follow, the court adopts the M&R as its own, grants defendant's motion, denies plaintiff's motion, and affirms defendant's final decision.
On August 11, 2011, plaintiff filed an application for supplemental security income benefits, alleging disability beginning January 11, 2011. The application was denied both initially and upon reconsideration. Plaintiff filed a request for a hearing before an administrative law judge ("ALJ"), who, after a hearing on January 24, 2013, denied plaintiff's claims by order issued June 13, 2013. Following the ALJ's denial of her application, plaintiff timely filed a request for review with the Appeals Council. On September 22, 2014, the Appeals Council denied plaintiff's request for review, leaving the ALJ's decision as defendant's final decision. On November 21, 2014, plaintiff timely filed complaint in this court seeking review of defendant's decision.
The court has jurisdiction under 42 U.S.C. § 405(g) to review defendant's final decision denying benefits. The court must uphold the factual findings of the ALJ "if they are supported by substantial evidence and were reached through application of the correct legal standard."
To assist it in its review of defendant's denial of benefits, the court may "designate a magistrate judge to conduct hearings . . . and to submit . . . proposed findings of fact and recommendations for the disposition [of the motions for judgment on the pleadings]."
The ALJ's determination of eligibility for Social Security benefits involves a five-step sequential evaluation process, which asks whether:
In the instant matter, the ALJ performed the sequential evaluation. At step one, the ALJ found that plaintiff had not engaged in substantial gainful activity since January 11, 2011, the alleged onset date. At step two, the ALJ found that plaintiff had the following severe impairments: arthropathy attributed to Lyme disease, anxiety and depression, and osteoarthritis in her right knee. However, at step three, the ALJ further determinated that these impairments were not severe enough, either individually or in combination, to meet or medically equal one of the listings in the regulations. Applying the special technique for evaluation of mental impairments, the ALJ found that plaintiff's mental impairments resulted in mild restriction in activities of daily living and social functioning, and moderate limitations in concentration, persistence, or pace. In addition, the ALJ found that plaintiff had suffered no extended periods of decompensation.
Before proceeding to step four, the ALJ determined that during the relevant time period plaintiff had the residual functional capacity ("RFC") to perform light work, subject to certain limitations. Limitations included restriction to the performance of simple, routine, repetitive tasks, and no more than occasional interaction with other workers and the general public. In making this assessment, the ALJ found plaintiff's statements about the severity of her symptoms not fully credible. At step four, the ALJ concluded plaintiff was unable to perform her past relevant work. At step five, the ALJ found that there are jobs that exist in significant numbers in the national economy that plaintiff can perform. Thus, the ALJ concluded that plaintiff was not disabled under the terms of the Social Security Act.
Plaintiff raises objections to the magistrate judge's treatment of four claims. First, plaintiff argues that the ALJ improperly weighed the opinions of two of her physicians. Second, plaintiff asserts that the ALJ did not account properly for plaintiff's limitations in concentration, persistence, or pace when determining her RFC. Third, plaintiff contends that the ALJ erred in finding plaintiff's subjective complaints about the severity of her symptoms not to be credible. Fourth, plaintiff argues that failure to weigh properly the physicians' opinions, coupled with failure to find her statements credible, caused the ALJ to arrive at an erroneous RFC determination.
Plaintiff argues that the ALJ erred in assigning only minimal weight to the opinions of her treating physician, Dr. Sabra Bellovin, and one of her consultative examining physicians, Dr. Vinod Shah. Both physicians shared similar opinions that plaintiff is functionally disabled and incapable of performing even sedentary work. (Tr. 559, 670).
An ALJ must weigh and evaluate all medical opinions received, regardless of their source. 20 C.F.R. §§ 404.1527(c), 416.927(c). Generally, opinions from treating sources are given greater weight than opinions from non-treating sources, such as consultative examiners. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). However, any medical opinion, even one from a treating source, may be given less weight if it is not well supported or if it is inconsistent with other evidence in the record. 20 C.F.R. §§ 404.1527(c)(3)-(4), 416.927(c)(3)-(4);
While an ALJ is under no obligation to accept any medical opinion, he or she must nevertheless explain the weight afforded such opinions.
Plaintiff argues the ALJ was wrong to assign only minimal weight to Dr. Bellovin's opinion. In particular, plaintiff asserts four bases of error, arguing that the ALJ should have accorded substantial weight to Dr. Bellovin's opinion where it was internally consistent, made appropriate use of plaintiff's subjective complaints, aligned with other medical evidence in the record, and was not conclusory.
In a medical source statement dated April 5, 2012, Dr. Bellovin expressed her opinion on plaintiff's work capability: "Due to the persistent pain and pervasive exhaustion, as well as cognitive difficulties, I do not feel that [plaintiff] is capable of even sedentary work." (Tr. 670). The ALJ, after describing the content of Dr. Bellovin's treatment notes, considered the weight that should be accorded to Dr. Bellovin's opinion:
(Tr. 23).
First, plaintiff disputes the ALJ's conclusion that Dr. Bellovin's opinion is not supported by the physician's own clinical findings and notes. Plaintiff construes the ALJ's assessment as based upon the reasoning, "that because Dr. Bellovin's treatment notes did not indicate that [plaintiff] was `essentially bedridden,' Dr. Bellovin's opinion was not supported by her clinical findings." (DE 38, 4). Read this way, plaintiff criticizes the ALJ's analysis because "Dr. Bellovin did not opine that [plaintiff] was bedridden; she said that she could not perform full-time work without frequent absence." (
"[I]f a physician's opinion is not supported by clinical evidence . . . it should be accorded significantly less weight."
Plaintiff mischaracterizes the ALJ's analysis. The ALJ did not construe Dr. Bellovin's opinion to be that plaintiff is disabled because she is bedridden; the ALJ stated clearly that it is "
Such mixed medical evidence does not create a contradiction undermining the ALJ's decision.
Next, plaintiff argues that the ALJ provided insufficient support for his conclusion that Dr. Bellovin relied overly much upon plaintiff's subjective complaints regarding her symptoms. Plaintiff contends that regulations do not preclude consideration of a patient's subjective description of his or her symptoms, citing for support 20 C.F.R. § 404.1527, which describes "[m]edical opinions [as] statements from physicians . . . that reflect judgments about the nature and severity of [a patient's] impairment(s), including [a patient's] symptoms." § 404.1527(a)(2).
While some reliance on a patient's subjective complaints is permissible, a physician errs in relying overly much upon subjective complaints.
The ALJ found such over-reliance occurred where "Dr. Bellovin's assessment of the claimant's capacity for work-related activities in April 2012 and December 2012 was overshadowed by [plaintiff]'s subjective complaints, which are not supported by Dr. Bellovin's own clinical findings and notes." (Tr. 23). As described previously, the ALJ determined that objective medical evidence in Dr. Bellovin's treatment notes was insufficient to support her opinion of plaintiff's work capabilities. Therefore, the ALJ reasoned, Dr. Bellovin must have relied upon the other evidence in her treatment notes, namely plaintiff's subjective complaints, in order to arrive at her opinion that plaintiff could not perform even sedentary work. (Tr. 23). In addition, the ALJ referenced portions of Dr. Bellovin's notes in which Dr. Bellovin emphasizes plaintiff's reported symptoms and predicts that they will continue to affect her capacity to work. (
Plaintiff argues that the ALJ erred in finding Dr. Bellovin's opinion inconsistent with other medical evidence in the record where such other evidence was not relevant to plaintiff's disability. In particular, plaintiff dismisses results of neurological and strength tests as irrelevant in measuring the severity of plaintiff's Lyme disease, partly relying upon Dr. Shah's findings: "The patient has a history of Lyme disease, babesiosis, and fibromyalgia. It seems that generally with those diseases, [plaintiff] would not have any abnormal physical finding, at least I can say, but is sure for fibromyalgia." (Tr. 559).
The ALJ considered evidence from not just Drs. Bellovin and Shah, but also from at least six other medical doctors familiar with plaintiff's conditions. (
Plaintiff disputes the ALJ's description of Dr. Bellovin's opinion as "conclusory, providing very little explanation of the evidence relied on in forming that opinion." (Tr. 23). Rather, plaintiff argues, Dr. Bellovin's evaluation "is actually quite detailed and specific." (DE 38, 2). However, for the reasons stated in the preceding sections, the ALJ explained in detail why he determined Dr. Bellovin's opinion to be conclusory and accorded it little weight. Namely, the treatment notes did not support Dr. Bellovin's opinion on plaintiff's work capability, Dr. Bellovin relied overly much on plaintiff's subjective complaints in order to reach her opinion, and Dr. Bellovin's opinion conflicted with other medical evidence in the record.
In sum, where the ALJ sufficiently explained his reasons for giving little weight to the opinion of Dr. Bellovin, and where that explanation was supported by substantial evidence,
Plaintiff argues that the ALJ erred in assigning only minimal weight to Dr. Shah's medical opinion regarding plaintiff's work capability. For different reasons, plaintiff faults also the M&R for the same finding. With regard to the ALJ's reasoning, plaintiff argues that the ALJ failed to explain how tests on strength and neurology were relevant for measuring the effects of plaintiff's Lyme disease. With regard to the M&R, plaintiff argues that its finding of an inconsistency between Dr. Shah's treatment notes and his diagnosis is an impermissible, post-hoc justification.
The ALJ described Dr. Shah's consultative examination of plaintiff, and then described his reasons for weighting it as follows:
(Tr. 19-20).
Where the ALJ described and considered seven other medical doctors' opinions regarding plaintiff's condition, and where he found that at least four of those opinions are inconsistent with Dr. Shah's diagnoses (Tr. 19-24), the ALJ provided sufficient explanation in deciding to assign no weight to Dr. Shah's opinion.
With regard to the M&R, the magistrate judge did not err, where he described and considered Dr. Shah's objective treatment notes, compared them to plaintiff's subjective report of symptoms, and found that Dr. Shah's notes were inconsistent with his medical opinion of plaintiff's work capability. Such descriptions of the record demonstrated that substantial evidence supported the ALJ's determination to give no weight to Dr. Shah's opinion. Where the ALJ already explained that the opinion was inconsistent with examination findings, the M&R analysis is not post-hoc rationalization. (Tr. 19-20);
Plaintiff argues that the ALJ did not account properly for plaintiff's limitations in concentration, persistence, or pace, as required by
The ALJ noted that plaintiff has moderate difficulties with regard to concentration, persistence, or pace. In making the RFC determination, the ALJ limited plaintiff to "work requiring only simple, repetitive, routine tasks. She should have no more than occasional interaction with other workers and the general public." (Tr. 18). In this case, in contrast to
First, the ALJ considered a psychiatric evaluation performed in October 2011 by a consultative physician showing plaintiff demonstrated "minimal impairment of attention and concentration and rather mild impairment of short-term memory." (Tr. 21, 565). The physician found plaintiff's "attention and concentration skills and fund of knowledge were adequate," and concluded that plaintiff's "ability to perform simple repetitive tasks and to persist at those tasks primarily would be only limited by her objective physical findings and somatic complaints." (Tr. 21, 565). The ALJ noted that a psychological evaluation conducted some years prior had shown similar results, particularly that plaintiff's "adaptive behaviors are within the average to high average range and indicate that she is capable of normal functioning." (Tr. 20, 510).
In addition, in reviewing plaintiff's most recent mental health treatment and examinations, the ALJ "did not note severe cognitive limitations, and indeed [plaintiff] did well on portions related to memory and attention and concentration." (Tr. 23, 561-66, 672-94). In particular, the ALJ cited a report finding plaintiff's "[a]ttention, concentration and memory grossly intact." (Tr. 23, 677). The ALJ described the results of plaintiff's "neurological examination [to be] entirely within normal limits" (Tr. 22), and plaintiff's mental status exam showed she "has normal attention and concentration." (Tr. 807).
The ALJ further elaborated on his determination of plaintiff's work capabilities regarding concentration, persistence, or pace, where he described a report by the state agency psychologist, Dr. Robert Stainback, whose opinion the ALJ assigned substantial weight:
(Tr. 23-24, 121-39). With regard to sustained concentration and pace, Dr. Stainback specifically found, that plaintiff was not significantly limited in her "ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerance," that plaintiff was not significantly limited in her "ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods," and that plaintiff was not significantly limited in her "ability to sustain an ordinary routine without special supervision." (Tr. 135-36). In light of this substantial level of detail in discussing the evidence in the record bearing on mental functional capacity limitations, this case is distinguishable from
Moreover, the ALJ's RFC included a limitation to only occasional contact with coworkers and the general public, which addresses plaintiff's moderate difficulties in concentration and persistence.
Plaintiff argues that the ALJ mischaracterized evidence of her daily life as being unsupportive of her subjective complaints regarding the severity of her symptoms, and that this mischaracterization caused the ALJ to find her testimony not to be credible. In particular, plaintiff argues that the ALJ erred in forming a general opinion about plaintiff's testimony that she was bedridden where the ALJ focused upon several isolated incidents where she engaged in physically demanding activities. The M&R cogently addressed the issues raised by plaintiff in this argument, which repeats many of the points plaintiff raised in her original motion for judgment on the pleadings. Accordingly, the court addresses only the most relevant issue of the ALJ's discretion in weighing credibility.
If the ALJ does not find plaintiff's testimony to be credible, the ALJ must cite "specific reasons for the finding on credibility, supported by the evidence in the case record." SSR 96-7P, 1996 WL 374186, at *2 (July 2, 1996). The ALJ satisfied that requirement here, where he recited in his decision plaintiff's testimony describing comprehensively her activities of daily living, and where he contrasted that with specific evidence in the record demonstrating plaintiff's physically active horseback riding hobby and her engagement in various other physically demanding activities. (Tr. 22-24);
Plaintiff argues that the ALJ's assessment of plaintiff's RFC was flawed, on the bases that the ALJ assigned too little weight to the opinions of Drs. Bellovin and Shah, and that the ALJ improperly found plaintiff's testimony not to be credible. For the reasons explained previously, plaintiff's arguments fail on both of these points. Accordingly, the court rejects plaintiff's argument regarding RFC, and upholds defendant's decision as to plaintiff's capacity to perform light work, subject to certain limitations.
Based on the foregoing, the court ADOPTS the M&R as its own. Plaintiff's motion for judgment on the pleadings (DE 22) is DENIED, and defendant's motion for judgment on the pleadings (DE 31) is GRANTED. The clerk of court is DIRECTED to close this case.
SO ORDERED.