Caraway v. Social Security Administration
ORDER denying Caraway's 2 request for relief and affirming the Commissioner's decision. Signed by Magistrate Judge Jerome T. Kearney on 09/15/2014. (rhm)
IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF ARKANSAS
April M. Caraway
CASE NO. 2:14CV00043 JTK
Carolyn W. Colvin, Acting Commissioner,
Social Security Administration
ORDER AFFIRMING THE COMMISSIONER
April M. Caraway seeks judicial review of the denial of her application for disability
insurance benefits (DIB) and supplemental security income (SSI). April last worked in 2005 as a
certified nurse’s assistant.1 Caraway applied for DIB on April 22, 2011 and SSI on May 3, 2011,
with an alleged onset date of November 20, 2005.2, 3 Caraway’s date last insured (DLI) is
December 31, 2010.4 Caraway bases disability on hip disease, joint pain, knee pain, high blood
pressure, diabetes, mild depression, and arthritis.5
The Commissioner’s decision. The Commissioner’s ALJ determined that Caraway has
not engaged in substantial gainful activity since the alleged onset date.6 Caraway has severe
impairments - Legg-Perthes disease with residual hip deformity, obesity, depression, diabetes
SSA record at pp. 47-48.
Id. at p. 142.
Id. at p. 151.
Id. at p. 172.
Id. at p. 165.
Id. at p. 24.
mellitus and hypertension.7 None of Caraway’s severe impairments meet the listings, and
Caraway can perform sedentary work except she can only sit up to six hours in an eight hour
workday, stand/walk up to two hours, lift/carry up to ten pounds occasionally, and needs to
change position from sitting to standing or standing to sitting every hour.8 The ALJ held that
Caraway cannot perform any past relevant work,9 but there are positions available in significant
numbers in the national economy that Caraway can perform - document preparer and charge
account clerk.10 Caraway’s application was denied.11
After the Commissioner’s Appeals Council denied a request for review, the ALJ’s
decision became a final decision for judicial review.12 Caraway filed this case to challenge the
decision. In reviewing the decision, the Court must determine whether substantial evidence
supports the decision and whether the ALJ made a legal error.13
Id. at pp. 24-26.
Id. at p. 29.
Id. at p. 30.
See Anderson v. Sullivan, 959 F.2d 690, 692 (8th Cir. 1992) (stating, “the Social Security
Act precludes general federal subject matter jurisdiction until administrative remedies have been
exhausted” and explaining that the appeal procedure permits claimants to appeal only final
See 42 U.S.C. § 405(g) (requiring the district court to determine whether the
Commissioner’s findings are supported by substantial evidence and whether the Commissioner
conformed with applicable regulations); Long v. Chater, 108 F.3d 185, 187 (8th Cir. 1997) (“We
will uphold the Commissioner’s decision to deny any applicant disability benefits if the decision is
not based on legal error and if there is substantial evidence in the record as a whole to support the
conclusion that the claimant was not disabled.”).
Substantial evidence is “less than a preponderance but . . . enough that a reasonable mind
would find it adequate to support the conclusion.”14 For substantial evidence to exist in this case,
a reasonable mind must accept the evidence as adequate to support the ALJ’s denial of benefits.15
Caraway’s allegations. Caraway argues that the decision is not supported by substantial
evidence because (1) the ALJ did not properly consider the opinion of the treating physician; and
(2) the ALJ erred in the credibility determination.
Treating physician. Caraway maintains that the ALJ did not properly consider the
Medical Source Statement of her treating physician with respect to the RFC determination. The
Statement, however, was not submitted until more than a year after the ALJ rendered her
decision.16 Therefore, it was not possible for the ALJ to consider this opinion.
Caraway submitted the Statement following her request for a review by the Appeals
Council.17 The Appeals Council denied Caraway’s request for review on February 4, 2014,
noting that it considered the Medical Source Statement.18 “Where, as here, the Appeals Council
considers new evidence but denies review, [the court] must determine whether the ALJ’s
decision was supported by substantial evidence on the record as a whole, including the new
evidence.”19 Even with the additional evidence, the ALJ’s RFC determination is supported by
Jones v. Astrue, 619 F.3d 963, 968 (8th Cir. 2010) (internal quotations and citations
Britton v. Sullivan, 908 F.2d 328, 330 (8th Cir. 1990).
SSA record at p. 395.
Id. at pp. 14 & 395.
Id. at pp. 1-2.
Davidson v. Astrue, 501 F.3d 987, 990 (8th Cir. 2007).
substantial evidence. The limited amount of treatment notes, observations contained in the
treatment notes, conservative treatments prescribed, state agency opinions, and evidence of daily
activities all support the assigned RFC.
What is perhaps most striking is the limited amount of medical evidence in the record.
Although Caraway alleges disability based on seven impairments, the record contains treatment
notes from less than twenty separate occasions. Nine of those notes are from doctor visits in the
1980s.20 The remaining notes are spread over a large period of time - 2005 to 2012.21 The small
number of treatment notes weighs against a finding of disability because it establishes that
Caraway only sought episodic care.22
The treatment notes from the 1980s concern Caraway’s hip impairment. In 1985 Caraway
was diagnosed with Legg-Perthes disease in her right hip.23, 24 At the age of seven, Caraway was
SSA record at pp. 370-394.
Id. at pp. 265-270, 272-276, 281, 285-291, 293-294, 337-339 & 351-352.
See Gwathney v. Chater, 104 F.3d 1043, 1045 (8th cir. 1997) (failing to seek medical
assistance for alleged physical and mental impairments contradicted claimant’s allegations of
disabling conditions and supported unfavorable decision); Ostronski v. Chater, 94 F.3d 413, 419
(8th Cir. 1996) (complaints of disabling pain and functional limitations are inconsistent with the
failure to take prescription pain medication or to seek regular medical treatment for symptoms).
Legg-Calvé-Perthes disease is a member of the osteochondrosis family of diseases.
“Osteochondroses comprise group of diseases of children and adolescents in which localized
tissue death (necrosis) occurs, usually followed by full regeneration of healthy bone tissue. . . .
Osteochondrosis can affect different areas of the body and is often categorized by one of three
locations: articular, non-articular, and physeal. . . . Articular disease occurs at the joints
(articulations). One of the more common forms is Legg-Calvé-Perthes disease, occurring at the
hip.” Victor Leipzig, 4 The Gale Encyclopedia of Med. 3185 (4th ed).
SSA record at p. 387.
placed in a brace.25 Approximately a year and a half later the brace was removed, and radiology
reports revealed that Caraway was healed.26 Caraway’s treating physician, however, noted that
there was the possibility of early degenerative changes in the hip.27 Further, he opined that
Caraway would likely need a total hip replacement in the future.28 The next record available with
respect to Caraway’s hip impairment is a July 2011 radiological report that reveals a deformity
of Caraway’s right femoral head and a narrowing of the right hip joint.29 The report also noted,
however, that the rest of the visualized bones showed no acute fracture, lytic or blastic changes,
and the soft tissues were unremarkable.30 These are the only medical records specifically
addressing Caraway’s hip impairment. In other records physicians observe that Caraway moves
all extremities equally, has good strength, exhibits normal motor and sensory responses, and has
a normal gait.31
There are only a few notes addressing Caraway’s hypertension.32 Although a March 19,
2010, record states that Caraway has experienced some dizziness, swelling and numbness, the
Id. at pp. 370 & 372.
Id. at p. 372.
Id. at p. 300.
Id. at pp. 268, 270, 275 & 294.
Id. at pp. 265, 270, 273, 337, 339 & 351.
note indicates that Caraway is in no acute distress and suffers from only mild hypertension.33
Later notes establish that Caraway’s blood pressure is good.34 She is prescribed lisinopril, and
still takes it today.35 The medical records addressing Caraway’s diabetes mellitus also indicate
that Caraway is in no acute distress.36 After the diabetes diagnosis, Caraway is prescribed
metformin.37 She remains on that prescription today, and the record is void of evidence of any
acute effects from diabetes.38 There is one treatment record with respect to Caraway’s
depression.39 Although the physician determines that Caraway is suffering from moderately
severe depression, he also observes that Caraway is in no acute distress, is pleasant, and does not
appear sad or depressed.40 Caraway is prescribed Cymbalta and still takes it today.41 She has
sought no further treatment for depression. Almost every medical record observes that Caraway
is obese.42 She is told on multiple occasions that she needs to lose weight, but remains obese.43
There is nothing in the notes that indicate Caraway has work limitations due to her obesity.
Id. at p. 270.
Id. at pp. 339 & 351.
Id. at pp. 53 & 275.
Id. at pp. 265, 274, 337, 339 & 351.
Id. at p. 275.
Id. at p. 53.
Id. at p. 351.
Id. at pp. 54 & 351.
Id. at pp. 265, 270, 273, 293, 337, 339 & 351.
Id. at pp. 268, 270, 273, 338, 342 & 352.
The treatment notes establish that Caraway was treated conservatively for her
impairments. The only treatment for her hip impairment was a brace that was removed in 1987.
For her other impairments, Caraway has consistently been treated with prescription medications.
Although Caraway alleges disabling pain, she has only recently been prescribed a pain
medication, and has had no invasive treatments. Conservative treatment has consistently been
found to support denials of disability.44
The opinion evidence submitted by state agency physicians also supports the ALJ’s RFC.
In a June 2011 Disability Determination for Social Security Administration, General Physical
Examination, a state agency physician determined that Caraway suffers from obesity,
hypertension, diabetes, hip pain, knee pain and depression.45 No limitations, however, were
assessed.46 In a July 2011 Physical Residual Functional Capacity Assessment, a state agency
physician determined that Caraway can function at the sedentary exertion level.47 This opinion
was affirmed in November 2011.48 A Mental Diagnostic Evaluation was completed in August
2011.49 The state physician determined that Caraway suffers from depression, but also found that
Caraway is able to communicate in a socially adequate manner, can communicate her needs
effectively, can cope with mental and cognitive demands of work tasks, has good concentration,
See Perks v. Astrue, 687 F.3d 1086, 1092 (8th Cir. 2012); Gowell v. Apfel, 242 F.3d
793, 796 (8th Cir. 2001); Black v. Apfel, 143 F.3d 383, 386 (8th Cir. 1998).
SSA record at p. 299.
Id. at p. 310.
Id. at p. 346.
Id. at p. 304.
is not easily distracted or inattentive, and has good task persistence.50 Further, Caraway’s mood
was within normal limits; her affect was appropriate; her speech was normal; her thought
processes were logical and coherent; there was no indication of delusional thinking, thought
disorder or auditory or visual hallucinations; and she was attentive with memory intact.51
When viewed together with the treatment notes and state agency physician opinions,
Caraway’s Function Report provides additional support for the RFC determination. In the
Function Report, Caraway indicates that during the day she watches television, reads, takes her
daughter to school, cooks light suppers and does light housework.52 Other than her husband
shaving her legs for her, she is able to care for her personal needs.53 She is able to drive and goes
out alone.54 She shops for groceries three times a week, for about twenty minutes each time.55
The medical opinion submitted to the Appeals Council is a Medical Source Statement
completed by an osteopathic physician that Caraway met with only once.56 In the Statement, the
physician sets forth limits that, if true, prevent all work.57 The physician opines that Caraway is
not capable of sedentary work, can sit only one hour in an eight hour workday, cannot stand or
Id. at pp. 306-07.
Id. at pp. 305-06.
Id. at p. 183.
Id. at p. 184.
Id. at p. 186.
Id. at p. 396.
walk during an eight hour workday, and cannot lift or carry any weight, among other things.58
It is important first to emphasize that this physician would not be considered a treating
Treating source means your own physician, psychologist, or other acceptable
medical source who provides you, or has provided you, with medical treatment or
evaluation and who has, or has had, an ongoing treatment relationship with you.
Generally we will consider that you have an ongoing treatment relationship with
an acceptable medical source when the medical evidence establishes that you see,
or have seen, the source with a frequency consistent with accepted medical
practice for the type of treatment and/or evaluation required for your medical
condition(s). . . . We will not consider an acceptable medical source to be your
treating source if your relationship with the source is not based on your medical
need for treatment or evaluation, but solely on your need to obtain a report in
support of your claim for disability. In such a case, we will consider the
acceptable medical source to be a nontreating source.59
Given that Caraway saw this physician only once, and there are no treatment notes
corresponding to the Medical Source Statement, the only conclusion is that Caraway sought this
medical source to obtain a report in support of her claim for disability. Therefore, this opinion is
not entitled to controlling weight. Additionally, the physician’s opinion is inconsistent with the
medical records discussed above.
Even in light of the additional Medical Source Statement, a reasonable mind would
accept the evidence as adequate to support the ALJ’s RFC. The RFC is supported by substantial
Credibility determination. Caraway further asserts that the ALJ erred in her
determination that Caraway’s allegations of pain and limitations are not supported by the record.
Id. at pp. 396-402.
20 C.F.R. §§ 404.1502 & 416.902 (emphasis added).
An ALJ must evaluate the claimant’s credibility because subjective complaints play a
role in determining the claimant’s ability to work.60 To evaluate Caraway’s credibility, the ALJ
followed the required two-step process and considered the required factors,61 so the dispositive
question is whether substantial evidence supports the credibility evaluation. The ALJ’s
determination that Caraway’s subjective complaints of pain and limitations are not credible to
the extent that they conflict with the assigned RFC is supported by substantial evidence.
As discussed above, the medical evidence available is incredibly limited. Although
Caraway complains of disabling pain and limitations, evidence of such is not contained in the
treatment notes. Further, the opinions of the state agency physicians conflict with Caraway’s
allegations. Such discrepancies support the ALJ’s credibility determination.62 Additionally,
Caraway was advised on multiple occasions that she needed to lose weight. Losing weight would
certainly positively impact Caraway’s high blood pressure and diabetes. Caraway has lost very
little weight throughout the course of her treatment. This also lends support to the ALJ’s
credibility determination.63 A reasonable mind would accept the evidence as adequate to support
the ALJ’s credibility determination. Therefore, the credibility determination is supported by
See Ellis v. Barnhart, 392 F.3d 988, 995-96 (8th Cir. 2005).
See SSR 96-7p, Policy Interpretation Ruling Titles II & XVI: Evaluation of Symptoms in
Disability Claims: Assessing the Credibility of an Individual’s Statements.
See Goodale v. Halter, 257 F.3d 771, 774 (8th Cir. 2001) (“Subjective complaints may
be discounted if there are inconsistencies in the evidence as a whole, and the ALJ may properly
rely upon discrepancies between a claimant’s allegations of pain and her treatment history,
medicinal selections, and daily activities in disregarding her subjective complaints.”) (internal
quotations and citations omitted).
See Gulliams v. Barnhart, 393 F.3d 798, 803 (8th Cir. 2005) (“A failure to follow a
recommended course fo treatment also weighs against a claimant’s credibility.”).
Conclusion. Substantial evidence supports the ALJ’s decision. The ALJ made no legal
error. For these reasons, the court DENIES Caraway’s request for relief (docket entry # 2) and
AFFIRMS the Commissioner’s decision.
It is so ordered this 15th day of September, 2014.
UNITED STATES MAGISTRATE JUDGE
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