KIRTAN KHALSA, Magistrate Judge.
Claimant Phyllis Quintana ("Ms. Quintana") alleges that she became disabled on September 1, 2012, at the age of thirty-two because of arthritis in both knees, back problems, depression, posttraumatic stress syndrome ("PTSD"), and anxiety. (Tr. 255, 259.
On August 13, 2013, Ms. Quintana filed an application for Social Security Disability Insurance Benefits ("DIB") under Title II of the Social Security Act (the "Act"), 42 U.S.C. § 401 et seq. (Tr. 230-33.) She also filed an application for Supplemental Security Income ("SSI") under Title XVI of the Act, 42 U.S.C. § 1381 et seq. (Tr. 234-39.) Ms. Quintana's applications were initially denied on January 7, 2014, and January 28, 2014. (Tr. 96-110, 111, 112-26, 153-55, 156-59.) They were denied again at reconsideration on July 2, 2014. (Tr. 127, 128-39, 141-52, 166-68, 170-73.) On August 22, 2014, Ms. Quintana requested a hearing before an Administrative Law Judge ("ALJ"). (Tr. 174-75.) The ALJ conducted a hearing on November 13, 2015. (Tr. 55-95.) Ms. Quintana appeared in person at the hearing with attorney representative Michael Armstrong. (Id.) The ALJ took testimony from Ms. Quintana (Tr. 61-89), and an impartial vocational expert ("VE"), Cassandra Humphress (Tr. 89-94). On January 8, 2016, ALJ John W. Rolph issued an unfavorable decision. (Tr. 28-48.) On December 13, 2016, the Appeals Council issued its decision denying Ms. Quintana's request for review and upholding the ALJ's final decision. (Tr. 1-4.) On February 15, 2017, Ms. Quintana timely filed a Complaint seeking judicial review of the Commissioner's final decision. (Doc. 1.)
An individual is considered disabled if she is unable "to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A) (pertaining to disability insurance benefits); see also 42 U.S.C. § 1382(a)(3)(A) (pertaining to supplemental security income disability benefits for adult individuals). The Social Security Commissioner has adopted the familiar five-step sequential analysis to determine whether a person satisfies the statutory criteria as follows:
See 20 C.F.R. § 404.1520(a)(4) (disability insurance benefits); 20 C.F.R. § 416.920(a)(4) (supplemental security income disability benefits); Fischer-Ross v. Barnhart, 431 F.3d 729, 731 (10th Cir. 2005); Grogan v. Barnhart, 399 F.3d 1257, 1261 (10
This Court must affirm the Commissioner's denial of social security benefits unless (1) the decision is not supported by "substantial evidence" or (2) the ALJ did not apply the proper legal standards in reaching the decision. 42 U.S.C. § 405(g); Hamlin v. Barnhart, 365 F.3d 1208, 1214 (10
The ALJ made his decision that Ms. Quintana was not disabled at step five of the sequential evaluation. (Tr. 47-48.) Specifically, the ALJ determined that Ms. Quintana met the insured status requirements of the Social Security Act through March 31, 2013, and that Ms. Quintana had not engaged in substantial gainful activity since September 1, 2012. (Tr. 33.) He found that Ms. Quintana had the following severe impairments: opioid dependence (on Suboxone Replacement Therapy), morbid obesity, bilateral knee impairment with pain, lumbar spine impairment with pain and radiculopathy, right leg pain status-post deep vein thrombosis (DVT), chronic pain syndrome, PTSD, depression NOS/dysthymia, and anxiety disorder (NOS). (Tr. 34.) The ALJ also determined that Ms. Quintana had nonsevere impairments of a history of polysubstance abuse (methamphetamine and marijuana), tobacco abuse, shortness of breath, nausea, fatigue and sleep apnea, heel pain, cellulitis of the face, mild degenerative changes of the hips, allergies and allergic rhinitis, status-post ventral hernia repair/umbilical hernia repair, pruritic dermatitis, cervical pain, dental disease, vaginal bleeding, constipation and hematochezia, benign headache, and hemorrhoids. (Tr. 35-36.) The ALJ, however, determined that Ms. Quintana's impairments did not meet or equal in severity one of the listings described in Appendix 1 of the regulations. (Tr. 36-38.) As a result, the ALJ proceeded to step four and found that Ms. Quintana had the residual functional capacity
(Tr. 38.) The ALJ then determined at step five that considering Ms. Quintana's age, education, work experience, and RFC, there were jobs that existed in significant numbers in the national economy that the claimant could perform. (Tr. 47-48.)
In support of her Motion, Ms. Quintana argues that (1) the ALJ failed to give adequate reasons for rejecting the opinion of treating provider Silaja Cheruvu, M.D.; and (2) that the ALJ failed to resolve the conflict between the DOT and VE testimony in violation of SSR 00-4p. (Doc. 18 at 14-21.) For the reasons discussed below, the Court finds there is no reversible error.
On September 19, 2014, Ms. Quintana presented to First Choice Community Health South Valley Health Commons and saw Dr. Will Kaufman, M.D. (Tr. 682.) The purpose of her visit was to "establish Suboxone program."
On October 14, 2014, Nurse Practitioner Karen Farias enrolled Ms. Quintana in the Suboxone program and took a history of her present illness. (Tr. 679-81.) NP Farias noted that Ms. Quintana had been on Suboxone for the past three years through UNM Focus and was transitioning her care to First Choice. (Tr. 679.) Ms. Quintana reported a history of right lower extremity deep vein thrombosis; neck pain, mostly right side, and associated with bilateral temple headaches; bilateral knee pain that is "mostly controlled with Suboxone"; right back and radicular pain that was helped with Gabapentin; and sleep apnea.
On October 27, 2014, Ms. Quintana saw NP Farias for follow up. (Tr. 669-70.) Ms. Quintana reported some increased anxiety related to her mother being ill. (Tr. 669.) Ms. Quintana also reported, inter alia, that she was still having trouble sleeping, but that the Flexeril helped her back "a lot." (Id.)
On November 11, 2014, Ms. Quintana saw NP Farias for follow up. (Tr. 675.) Ms. Quintana reported worsening pain in her knees and back due to cold weather. (Id.) On physical exam, NP Farias noted that Ms. Quintana ambulated without an assistive device and had no obvious weakness or limp, but did appear uncomfortable. (Id.) NP Farias further noted that Ms. Quintana was pleasant, cooperative, and appropriate. (Id.) NP Farias increased the Gabapentin dose for anxiety, and noted that Ms. Quintana wanted a referral for an exercise program at First Choice Community Healthcare for her pain and weight loss. (Id.)
On October 30, 2014, Ms. Quintana saw Silaja Cheruvu, M.D., for an initial FCCH Opiate Dependence exam. (Tr. 676-78.) Dr. Cheruvu noted that Ms. Quintana presented seeking treatment for opiate dependence. (Tr. 676.) Dr. Cheruvu also noted a history of anxiety and depression. (Id.)
Ms. Quintana saw Dr. Cheruvu again on December 10, 2014, February 22, 2015, March 11, 2015, June 9, 2015, July 9, 2015, August 13, 2015, and September 15, 2015. (Tr. 632-35, 639-45, 646, 650-53, 654-61, 662-68, 671-74.) At each of these visits, Dr. Cheruvu noted that Ms. Quintana presented for continued Suboxone opiate replacement therapy. (Id.) Dr. Cheruvu's physical exams noted only Ms. Quintana's vital signs and measurements from flowsheet; i.e., height, weight, body surface area and body mass index. (Id.) Dr. Cheruvu also noted at each visit that Ms. Quintana was alert and oriented, and in no acute distress. (Id.) Dr. Cheruvu's diagnosis for each visit, without more, was "opioid dependence, on replacement therapy." (Id.)
On October 15, 2015, Dr. Cheruvu signed two completed assessment forms on Ms. Quintana's behalf — a Medical Assessment of Ability To Do Work Related Activities (Physical) and a Medical Assessment of Ability To Do Work Related Activities (Mental). (Tr. 775, 776.) Both forms instructed the health care provider completing the form to "[p]lease consider patient's medical history and the chronicity of findings as from 2013 to current examination." (Tr. 775, 776.) As to Ms. Quintana's physical limitations, Dr. Cheruvu indicated that Ms. Quintana could not maintain effort for long periods without a need to decrease activity or pace, or to rest intermittently because of pain, fatigue, and dizziness. (Tr. 775.) She assessed that Ms. Quintana could both occasionally and frequently lift and/or carry less than 10 pounds, stand and/or walk less than 2 hours in an 8-hour day, and sit less than four hours in an 8-hour day. (Id.) Dr. Cheruvu explained that on account of blood clots and issues with her knee and feet "no circulation is an issue," and thus "[s]itting and walking for more than 2 hours is not possible." (Id.) Dr. Cheruvu noted Ms. Quintana suffers "siadica [sic] in lower back witch [sic] causes pain and muscil [sic] tension." (Id.) Dr. Cheruvu also assessed that Ms. Quintana was limited in her ability to push and/or pull in upper extremities, and that she should never kneel, stoop or crawl, and only occasionally crouch. (Id.)
As to Ms. Quintana's mental limitations, Dr. Cheruvu noted that the form was "[c]ompleted by patient w/my help." (Tr. 776.) She indicated therein that Ms. Quintana suffers from a pain producing impairment, injury or sickness; her pain is severe; she suffers from fatigue as a result of her impairments; and she has to rest or lie down at regular intervals because of her pain and/or fatigue. (Tr. 776.) Dr. Cheruvu assessed that Ms. Quintana was slightly limited in her ability to maintain regular attendance and be punctual within customary tolerance; and moderately limited in her ability to (1) maintain attention and concentration for extended periods (i.e., 2-hour segments), (2) perform activities within a schedule, (3) maintain physical effort for long periods without a need to decrease activity or pace, or to rest intermittently (i.e., 2-hour segments), (4) sustain an ordinary routine without special supervision, (5) work in coordination with/or proximity to others without being distracted by them, and (6) make simple work-related decisions. (Id.) Dr. Cheruvu assessed that Ms. Quintana was markedly limited in her ability to complete a normal workday and workweek without interruptions from pain or fatigue based symptoms and to perform at a consistent pace without unreasonable number and length of rest periods. (Id.) Dr. Cheruvu explained that Ms. Quintana "[h]as severe depression which is diagnosed as PTSD also from past issues. Anxiety every day. Sleep disorder is moderate, uses CPAP — 3 liter oxygen at night. Substance Suboxone treatment." (Id.)
The ALJ accorded Dr. Cheruvu's opinion little weight. (Tr. 45.) He explained that the assessment forms appeared to be completed by Ms. Quintana and only signed off by Dr. Cheruvu. (Id.) He also explained that Dr. Cheruvu's opinion was not consistent with the medical evidence of record. (Id.) Ms. Quintana argues that the ALJ failed to provide legitimate reasons for rejecting Dr. Cheruvu's opinion as a treating physician. (Doc. 18 at 14-17.) Specifically, Ms. Quintana argues that the ALJ's claim that the assessment forms were completed by Ms. Quintana and merely signed off by Dr. Cheruvu is speculation. (Id. at 16.) She asserts that the ALJ should have, at the very least, recontacted Dr. Cheruvu for clarification. (Id. at 16-17.) Ms. Quintana further argues that the ALJ failed to explain or identify which parts of the record were inconsistent with Dr. Cheruvu's opinion. (Id. at 17.) The Commissioner contends that the ALJ gave two valid reasons for rejecting Dr. Cheruvu's opinion and that the preceding pages of the ALJ's decision noted contradictory findings by both the State agency nonexamining and examining consultants, to which the ALJ accorded great weight. (Doc. 20 at 8-13.) The Commissioner further contends that the ALJ reasonably interpreted the handwritten note initialed by Dr. Cheruvu on the assessment form and was in the best position to resolve any conflicts in the evidence. (Id.)
When properly rejecting a treating physician's opinion, an ALJ must follow two steps. Langley, 373 F.3d at 1119. First, the ALJ must first determine whether the opinion qualifies for "controlling weight." Id. To do so, the ALJ must consider whether the opinion is well supported by medically acceptable clinical and laboratory diagnostic techniques." Id. If the answer is "no," the inquiry ends. Id. If the opinion is well supported, the ALJ must then determine if it is consistent with other substantial evidence in the record. Id. If the opinion is deficient in either of these respects, the opinion is not entitled to controlling weight. Id. However, even if a treating physician's opinion is not entitled to controlling weight, it is still entitled to deference and must be weighed using the relevant regulatory factors. Id.
Here, the ALJ failed to provide a proper analysis under the treating physician rule, and this is error. Langley, 373 F.3d at 1119. However, the ALJ's error is harmless because his decision is sufficiently clear for the Court to determine why he chose not to give Dr. Cheruvu's opinion controlling weight. See Andersen v. Astrue, 319 F. App'x 712, 721 (10
The ALJ's explanation that Dr. Cheruvu's opinion was not consistent with the medical evidence of record is supported by substantial evidence. Although Ms. Quintana contends that the ALJ failed to indicate which part of the record he was referring to in his explanation, the Court notes that the ALJ's determination immediately preceding his evaluation of Dr. Cheruvu's opinion detailed Ms. Quintana's medical history related to her physical and mental impairments.
As to Ms. Quintana's alleged mental impairments, the ALJ made step two findings, which Ms. Quintana has not disputed, that Ms. Quintana had mild restrictions in her activities of daily living, mild difficulties in her social functioning, and moderate difficulties in concentration, persistence or pace. (Tr. 37.) The ALJ then discussed at step four that Ms. Quintana's mental status exams demonstrated she was oriented, attentive, neat, clean, her memory was good, her judgment and insight were fair, her intelligence average, and that she had no abnormalities with language process, thought process, cognitive functioning or memory.
The ALJ's discussion of the medical evidence record, therefore, demonstrates that Dr. Cheruvu's assessments related to Ms. Quintana's ability to do work-related physical and mental activities were not consistent with the medical evidence record.
The ALJ rejected Dr. Cheruvu's assessments on the basis of contradictory medical evidence. Therefore, even if the ALJ improperly speculated that Dr. Cheruvu's assessments appeared to have been completed by the claimant and only signed off by Dr. Cheruvu, to do so was harmless in light of the medical record evidence.
Lastly, the Court's review of the record demonstrates that Dr. Cheruvu's relationship with Ms. Quintana was for Suboxone replacement therapy, and that Dr. Cheruvu's treatment notes reflected physical exams that were limited to vital signs and flowsheet measurements. (Tr. 634, 641, 652, 656, 664, 673.) Further, Dr. Cheruvu's contemporaneous evaluation of Ms. Quintana's mental status consistently indicated "[a]lert and oriented. No acute distress." (Id.) See 20 C.F.R. §§ 404.1527(c)(2)(ii) and 416.927(c)(2)(ii) (explaining that the ALJ looks at the treatment the source provided and at the kinds and extent of examinations and testing the source performed when weighing medical source evidence); see also 20 C.F.R. §§ 404.1527(c)(3) and 416.927(c)(3) (explaining that the more a medical source presents relevant evidence to support their opinion, particularly medical signs and laboratory findings, the more weight will be given to their opinion). Thus, the limited nature and extent of Dr. Cheruvu's treatment relationship with Ms. Quintana, along with her limited treatment notes, further support the ALJ's determination to accord little weight to Dr. Cheruvu's functional assessments related to Ms. Quintana ability to work related physical and mental activities.
Ms. Quintana generally argues that the ALJ failed to resolve a conflict between the DOT and the VE testimony related to her standing/walking limitations. (Doc. 18 at 18-21.) Specifically, Ms. Quintana contends that because the ALJ's hypothetical limited Ms. Quintana to a combined total of four hours of standing and/or walking in an 8-hour workday, that the ALJ was required to elicit specific testimony regarding the conflict between the light exertional jobs the VE identified and the DOT because a full range of light work requires walking for up to six hours in an eight-hour workday. (Id.) Ms. Quintana also contends that the ALJ was required to elicit specific VE testimony regarding the conflict between the sedentary exertional jobs the VE identified and the DOT because the ALJ's hypothetical requires Ms. Quintana to change positions a minimum of once every hour thereby effectively limiting her to standing and/or walking for four hours and sitting for four hours, and further requires that she must be able to sit and stand at will. (Id.) The Commissioner asserts that the ALJ reasonably relied on VE testimony at step five. (Doc. 20 at 13-18.)
The Commissioner's step five showing that the claimant can perform other work existing in the national economy must be supported by substantial evidence. Thompson v. Sullivan, 987 F.2d 1482, 1487 (10
SSR 00-4p, 2000 WL 1898704, at *4.
The Tenth Circuit has held in unpublished cases that because the DOT does not discuss the availability of a sit/stand option, a VE's testimony about the availability of jobs with a sit/stand option does not raise an apparent conflict with the DOT. See Wahpakeche v. Colvin, 640 F. App'x 781, 785-86 (10
Here, the ALJ limited Ms. Quintana to a combined total of four hours of standing and/or walking in an eight-hour workday. (Tr. 38.) This limitation, on its face, reduced Ms. Quintana's ability to do a full range of light work, thereby precluding the light exertional jobs the VE identified absent specific resolution of the apparent conflict.
The ALJ's RFC did not restrict Ms. Quintana to sitting and standing/walking for a total of 4 hours each in an 8-hour workday. Here, the ALJ determined that Ms. Quintana "can stand and walk a combined total of four hours in an eight-hour day, for 45 to 60 minutes at a time. She can sit for six hours in an eight-hour day for 60-90 minutes at a time." (Tr. 38.) In other words, Ms. Quintana can sit for a total of six hours over the course of the day, but cannot sit at any one time for longer than one and a half hours. Additionally, she can stand/walk for a total of four hours in an eight hour workday, if necessary, but cannot stand/walk at any one time for longer than one hour. These limitations fall within the exertional standing/walking and sitting requirements of sedentary work. SSR 83-10, 1983 WL 31251, at *5-6; see also 20 C.F.R. §§ 404.1567(a), 416.967(a). Further, the hearing testimony makes clear that the ALJ was not effectively restricting Ms. Quintana to standing/walking and sitting for a total of 4 hours each in an 8-hour workday, and the ALJ related with precision to the VE Ms. Quintana's limitations with respect to standing/walking and sitting, as she was required to do. (Tr. 91.) See Hargis v. Sullivan, 945 F.2d 1482, 1492 (10
Additionally, the ALJ defined how often Ms. Quintana needed to change positions. The purpose of incorporating an individual's need to alternate between sitting and standing in the RFC assessment is to address symptoms, including pain, that may have an impact on an occupation's strength demands. SSR 96-8p, 1996 WL 374184, at *6. SSR 83-12 states in pertinent part that
SSR 83-12, 1983 WL 31253, at *4. SSR 96-9p instructs that the extent of the erosion to the occupational base would depend on the facts in the case record, and that the RFC assessment must be specific as to the frequency of the individual's need to alternate sitting and standing. SSR 96-9p, 1996 WL 374185, at *7; see also Vail v. Barnhart, 84 F. App'x 1, 5 (10
For the reasons stated above, Ms. Quintana's Motion to Reverse and Remand for a Rehearing With Supporting Memorandum (Doc. 18) is
The ALJ also discussed State agency nonexamining medical consultant opinion evidence. (Tr. 46.) The ALJ accorded Ronald Davis, M.D.,'s and Lawrence Kuo, M.D.'s assessments great weight explaining they were consistent with the evidence of record. (Id.) They each assessed that Ms. Ramos was capable of less than light exertional work; i.e., light work with certain postural limitations. (Tr. 104-06, 120-22, 148-49.) The ALJ tempered their findings with additional postural and environmental limitations based on evidence at the hearing level. (Tr. 46.) See Chapo v. Astrue, 682 F.3d 1285, 1288 (10
The record also contains several forms completed by Minda Brown Jaramillo, LCSW, related to Ms. Quintana's mental impairments. (Tr. 778-79, 780, 781, 788.) The ALJ accorded no weight to LCSW Jaramillo's assessments. (Tr. 45.) The record also contains a form prepared by James Libertoff, LCSW, that indicated Ms. Quintana meets certain of the Part A and Part B criteria for Listing 12.06 — Anxiety-Related Disorders. (Tr. 786.) The ALJ accorded some weight to LCSW Libertoff's assessment to the extent his limitations translated to a limitation to unskilled work. (Tr. 45.) Ms. Quintana did not dispute the ALJ's findings related to these other medical source opinions. See SSR 06-03p, 2006 WL 2329939, at *2 (describing other medical sources are nurse practitioners, physician assistants, licensed clinical social workers, naturopaths, chiropractors, audiologists, and therapist).