Smith v Social Security Administration, Commissioner

Filing 11

MEMORANDUM OPINION Signed by Judge William M Acker, Jr on 8/27/14. (SAC )

FILED
2014 Aug-27 PM 02:54
U.S. DISTRICT COURT
N.D. OF ALABAMA

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
EASTERN DIVISION
ALICELEENA M. SMITH,

}
}
Plaintiff,
}
}
v.
}
}
SOCIAL SECURITY
}
ADMINISTRATION, COMMISSIONER, }
}
Defendant.
}

Civil Action No.
12:12-CV-03900-WMA

MEMORANDUM OPINION
Aliceleena M. Smith (“Smith”) brings this action pursuant to
42 U.S.C. § 405(g) for judicial review of a final decision denying
her application for Disability Insurance Benefits from July 1,
2009, to December 31, 2009. Smith timely pursued and exhausted her
administrative remedies before the Social Security Administration.
An administrative law judge (“ALJ”) issued a decision unfavorable
to her that became the Commissioner's final decision when the
Appeals Council denied review.

Smith asserts on appeal that the

ALJ's decision should be reversed because his conclusions are
inconsistent with applicable law and his findings do not have
substantial supporting evidence. More specifically, Smith contends
that the ALJ disregarded her treating physician’s opinion without
good cause and found that her subjective complaints of pain lacked
full credibility without substantial evidence. As explained below,
the court finds that the Commissioner’s final decision must be
affirmed because the ALJ had good cause to disregard the treating
1

physician’s opinion and had substantial evidence to support his
credibility assessment.
STATUTORY AND REGULATORY FRAMEWORK
To

qualify

“disabled.”
any

for

disability

benefits,

a

claimant

must

be

Disability is defined as the “inability to engage in

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. § 423(d)(1)(A); 42 U.S.C. § 416(I).

For the purposes of

evaluating entitlement to disability benefits, a “physical or
mental impairment” is defined as “an impairment that results from
anatomical, physiological, or psychological abnormalities which are
demonstrable

by

medically

acceptable

clinical

and

laboratory

diagnostic techniques.” 42 U.S.C. § 423(d)(3).
Social Security regulations outline a five-step process for
determining

whether

a

claimant

is

disabled.

404.1520(a)(4)(i)-(v), 416.920(a)(4)(i)-(v).

20

C.F.R.

§§

First, the ALJ must

determine whether the claimant is engaging in substantial gainful
activity. 20 C.F.R. § 404.1520(a)(4)(i). If the ALJ finds that the
claimant engages in substantial gainful activity, the claimant
cannot

claim

404.1520(b).

disability,

and

the

inquiry

ends.

20

C.F.R.

§

Second, if the claimant is found not to have engaged

in substantial gainful activity, the ALJ must determine whether the

2

claimant has a medically determinable impairment or a combination
of medical impairments that significantly limit the claimant's
ability

to

perform

404.1520(a)(4)(ii).

basic

work

activities.

20

C.F.R.

§

Absent such impairment, the claimant cannot

successfully claim disability. Id.

Third, the ALJ must determine

whether the claimant's impairment meets or equals the criteria for
an impairment in the Listing of Impairments. See 20 C.F.R. §§
404.1520(d), 404.1525, 404.1526.
claimant

must

be

If such criteria are found, the

declared

disabled.

20

C.F.R.

§

404.1520(a)(4)(iii).
If the claimant does not meet the requirements for being
declared disabled under the third step, the ALJ may still find
disability under the final two steps of the process.

Before

undertaking these steps, the ALJ must determine the claimant's
residual

functional

capacity

(“RFC”),

which

refers

to

the

claimant's ability to work despite the impairment. 20 C.F.R. §
404.1520(e).

When determining a claimant's RFC, the ALJ considers

all evidence relevant to impairment.
In the fourth step, the ALJ determines whether the claimant's
RFC allows the claimant to perform past relevant work. 20 C.F.R. §
404.1520(a)(4)(iv). If the claimant is found capable of performing
past

relevant

disability. Id.

work,

the

claimant

cannot

successfully

claim

If the ALJ finds the claimant unable to perform

past relevant work, the process continues to the fifth step. 20
C.F.R. § 404.1520(a)(4)(v).

The fifth and final step requires the
3

ALJ to determine whether the claimant is able to perform any other
work commensurate with the claimant's RFC, age, education, and work
experience. 20 C.F.R. § 404.1520(g).

Vocational expert (“VE”)

testimony is required when a claimant cannot perform the full range
of work at a particular exertional level or has a non-exertional
impairment such as pain, fatigue, or mental illness. Foot v.
Chater, 67 F.3d 1553, 1558-59 (11th Cir. 1995).
In the present case, the ALJ applied the five-step disability
analysis and determined that Smith was not disabled based on the
fifth

step.

The

ALJ

found

that

Smith

had

not

engaged

in

substantial gainful activity during the time at issue, had severe
impairments

that

did

not

meet

or

equal

a

listed

impairment

(arthritis of the knees, degenerative disc disease, fibromyalgia,
hypertension, and obesity), and could not engage in past relevant
work. R. 14.

However, the ALJ concluded that Smith had the RFC to

perform sedentary work as defined in 20 C.F.R. § 416.1567(a),
assuming that, at her option, she could sit or stand and that she
could “engage in frequent, but not repetitive, manipulative work
with the bilateral hands.” R. 14-18.

Based on this RFC and also on

VE testimony, the ALJ found that Smith could perform other jobs in
the

national

economy

that

exist

in

significant

numbers

accordingly, that Smith was not “disabled.” R. 25-26.

4

and,

FACTUAL BACKGROUND
Smith claims that her disability began on July 1, 2009, and
seeks Disability Insurance Benefits through December 31, 2009, the
date through which her earnings record shows that she acquired
sufficient quarters of coverage to remain insured (“date last
insured”). R. 12.
insured. R. 25.

She was forty-two years old on the date last

She completed high school and some college and has

past relevant work as a nurse’s aide. R. 25, 105.
Regarding the medical evidence, this section focuses on the
evidence related to the issues on appeal, specifically, Smith’s
severe impairments of arthritis of the knees, degenerative disc
disease, fibromyalgia, hypertension (high blood pressure), and
obesity. See R. 14.1

Although the appeal only concerns benefits

for July 1, 2009, through December 31, 2009 (“insured period”), the
ALJ considered as context Smith’s medical records from before and
after that period, i.e., her “longitudinal”2 medical history, so
this section summarizes that medical history as well. R. 20-24.

1

Smith does not contest the ALJ’s findings with respect to her nonsevere impairments that did not more than minimally limit her ability to
work, so the testimony and medical evidence on those topics are not
relevant to this appeal. See Doc. 8; R. 14-18.
2

According to Merriam-Webster, the medical definition of
“longitudinal” is “involving the repeated observation or examination of a
[] subject[] over time with respect to one or more study variables (as
general health, the state of a disease, or mortality). . . .” MERRIAMWEBSTER, http://www.merriam-webster.com/dictionary/longitudinal (last
visited Aug. 26, 2014).

5

Before the Insured Period
In an early record considered by the ALJ, Smith underwent an
examination by an orthopedist, Kenneth Vandervoort, M.D., in July
2006 for ongoing problems in her knees and lower back. R. 286.

Dr.

Vandervoort noted that Smith had obesity and hypertension. Id. His
examination revealed that her knees were mildly tender to palpation
with good range of motion and that her lumbar spine had mild
limitation in range of motion and tenderness. Id.

Dr. Vandervoort

diagnosed lumbar spine degenerative disc disease and mild to
moderate arthritis in both knees. Id. He recommended that Smith be
restricted to low physical demand work with limited standing,
walking, and stair climbing, and that she lose weight. Id.
Smith began seeing a rheumatologist, Dr. Vishala Chindalore,
M.D.,

at

some

point

prior

to

January

2007.

R.

20.

At

an

appointment with Dr. Chindalore in April 2007, Smith reported pain
in both knees and some back pain. R. 394.

Dr. Chindalore found

osteoarthritic changes in the knees and judged the back pain
stable. R. 394-95. He gave her Hyalgan knee injections. Id.

Smith

was referred to a cardiologist, who recommended in June 2007 that
Smith, among other things, walk five days a week for twenty
minutes. R. 477. At a follow-up appointment with Dr. Chindalore in
September 2007, he found osteoarthritic changes of Smith’s hands
and knees and some spasm in her back, and he assessed her knee pain
and back pain as stable. R. 392-93.

By Smith’s November 2007

appointment, Dr. Chindalore judged that her back pain had remained
6

stable and her knee pain had improved, although her left knee had
a painful range of motion. R. 393.

By her September 2008 visit,

her left knee’s range of motion had improved, but her lumbar spine
flexion had become painful. R. 391.

Smith used Lidoderm patches

for knee pain and was prescribed Amrix, a muscle relaxer, for back
pain. R. 21.

She followed up with Dr. Chindalore in November 2008,

at which time the examination revealed painful range of motion of
multiple joints, painful lumbar spine flexion, back spasm, abnormal
gait, and a few positive trigger points. R. 389.

Dr. Chindalore

found that osteoarthritis in Smith’s knees “limits her with her
ability to work.” Id. A later appointment in January 2009 revealed
that Celebrex had “helped her a lot” and, while she still had knee
pain, she had good range of motion in her joints. R. 388.
In 2009, several months before the alleged onset date, Smith
visited a primary care doctor and was admitted to the hospital.
The primary care appointment took place in January 2009.

The

primary care doctor noted that Smith continued to ride her bike
three times a week for twenty minutes and had seen improvement in
her muscle tone. R. 297.

Smith was admitted to the hospital in

April 2009 with chest pain. R. 337-38.

Among other things, she was

advised to exercise and to follow a low-cholesterol and low-sugar
diet. Id.
Smith had an appointment with Dr. Chindalore on June 23, 2009,
just before the alleged onset date of July 1, 2009. R. 21.

Smith

reported that she “is doing about the same” and “actually has a lot
7

of pain in her joints.” R. 544.

Dr. Chindalore’s examination

revealed some knee tenderness, anserine bursa pain, a normal gait,
and good range of motion in both hands and wrists. Id.

Her low

back appeared benign with lumbar spine flexion within normal
limits. Id.

Dr. Chindalore also noted that Smith’s hypertension

was under good control. Id.

He recommended that she take two Aleve

twice daily and take vitamin D supplements. R. 21.
During the Insured Period
After the alleged onset date of July 1, 2009, Smith had a
follow-up appointment with Dr. Chindalore on August 20, 2009. R.
544.

His examination revealed a normal gait and good range of

motion in her hands, wrists, and knees. Id. Her low back continued
to appear benign with her lumbar spine flexion within normal
limits. Id.

Dr. Chindalore assessed Smith’s knee pain as “better”

and her leg pain as “improved.” Id.

Smith returned to see Dr.

Chindalore on October 22, 2009, and he found that her knee pain
continued

to

be

“better,”

although

he

did

note

some

knee

osteoarthritic changes. R. 684.3
Smith visited the primary care doctor again on September 22,

3

At the October 2009 appointment, Smith also had some paresthesias
and was given samples of Lyrica for it. R. 684. The medical definition
of “parethesia” is “a sensation of pricking, tingling, or creeping on the
skin having no objective cause and usually associated with injury or
irritation of a sensory nerve or nerve root.” MERRIAM-WEBSTER,
http://www.merriam-webster.com/medical/paresthesia (last visited Aug. 26,
2014). Dr. Chindalore did not connect paresthesia to one of the severe
impairments claimed by Smith and/or acknowledged by the ALJ, so this
complaint does not affect the disability determination.

8

2009,4 and on November 10, 2009. R. 597, 616.

In September 2009,

Smith said that she felt tired for one month after changing her
blood pressure medicine but was “feeling well other than fatigue,
and [her] blood pressure creeping up.” R. 597.

She indicated that

she got extremely tired climbing stairs but that she could exercise
“ok” on her exercise bike. Id.

At the November 2009 appointment,

the doctor noted some tenderness in Smith’s back but found no
decreased range of motion. R. 21.

Smith also confirmed that she

had been using her exercise bike. R. 616.
Smith’s final appointment during the insured period was with
Dr. Chindalore on December 17, 2009.

At that appointment, Smith

noted that “[s]he still hurts quite a bit.” R. 682.

Examination

revealed some osteoarthritic changes of the hands and knees and
some spasm in her back and neck. Id.

Lumbar spine flexion remained

within normal limits and her gait remained normal. Id. Both hands,
wrists, and knees had good range of motion. Id.

Dr. Chindalore did

not assess whether Smith’s knee or back pain had improved, remained
stable, or deteriorated. See id.

He changed her medication, but

apparently due to side effects from her previous medication. Id.
He also noted that her hypertension was stable. Id.
After the Insured Period
Smith visited her primary care doctor in March 2010, reporting
4

Smith saw Dr. Robert L. Cater on all primary care visits to
C.A.R.E.S. Immediate Family Care Occupational Medicine, except that she
saw Dr. Michael G. Gaines on August 21, 2009. R. 583-604.

9

throbbing left knee pain that had lasted for two weeks and worsened
with certain weather and with bending. R. 593.

The doctor found

arthritis of the left knee and continued her current medications.
R. 22, 627.
At an appointment with Dr. Chindalore also in March 2010, he
described Smith as “doing reasonably well on the current therapy”
but noted that “she is having a lot of problems with her shoulders
and

back.”

R.

683.

His

examination

showed

a

few

positive

fibromyalgia trigger points, some back spasm, lumbar spine flexion
within normal limits, and a normal gait. Id.

Smith’s hands,

wrists, and knees had good range of motion. Id.

Dr. Chindalore

assessed her back pain as stable and decided to continue the
current therapy for osteoarthritis. Id.
Smith

returned

to

her

primary

care

doctor

in

May

2010,

complaining of burning pain in her right knee lasting for three
weeks.

R.

591.

The

doctor

observed

that

Smith

limped

and

recommended that she take Aleve and apply Icy-Hot for right knee
tendonitis. R. 22, 628.
Smith

had

an

Four months later, in September 2010,

appointment

with

her

primary

care

doctor

and

complained of lower back discomfort and leg pain, ongoing for two
to three weeks and worse with walking. R. 585. The doctor assessed
the pain as reflecting arthritis and refilled her pain medication.
R. 22, 637.

At her last primary care appointment of record in

January 2011, Smith reported right knee pain with the most recent
pain onset one week prior, at a 10 on a pain scale of 1 to 10. R.
10

583.

She said that she was not resting well and woke up from the

pain. R. 584.

Smith requested and received a referral for a MRI to

further investigate her knee problems. R. 583.

The doctor noted

that she had a history of degenerative disc disease but her lower
back was not giving her problems now. Id.
Smith’s final two appointments of record with Dr. Chindalore
occurred in March 2011.

Dr. Chindalore notes at the earlier March

appointment that he had not seen Smith for almost a year. R. 680.
At that appointment, Smith claimed that “[s]he is hurting all
over.” Id.

She said that she had a meniscal tear in the right

knee, for which she had a knee brace and which “hurt[] her a lot at
night.” Id.

Dr. Chindalore’s examination showed a normal gait and

good range of motion in her hands, wrists, and right knee. Id.
Smith’s low back appeared benign, and her lumbar spine flexion was
within normal limits. Id.

She was continued on her current pain

medication, Cymbalta, prescribed by the primary care doctor. R.
680, supra n. 4.

At her appointment in late March 2011, Smith

reported that she “was doing much better” on the 30 mg of Cymbalta
but she started feeling nervous when she increased to 60 mg of
Cymbalta.
positive

R. 680.

Dr.

fibromyalgia

Chindalore’s examination

trigger

points

changes of the hands and knees. R. 681.

and

some

noted

a

few

osteoarthritic

Smith had good range of

motion in both hands, wrists, and knees. Id.
After Smith’s March 2011 appointments with Dr. Chindalore, he

11

wrote an opinion letter dated April 8, 2011. R. 651.

In the

letter, he said that she “has established diagnoses of severe
osteoarthritis, back pain, knee pain, myalgias, chronic muscle
spasms, anemia, neutropenia, and fibromyalgia. Due to her multiple
medical

problems

Ms.

Smith

is

now

totally

and

permanently

disabled.” Id.
The final piece of pertinent medical evidence is Smith’s
testimony at the video hearing before the ALJ.5 See R. 12, 22-23.
At the hearing, Smith said that she cannot sit or stand for too
long due to her pain. R. 22.

She reported problems in both hands

due to arthritis, with stiffening on some days, although she can
usually open and close them. Id.

She estimated that she typically

lies down for three to four hours every day due to fatigue. R. 2223.

Later in the hearing, she said that she lies down for four to

five hours per day. R. 23.
DISCUSSION
This court's sole function is to determine whether substantial
evidence supports the ALJ's findings of fact and whether the ALJ
employed the proper legal standards. Winschel v. Comm'r of Soc.
Sec., 631 F.3d 1176, 1178 (11th Cir. 2011).

Substantial evidence

is “such relevant evidence as a reasonable person would accept as
adequate to support a conclusion.” Crawford v. Comm'r of Soc. Sec.,

5

In her brief, Smith adopted the ALJ’s recitation of her testimony
as true and correct. Doc. 8 at 2.

12

363 F.3d 1155, 1158 (11th Cir. 2004).

This court may not decide

the facts anew, re-weigh the evidence, or substitute its judgment
for that of the ALJ. Bloodsworth v. Heckler, 703 F.2d 1233, 1239
(11th Cir. 1983).

Even if this court should find that the

preponderance of evidence weighs against the ALJ's decision, the
court must affirm the decision if it is supported by substantial
evidence. Id.
Unlike the deferential standard used in evaluating the ALJ's
factual

findings,

the

ALJ's

conclusions

of

law

are

not

presumptively valid. Martin v. Sullivan, 894 F.2d 1520, 1529 (11th
Cir. 1990).

The court must reverse the decision if the ALJ failed

“to apply the correct law or to provide the reviewing court with
sufficient reasoning for determining that the proper legal analysis
has been conducted.” Cornelius v. Sullivan, 936 F.2d 1143, 1145-46
(11th Cir. 1991).
Smith raises two issues on this appeal: (I) whether the ALJ
properly weighed the opinion letter dated April 8, 2011, from her
treating rheumatologist, Dr. Chindalore; and (II) whether the ALJ
properly weighed Smith's credibility in assessing her subjective
complaints of pain.
I.

The court addresses these two issues in turn.

Treating Rheumatologist’s Opinion Letter
Smith argues that the ALJ improperly disregarded the opinion

letter dated April 8, 2011, from her treating rheumatologist in
making the RFC determination.

Regulations require that a treating
13

physician's opinion be given controlling weight if well supported
“by

medically

acceptable

clinical

and

laboratory

diagnostic

techniques” and not inconsistent with other substantial evidence in
the record. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2).

In the

Eleventh Circuit, “the testimony of a treating physician must be
given substantial or considerable weight unless ‘good cause’ is
shown to the contrary.” Lewis v. Callahan, 125 F.3d 1436, 1440
(11th Cir. 1997) (citations omitted). To show such good cause, the
ALJ must clearly articulate his reasons for rejecting the treating
physician’s opinion. Id.; Winschel v. Comm’r of Soc. Sec., 631 F.3d
1176, 1176 (11th Cir. 2011).
Smith’s
letter

on

treating

April

8,

rheumatologist,
2011,

stating

Dr.

that

Chindalore,
she

“has

wrote a

established

diagnoses of severe osteoarthritis, back pain, knee pain, myalgias,
chronic muscle spasms, anemia, neutropenia, and fibromyalgia. Due
to her multiple medical problems Ms. Smith is now totally and
permanently disabled.” R. 651.

The ALJ discussed this letter and

gave as grounds for according it no weight that it purports to make
a disability determination reserved to the Commissioner; that it
lists

diagnoses

while

“fail[ing]

to

specify

any

functional

limitations that might support the disability rating”; and that it
does not clearly refer to the insured period.6 R. 24.

6

The court

Defendant argues that the ALJ also gave Dr. Chindalore’s opinion
letter no weight because it was inconsistent with the doctor’s treatment
notes from Smith’s insured period. Doc. 10 at 12. The ALJ did not
explicitly give this reason, however, and the court considers only the

14

finds that the opinion letter’s failure to specify functional
limitations and its unclear time referent gave the ALJ a good
reason to accord it no weight.
The ALJ had grounds to give less weight to Dr. Chindalore’s
opinion letter because it constituted an opinion on the ultimate
determination reserved to the Commissioner.
not

medical

opinions

determinations

with

reserved

to

controlling
the

Doctors’ opinions are

weight

Commissioner,

when

they

are

particularly

on

whether a person is disabled or unable to work. 20 C.F.R. §§
404.1527(d),

927(d).

However,

such

opinions

must

still

be

considered. SSR 96-5p, 61 Fed. Reg. 34,471, 34,472 (1996).
That

the

opinion

letter

only

listed

impairments

without

describing how they limit Smith’s ability to work more seriously
undermines the opinion letter’s utility.

The severity of any

impairment is measured for disability purposes “in terms of its
effect upon [the] ability to work.” Moore v. Barnhart, 405 F.3d
1208, 1213 n.6 (11th Cir. 2005) (quoting McCruter v. Bowen, 791
F.2d

1544,

1547

(11th

Cir.

1986));

see

also

20

C.F.R.

§

404.1520(d)-(g) (“Your impairment(s) must prevent you from making
an adjustment to any other work.”).

The Eleventh Circuit has

rejected challenges to RFC determinations based solely on a person
having a particular impairment. Id.

“The mere existence of these

impairments does not reveal the extent to which they limit her

reasons that the ALJ actually gave. See Lewis, 125 F.3d at 1440.

15

ability to work or undermine the ALJ's determination.” Id.

The

conclusory way that Dr. Chindalore listed Smith’s impairments
before writing his assessment that she was totally and permanently
disabled gave the ALJ good cause to accord little or no weight to
the opinion letter.
Even more problematic is Dr. Chindalore’s wording in the
opinion

letter

that

disabled.” R. 654.

Smith

“is

now

totally

and

permanently

Attributing to “now” its natural meaning, the

letter reads as an opinion that Smith was totally and permanently
disabled as of the letter’s date of April 8, 2011——which has little
relevance to determining whether Smith was disabled during the
insured period more than a year earlier. Wilson v. Apfel, 179 F.3d
1276, 1278-79 (11th Cir. 1999) (per curiam); Douglas v. Comm'r of
Soc. Sec., 486 Fed. Appx. 72, 75-76 (11th Cir. 2012) (per curiam)
(unpublished).

Although Smith correctly notes that Dr. Chindalore

could have based his assessment on more recent appointments than
those in June and August 2009, this argument weighs even more
against the opinion referring to the insured period. Smith visited
Dr. Chindalore in March 2010 and twice in March 2011.

Why would

Dr. Chindalore write a letter in April 2011 assessing Smith’s
condition as of July 2009 through December 2009 without explicitly
referring to that time period and instead stating that Smith “is
now

totally

and

permanently

disabled?”

The

ALJ

reasonably

concluded that the opinion letter did not unambiguously or even

16

likely refer to the insured period and, therefore, accorded it no
weight.
The

ALJ

considered

several

problematic

aspects

of

Dr.

Chindalore's opinion letter and clearly articulated his reasons for
giving it no weight. See R. 24.

The court finds that the ALJ’s

decision was reasonable and supported by substantial evidence in
light of the conclusory nature of the opinion letter and the
improbability that it referred to Smith’s condition during the
insured period. See Winschel, 631 F.3d at 1176.
II.

Smith’s Subjective Complaints of Pain
Smith

contends

on

appeal

that

the

ALJ did

not

properly

consider her subjective complaints of pain when determining her RFC
and her disability status.

The ALJ found that Smith’s subjective

complaints of pain supported the RFC of sedentary work with a sit/
stand option and a restriction on repetitive manipulative work with
her hands. R. 22.

However, he found her subjective complaints of

pain “not fully credible” to the extent that she alleged more
severe functional limitations during the insured period. Id.
A “pain standard” applies when the claimant tries to establish
disability through her subjective complaints of pain. Foote v.
Chater, 67 F.3d 1553, 1560 (11th Cir. 1995).

Under this standard,

a claimant testifying about her pain must show “(1) evidence of an
underlying medical condition and either (2) objective medical
evidence that confirms the severity of the alleged pain arising
17

from that condition or (3) that the objectively determined medical
condition is of such a severity that it can be reasonably expected
to give rise to the alleged pain.” Holt v. Sullivan, 921 F.2d 1221,
1223 (11th Cir. 1991) (citation omitted).

The parties in the

present case implicitly proceed under the option requiring evidence
confirming the severity of Smith’s alleged pain, as neither party
contends that any one of Smith’s conditions is so severe that it
can reasonably be expected to give rise to the alleged pain without
confirmation. See id.; R. 20-24; Doc. 8 at 8-10.
In assessing the claimant’s subjective complaints of pain, the
ALJ may decide that the claimant’s testimony is not credible so
long as the ALJ “articulate[s] explicit and adequate reasons for
doing so.” Holt, 921 F.2d at 1223 (quotation omitted).

The ALJ

should consider the claimant’s daily activities, symptoms, types
and dosages of medications, and other treatments. Dyer v. Barnhart,
395 F.3d 1206, 1212 (11th Cir. 2005); 20 C.F.R. § 404.1529(c)(3).
Although the ALJ need not address every piece of evidence, the ALJ
must consider the claimant’s “medical condition as a whole” when
assessing her credibility, and the ALJ’s credibility conclusion “as
a whole” must be supported by substantial evidence. Dyer, 395 F.3d
at 1210-11.

If the ALJ’s decision is supported by clear reasons

and substantial evidence, the court may not disturb the credibility
determination or re-weigh the related evidence. Foote v. Chater, 67
F.3d 1553, 1561-62 (11th Cir. 1995).

The court finds that the ALJ

expressed clear reasons for not finding Smith’s pain testimony
18

fully credible and had substantial supporting evidence for those
reasons.
The ALJ provided three primary reasons for not finding Smith’s
pain testimony fully credible, considering both her longitudinal
medical history and her doctors’ functionality assessments. First,
the ALJ noted that Smith was advised to exercise and that she
successfully did so during the insured period. R.23.

Second, the

ALJ observed that Dr. Chindalore’s treatment notes during the
insured period show improvement in Smith’s knee and leg pain and
did not make significant findings as to her hands. Id.
ALJ

found

some

support

for

the

RFC

in

one

Third, the

doctor’s

earlier

functionality assessment, and no more recent opinion credibly
undermined the RFC determination. R. 23-24.
the

ALJ

did

not

have

substantial

Smith contends that

evidence

for

his

adverse

credibility determination based on any of these reasons.
(1)

The ALJ found Smith’s pain testimony not fully credible

in part because she was advised to exercise and she successfully
exercised during the insured period.

More specifically, the ALJ

referred to a cardiologist’s recommendation in June 2007 that Smith
walk

five

times

per

week,

R.

477.,

and

a

hospital

doctor’s

recommendation in April 2009 that she exercise, R. 337-38. The ALJ
also referenced treatment notes showing that Smith successfully
used her exercise bike. R. 22.

Smith reported in January 2009 that

she rode her bike three times a week for twenty minutes. R. 297.
Smith also stated at a November 2009 appointment, in the middle of
19

the insured period, that she had been using her exercise bike. R.
616.7

The ALJ inferred that the treating doctors did not consider

Smith’s pain so debilitating that it precluded limited exercise,
and the fact that she engaged in such exercise supported that
inference. R. 23.

Smith argues that the ALJ impermissibly “played

doctor” and made “independent [medical] findings” by attributing
significance to the exercise recommendations and Smith’s exercise
routine. Doc. 8 at 9 (quoting Rohan v. Chater, 98 F.3d 966, 970
(7th Cir. 1996)).

Smith also points out that none of the treatment

notes indicate that the doctors disbelieved her pain symptoms. Id.
The court would hesitate if the ALJ had based his credibility
determination solely on the exercise recommendations and Smith’s
exercise routine, but the ALJ specifically qualified that “[b]y
itself, the claimant’s ability to exercise for short periods might
not indicate her capacity for the sedentary position described in
this decision.” R. 22.
factors

did

the

ALJ

Only after considering the other two

conclude

that

he

did

not

find

Smith’s

subjective complaints of pain fully credible. See R. 21-23. As for
“playing doctor,” the ALJ necessarily must draw conclusions from
medical records and reconcile conflicting evidence as part of
deciding the RFC. 20 C.F.R. §§ 404.1529(a), (c)(4).

The ALJ

considered Smith’s ability to exercise immediately after noting her

7

The ALJ does not reference Smith’s September 2009 appointment
when she indicated that she got extremely tired climbing stairs but that
she could exercise “ok” on her bike. R. 597.

20

claim of July 22, 2009, that she needed to hold onto a cart to do
any shopping. R. 22, 212.
exercise

recommendations

Juxtaposing this statement with the
and

her

exercise

routine

is

not

unreasonable, and the ALJ did not rely on this factor alone for his
adverse credibility decision.
(2)

The ALJ heavily weighed in his credibility determination

the treatment notes from before and during the insured period that
showed improvement in Smith’s knee and leg pain but did not make
significant findings as to her hands. R. 22.

Smith counters that

her condition actually had not improved, that the record contained
numerous instances when she had complained of pain, and that the
ALJ ignored the longitudinal medical history.

As an initial

matter, the ALJ incorrectly referred to Smith’s August 20, 2009,
appointment as her last appointment of record with Dr. Chindalore.
In fact, she also had appointments with him during the insured
period on October 22, 2009, and December 17, 2009, and after the
insured period in March 2010 and in March 2011.

As explained

below, the omission of these treatment notes does not undermine the
ALJ’s credibility determination.
For his credibility determination, the ALJ focused on the
change in Smith’s condition as described in Dr. Chindalore’s
treatment

notes

appointments.

from

her

Previously,

January,
at

her

June,

November

and

August

2009

2008

appointment,

examination revealed painful range of motion of multiple joints,
painful lumbar spine flexion, back spasm, abnormal gait, and a few
21

positive trigger points. R. 389.

By the January 2009 appointment,

Smith still had knee pain but she had good range of motion in her
joints and she stated that Celebrex had “helped her a lot.” R. 388.
Smith reported at her June 23, 2009, appointment that she was
“doing about the same” and “actually has a lot of pain in her
joints.” R. 544.

Her examination revealed some knee tenderness,

anserine bursa pain (knee area)8, a normal gait, and good range of
motion in her hands and wrists. Id.

The ALJ emphasized the August

20, 2009, appointment at which Dr. Chindalore found Smith's knee
pain “better” and her leg pain “improved.” R. 544.

She had a

normal gait, lumbar spine flexion within normal limits, and good
range of motion in her hands, wrists, and knees. Id.
The

treatment

notes

for

the

two

appointments

with

Dr.

Chindalore during the insured period not considered by the ALJ do
not differ significantly.

Smith returned to see Dr. Chindalore on

October 22, 2009. R. 684.

He found that her knee pain continued to

be “better,” although he did note some knee osteoarthritic changes.
Id.

At the appointment on December 17, 2009, Dr. Chindalore did

not assess whether Smith’s knee, leg, and back pain had improved,
remained stable, or deteriorated. See R. 682. Examination revealed
some osteoarthritic changes of her hands and knees and some spasm

8

Anserine bursa is a fluid-filled sack between tendons and the
tibial collateral ligament of the knee joint. DICTIONARY.COM,
http://dictionary.reference.com/browse/anserine+bursa,
http://dictionary.reference.com/browse/bursa?s=t (last visited Aug. 21,
2014).

22

in her back and neck, but her gait stayed normal, her lumbar spine
flexion remained within normal limits, and she had good range of
motion in her hands, wrists, and knees. Id.

Dr. Chindalore did

change Smith’s medication, but apparently because of side effects
that she had experienced on the previous medication. Id.

The

December 2009 treatment notes suggest more conservative improvement
than the August 2009 treatment notes, but they do not undermine the
ALJ’s conclusion that Smith’s knee and leg pain had improved
shortly before and during the insured period.9
Smith

emphasizes

that

she

complained

of

pain

at

the

appointments with Dr. Chindalore that the ALJ discussed, both
before

and

during

the

insured

period.

The

ALJ

explicitly

considered Smith’s complaints and did not find them fully credible,
primarily because they conflicted with Dr. Chindalore’s assessment
that Smith’s condition and pain had improved by August 2009 (and by
October 2009).10 R. 22-24.

Although Smith disagrees with the ALJ’s

conclusion, the ALJ had a responsibility to weigh the totality of

9

Defendant argues that the ALJ considered Dr. Chindalore’s
conservative treatment regimen in determining Smith’s credibility. Doc.
10 at 6-7. However, the ALJ only explicitly referred to Dr. Chindalore’s
“progression of treatment” once, as a reason to disregard his November
2008 functionality assessment and in the context of Smith’s condition
improving. R. 23-24. The court only reviews the reasons that the ALJ
actually gave. Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991).
10

The ALJ did not doubt Smith’s credibility because of a lack of
corroborating medical evidence, an impermissible inference in the
Eleventh Circuit for fibromyalgia, although not for Smith’s other
conditions. See Moore v. Barnhart, 405 F.3d 1208, 1212 (11th Cir. 2005).
Rather, the ALJ based his decision on inconsistencies between Smith’s
testimony and the medical evidence, which relates predominantly to her
knee, leg, and back pain. See R. 22-24.

23

the evidence, including to what extent Dr. Chindalore’s medical
opinions conflicted with Smith’s pain testimony. See 20 C.F.R. §§
404.1529(a),

(c)(4)

(“Your

symptoms,

including

pain,

will

be

determined to diminish your capacity for basic work activities to
the extent that [they] can reasonably be accepted as consistent
with the objective medical evidence and other evidence”).

The ALJ

reasonably gave more weight to Dr. Chindalore’s judgment and had
substantial evidence to find Smith’s inconsistent pain testimony
not fully credible.
When arguing that the ALJ did not consider her longitudinal
medical

history,

occurred

after

Smith

the

references

insured

several

period.

Doc.

appointments

8

at

10.

The

that
ALJ

considered these later appointments when determining that Smith had
severe

impairments,

see

R.

22,

but

not

when

assessing

the

credibility of Smith’s complaints of pain for the insured period,
see R. 22-24.

The ALJ properly did not include the treatment notes

from after the insured period.

The Eleventh Circuit has explained

that medical opinions relating to time periods after the insured
period are not probative of whether the claimant was “disabled”
during the insured period. Wilson v. Apfel, 179 F.3d 1276, 1278-79
(11th Cir. 1999) (per curiam); Carrol v. SSA, 453 Fed. Appx 889,
892 (11th Cir. 2011); Douglas v. Comm'r of Soc. Sec., 486 Fed.
Appx. 72, 75-76 (11th Cir. 2012) (per curiam); but see B o y d

v.

Heckler, 704 F.2d 1207, 1211 (11th Cir. 1983), superseded on other

24

grounds by 42 U.S.C. § 423(d)(5) (unless claimant began seeing the
sole

treating

physician

after

the

insured

period).

If

the

treatment notes from Smith’s 2010 and 2011 appointments indeed
indicate that she was in poor condition and had significant pain,
such records could indicate that her condition had deteriorated;
they do not necessarily mean that she was in that condition
throughout the insured period. Carrol, 453 Fed. Appx. at 75-76.
(3) In judging the credibility of Smith’s pain testimony, the
ALJ also considered whether any medical assessments of Smith’s
functionality credibly opposed or supported the RFC. The ALJ found
that Dr. Vandervoort’s assessment from July 2006, although well
before the insured period, was consistent with the RFC. R. 23.

Dr.

Vandervoort recommended that Smith be restricted to low physical
demand work with limited standing, walking, and stair climbing,
which is consistent with the RFC of sedentary work with a sit-stand
option. Id.

As for Dr. Chindalore’s November 2008 assessment that

osteoarthritis in Smith’s knees “limits her with her ability to
work,” R. 389, the ALJ accorded it little weight because the
assessment was “vague” and because the November 2008 treatment
notes show far more serious findings than the notes from the
insured period, R. 23-24.

In November 2008, Smith had painful

range of motion of multiple joints, painful lumbar spine flexion,
back spasm, abnormal gait, and a few positive trigger points. R.
389.

In contrast, on August 20, 2009, she had good range of motion

in her hands, wrists, and knees, a lumbar spine flexion within
25

normal limits, a normal gait, “better” knee pain, and “improved”
leg pain. R. 544.

Accordingly, the ALJ did not find the November

2008 assessment applicable to Smith’s condition during the insured
period. R. 24.

The ALJ disregarded Dr. Chindalore’s April 2011

opinion letter

because,

as

discussed

in

Section

I

above,

it

purported to make a determination reserved to the Commissioner,
listed diagnoses without explaining functional limitations, and did
not clearly refer to the insured period. R. 24.

Thus, the ALJ

found that the July 2006 assessment was consistent with the RFC and
that no later assessment undermined it.
The

ALJ

provided

several

explicit

reasons

for

his

determination that Smith’s subjective complaints of pain during the
insured period were not fully credible. The ALJ considered Smith’s
“medical condition as a whole,” including the progression of her
treatment and symptoms, her daily activities, and her doctors’
functionality assessments. See Dyer v. Barnhart, 395 F.3d 1206,
1212 (11th Cir. 2005); 20 C.F.R. § 404.1529(c)(3). Despite Smith’s
disagreement with his decision, the ALJ did have “such relevant
evidence as a reasonable person would accept as adequate to support
[the] conclusion” that Smith’s pain testimony was not credible to
the extent that it conflicted with her doctors’ findings and the
RFC. See Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158 (11th
Cir. 2004).

Smith argues that the evidence supports the opposite

conclusion, but such an argument misconstrues this court’s role.
Regardless of whether the evidence also supports a different
26

conclusion, this court cannot re-weigh the evidence or disturb the
ALJ’s credibility decision so long as the ALJ applied the correct
legal analysis, provided clear reasons, and supported his decision
with substantial evidence. Foote v. Chater, 67 F.3d 1553, 1561-62
(11th Cir. 1995).

The ALJ has satisfied this burden.
CONCLUSION

The court concludes that the ALJ applied the proper legal
standards and had substantial evidence to support his determination
that

Smith

Accordingly,
affirmed.

was
the

not

disabled

Commissioner's

during
final

the

insured

decision

is

due

period.
to

be

An appropriate, separate order will be entered.

DONE this 27th day of August, 2014.

_____________________________
WILLIAM M. ACKER, JR.
UNITED STATES DISTRICT JUDGE

27