Lisa Dunn v. Carolyn Colvin
Filing
UNPUBLISHED AUTHORED OPINION filed. Originating case number: 3:13-cv-00222-JAG Copies to all parties and the district court/agency. [999593534].. [14-1565]
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 1 of 30
UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 14-1565
LISA DUNN,
Plaintiff - Appellant,
v.
CAROLYN W. COLVIN,
Administration,
Acting
Commissioner,
Social
Security
Defendant - Appellee.
Appeal from the United States District Court for the Eastern
District of Virginia, at Richmond.
John A. Gibney, Jr.,
District Judge. (3:13-cv-00222-JAG)
Argued:
March 25, 2015
Decided:
June 1, 2015
Before MOTZ and GREGORY, Circuit Judges, and Mary G. LEWIS,
United States District Judge for the District of South Carolina,
sitting by designation.
Affirmed by unpublished opinion. Judge Lewis wrote the opinion,
in which Judge Motz and Judge Gregory joined.
ARGUED: Bruce Knight Billman, Fredericksburg, Virginia, for
Appellant. Elizabeth Wu, OFFICE OF THE UNITED STATES ATTORNEY,
Richmond, Virginia, for Appellee.
ON BRIEF: Nora Koch, Acting
Regional Chief Counsel, Taryn Jasner, Supervisory Attorney,
Meriah Russell, Assistant Regional Counsel, Office of the
General Counsel, SOCIAL SECURITY ADMINISTRATION, Philadelphia,
Pennsylvania; Dana J. Boente, United States Attorney, OFFICE OF
THE UNITED STATES ATTORNEY, Alexandria, Virginia, for Appellee.
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 2 of 30
Unpublished opinions are not binding precedent in this circuit.
2
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 3 of 30
MARY GEIGER LEWIS, District Judge:
Lisa Dunn (Appellant) brought this action under 42 U.S.C.
§
405(g)
in
the
district
court
of
the
Eastern
District
of
Virginia seeking judicial review of the final decision of the
Commissioner
of
the
Social
Security
Administration
(Appellee)
denying her application for disability insurance benefits (DIB).
Appellant, a high school graduate, was born on May 19, 1973.
She has previously worked as a waitress, para-educator, daycare
worker, bookkeeper, and cashier.
disabled
on
May
1,
2007,
She alleged that she became
based
on
rheumatoid
fibromyalgia, headaches, depression, and anxiety.
arthritis,
As noted by
Appellant at oral argument, however, this case is concerned only
with her psychiatric problems.
The parties filed cross-motions for summary judgment, which
were
referred
to
the
magistrate
Recommendation (Report).
judge
for
a
Report
and
In the magistrate judge’s Report, he
suggested that the district court grant Appellee’s motion for
summary
judgment.
judgment
and
Appellant
district
court
granted
Appellee’s
deny
filed
overruled
the
motion
Appellant’s
objections
motion
to
objections,
for
summary
the
for
summary
Report.
adopted
The
the
Report,
judgment,
denied
Appellant’s motion for summary judgment, and affirmed Appellee’s
final decision denying Appellant’s claim for DIB.
3
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 4 of 30
Appellant then timely filed her notice of appeal with this
Court.
We
42 U.S.C.
have
§ 405(g)
jurisdiction
and
28
to
consider
U.S.C.
§
her
1291.
appeal
under
Discerning
no
reversible error, we affirm.
I.
In
a
Social
Security
case
such
as
this,
it
is
the
plaintiff’s duty to both produce evidence and prove that she is
disabled under
§ 405(g).
1995).
the
Social
Security
Act,
§
205(g),
42
U.S.C.
See Pass v. Chater, 65 F.3d 1200, 1203 (4th Cir.
Our review of the decision of the Administrative Law
Judge (ALJ) in an action involving disability benefits is quite
limited.
We must uphold the ALJ’s factual findings if they are
supported by substantial evidence and reached by applying the
correct legal standard.
(4th
Cir.
evidence
as
2012).
a
Hancock v. Astrue, 667 F.3d 470, 472
“Substantial
reasonable
mind
evidence
might
is
accept
such
as
relevant
adequate
to
support a conclusion.”
Craig v. Chater, 76 F.3d 585, 589 (4th
Cir.
citations
1996)
omitted).
(internal
It
“consists
of
more
omitted)
than
a
(quotation
mere
marks
scintilla
of
evidence but may be less than a preponderance.” Smith v. Chater,
99 F.3d 635, 638 (4th Cir. 1996).
When we review whether substantial evidence supports the
findings of the ALJ, “we do not undertake to reweigh conflicting
4
Appeal: 14-1565
Doc: 31
evidence,
Filed: 06/01/2015
make
credibility
Pg: 5 of 30
determinations,
judgment for that of the [ALJ].”
or
substitute
our
Johnson v. Barnhart, 434 F.3d
650, 653 (4th Cir. 2005) (internal citations and quotation marks
omitted).
to
“Where conflicting evidence allows reasonable minds
differ
as
to
whether
a
claimant
.
.
.
is
disabled,
responsibility for that decision falls on [the ALJ].”
F.3d at 589.
the
Craig, 76
“[T]he substantial evidence standard ‘presupposes
. . . a zone of choice within which the decisionmakers can go
either
way,
without
administrative
interference
decision
is
not
by
subject
the
to
courts.
reversal
An
merely
because substantial evidence would have supported an opposite
decision.’”
Clarke v. Bowen, 843 F.2d 271, 272-73 (8th Cir.
1988) (quoting Baker v. Heckler, 730 F.2d 1147, 1150 (8th Cir.
1984)) (internal citation omitted).
Consequently,
province
of
the
it
is
courts
beyond
to
dispute
resolve
that
factual
it
is
matters
not
in
the
Social
Security cases such as this de novo. “At the same time, they
must
escape
not
abdicate
their
duty
their
to
traditional
scrutinize
‘the
functions;
they
record
a
as
whole’
determine whether the conclusions reached are rational.”
v.
Celebrezze,
331
F.2d
541,
543
(4th
Cir.
1964)
cannot
Thomas
(quoting
Universal Camera Corp. v. N.L.R.B., 340 U.S. 474, 490 (1951)).
5
to
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 6 of 30
II.
The Social Security Administration has established a fivestep sequential evaluation process for determining if a person
is
disabled.
20
C.F.R.
§
404.1520(a)(4)(i-v)
(2004).
In
relevant part, the Code of Federal Regulations provides:
At the first step, we consider your work
activity, if any.
If you are doing substantial
gainful activity, we will find that you are not
disabled....
At the second step, we consider the medical
severity of your impairment(s). If you do not have a
severe medically determinable physical or mental
impairment that meets the duration requirement in [20
C.F.R.] § 404.1509, or a combination of impairments
that is severe and meets the duration requirement, we
will find that you are not disabled....
At the third step, we also consider the medical
severity of your impairment(s).
If you have an
impairment(s) that meets or equals one of our listings
in appendix 1 of this subpart and meets the duration
requirement, we will find that you are disabled....
At the fourth step, we consider our assessment of
your residual functional capacity and your past
relevant work. If you can still do your past relevant
work, we will find that you are not disabled....
At the fifth and last step, we consider our
assessment of your residual functional capacity and
your age, education, and work experience to see if you
can make an adjustment to other work. If you can make
an adjustment to other work, we will find that you are
not disabled. If you cannot make an adjustment to
other work, we will find that you are disabled.
Id.
The
parties
agree
that:
(1)
Appellant
is
not
currently
engaged in any substantial gainful activity; (2) Appellant has
6
Appeal: 14-1565
Doc: 31
several
Filed: 06/01/2015
medically
Appellant’s
Pg: 7 of 30
determinable
severe
impairments
severe
do
not
impairments,
meet
or
(3)
equal
an
impairment in any of Appellee’s Listing of Impairments, and, (4)
Appellant’s impairments prevent her from returning to her past
relevant
work.
They
disagree,
however,
as
to
Appellant’s
residual functional capacity--key to determining whether she is
able to do other work.
III.
There are two issues presented by this appeal: (1) whether
the ALJ was correct in his decision not to give the opinion of
the treating physician controlling weight, and (2) whether, in
making his credibility determination as to Appellant, the ALJ
erred
in
his
Appellant’s
consideration
treatment
and
of
her
medications as prescribed.
the
conservative
non-compliance
with
nature
taking
of
her
We will consider these issues in
turn.
A.
First, Appellant contends that the ALJ erred in assigning
limited weight to the opinions of her treating physician, Dr.
John
Swing,
Gosnell.
and
her
treating
We are unconvinced.
7
psychiatric
counselor,
Betty
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 8 of 30
When evaluating medical opinions, the ALJ should consider
“(1) whether the physician has examined the applicant, (2) the
treatment relationship between the physician and the applicant,
(3)
the
supportability
of
the
physician’s
opinion,
(4)
the
consistency of the opinion with the record, and (5) whether the
physician is a specialist.”
Johnson, 434 F.3d at 654.
An ALJ’s determination as to the weight to be assigned to a
medical
opinion
indication
generally
that
the
will
ALJ
not
has
be
disturbed
dredged
up
absent
some
“specious
inconsistencies,” Scivally v. Sullivan, 966 F.2d 1070, 1077 (7th
Cir. 1992), or has failed to give a sufficient reason for the
weight
afforded
a
particular
opinion,
see
20
C.F.R.
§ 404.1527(d) (1998).
According to 20 C.F.R. §§ 404.1527(d)(2) & 416.927(d)(2), a
treating source’s opinion on issues of the nature and severity
of the impairments will be given controlling weight when well
supported
by
medically
acceptable
clinical
and
laboratory
diagnostic techniques and when the opinion is consistent with
the
other
substantial
evidence
in
the
record.
Conversely,
however, “the ALJ holds the discretion to give less weight to
the testimony of a treating physician in the face of persuasive
contrary evidence.”
Mastro v. Apfel, 270 F.3d 171, 178 (4th
Cir. 2001); see also Craig, 76 F.3d at 590 (finding that “if a
physician’s opinion in not supported by clinical evidence or if
8
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 9 of 30
it is inconsistent with other substantial evidence, it should be
accorded significantly less weight”).
Of course, a medical expert’s opinion as to whether one is
disabled
is
not
dispositive;
opinions
as
to
reserved for the ALJ and for the ALJ alone.
404.1527(e)(1) (1998).
presents
better
given.
relevant
that
he
disability
are
See 20 C.F.R. §
Generally, the more the medical source
evidence
explains
to
it,
support
the
more
his
opinion,
weight
his
and
opinion
the
is
See 20 C.F.R. § 404.1527(d)(3) (1998). Additionally, the
more consistent the opinion is with the record as a whole, the
more
weight
the
ALJ
will
give
to
it.
See
20
C.F.R.
§ 404.1527(d)(4) (1998).
In rendering his decision on this issue, the ALJ considered
the opinions of four medical sources:
(1) John Swing, M.D.; (2)
Betty Gosnell, L.P.C; (3) Martha Merrion, Ph.D.; and (4) Sandra
Francis, Ph.D.
As the ALJ noted in his decision, Appellant came to Dr.
Swing
on
anxiety.”
March
7,
J.A. 10. ∗
2007,
“due
to
worsening
depression
and
“She complained of anhedonia, decreased
motivation, and increased crying.
∗
On exam she had depressed
Citations herein to “J.A.” refer to the contents of the
Joint Appendix filed by the parties in this appeal; and
citations to “A.R.” refer to the Social Security Administrative
Record that Appellee filed with the district court.
9
Appeal: 14-1565
mood
Doc: 31
and
Filed: 06/01/2015
congruent
Pg: 10 of 30
affect.”
Id.
“On
April
4,
2007,
reported her medications were causing her to be jittery.
noted to continue to be anxious.”
she
She
Id.
Appellant came to Dr. Swing again on May 30, 2007, and
“expressed . . . increased depression and sadness, and decreased
sleep.”
Id.
The next time Appellant saw Dr. Swing was on July
16, 2007, at which time “she expressed that she was going to get
a new job, because her current job was causing too much stress.
She was cooperative and talkative.
stable.”
She was noted to be fairly
Id.
In Dr. Swing’s “Psychiatry Progress Note” on August 16,
2007, “he noted that her depression was largely under control,
but her [anxiety] persisted.
She reported that she was much
better overall, and she was noted as to be calm.”
Id.
He also
noted that she had “no suicidal or homicidal ideation.”
Id.
The ALJ noted that Appellant returned to Dr. Swing on November
13, 2007, at which time “[s]he reported feeling overwhelmed,
depressed and anxious.”
Id.
Thereafter, on December 4, 2007,
“she complained of feeling ‘discouraged.’”
Id.
On January 10, 2008, the ALJ noted from Dr. Swing’s records
that Appellant “was pleasant, calm, and cooperative, with no
suicidal or homicidal ideation.
Id.
She was noted to be improving.”
Appellant saw Dr. Swing again on March 3, 2008.
reported
anxiety
due
to
her
recent
10
medical
course,
and
“She
was
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
striving for answers.”
Pg: 11 of 30
Id. at 12.
During Appellant’s March 31,
2008, appointment with Dr. Swing, she “reported having tremors
from the medications.
During
She was anxious.”
Appellant’s
June
10,
Id.
2008,
appointment
with
Dr.
Swing, he “noted that [Appellant’s] mild anxiety persisted.
He
also marked that she had no homicidal or suicidal ideation.”
Id. at 13.
Then, during Appellant’s July 8, 2008, appointment
with Dr. Swing, “she was reportedly calm with no homicidal or
suicidal ideation.”
2008.
felt
Id.
that
Id.
Appellant saw Dr. Swing on October 20,
At that time, she “reported to Dr. Swing that she
she
was
doing
okay.
She
reported
some
anxiety, and was taking extra Xanax during the day.”
increased
Id.
Appellant returned to Dr. Swing on January 22, 2009.
at 14.
taking
“She was quiet and calm.
her
full
dosage
of
She reported that she was not
medication
afford it, but believed she needed it.
suicidal or homicidal ideation.”
appointment
on
April
homicidal ideation.
appointment,
crying.”
Id.
“she
16,
Id.
because
she
could
not
She was stable, with no
Id. at 14.
2009,
Id.
“[s]he
During Appellant’s
had
no
suicidal
or
During Appellant’s April 21, 2009,
complained
[of]
depression
and
increased
Appellant reported on May 14, 2009, that “she had
not started a prescribed medication.
homicidal ideation.”
Id.
There was no suicidal or
And then “[o]n June 18, 2009, she was
mostly calm, but was slight[ly] anxious at times.”
11
Id.
Appeal: 14-1565
Doc: 31
According
Filed: 06/01/2015
to
the
ALJ,
Pg: 12 of 30
in
regards
to
Betty
Gosnell,
Appellant’s counselor,
Treatment notes from [Appellant’s] counselor in 2009
reflect that [Appellant] was reporting generalized
fatigue and pain, but her boyfriend was being a bit
more attentive to her. She noted positive experience
from the neurofeedback sessions and expressed this
[at] each appointment.
Treatment notes dated
November 4, 2009[], reflect that [Appellant] was in
good spirits, had a goal of cooking more healthy
foods for her family, and she was cooking more from
scratch to save money at the grocery store.
Id. at 15 (citations omitted).
There appears to be no dispute
as to the ALJ’s finding on this issue and, thus, we need not
discuss it here except to say that the ALJ’s summarization of
Gosnell’s notes are in accord with our own review of the notes.
Dr. Swing completed a Mental Impairment Questionnaire on
January 21, 2009, in which he checked “severe” as it relates to
eleven
of
a
abilities.
list
of
twenty
of
Appellant’s
A.R. 893-94; see also J.A. 18.
work-related
“Severe indicates
that the activity is totally precluded on a sustained basis and
would
result
minutes.”
in
failing
A.R. 893.
after
limitations:
“work[ing]
coordination
without
being
short
duration:
5-10
Dr. Swing marked as severe the following
work-related
in
even
distracted,”
needing
with
or
“special
[in]
“mak[ing]
supervision,”
proximity
simple
to
work
others
related
decisions,” “complet[ing] a normal workday and work week without
interruptions
from
psychologically
12
based
symptoms
and
.
.
.
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 13 of 30
perform[ing] at a consistent pace without an unreasonable number
and
length
general
of
rests,”
public
responding
or
“interact[ing]
customers,”
appropriately
to
appropriately
“accept[ing]
criticism
with
the
instructions
and
from
supervisors,”
“get[ting] along with co-workers or peers without distracting
them or exhibiting behavioral extremes,” “maintain[ing] socially
appropriate behavior and . . . adher[ing] to basic standards of
neatness
and
expected
changes
goals
or
cleanliness,”
in
mak[ing]
the
“respond[ing]
work
plans
setting,”
appropriately
“set[ting]
independently,”
and
realistic
“travel[ing]
unfamiliar settings and us[ing] public transportation.”
893-94.
limited
to
in
A.R.
However, the ALJ was permitted to afford these opinions
weight,
to
the
extent
that
other medical evidence in the record.
they
are
controverted
by
See Meyer v. Colvin, 754
F.3d 251, 256 (4th Cir. 2014).
Gosnell, who provided therapy for Appellant from June 27,
2007,
until
July
22,
2008,
three
to
four
times
a
month,
completed a mental status evaluation on July 29, 2008, which the
ALJ summarized as follows:
Ms.
Gosnell
opined
that
she
did
not
believe
[Appellant] was able to maintain a job at the time
she completed the mental status evaluation form.
[On] January 5, 2009, Ms. Gosnell indicated that the
[Appellant] had mild-to-moderate impairments in her
ability to perform activities of daily living, and
marked impairments in ability to maintain social
relationships
and
in
maintaining
concentration,
persistence, and pace.
She opined that [Appellant]
13
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 14 of 30
had severe impairments in her ability to maintain
attention and concentration for at least 2 straight
hours;
sustain
an
ordinary
routine
without
supervision, to complete a normal workday without
interruptions from psychologically based symptoms and
perform at a consistent pace without an unreasonable
number and length of rests; to respond appropriately
to expected and unexpected changes in the work
setting, and to travel in unfamiliar settings and use
public transport.
She opined that [Appellant] would
have moderately severe limitations in her ability to
set realistic goals, to accept instructions and
respond appropriately to criticism from supervisors;
to ask simple instructions or request assistance from
supervisors; to work in coordination or proximity to
others without being distracted; to make simple work
decisions; and to understand, remember, and carry out
detailed instructions.
She indicated that the
claimant would be moderately limited in her ability
to remember locations and work-like procedures, to
understand[,] remember, and carry [ ] out simple
instructions, to interact appropriately with the
general public, and to be aware of normal hazards and
take necessary precautions.
J.A. 17.
Having reviewed Gosnell’s mental status evaluation for
ourselves, we think that the ALJ has correctly summarized it,
and there appears to be no argument to the contrary.
Dr. Merrion of the Virginia Department of Rehabilitative
Services examined Appellant on February 26, 2009.
Dr.
Merrion
found
Appellant
“capable
of
doing
A.R. 907.
simple
and
repetitive tasks consistently well if she were not as dependent
as she is.”
Id. at 911.
Dr. Merrion also stated that Appellant
“could take supervision and follow directions[,] but supervisors
would tend to be exasperated with her. . . .
Working with too
many
render
coworkers
or
the
public
would
14
tend
to
her
less
Appeal: 14-1565
Doc: 31
efficient.
.
Filed: 06/01/2015
.
.
Pg: 15 of 30
[Appellant]
has
a
mildly
to
moderately
impaired ability to deal with the normal stressors and demands
encountered in competitive employment.”
Dr.
Francis,
the
last
Id.
non-examining
State
Agency
psychologist to review Appellant’s records for Appellee prior to
the
hearing
before
the
ALJ,
concluded
that,
“[d]ue
to
her
psychiatric impairments, [Appellant] is . . . limited to tasks
that
only
require
limited
contact
with
involving simple, unskilled work tasks.”
the
general
J.A. 18.
public,
To be more
specific, Dr. Francis stated that Appellant “is able to meet the
basic demands of competitive work on a sustained basis despite
the limitations stemming from her mental impairments.
She is
capable of simple routine work in a nonstressful environment
with limited contact with the public and coworkers.
A.R. 929.
Based upon all of the medical evidence, the ALJ gave the
opinion
of
consistent
Dr.
Francis
with
[Appellant].”
weight
to
inconsistent
objective
J.A.
the
[Appellant’s]
“significant
opinions
with
their
findings
made
Further,
18.
treating
weight
the
of
Dr.
treatment
[Appellant’s] medical records.”
Id.
upon
ALJ
Swing
psychiatric
because
and
was]
examination
“assigned
sources,
notes
[it
Ms.
as
contained
of
limited
Gosnell,
they
are
throughout
As to Dr. Merrion, the ALJ
gave her opinion “greater but not controlling weight because she
had the opportunity to examine [Appellant], but only saw her on
15
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
one occasion.”
Id.
Pg: 16 of 30
We are of the opinion that substantial
evidence supports the ALJ’s decision to assign the weight that
he did to the various medical opinions.
We must defer to the ALJ’s assignments of weight unless
they are not supported by substantial evidence.
F.3d at 472.
Hancock, 667
Here, some of Dr. Swing’s treatment notes suggest
that Appellant experienced periods of improvement.
For example,
Dr. Swing wrote “[o]n January 10, 2008, [that Appellant] was
pleasant, calm and cooperative, with no suicidal or homicidal
ideation.
She was noted to be improving.”
J.A. 10.
And “[o]n
June 18, 2009, she was mostly calm, but was slight[ly] anxious
at times.”
Id.
Simply stated, there is more than a “scintilla
of evidence” in the record supporting the ALJ’s conclusion that
Dr. Swing’s opinion is incongruent with both his own treatment
notes and some of the other medical evidence in the record.
In the medical opinion that Gosnell presented to the ALJ,
“Ms. Gosnell opined that she did not believe [Appellant] was
able to maintain a job at the time she completed the mental
status evaluation form” on July 29, 2008.
Id. at 17.
Under our
deferential standard of review, there is enough evidence in the
record to support the ALJ’s decision to accord this opinion less
weight.
During
Gosnell,
she
Appellant’s
stated
October
that
she
5,
was
16
2007,
“feeling
appointment
better
and
with
more
Appeal: 14-1565
Doc: 31
energized.”
Filed: 06/01/2015
Pg: 17 of 30
She also told Gosnell that she was “willing to try
to venture out a bit and look for a job.”
A.R. 948.
At
Appellant’s October 15, 2007, appointment, Gosnell wrote in her
notes that Appellant “is excited about [a] possible job at Rite
Aid.
She is eager to be interviewed and feels that she has a
good shot at it.”
Id.
Appellant also reported that “she is optimistic and upbeat
in the face of financial and relationship problems.
She is
better to get out of the house and says that she believes that
neurofeedback has been helpful.”
Id.
At Appellant’s October
19, 2007, session, she said that she was “doing pretty well but
feeling achy.
Her first interview went well.”
Id.
“She has
been able to drive to her appointments and tend to her families’
needs.
This energizes her.”
And,
then
on
June
23,
Id.
2009,
just
weeks
before
Gosnell
completed her mental evaluation for Appellant, she stated in her
notes that Appellant reported that “[s]ummer is going pretty
well.”
A.R. 957.
“[Appellant] is enjoying the warmer weather
and longer periods of daylight.
She says that life does not
seem as overwhelming in the summer time. She is getting more
physical exercise than in cold weather.”
noted
that
Appellant
“reports
that
that
Id.
helps
Gosnell also
quite
a
bit.
Relationship is going okay right now although she struggles with
his parents and his relationship with his mother.”
17
Id.
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 18 of 30
Thus, as with Dr. Swing’s opinion, a reasonable mind might
agree with the ALJ’s finding that Gosnell’s opinion does not
comport with her own treatment notes or with other evidence in
the record.
weight
to
We hold that the ALJ’s decision to accord limited
Gosnell’s
and
Swing’s
opinions
is
supported
by
substantial evidence.
B.
Second, Appellant argues that the ALJ erred in considering
the conservative nature of Appellant’s treatment and her noncompliance in determining whether she was credible.
We are
unpersuaded.
On this issue, the ALJ stated the following:
[Appellant’s]
testimony
regarding
her
extreme
symptoms
and
limitations
is
not
credible.
[Appellant] has not generally received the type of
medical treatment one would expect for a totally
disabled
individual.
Although
[Appellant]
has
received
treatment
for
the
allegedly
disabling
impairments, that treatment has been essentially
routine and conservative in nature.
Further the
record shows that [Appellant] has not been compliant
with recommended treatment. Treatment notes from Dr.
Swing indicate compliance issues with medications,
where [Appellant] had failed to start medications as
prescribed, or had self-discontinued medications.
Treatment notes from [Appellant’s] primary care
physician, as recent as November 2010, also show
[Appellant] having compliance issues [and] selfdiscontinuing
medications.
While
[Appellant]
complained of migraine headaches and rheumatoid
arthritis, the record shows that these have been
responsive to treatment, including medications and
trigger point injections.
[Appellant’s] routine and
18
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 19 of 30
conservative treatment and failure to comply with her
treatment
regimen
diminishes
her
credibility
regarding the frequency and severity of her symptoms,
and the extent of her functional limitations.
J.A.
17
(internal
citation
omitted).
As
already
noted,
in
reviewing whether substantial evidence supports the findings of
the ALJ, “we do not undertake to reweigh conflicting evidence,
make credibility determinations, or substitute our judgment for
that of the [ALJ].”
Johnson, 434 F.3d at 653.
1.
Prior to the ALJ’s consideration of Step Four of the fivestep
sequential
plaintiff’s
evaluation,
Residual
the
Functional
§§ 416.920(e)-(f), 416.945(a)(1).
ALJ
Capacity
must
determine
(RFC).
20
C.F.R.
Under SSR 83-10, one’s RFC is
[a] medical assessment of what an individual can do
in a work setting in spite of the functional
limitations and environmental restrictions imposed by
all
of
his
or
her
medically
determinable
impairment(s).
RFC is the maximum degree to which
the individual retains the capacity for sustained
performance of the physical-mental requirements of
jobs.
Id.
In his decision, the ALJ stated that,
[a]fter careful consideration of the entire record,
[he
found]
that
[Appellant]
has
the
residual
functional capacity to perform a full range of light
work as defined in 20 C.F.R. 404.1567(b)[,] except
she should [have] no greater than moderate exposure
to hazards such as machinery and heights.
She is
limited to occasionally climbing ramps, stairs,
19
the
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 20 of 30
ladders, ropes and scaffolds.
She can occasionally
balance, stoop, kneel, crouch and crawl.
She is
capable
of
understanding,
carrying
out
and
remembering simple instructions in an unskilled
position, with no greater than occasional contact of
the general public.
J.A. 9
“[W]hether a person is disabled by pain or other symptoms
is a two-step process.
First, there must be objective medical
evidence showing the existence of a medical impairment(s) which
results
from
anatomical,
physiological,
or
psychological
abnormalities and which could reasonably be expected to produce
the pain or other symptoms alleged.”
Craig, 76 F.3d at 594
(citations omitted) (emphasis omitted).
“At this stage of the
inquiry, the pain claimed is not directly at issue; the focus is
instead on establishing a determinable underlying impairment—a
statutory
requirement
for
entitlement
to
benefits—which
could
reasonably be expected to be the cause of the disabling pain
asserted by the claimant.”
is
complete,
the
ALJ
Id.
Second, after the first inquiry
must
evaluate
“the
intensity
and
persistence of the claimant’s pain, and the extent to which it
affects her ability to work[.]”
Id. at 585.
“This evaluation
must take into account not only the claimant’s statements about
her pain, but also ‘all the available evidence,’ including the
claimant’s
findings,
medical
any
history,
objective
medical
medical
20
signs,
evidence
of
and
pain
laboratory
(such
as
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 21 of 30
evidence of reduced joint motion, muscle spasms, deteriorating
tissues, redness, etc.).”
account “any
other
Id.
evidence
The ALJ must also take into
relevant
to
the
severity
of
the
impairment, such as evidence of the claimant’s daily activities,
specific descriptions of the pain, and any medical treatment
taken to alleviate it[.]”
Id.
“[T]here must be . . . a medical impairment . . . which,
when
considered
statements
of
with
the
all
the
individual
evidence
or
his
.
.
.
physician
(including
as
to
the
intensity and persistence of such pain or other symptoms which
may reasonably be accepted as consistent with the medical signs
and findings), would lead to a conclusion that the individual is
under a disability.”
42 U.S.C. § 423(d)(5)(A).
According to the ALJ, Appellant has the following severe
impairments:
rheumatoid
arthritis,
depression, and anxiety.
J.A. 6.
fibromyalgia,
headaches,
And, the ALJ found that
Appellant’s “medically determinable impairments could reasonably
be
expected
to
cause
the
alleged
symptoms;
however,
[Appellant’s] statements concerning the intensity, persistence
and limiting effects of these symptoms are not credible to the
extent
that
they
are
inconsistent
functional capacity assessment.”
above,
the
ALJ
avowed
that
with
J.A. 10.
“[Appellant]
the
. .
.
residual
Further, as stated
has
not
generally
received the type of medical treatment one would expect for a
21
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
totally disabled individual.
treatment
for
treatment
nature.”
has
the
been
Pg: 22 of 30
Although [Appellant] has received
allegedly
disabling
essentially
routine
impairments,
and
that
conservative
in
J.A. 17.
In response to the ALJ’s holding regarding the routine and
conservative nature of Appellant’s treatment, Appellant argues
that “[t]he characterization of [Appellant’s] psychiatric care
as ‘routine and conservative’ is an incorrect legal standard of
evaluation of credibility where the term is undefined in the
regulations
and
record.
beliefs
any
given
of
(emphasis omitted).
The
term
decision
is
idiosyncratic
maker.”
Appellant’s
to
Br.
the
26
We disagree.
First, according to 20 C.F.R. § 404.1529(c)(3)(iv)-(v), in
determining
if
someone
is
disabled,
it
is
appropriate
to
consider such things as:
(iv) The type, dosage, effectiveness, and side effects of
any medication you take or have taken to alleviate your
pain or other symptoms; [and]
(v) Treatment, other than medication, you receive or
have received for relief of your pain or other
symptoms[.]
Id.
Therefore, inasmuch as the ALJ is allowed to consider the
nature of Appellant’s treatment in determining whether she is
disabled, a reasonable mind might agree that the conservative
nature of Appellant’s treatment is an adequate basis to support
22
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 23 of 30
the ALJ’s conclusion that Appellant’s testimony of her disabling
condition was incredible.
See Craig, 76 F.3d at 589.
Second, contrary to any suggestion otherwise, this Court
has long held that it is appropriate for the ALJ to consider the
conservative nature of a plaintiff’s treatment –- among other
factors -- in judging the credibility of the plaintiff.
As this
Court held in Craig, “[a]lthough a claimant’s allegations about
her pain may not be discredited solely because they are not
substantiated by objective evidence of the pain itself or its
severity,
they
inconsistent
need
with
not
the
be
accepted
available
to
evidence,
the
extent
including
they
are
objective
evidence of the underlying impairment, and the extent to which
that impairment can reasonably be expected to cause the pain the
claimant alleges she suffers[.]”
Craig, 76 F.3d at 595.
See
also Gross v. Heckler, 785 F.2d 1163, 1165-66 (4th Cir. 1986)
(finding the claimant’s claim that he was disabled not credible
when “[h]is arthritis responded to conservative treatment, and
his stomach pains were relieved by antacids.
If a symptom can
be reasonably controlled by medication or treatment, it is not
disabling.”); Shively v. Heckler, 739 F.2d 987, 990 (4th Cir.
1984) (“Claimant’s allegations that he suffered such severe pain
are not supported by x-rays or neurological findings.
He has
never been hospitalized for his back pain or other ailments. At
the
prior
supplemental
hearing,
23
claimant
indicated
that
the
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 24 of 30
medication he was taking for pain was Extra Strength Tylenol and
Extra Strength Excedrin, both nonprescription medicines.
latest
supplemental
hearing,
claimant
testified
that
At the
he
was
taking Nalfon, which the Physician’s Desk Reference describes as
an analgesia for treatment of mild to moderate pain, prescribed
for
relief
from
acute
osteoarthritis.
The
flairs
ALJ
of
observed
rheumatoid
that
arthritis
stronger
and
medications
could have been prescribed.”).
Third,
treatment
determining
in
as
allowing
one
a
of
the
the
claimant’s
conservative
factors
a
credibility,
nature
court
we
may
are
of
one’s
consider
in
accord
several other courts of appeals that have held the same.
in
with
See,
e.g., Smith v. Colvin, 756 F.3d 621, 626 (8th Cir. 2014) (noting
with
approval
that
the
ALJ’s
credibility
determination
was
based, in part, on finding that the plaintiff’s treatment was
“essentially routine and/or conservative in nature”) (internal
quotation marks omitted); Wall v. Astrue, 561 F.3d 1048, 1068–69
(10th Cir. 2009) (holding that a history of conservative medical
treatment undermines allegations of disabling symptoms); Parra
v.
Astrue,
481
F.3d
742,
751
(9th
Cir.
2007)
(stating
that
evidence of conservative treatment permits the ALJ to discount
the
claimant’s
testimony
regarding
the
severity
of
an
impairment); Sienkiewicz v. Barnhart, 409 F.3d 798, 804 (7th
Cir. 2005) (noting with approval the ALJ’s consideration of the
24
Appeal: 14-1565
Doc: 31
nature
of
Filed: 06/01/2015
plaintiff’s
conservative”
in
Pg: 25 of 30
treatment
making
his
as
having
credibility
been
“routine
decision)
and
(internal
quotation marks omitted); Knepp v. Apfel, 204 F.3d 78, 83 (3d
Cir. 2000) (same); Wolfe v. Chater, 86 F.3d 1072, 1078 (11th
Cir.
1996)
(holding
that
a
physician’s
conservative
medical
treatment for a particular condition tends to negate a claim of
disability).
Fourth, and finally, as to Appellant’s argument that “[t]he
term [conservative treatment] is idiosyncratic to the beliefs of
any
given
substantial
choice
decision
evidence
within
which
maker[,]”
standard
the
Appellant’s
‘presupposes
decisionmakers
without interference by the courts.
.
can
Br.
.
go
.
26,
a
“the
zone
either
of
way,
An administrative decision
is not subject to reversal merely because substantial evidence
would have supported an opposite decision.’”
Clarke, 843 F.2d
at 272-73.
In reviewing Appellant’s arguments, it appears that she may
be missing the reason as to why it is proper for the ALJ to
consider the conservative treatment of a claimant in making a
credibility decision.
It is as simple as this:
if all that the
claimant needs is conservative treatment, it is reasonable for
an ALJ to find that the alleged disability is not as bad as the
claimant says that it is.
Put another way, when a claimant
complains that her alleged disability is so bad that she is
25
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 26 of 30
unable to work in any job whatsoever, but the ALJ finds that the
treatment was not as aggressive as one would reasonably think
would be employed if the alleged disability were actually that
severe, then it is reasonable for the ALJ to conclude that the
conservative treatment bears on the claimant’s credibility.
Of
course,
there
may
be
any
number
of
reasons
for
a
physician to prescribe a “conservative” course of treatment, and
it
is
for
that
necessarily
render
benefits.
which
is
the
any
treatment
other reasons.
that
that
a
such
alone
ineligible
claimant
treatment
for
would
not
disability
But we are not presented here with a situation in
there
aggressive
reason
suggestion
yet
that
received
Appellant
conservative
required
treatment
more
for
From the record as detailed herein, it appears
conservative
nature
of
Appellant’s
treatment
sufficient to prevent her from being totally disabled.
was
Because
it is well established in this circuit that the ALJ can consider
the conservative nature of a claimant’s treatment in making a
credibility
determination,
we
hold
that
there
is
substantial
evidence in the record to support the ALJ’s decision to take the
conservative nature of Appellant’s treatment into consideration
in finding her claim of total disability incredible.
26
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 27 of 30
2.
Next, Appellant maintains that her “alleged non-compliance
with prescribed medication regimens is an improper factor for
evaluation of credibility in the absence of any connection to
[Appellant’s] credibility such as [Appellant] did not need the
medication,
produce
was
failing
disability
compliance.”
or
to
take
was
the
medication
attempting
Appellant’s Br. 30.
to
in
hide
order
the
to
non-
We disagree.
Under 20 C.F.R. § 404.1530,
to get benefits, you must follow treatment prescribed
by your physician if this treatment can restore your
ability to work . . . .
If you do not follow the
prescribed treatment without a good reason, we will
not find you disabled or, if you are already
receiving benefits, we will stop paying you benefits.
. . .
We will consider your physical, mental,
educational, and linguistic limitations (including
any lack of facility with the English language) when
determining if you have an acceptable reason for
failure to follow prescribed treatment.
As the ALJ noted in his decision, according to Appellant’s
medical records, she had been non-compliant with her recommended
treatment.
“[t]reatment
with
J.A.
17.
notes
from
medication,
where
According
Dr.
Swing
to
the
indicate
[Appellant]
had
ALJ’s
decision,
compliance
failed
to
issues
start
medications as prescribed, or had self-discontinued medications.
Treatment notes from [Appellant’s] primary care physician, as
recent as November 2010, also show [Appellant] having compliant
issues [and] self-discontinuing medications.”
27
Id.
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 28 of 30
Specifically, we note that, although Dr. Swing had earlier
prescribed
Abilify,
during
Appellant’s
November
19,
2007,
appointment, Appellant confessed that she had not yet started
taking the medication because she was “afraid of weight gain.”
A.R. 677.
On October 20, 2008, Appellant told her doctor that
she was not taking her medications as prescribed because she
could not afford them.
Id. at 978.
Although noncompliance
indicates a lack of credibility only where “there are no good
reasons” for failing to follow treatment, SSR 96-7p, 1996 WL
374186 (July 2, 1996), there is nothing in the record as to
whether
Appellant
made
any
attempt
to
obtain
assistance
in
purchasing her prescription medications.
In
Dr.
Swing’s
notes
from
Appellant’s
May
14,
2009,
appointment, id. at 975, he noted that she had failed to begin
taking
Wellbutrin,
appointment,
as
directed
id. at 976.
during
her
April
21,
2009,
During Appellant’s November 4, 2010,
appointment with Dr. Dana B. Brown, Appellant informed Dr. Brown
that she had, on her own, discontinued taking Wellbutrin, id. at
1074, since her last visit on October 18, 2010.
Although Dr.
Brown had previously “started her on Provigil, . . . she was
afraid of the medicines and never did start it.”
Id.
Appellant argues in her brief that she “never engaged in
behavior which reflects poorly on her credibility when it comes
to taking medications.”
Appellant’s Br. 39.
28
But based on this
Appeal: 14-1565
Doc: 31
Filed: 06/01/2015
Pg: 29 of 30
record, the ALJ was free to conclude otherwise.
That is, the
ALJ could reasonably have determined that the severe symptoms
Appellant described were inconsistent with her failure to fully
comply
with
the
treatment
her
physicians
prescribed.
Cf.,
Johnson, 434 F.3d at 658 (failure to seek care of a medical
specialist
undermined
the
credibility
of
claimant’s
about her subjective assessments of her pain).
testimony
And we may not
“re-weigh conflicting evidence, make credibility determinations,
or substitute our judgment for that of the” ALJ.
Craig, 76 F.3d
at 589.
In
any
event,
the
ALJ
did
not
deny
Appellant
benefits
solely because of the evidence of her non-compliance.
Rather,
Appellant’s non-compliance was merely one of a number of factors
the
ALJ
considered
in
determining
that
Appellant’s
about her symptoms was only partially credible.
testimony
Because the
ALJ’s determination is supported by substantial record evidence,
we cannot disturb it.
IV.
Certainly,
the
ALJ
could
have
done
a
better
job
in
explaining the bases for finding that Appellant is not disabled
under the Act.
But, the fact that the ALJ could have offered a
more thorough explanation for his decision does not change our
conclusion that substantial evidence in the record supports that
29
Appeal: 14-1565
Doc: 31
decision.
Filed: 06/01/2015
Pg: 30 of 30
We hold that “the ALJ’s factual findings . . . are
supported by substantial evidence and [were] reached by applying
the correct legal standard.”
Hancock, 667 F.3d at 472.
V.
For these reasons, we affirm the judgment of the district
court.
AFFIRMED
30
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?