LINCOLN D. ALMOND, Magistrate Judge.
This matter is before the Court for judicial review of a final decision of the Commissioner of the Social Security Administration ("Commissioner") denying Disability Insurance Benefits ("DIB") under the Social Security Act (the "Act"), 42 U.S.C. § 405(g). Plaintiff filed his Complaint on August 3, 2018 seeking to reverse the Decision of the Commissioner. On January 11, 2019, Plaintiff filed a Motion to Remand or Reverse the Decision of the Commissioner. (ECF Doc. No. 11). On February 8, 2019, the Commissioner filed a Motion for an Order Affirming the Commissioner's Decision. (ECF Doc. No. 12). On February 28, 2019, Plaintiff filed his Reply. (ECF Doc. No. 14).
This matter has been referred to me for preliminary review, findings and recommended disposition. 28 U.S.C. § 636(b)(1)(B); LR Cv 72. Based upon my review of the record, the parties' submissions and independent research, I find that there is substantial evidence in this record to support the Commissioner's decision and findings that Plaintiff is not disabled within the meaning of the Act. Consequently, I recommend that Plaintiff's Motion to Remand (ECF Doc. No. 11) be DENIED and that the Commissioner's Motion to Affirm (ECF Doc. No. 12) be GRANTED.
Plaintiff filed an application for DIB on January 8, 2016 (Tr. 154-160) alleging disability since December 22, 2015. The application was denied initially on March 16, 2016 (Tr. 71-78) and on reconsideration on November 29, 2016. (Tr. 80-91). Plaintiff requested an Administrative Hearing. On October 2, 2017, a hearing was held before Administrative Law Judge Gerald Resnick (the "ALJ") at which time Plaintiff, represented by counsel, and a Vocational Expert ("VE") appeared and testified. (Tr. 38-58). The ALJ issued an unfavorable decision to Plaintiff on November 16, 2017. (Tr. 12-37). The Appeals Council denied Plaintiff's request for review on May 8, 2018. (Tr. 4-8). Therefore, the ALJ's decision became final. A timely appeal was then filed with this Court.
Plaintiff argues that the ALJ erred in the assessment of his residual functional capacity and improperly addressed his subjective complaints.
The Commissioner disputes Plaintiff's claims and contends that the ALJ's conclusions are supported by substantial evidence and must be affirmed.
The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla —
Where the Commissioner's decision is supported by substantial evidence, the court must affirm, even if the court would have reached a contrary result as finder of fact.
The court must reverse the ALJ's decision on plenary review, however, if the ALJ applies incorrect law, or if the ALJ fails to provide the court with sufficient reasoning to determine that he or she properly applied the law.
The court may remand a case to the Commissioner for a rehearing under sentence four of 42 U.S.C. § 405(g); under sentence six of 42 U.S.C. § 405(g); or under both sentences.
Where the court cannot discern the basis for the Commissioner's decision, a sentence-four remand may be appropriate to allow her to explain the basis for her decision.
In contrast, sentence six of 42 U.S.C. § 405(g) provides:
42 U.S.C. § 405(g). To remand under sentence six, the claimant must establish: (1) that there is new, non-cumulative evidence; (2) that the evidence is material, relevant and probative so that there is a reasonable possibility that it would change the administrative result; and (3) there is good cause for failure to submit the evidence at the administrative level.
A sentence six remand may be warranted, even in the absence of an error by the Commissioner, if new, material evidence becomes available to the claimant.
The law defines disability as the inability to do 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 twelve months. 42 U.S.C. §§ 416(i), 423(d)(1); 20 C.F.R. § 404.1505. The impairment must be severe, making the claimant unable to do her previous work, or any other substantial gainful activity which exists in the national economy. 42 U.S.C. § 423(d)(2); 20 C.F.R. §§ 404.1505-404.1511.
Substantial weight should be given to the opinion, diagnosis and medical evidence of a treating physician unless there is good cause to do otherwise.
Where a treating physician has merely made conclusory statements, the ALJ may afford them such weight as is supported by clinical or laboratory findings and other consistent evidence of a claimant's impairments.
The ALJ is required to review all of the medical findings and other evidence that support a medical source's statement that a claimant is disabled. However, the ALJ is responsible for making the ultimate determination about whether a claimant meets the statutory definition of disability. 20 C.F.R. § 404.1527(e). The ALJ is not required to give any special significance to the status of a physician as treating or non-treating in weighing an opinion on whether the claimant meets a listed impairment, a claimant's residual functional capacity (
The ALJ has a duty to fully and fairly develop the record.
The ALJ is required to order additional medical tests and exams only when a claimant's medical sources do not give sufficient medical evidence about an impairment to determine whether the claimant is disabled. 20 C.F.R. § 416.917;
The ALJ must follow five steps in evaluating a claim of disability.
In determining whether a claimant's physical and mental impairments are sufficiently severe, the ALJ must consider the combined effect of all of the claimant's impairments, and must consider any medically severe combination of impairments throughout the disability determination process. 42 U.S.C. § 423(d)(2)(B). Accordingly, the ALJ must make specific and well-articulated findings as to the effect of a combination of impairments when determining whether an individual is disabled.
The claimant bears the ultimate burden of proving the existence of a disability as defined by the Social Security Act.
Once the ALJ finds that a claimant cannot return to her prior work, the burden of proof shifts to the Commissioner to establish that the claimant could perform other work that exists in the national economy.
Exclusive reliance is not appropriate when a claimant is unable to perform a full range of work at a given residual functional level or when a claimant has a non-exertional impairment that significantly limits basic work skills.
"Pain can constitute a significant non-exertional impairment."
Where an ALJ decides not to credit a claimant's testimony about pain, the ALJ must articulate specific and adequate reasons for doing so, or the record must be obvious as to the credibility finding.
A lack of a sufficiently explicit credibility finding becomes a ground for remand when credibility is critical to the outcome of the case.
The ALJ decided this case adverse to Plaintiff at Step 5. At Step 2, the ALJ determined that Plaintiff's depression, anxiety and bipolar disorder were severe impairments. (Tr. 18-20). At Step 3, the ALJ found that Plaintiff's combined impairments did not meet or medically equal a Listing. (Tr. 20-22). As to the RFC, the ALJ found that Plaintiff could perform a full range of work at all exertional levels with simple, routine and repetitive work carrying out one-step to three-step tasks that are non-abstract, and neither complex nor detailed in a stable work environment that involved performing the same tasks in the same place and around the same people. (Tr. 22-30). The ALJ further found that Plaintiff must have only brief and superficial interactions with supervisors or coworkers with no requirement for teamwork or interaction with the general public.
There is no dispute that Plaintiff suffers from depression, anxiety and bipolar disorder, and that his social limitations preclude his former work as a public bus driver. He has pursued many treatment options including psychiatric medications and counseling. (Tr. 398, 471-474). He was sixty years old at his onset date on December 22, 2015. From 1988 through 2015, Plaintiff had a stable employment history driving busses for the Rhode Island Public Transit Transit Authority. He left his position as a driver after a stressful interaction with a passenger. (Tr. 400).
In January 2016, he was evaluated by Nurse Janice Archer who noted he was "unable to work" and suffered from major depression and moderate OCD. (Tr. 398-400). Then, in March 2016, he had a consultative psychological examination completed by Dr. Louis Turchetta in connection with his DIB application. Dr. Turchetta concluded that Plaintiff could interact appropriately with coworkers and understand and carry out instructions but would be "challenged to respond appropriately to daily work pressures given his emotional issues." (Tr. 395). Roughly two weeks later, Dr. Stacey Fiore reviewed the record following Dr. Turchetta's examination and opined that Plaintiff had nonsevere, mild mental impairments. (Tr. 74-76).
In August 2016, Plaintiff sought emergency treatment for "generalized fatigue" after changing his medications and received treatment at Butler Hospital where he specifically requested assistance managing his medications because he had stopped taking them due to the side effects. (Tr. 533-534). Plaintiff's discharge summary from Butler Hospital indicated unspecified mood and anxiety disorders. (Tr. 537). He indicated feelings of hopelessness and somatic and racing thoughts, but was "well groomed, appropriately dressed, cooperative, made good eye contact and showed intact concentration, memory, intellectual functioning and judgment." (Tr. 537). Plaintiff was prescribed Lamictal, as the side effects were more favorable than his previous medication and he reported "marked mood improvement and decreased anxiety" upon discharge. (Tr. 540).
On September 25, 2016, Plaintiff underwent a "Fitness for Duty" psychological examination conducted by Dr. Chris Cunningham. (Tr. 565-585). He reported a history of unexcused absences from work due to "Dumping Syndrome" following gastric bypass. (Tr. 566-567). Dr. Cunningham administered several tests and ultimately concluded that Plaintiff no longer would be able to interact with the public, which foreclosed his return to his job as a public bus driver. (Tr. 570-571). He also noted, however, that Plaintiff's self-reports should be scrutinized because they are suggestive of someone who is "trying to make themselves look `worse' or with mental health problems that have a greater intensity and thereby a greater degree of negative impact in their lives." (Tr. 569).
Plaintiff then resumed treatment with West Bay Psychiatric Associates under the care of Brian Hickey, APRN. (Tr. 547-561). He was cooperative and showed no deficits in speech, perception, affect, attention/concentration insight or judgment. (Tr. 561-563). Mr. Hickey noted that Lamictal was "working well," and Plaintiff was stable. (Tr. 560). Treatment notes from March and April 2017 indicate Plaintiff was stable. (Tr. 553-555). In July 2017, Mr. Hickey adjusted Plaintiff's Lamictal dosage to help him maintain stability. Treatment records indicate Plaintiff stopped taking Lamictal and was "doing much better" as of August 2017. (Tr. 548). In October 2017, Mr. Hickey completed the "Mental Medical Assessment Form" indicating a Global Assessment of Functioning ("GAF") ranging from 64 to 66, reflecting mild symptoms but also that Plaintiff was "seriously limited" and was "unable to meet competitive standards" in 14 of 25 areas of mental functioning. (Tr. 630-632).
In November 2016, Dr. Marsha Hahn reviewed the available records in connection with Plaintiff's request for reconsideration of his DIB claim, including those from his week-long stay at Butler Hospital, and Dr. Hahn noted that while Plaintiff prefers "more independent, solitary pursuits" his social skills are "adequate for most work settings" and that he could sustain attention and concentration for two-hour periods during a normal workweek while completing simple tasks. (Tr. 84-89).
After considering the medical evidence of record, the ALJ assessed an RFC for a full range of work at all exertional levels with simple, routine and repetitive work as fully described above. In making this assessment, the ALJ was faced with varying medical opinions as to Plaintiff's functional capacity. The ALJ based his RFC determination primarily on the opinions of the state agency consulting psychologist, Dr. Hahn; consultative psychological examiner, Dr. Turchetta; and Dr. Cunningham, a psychologist who completed the Fitness for Duty examination. The ALJ noted that their assessments were entitled to great weight and favored them over the initial opinion of state agency consultant Dr. Fiore, and the assessments from Nurses Janice Archer and Brian Hickey, who treated Plaintiff. The ALJ gave less probative weight to the opinion of Dr. Fiore because additional medical evidence was received and reviewed following her opinion, and because the opinion was inconsistent with subsequent testimony and medical evidence received into the record. Further, the ALJ determined that neither Ms. Archer nor Mr. Hickey was an "acceptable medical source
Plaintiff challenges the ALJ's evaluation of the various treating and consulting medical opinions of record. He argues that the ALJ's RFC determination is not supported by substantial evidence regarding the limiting effects of Plaintiff's mental impairments. In his Reply Memorandum, Plaintiff emphasizes his argument that the ALJ erred by basing his conclusion on "his own lay understanding of the medical record." (ECF Doc. No. 14 at p. 1). Specifically, Plaintiff notes that the ALJ added "multiple limitations in the RFC" that Dr. Hahn did not opine to.
Plaintiff also argues that the ALJ's conclusions were improperly based upon an outdated state agency review completed by Dr. Hahn. Plaintiff asserts that the ALJ erred in giving "great weight" to Dr. Hahn's review, and favoring it over the treatment records from West Bay Psychiatric Associates. (ECF Doc. No. 11-1 at p. 8). Plaintiff further points out that Dr. Hahn also did not have access to the Fitness for Duty examination completed by Dr. Cunningham.
Here, it is clear that the ALJ carefully considered all of the evidence before him, including medical evidence that post-dated Dr. Hahn's assessment. Although Plaintiff points the Court to several perceived defects in the evidence and opinions supporting the RFC, the ALJ is ultimately responsible for reviewing all the relevant medical and other evidence, weighing competing opinions and resolving evidentiary conflicts. The ALJ weighed the competing evidence in this record, and Plaintiff has shown no error in his ultimate decision to favor the opinions of Dr. Hahn, Dr. Turchetta and Dr. Cunningham. "The ALJ's resolution of evidentiary conflicts must be upheld if supported by substantial evidence, even if contrary results might have been tenable also."
Plaintiff next contends that the ALJ failed to thoroughly consider and address his subjective complaints. (ECF Doc. No. 11-1 at p. 14). A reasonable review of the ALJ's decision, however, reveals that he fully and fairly considered Plaintiff's subjective complaints in compliance with the applicable legal standards. (Tr. 22-23). The ALJ found, for example, that Plaintiff's conditions could reasonably be expected to cause the symptoms he alleged but also noted that his self-reported statements concerning the "intensity, persistence and limiting effects" of the disabling mental limitations were not entirely consistent with the evidence contained in the record. (Tr. 23). The ALJ analyzed Plaintiff's medical history in detail and acknowledged his history of diabetes, hypertension, sleep apnea, obesity and gastric dumping syndrome. (Tr. 18-20). Additionally, the ALJ considered the effects of Plaintiff's depression, anxiety and bipolar disorder. However, he found a disconnect between Plaintiff's complaints, the medical evidence of record and Plaintiff's reported daily activities. For instance, the ALJ noted that Plaintiff was well-groomed with adequate hygiene and able to manage money, remember to take medications, attend appointments, drive a car, use public transportation and behave appropriately with medical examiners. (Tr. 20-21, 197-198, 394, 537, 582). He also noted that Plaintiff's mental status examinations indicated that his cognitive functioning was intact. (Tr. 21). Additionally, Dr. Cunningham noted that Plaintiff's self-assessment should be viewed with caution because his answers were "consistent with someone trying to make themselves look worse." (Tr. 24). Further, Mr. Hickey indicated that Plaintiff was emotionally stable with normal sleep, fair energy and average moods. (Tr. 550, 555-560). This medical evidence all undercuts the Plaintiff's self-reported limitations.
Plaintiff next suggests that the ALJ did not "clearly articulate" specific reasons given to the weight of Plaintiff's symptoms, nor address the "vast majority" of factors set forth in SSR 16-3p. (ECF Doc. No. 14 at p. 7). Contrary to Plaintiff's arguments, the ALJ thoroughly reviewed such evidence and made several relevant observations. For example, the ALJ noted that Plaintiff reported a need for frequent breaks and absences (Tr. 23-28), but noted that collectively, Dr. Turchetta and Dr. Hahn found that "claimant would be capable of maintaining attention and concentration in two-hour intervals" and specifically noted that Dr. Turchetta did not state that Plaintiff "required unscheduled absences or frequent work breaks." (Tr. 28). The ALJ also accurately noted that Dr. Hahn opined that Plaintiff could sustain a regular work schedule and that his social skills were "adequate for most work settings." (Tr. 27, 88-89).
In short, the ALJ was presented with conflicting medical and other evidence. While reasonable minds could differ as to the interpretation of this evidence, the issue is not whether this Court would have reached the same conclusion as did the ALJ regarding Plaintiff's credibility. Rather, the narrow issue presented is whether the ALJ's finding has adequate support in the record. The ALJ thoroughly weighed the evidence in the context of the record as a whole and in accordance with SSR 16-3p. The ALJ also adequately explained his reasoning. Since the ALJ's interpretation of Plaintiff's work history, daily activities and the limitations evidenced by his treatment records is supported by the record, such interpretation is entitled to deference and supports the ALJ's credibility determination. Plaintiff has shown no reversible error in this finding.
For the reasons discussed herein, I recommend that Plaintiff's Motion to Remand (ECF Doc. No. 11) be DENIED and that the Commissioner's Motion to Affirm (ECF Doc. No. 12) be GRANTED. I further recommend that Final Judgment enter in favor of Defendant.
Any objection to this Report and Recommendation must be specific and must be filed with the Clerk of the Court within fourteen days of its receipt.