Quiles v. Social Security Administration, Commissioner
MEMORANDUM OPINION. Signed by Judge Abdul K Kallon on 10/19/12. (CVA)
2012 Oct-19 AM 08:39
U.S. DISTRICT COURT
N.D. OF ALABAMA
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
ANNA LOUISE QUILES,
MICHAEL J. ASTRUE,
COMMISSIONER OF SOCIAL
Civil Action Number
Plaintiff Anna Louise Quiles (“Quiles”) brings this action pursuant to
Section 205(g) of the Social Security Act (“the Act”), 42 U.S.C. § 405(g), seeking
review of the final adverse decision of the Commissioner of the Social Security
Administration (“SSA”). This court finds that the Administrative Law Judge’s
(“ALJ”) decision - which has become the decision of the Commissioner - is
supported by substantial evidence and, therefore, AFFIRMS the decision denying
I. Procedural History
Quiles filed her applications for Title II disability insurance benefits and
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Title XVI Supplemental Security Income on December 2, 2008, alleging a
disability onset date of February 2, 2008, due to chronic asthma. (R. 68-69, 119124, 145). After the SSA denied her applications on January 22, 2009, Quiles
requested a hearing. (R. 70-74, 81-82). At the time of the hearing on July 10,
2010, Quiles was 44 years old, had a high school diploma and a cosmetology
license, and past relevant light, skilled work as a cosmetologist, and light, semiskilled work as a bar tender. (R. 42, 63). Quiles has not engaged in substantial
gainful activity since February 2, 2008. (R. 19, 145).
The ALJ denied Quiles’s claim on September 29, 2010, which became the
final decision of the Commissioner when the Appeals Council refused to grant
review on July 18, 2011, (R. 1-6, 14). Quiles then filed this action pursuant to
section 1631 of the Act, 42 U.S.C. § 1383(c)(3). Doc. 1.
II. Standard of Review
The only issues before this court are whether the record contains substantial
evidence to sustain the ALJ’s decision, see 42 U.S.C. § 405(g); Walden v.
Schweiker, 672 F.2d 835, 838 (11th Cir. 1982), and whether the ALJ applied the
correct legal standards, see Lamb v. Bowen, 847 F.2d 698, 701 (11th Cir. 1988);
Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1986). Title 42 U.S.C. §§ 405(g)
and 1383(c) mandate that the Commissioner’s “factual findings are conclusive if
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supported by ‘substantial evidence.’” Martin v. Sullivan, 894 F.2d 1520, 1529
(11th Cir. 1990). The district court may not reconsider the facts, reevaluate the
evidence, or substitute its judgment for that of the Commissioner; instead, it must
review the final decision as a whole and determine if the decision is “reasonable
and supported by substantial evidence.” See id. (citing Bloodsworth v. Heckler,
703 F.2d 1233, 1239 (11th Cir. 1983)).
Substantial evidence falls somewhere between a scintilla and a
preponderance of evidence; “[i]t is such relevant evidence as a reasonable person
would accept as adequate to support a conclusion.” Martin, 849 F.2d at 1529
(quoting Bloodsworth, 703 F.2d at 1239) (other citations omitted). If supported by
substantial evidence, the court must affirm the Commissioner’s factual findings
even if the preponderance of the evidence is against the Commissioner’s findings.
See Martin, 894 F.2d at 1529. While the court acknowledges that judicial review
of the ALJ’s findings is limited in scope, it notes that the review “does not yield
automatic affirmance.” Lamb, 847 F.2d at 701.
III. Statutory and Regulatory Framework
To qualify for disability benefits, a claimant must show “the inability to
engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairments which can be expected to result in death or which
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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). A physical or mental
impairment is “an impairment that results from anatomical, physiological, or
psychological abnormalities which are demonstrated by medically acceptable
clinical and laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3).
Determination of disability under the Act requires a five step analysis. 20
C.F.R. § 404.1520(a)-(f). Specifically, the Commissioner must determine in
whether the claimant is currently unemployed;
whether the claimant has a severe impairment;
whether the impairment meets or equals one listed by the Secretary;
whether the claimant is unable to perform his or her past work; and
whether the claimant is unable to perform any work in the national
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986). “An affirmative
answer to any of the above questions leads either to the next question, or, on steps
three and five, to a finding of disability. A negative answer to any question, other
than step three, leads to a determination of ‘not disabled.’” Id. at 1030 (citing 20
C.F.R. § 416.920(a)-(f)). “Once a finding is made that a claimant cannot return to
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prior work the burden shifts to the Secretary to show other work the claimant can
do.” Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir. 1995) (citation omitted).
IV. The ALJ’s Decision
In performing the Five Step sequential analysis, the ALJ initially
determined that Quiles had not engaged in substantial gainful activity since her
alleged onset date and therefore met Step One. (R. 19). Next, the ALJ
acknowledged that Quiles’s severe impairments of asthma and hypertension met
Step Two. Id. The ALJ then proceeded to the next step and found that Quiles did
not satisfy Step Three since she “does not have an impairment or combination of
impairments that meets or medically equals one of the listed impairments.” (R.
23). Although the ALJ answered Step Three in the negative, consistent with the
law, see McDaniel, 800 F.2d at 1030, the ALJ proceeded to Step Four, where he
determined that Quiles
has the residual functional capacity [RFC] to perform work consistent
with Exhibit 8F, the state agency physical residual functional capacity
assessment, with the modifications of: the ability to lift and carry
modified from medium to 20 pounds occasionally and 10 pounds
frequently; the ability to stand and walk is modified to 4 hours out of
an 8 hour workday; she can sit for 6 of 8 hours; she can change
positions from sitting and standing as needed throughout the day; she
can do unlimited pushing and pulling, she can frequently climb ramps
and stairs, she can never climb ladders, ropes, or scaffolds; she can
frequently balance and do occasional stooping; she can frequently
perform the remaining posturals; she has no manipulative, visual or
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communication limitations; she must avoid moderate exposure to
pulmonary irritants such as fumes, gases, and dust; she must avoid
concentrated exposure to extremes of heat and cold; she must avoid
unprotected heights; and she experiences mild to moderate pain.
As for the opinion evidence, the undersigned gives some weight to
the opinion of Dr. Cranford in Exhibit 6F, the food stamp application,
in that the doctor noted that the claimant suffered from chronic
asthma specifically induced by chemical, environmental and seasonal
exposure, but rejects the doctor’s opinion that asthma prevents the
claimant from working in order for the claimant to be eligible for
food stamps. In Exhibit 5F, Dr. Cranford indicated the claimant’s
asthma was well controlled and she was doing well with her inhaler.
The claimant herself testified at the hearing her asthma had improved
since she stopped smoking. The undersigned finds that Dr.
Cranford’s opinion is inconsistent with his own treatment notes and
the medical evidence in the record. The medical record fails to reveal
the type of significant clinical and laboratory abnormalities one
would expect if the claimant were in fact disabled. . . . Considerable
weight is given to the Mental RFC assessment by the state agency
psychological consultant whose opinion was consistent with the
medical evidence as a whole and this decision. The claimant was
never referred to a mental health specialist by her treating physicians
and does not require treatment for any mental impairment and has no
severe mental impairment.
(R. 25-26). In light of Quiles’s RFC, the ALJ determined that Quiles was “unable
to perform[ ] any past relevant work” because the “demands of the claimant’s past
relevant work as a cosmetologist and bartender exceed the [RFC].” (R. 26).
Therefore, the ALJ proceeded to Step Five where he considered Quiles’s age,
education, experience, and RFC, and determined that there are “jobs that exist in
significant numbers in the national economy that the claimant can perform.” Id.
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Because the ALJ answered Step Five in the negative, the ALJ determined that
Quiles is not disabled. (R. 27); see also McDaniel, 800 F.2d at 1030.
Quiles asserts that the ALJ erred because he (1) failed to properly consider
Quiles’s depression and obesity at Step Two, (2) relied on a state agency opinion
that was “superseded by multiple items of evidence,” (3) failed to consider
Quiles’s asthma and hypertension in combination, (4) discounted the treating
physician Dr. Ralph Cranford, and (5) failed to develop the record by obtaining a
medical source opinion. Doc. 8 at 6-7. For the reasons stated below, the court
finds that the ALJ’s opinion is supported by substantial evidence.
The ALJ properly considered Quiles’s impairments at Step Two
At Step Two of the sequential process, the ALJ must determine whether a
claimant’s impairments are severe. See 20 C.F.R. §§ 404.1520(a)(4)(ii). A
disability finding requires “severe” impairments to last for at least twelve
consecutive months. See 20 C.F.R. §§ 404.1509.
Quiles’s Depression is Not a Severe Impairment
The court will review the relevant medical records to determine whether
In her disability applications, Quiles listed only asthma as limiting her ability to work.
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Quiles is correct that the ALJ failed to properly consider her depression. In that
regard, Quiles visited Dr. Christopher Roney at the Pulmonary & Sleep
Associates of Alabama, P.C. on September 29, 2006, where Dr. Roney noted that
Quiles’s past medical history included anxiety/depression and that Quiles was
currently taking Prozac. (R. 209). Two months later, on December 7, 2006,
Quiles presented again to Dr. Roney for “shortness of breath, cough and
wheezing” with “panic and some anxiety.” (R. 207). Dr. Roney noted that
Quiles’s asthma “symptoms are also compounded by anxiety and panic. . . . She is
to continue taking her Prozac for depression/anxiety. I feel her other episodes are
worsened by panic.” (R. 208). These are Dr. Roney’s only notes related to
Dr. James Cranford, Jr. at Greystone Internal Medicine, P.C. treated Quiles
from May 10, 2007, through October 3, 2008. (R. 217-227). The only progress
note related to Quiles’s depression was on August 20, 2008, where Dr. Cranford
reported Quiles was “doing well” and refilled her Prozac. (R. 226).
Quiles was also treated by various physicians at Cooper Green Hospital
from March 6, 2009, through June 29, 2009. (R. 283-295). On April 23, 2009,
Dr. Jacquline Perry evaluated Quiles and noted that she suffers from asthma and
anxiety and prescribed Prozac. (R. 292). On May 22, 2009, during a “routine visit
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[with] wheezing and weight gain,” Dr. Shirley Jones listed Quiles’s diagnoses as
asthma, “depression/anxi[ety]/Prozac,” hyperlipidemia, and hypertension. (R.
291). Lastly, Quiles’s February 17, 2010 progress note states that her past medical
history included depression and anxiety.2 (R. 289).
Based on the court’s review of the relevant treatment notes, the ALJ’s
failure to find that Quiles’s depression is a severe impairment is supported by
substantial evidence. There are no treatment notes from or referrals to a mental
health specialist. The treatment notes that do exist fail to address specifically
Quiles’s purported depression and, instead, Drs. Roney and Perry state only that
Quiles has anxiety secondary to her asthma. Moreover, even assuming Quiles has
a valid depression diagnosis, the medical record fails to establish a depression
diagnosis for at least twelve consecutive months. Instead, the record contains an
anxiety or depression diagnosis in December 2006, August 2008, April 2009, and
May 2009, which fail collectively to demonstrate that Quiles’s depression is
disabling. Significantly, the state agency examiner Dr. Robert Estock reported that
Quiles stated that Prozac and Xanax are prescribed for the panic attacks she feels
when she has an asthma attack and that “she has never had any mental health
issues except as related to her asthma.” (R. 242). Therefore, the ALJ’s
The examining physician’s name was not included on the progress note.
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determination that Quiles’s anxiety/depression diagnosis is not a severe
impairment is supported by substantial evidence.
Dr. Estock’s Opinion
Without any explanation or supporting evidence, Quiles contends that the
ALJ “erred in relying on the state agency medical opinion which was superseded
by multiple items of evidence.” Doc. 8 at 7. The court disagrees. On January 22,
2009, state agency disability examiner Dr. Robert Estock completed a psychiatric
review technique and noted that Quiles has non-severe anxiety-related disorders,
is prescribed Prozac and Xanax for “panic [symptoms] when she feels an asthma
attack starting,” and that Quiles stated that when she “feels an asthma attack
coming on she has [a] panic attack-like [symptoms] (fear of not being able to
breath). The Prozac and Xanax are prescribed for these reasons. [Plaintiff] states
that this is definitely not a mental health issue and that she has never experienced
any mental health issues except as related to her asthma.” (R. 230, 235, 242). Dr.
Estock opined further that Quiles has mild restriction of activities of daily living
and difficulties in maintaining social functioning, and no difficulties in
maintaining concentration, persistence, or pace and episodes of decompensation.
(R. 240). The ALJ gave Dr. Estock’s opinion “considerable weight” because it
was “consistent with the medical evidence as a whole.” (R. 26).
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The only evidence related to Quiles’s depression/anxiety received after Dr.
Estock’s assessment are the notes from Cooper Green physicians which, as
discussed above, do little to support Quile’s contention that her depression is
disabling. Moreover, Drs. Roney and Perry’s opinions that Quiles’s asthma
symptoms exacerbate her anxiety lend support to Dr. Estock’s opinion. In fact,
Quiles testified that her asthma attacks cause her anxiety and when Quiles’s
attorney asked her if she was “a little depressed,” she answered, “Well, yes, this is
very depressing - - having to come, and having to try and do something like this is
- - it’s hard.” (R. 50, 56). In other words, Quiles’s answer related only to the
hearing and she failed to otherwise expound on her purported depression
diagnosis. Therefore, the ALJ’s decision to give Dr. Estock’s opinion
“considerable weight” is supported by substantial evidence.
The ALJ did not err in failing to find Quiles disabled due to her obesity.
There is no evidence in the record that Quiles’s obesity prevents her from
performing light work. In fact, the evidence indicates otherwise since Quiles
testified that she can dust, sweep, mop with a Swiffer, drive, cook, “bring [her
husband] everything that he needs” because he uses a wheelchair, and maybe
bartend in a smoke free environment. (R. 52, 54, 59). Therefore, the ALJ did not
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err in failing to consider her obesity a severe condition.3
The ALJ considered Quiles’s impairments in combination with other
Quiles contends next that the ALJ erred in failing to “properly consider
[her] impairments in combination.” Doc. 8 at 8. This argument is unpersuasive.
At Step Two of the sequential process, the ALJ found that Quiles’s obesity “singly
and in combination with other impairments do not cause more than minimal
limitation in [Quiles’s] ability to perform basic work activities. The undersigned
has considered the claimant’s obesity in accordance with Social Security Ruling
02-1p.” (R. 22). Furthermore, the ALJ also found that Quiles’s “depression,
anxiety, hyperlipidemia, considered singly and in combination, do not cause more
than minimal limitation in the claimant’s ability to perform basic mental work
activities.” Id. At Step Three of the sequential process, the ALJ’s finding that
Quiles “does not have an impairment or combination of impairments” that meets a
listing “evidences [the ALJ’s] consideration of the combined effect of [the
claimant’s] impairments.” Jones v. Dep’t of Health and Human Serv., 941 F.2d
1529, 1533 (11th Cir. 1991); (R. 23). Finally, at Step Four of the sequential
process, the ALJ stated that he “considered all symptoms and the extent to which
Quiles failed to list obesity as an impairment limiting her ability to work on her disability
applications. (R. 145).
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these symptoms can reasonably be accepted as consistent with the objective
medical evidence and other evidence.” (R. 24) (emphasis added). Therefore,
Quiles’s bald assertion that the ALJ failed to consider her impairments in
combination is unfounded. The court finds that the ALJ’s opinion is supported by
Quiles contends next that the ALJ erred in discounting Dr. Ralph Cranford’s
opinion “without first contacting him for clarification of perceived
inconsistencies.” Doc. 8 at 7. In order to address Quiles’s contention, the court
will review Dr. Cranford’s treatment notes, which begin on May 10, 2007, when
Dr. Cranford treated Quiles for “lower back pain, specifically left sciatic
component radiating down left leg after a fall” and moving boxes. (R. 218). Dr.
Cranford noted that Quiles had an “unremarkable” lumbar spine, intact motor
sensory, positive straight leg raises on the left, and 2+ reflexes, and recommended
applying ice and heat, prescribed Celebrex, Skelaxin, Darvocet, and administered
Toradol “to get her through to work.” (R. 218).4 Dr. Cranford evaluated Quiles
again on June 11, 2007, for asthma and reported that her lungs were “clear with
Dr. Cranford evaluated Quiles on May 31, 2007, July 13, 2007, November 12, 2007, and
December 19, 2007, for conditions unrelated to her disability determination. (R. 219, 222, 224,
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minimal expiratory wheezes right and left upper lobes,” and advised her to
continue her medications. (R. 220). On June 21, 2007, Dr. Cranford noted that
Quiles “present[ed] for generalized injuries from [motor vehicle accident]” with
“secondary contusion of left orbit on steering wheel and diffuse discomfort in left
shoulder, neck, and lower lumbar spine” and that Quiles’s “x-rays reveal no
abnormality except some decreased disk space C5-6.” (R. 221). Dr. Cranford
advised Quiles to alternate applying ice and heat, and prescribed Celebrex, Ultram,
and Skelaxin. Id.
Quiles visited Dr. Cranford again on October 16, 2007, for a reevaluation of
her asthma and bronchitis and Dr. Cranford prescribed a trial of Symbicort. (R.
224). When Quiles returned on August 20, 2008, Dr. Cranford reported Quiles
“doing well. Using her inhaler, not overusing despite seasonal issues currently in
progress.” (R. 226). Then on October 30, 2008, Dr. Cranford completed a Food
Stamp Program Work Requirements form where he opined that Quiles was not
mentally or physically able to work due to her permanent and chronic asthma. (R.
229). The ALJ gave Cranford’s opinion that Quiles “suffered from chronic asthma
specifically induced by chemical, environmental and seasonal exposure “some
weight.” (R. 25). However, the ALJ rejected Dr. Cranford’s opinion that Quiles
asthma prevents her from working because on August 20, 2008, Dr. Cranford
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reported Quiles “doing well” and her asthma controlled, and because Quiles
testified at the hearing that her asthma had improved since she stopped smoking.
(R. 25-26, 45). In light of the fact that Dr. Cranford’s opinion that Quiles is
unable to work is inconsistent with his opinion that her asthma is controlled, the
ALJ’s decision to only give Dr. Cranford’s opinion “some weight” is supported by
substantial evidence. See 20 C.F.R. § 404.1527(c)(2) and (4); Phillips v.
Barnhart, 357 F.3d 1232, 1240-41 (11th Cir. 2004).
The ALJ did not err in failing to order a medical source opinion.
Lastly, the court disagrees with Quiles’s assertion that the ALJ erred by
failing to “obtain a medical source opinion by consultative examination or medical
advisor for the entire period.” Doc. 8 at 7. The ALJ is not required to order
additional medical opinions when, as here, the record contains sufficient evidence
for the ALJ to make a disability determination. Ingram v. Comm’r of Soc. Sec.,
496 F.3d 1253, 1269 (11th Cir. 2007) (citation omitted). Indeed, the ALJ’s
finding that Quiles has an RFC for light work is consistent with the record as a
whole and Quiles’s testimony of her daily activities. Ultimately, Quiles must meet
her burden of proving that she is disabled. See 20 C.F.R. § 416.912(c).
Notwithstanding Quiles’s unsubstantiated assertions to the contrary, the record
evidence simply does not support her disability claim, and she failed to articulate
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why additional medical evidence is warranted to evaluate her claim. Therefore,
the court finds that the ALJ’s decision is supported by substantial evidence.
Based on the foregoing, the court concludes that the ALJ’s determination
that Quiles is not disabled is supported by substantial evidence, and that the ALJ
applied proper legal standards in reaching this determination. Therefore, the
Commissioner’s final decision is AFFIRMED. A separate order in accordance
with the memorandum of decision will be entered.
Done the 19th day of October, 2012.
ABDUL K. KALLON
UNITED STATES DISTRICT JUDGE
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