Aper v. Social Security Administration Commissioner
Filing
13
MEMORANDUM OPINION. Signed by Honorable Mark E. Ford on August 7, 2015. (src)
IN THE UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF ARKANSAS
HARRISON DIVISION
BARBRA APER
PLAINTIFF
v.
Civil No. 3:14-CV-3040-MEF
CAROLYN COLVIN, Commissioner
Social Security Administration
DEFENDANT
MEMORANDUM OPINION
Plaintiff, Barbra Aper, brings this action under 42 U.S.C. § 405(g), seeking judicial review
of a decision of the Commissioner of Social Security Administration (Commissioner) denying her
claim for a period of disability and disability insurance benefits (“DIB”) under Title II of the Social
Security Act (hereinafter “the Act”), 42 U.S.C. § 423(d)(1)(A). In this judicial review, the court
must determine whether there is substantial evidence in the administrative record to support the
Commissioner’s decision. See 42 U.S.C. § 405(g).
I.
Procedural Background:
Plaintiff filed her application for DIB on April 19, 2012, alleging an onset date of
November 1, 2009, due to fibromyalgia, coronary artery spasm, angina, high blood pressure,
vertigo, depression, insomnia, irritable bowel syndrome, chronic fatigue, and chronic pain. Tr.
104-105, 117, 130-131.
The Commissioner denied Plaintiff’s applications initially and on
reconsideration. Tr. 52-53. An Administrative Law Judge (“ALJ”) held an administrative hearing
on October 30, 2013. Tr. 30-51. Plaintiff was present and represented by counsel.
At the time of the hearing, the Plaintiff was 56 years old. Tr. 23. She possessed a high
school education and past relevant work (“PRW”) experience as a bus driver, emergency medical
technician, and owner/manager of a grocery business. Tr. 23 34, 37, 47-48, 118, 125-129.
On December 13, 2013, the ALJ found Plaintiff’s fibromyalgia, hypertension, prior history
of vasospastic phenomenon, and obesity were severe, but did not meet or medically equal one of
the listed impairments in Appendix 1, Subpart P, Regulation No. 4. Tr. 14-16. After partially
discrediting her subjective complaints, the ALJ determined the Plaintiff retained the residual
functional capacity (“RFC”) to perform light work that involves no climbing or work near heights.
Tr. 16. With the assistance of a vocational expert, The ALJ then found Plaintiff could perform
work as a general office clerk, collector, and assembler. Tr. 24.
The Appeals Council denied review on February 3, 2014. Tr. 1-7. Subsequently, Plaintiff
filed this action. ECF No. 1. This case is before the undersigned by consent of the parties. ECF
No. 7. Both parties have filed appeal briefs, and the case is now ready for decision. ECF Nos. 10,
12.
II.
Applicable Law:
This court’s role is to determine whether substantial evidence supports the Commissioner’s
findings. Vossen v. Astrue, 612 F.3d 1011, 1015 (8th Cir. 2010). Substantial evidence is less than
a preponderance but enough that a reasonable mind would find it adequate to support the
Commissioner’s decision. Teague v. Astrue, 638 F.3d 611, 614 (8th Cir. 2011). We must affirm
the ALJ’s decision if the record contains substantial evidence to support it. Blackburn v. Colvin,
761 F.3d 853, 858 (8th Cir. 2014). As long as there is substantial evidence in the record that
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supports the Commissioner’s decision, the court may not reverse it simply because substantial
evidence exists in the record that would have supported a contrary outcome, or because the court
would have decided the case differently. Miller v. Colvin, 784 F.3d 472, 477 (8th Cir. 2015). In
other words, if after reviewing the record it is possible to draw two inconsistent positions from the
evidence and one of those positions represents the findings of the ALJ, we must affirm the ALJ’s
decision. Id.
A claimant for Social Security disability benefits has the burden of proving her disability
by establishing a physical or mental disability that has lasted at least one year and that prevents
her from engaging in any substantial gainful activity. Pearsall v. Massanari, 274 F.3d 1211, 1217
(8th Cir. 2001); see also 42 U.S.C. § 423(d)(1)(A). The Act defines “physical or mental
impairment” 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). A Plaintiff must show that his or her disability, not simply
their impairment, has lasted for at least twelve consecutive months.
The Commissioner’s regulations require her to apply a five-step sequential evaluation
process to each claim for disability benefits: (1) whether the claimant has engaged in substantial
gainful activity since filing his or her claim; (2) whether the claimant has a severe physical and/or
mental impairment or combination of impairments; (3) whether the impairment(s) meet or equal
an impairment in the listings; (4) whether the impairment(s) prevent the claimant from doing past
relevant work; and, (5) whether the claimant is able to perform other work in the national economy
given his or her age, education, and experience. See 20 C.F.R. § 404.1520(a)(4). Only if he
reaches the final stage does the fact finder consider the Plaintiff’s age, education, and work
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experience in light of his or her residual functional capacity. See McCoy v. Schweiker, 683 F.2d
1138, 1141-42 (8th Cir. 1982); 20 C .F.R. § 404.1520(a)(4)(v).
III.
Discussion:
Plaintiff raises the following issues on appeal: 1) whether the ALJ properly evaluated her
subjective complaints; 2) whether the ALJ failed to fully develop the record with regard to her
fibromyalgia; 3) whether the ALJ’s RFC determination is supported by substantial evidence, and,
4) whether she can perform work existing in significant numbers in the national economy.
The Court has reviewed the entire transcript. The complete set of facts and arguments are
presented in the parties’ briefs and the ALJ’s opinion, and they are repeated here only to the extent
necessary.
A.
Subjective Complaints:
In her first issue, the Plaintiff contends that the ALJ failed to conduct a proper credibility
analysis with regard to her fibromyalgia. The ALJ is required to consider all the evidence relating
to Plaintiff’s subjective complaints, including evidence presented by third parties that relates to:
1) Plaintiff’s daily activities; 2) the duration, frequency, and intensity of her pain; 3) precipitation
and aggravating factors; 4) dosage, effectiveness, and side effects of her medication; and, 5)
functional restrictions. See Polaski v. Heckler, 739 F.2d 1320, 1322 (8th Cir. 1984).
An ALJ may not discount the Plaintiff’s subjective complaints solely because the medical
evidence fails to support them. Id. However, as the Eighth Circuit has observed, “Our touchstone
is that [a claimant’s] credibility is primarily a matter for the ALJ to decide.” Edwards v. Barnhart,
314 F.3d 964, 966 (8th Cir. 2003). “An ALJ . . . may disbelieve subjective reports because of
inherent inconsistencies or other circumstances.” Travis v. Astrue, 477 F.3d 1037, 1042 (8th Cir.
2007) (quotation and citation omitted). In addition to the “objective medical basis” that should
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support the subjective testimony of disabling pain, this court also takes into account “all of the
evidence presented relating to subjective complaints, including the claimant’s prior work record,
and observations by third parties and treating and examining physicians.” Polaski, 739 F.2d at
1322.
The evidence makes clear that Dr. Apichart Radee treated the Plaintiff on seven occasions
in 2007 and 2008 for symptoms associated with vasospastic angina pectoris. Tr. 222-223, 238239. Dr. Radee prescribed Procardia, Zocor, and Crestor. During a follow-up in February 2009,
Plaintiff reported increased angina pectoris in cold weather. Tr. 222. Dr. Radee advised her to
continue her medications.
On March 4, 2009, Plaintiff presented in the emergency room (“ER”) for accelerated
hypertension and a severe headache with mild visual changes. Tr. 201-204, 280-288. Her blood
pressure was 170/110. Moreover, a CT of her head was negative. The doctor administered
Hydralazine and normalized her blood pressure. He also administered a Toradol injection for the
headache and Compazine for the nausea. The doctor then discharged her with a prescription for
Lisinopril and instructions to contact her cardiologist the following day.
On May 11, 2009, Dr. Radee indicated that she was doing well. Plaintiff voiced no
complaints related to her angina pectoris and hypertension. Tr. 222. Her blood pressure was
110/70, and a cardiac exam revealed an S4 gallop.
Due to her recent hospitalization for
questionable coronary artery spasm, Dr. Radee increased her dosage of Procardia.
On August 17, 2009, Plaintiff returned to Dr. Radee’s office with complaints of chest
discomfort. Tr. 222. At this time, her blood pressure was 130/80. However, both an EKG and a
cardiac exam were normal.
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Plaintiff did not seek out further treatment for her symptoms until a follow-up visit with
Dr. Radee on May 20, 2010. Tr. 222. The doctor indicated that she was doing well. Her blood
pressure was 110/76, and a cardiac exam was unremarkable. She reported no problems since her
move to Arkansas.
On February 7, 2011, Plaintiff returned to Dr. Radee’s office for complaints of a “tired
feeling” radiating bilaterally from her toes to her thighs and nocturnal numbness of both hands,
suggestive of possible peripheral neuropathy. Tr. 222. Dr. Radee noted that she had experienced
no cardiac symptoms during a stress test. Further, a prior coronary angiogram was normal,
revealing an ejection fraction rate of 71 percent. At this time, her blood pressure was normal at
120/80 and a cardiac exam was unremarkable. An EKG showed sinus rhythm with non-specific
ST-T change. Dr. Radee diagnosed her with chronic chest pain. He recommended that she
continue her current medications and prescribed Nitroglycerine to be taken as needed.
On January 26, 2012, Plaintiff conferred with cardiologist, Dr. Michael Camp. Tr. 298301. She presented with complaints of chest discomfort and indigestion. Dr. Camp noted her
history of vasospastic prinzmetal-type angina. Although her cardiac exam was normal, her blood
pressure was 148/80 and an ECG was borderline.
Her body mass index was also 37.5.
Accordingly, Dr. Camp diagnosed chest pressure, fibromyalgia, prinzmetal angina, and a possible
hiatal hernia. He then ordered a cardiolite stress test.
On January 30, 2012, an echocardiogram revealed overall normal left and right ventricular
function with an ejection fraction rate of 73 percent. Tr. 294-297. Therefore, Dr. Camp
recommended continued blood pressure and antiplatelet therapy. He also indicated that her
valvular heart disease was mild and would be treated medically.
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A stress test conducted on the same date showed an abnormal resting EKG, but Dr. Camp
concluded that this was a normal variant study and recommended further evaluation for noncardiac sources of her chest discomfort and shortness of breath. Tr. 295-295.
On February 25, 2012, Plaintiff presented at the Midway Clinic after falling on a concrete
step, injuring her left side, wrist, hand, knee, and ankle. Tr. 304-306, 459-461, 467. X-rays
showed a possible non-displaced scaphoid fracture, so an MRI was ordered. However, all other
x-rays revealed no acute fractures or dislocations. Plaintiff was administered an injection of
Toradol for a diagnosis of ankle strain/sprain and multiple site contusions. Her ankle and wrist
were wrapped; she was prescribed crutches and told to remain non-weight bearing; and, she was
prescribed Cataflam (an anti-inflammatory).
Two days later, she returned with continued
complaints of left wrist and hand pain, and she received a cock-up splint. Tr. 306-308, 462-463.
The MRI ultimately showed a benign cyst. Tr. 308-309, 318, 332, 464, 472. The doctor referred
her to an orthopedist.
On March 16, 2012, Plaintiff consulted with orthopedist, Dr. Russ Rauls, regarding her left
wrist pain and the popping sensation in her knee. Tr. 328-329, 344-345. She reported gradual
improvement in her wrist and no real pain in her knee. Dr. Rauls opined that the MRI of her left
wrist revealed a volar ligament injury on the radial side, as well as a benign cyst. Further, an
examination showed normal strength and sensation with mild tenderness over the volar aspect of
the wrist. The Plaintiff acknowledged some improvement in her left knee pain, and the exam
revealed full flexion and extension.
On May 8, 2012, Plaintiff returned to the Midway Medical Clinic complaining of continued
knee pain. Tr. 310-311, 465-466. She also requested a prescription for diet pills. Virginia
Hartness, an advanced practical nurse, diagnosed the Plaintiff with knee pain and fibromyalgia.
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However, an examination documented no tender points and the Plaintiff had a full range of motion
in all joints. Nurse Hartness referred her for physical therapy and recommended a follow-up with
Dr. Rauls.
On May 21, 2012, Dr. Rauls administered a Marcaine/Lidocaine injection into the
Plaintiff’s left knee. Tr. 330, 343, 458. He noted a good range of motion in both the hip and knee.
Upon her return on June 18, 2012, Plaintiff reported that the injection had been helpful. Tr. 337,
342. Because an examination revealed some hyperextension, Dr. Rauls recommended an MRI.
The MRI ultimately showed minimal degenerative changes with no evidence of a meniscus tear or
non-displaced fracture. Tr. 338. Accordingly, Dr. Rauls diagnosed her with “possible cartilage
irrigation from the fall,” noting that she would likely have pain off and on, but would continue to
improve. Tr. 38-339, 341.
On July 5, 2012, Dr. Karmen Hopkins, a non-examining, consultative physician completed
a physical RFC assessment. Tr. 351-358. After reviewing the Plaintiff’s records, Dr. Hopkins
opined that she could perform medium level work. Drs. Jerry Henderson and Janet Cathey
affirmed this assessment on October 5, 2012, and November 9, 2012, respectively. Tr. 397, 407.
On July 19, 2012, Plaintiff underwent a consultative mental diagnostic evaluation with Dr.
Kenneth Hobby. Tr. 35-370. She denied any history of inpatient or outpatient treatment for
emotional or psychiatric problems.
Further, although she reported a prior prescription for
Cymbalta, Plaintiff indicated that she could not take this medication due to side effects. Dr. Hobby
diagnosed Plaintiff with adjustment disorder with depressed mood and assessed her with a global
assessment of functioning score of 51-60.1 Dr. Hobby opined that mentally, she would probably
1
We recognize that the DSMBV was released in 2013, replacing the DSMBIV. The DSMBV has abolished
the use of GAF scores to “rate an individual’s level of functioning because of ‘its conceptual lack of clarity’ and
‘questionable psychometrics in routine practice.’” Alcott v. Colvin, No. 4:13BCVB01074BNKL, 2014 WL 4660364,
at *6 (W.D. Mo. Sept. 17, 2014) (citing Rayford v. Shinseki, 2013 WL 3153981, at *1 n. 2 (Vet. App. 2013)
8
be unable to persist on appropriate skill level work-like tasks for an 8-hour day due to the purported
mental fatigue resulting from her fibromyalgia. Tr. 368. However, he found she could understand,
remember, and carry out basic work-like tasks; respond adequately to work pressures; and attend
to and sustain concentration on basic work-like tasks. Dr. Hobby also noted a normal and steady
pace, adequate for basic work-like tasks.
On July 20, 2012, Dr. Christal Janssen completed a psychiatric review technique form. Tr.
375-390.
After reviewing all of Plaintiff’s medical records, Dr. Janssen found no severe
impairment and noted only mild limitations with regard to activities of daily living, social
functioning, and concentration, persistence, and pace.
Further, she found no episodes of
decompensation.
On August 1, 2012, the Plaintiff presented in the ER with complaints of chest pain and
pressure, as well as left shoulder pain. Tr. 425-433, 440. Emergency medical technicians
administered Nitroglycerine in route to the hospital, resolving her chest pain. However, her
shoulder and arm pain persisted. A portable chest x-ray was normal. The doctor diagnosed her
with coronary artery disease, fibromyalgia, and anxiety.
On August 30, 2012, Dr. Camp diagnosed Plaintiff with chest pressure symptoms
associated with possible progressive ischemic heart disease, severe and life-style limiting
fibromyalgia, a history of hiatal hernia, and a prior diagnosis of prinzmetal angina. Tr. 392-394,
454-456.
Her medications included Aspirin, Isosorbide, Nifedipine, Nitroglycerine patch,
Nitroglycerin spray, and Premarin.
(quoting the DSMBV)). However, because the DSMBIV was in use at the time Dr. Hobby conducted the medical
assessment in this case, the Global Assessment of Functioning scores remain relevant for consideration in this
appeal. Rayford, 2013 WL 3153981, at *1 n. 2.
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On September 5, 2012, Dr. Camp noted her treatment for severe chest pain radiating into
her neck, shoulders, and arms on August 1. Tr. 486-488. She reported experiencing recurrent
episodes of chest pressure over the past several weeks. Again, Dr. Camp noted her very life-style
limiting fibromyalgia issues, but documented no physical limitations or tender points to support
this diagnosis. Further, he noted a normal cardiac exam, and concluded that her problems were
very complex. Because the nature of her pain had changed since her last catheterization, Dr. Camp
ordered a second test. Again, testing revealed normal coronary arteries and a normal ejection
fraction rate of 50 percent. Tr. 489-492.
On June 26, 2013, Plaintiff returned to Dr. Camp’s office after experiencing an episode of
near syncope. Tr. 483-485. Records indicate that this was an isolated event lasting about 10
seconds. Dr. Camp diagnosed hypertension, sick sinus syndrome, near syncope, and noncardiac
chest pressure with a history of fibromyalgia. He made no changes to her medication and
documented “[n]o activity restriction from my standpoint.” Dr. Camp advised her to monitor her
blood pressure closely and taper off the Nifedipine when her systolic pressure was consistently
less than 130.
Contrary to the Plaintiff’s assertion, the ALJ properly evaluated her credibility. Although
he did not specifically mention Polaski, the ALJ considered the Polaski factors. He recited the
many notations of Dr. Camp indicating that her cardiac symptoms were improving and she was
doing well. At least two heart catheterizations and one stress test were normal, documenting a
normal ejection fraction rate. See Forte v. Barnhart, 377 F.3d 892, 895 (8th Cir. 2004) (holding
that lack of objective medical evidence is a factor an ALJ may consider). Further, at her last visit,
Dr. Camp indicated that she had an excellent prognosis and specifically noted “[n]o activity
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restrictions from my standpoint.” Thus, while we do agree that the Plaintiff’s heart condition is
somewhat limiting, it is not as disabling as alleged.
Plaintiff’s left knee, wrist, and hand injuries also appear to have improved with
conservative treatment. An injection into her knee in March 2012 was reportedly helpful. Patrick
v. Barnhart, 323 F.3d 592, 596 (8th Cir. 2003) (holding if an impairment can be controlled by
treatment or medication, it cannot be considered disabling). Further, an MRI showed only minimal
degenerative changes with no evidence of a meniscal tear or a non-displaced fracture, x-rays of
her hand and wrist were negative, and physical exams failed to yield any significant or permanent
limitations. See Forte, 377 F.2d 895. In fact, at her last visit with Dr. Rauls in July 2012, he
indicated that she would continue to improve. Plaintiff sought out no further treatment for her
knee pain after that, and she failed to participate in physical therapy as prescribed. The record is
also devoid of evidence documenting prescriptions for pain medication, calling into question her
actual level of pain. Rankin v. Apfel, 195 F.3d 427, 429 (8th Cir. 1999) (infrequent use of
prescription drugs supports discrediting complaints).
As for her fibromyalgia, the ALJ correctly points out that doctors diagnosed her with
fibromyalgia after a fall in February 2012, but there is no evidence to support this diagnosis. Lott
v. Colvin, 772 F.3d 546, 549 (8th Cir. 2014) (merely being diagnosed with a condition named in a
listing and meeting some of the criteria will not qualify a claimant for presumptive disability under
the listing). Fibromyalgia is a condition that causes pain in fibrous tissues, muscles, tendons,
ligaments and other “white” connective tissues. The disease is chronic, and “[d]iagnosis is usually
made [only] after eliminating other conditions.” Brosnahan v. Barnhart, 336 F.3d 671, 672 n.1
(8th Cir. 2003). The principal symptoms are “pain all over,” trauma, anxiety fatigue, disturbed
sleep, stiffness, irritable bowel symptoms, and the only symptom that discriminates between it and
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other diseases of a rheumatic character is the presence of multiple tender spots, more precisely
eighteen fixed locations on the body that when pressed firmly cause the patient who really has
fibromyalgia to flinch. See THE MERCK MANUAL 1369-1371 (16th ed. 1992).
As previously noted, repeated physical exams yielded few, if any limitations. See Ford v.
Astrue, 518 F.3d 979, 982 (8th Cir. 2008) (lack of supporting medical evidence is one factor that
may be considered in assessing credibility). There are certainly no indications in the record that
she exhibited the tender points necessary for a fibromyalgia diagnosis. Plaintiff relies on Dr.
Camp’s diagnosis of “very life-style limiting fibromyalgia” to establish the severity of her
fibromyalgia. However, Dr. Camp also found “no activity restrictions.” See Raney v. Barnhart,
396 F.3d 1007, 1010 (8th Cir. 2005) (none of the claimant’s treating physicians opined the claimant
was so impaired or disabled that the claimant could not work at any job). Further, he never referred
the Plaintiff to a rheumatologist, nor did he prescribe medication to treat her alleged fibromyalgia.
In fact, the record reveals only one medication prescribed for fibromyalgia. In May 2012, Nurse
Hartness prescribed Savella. Unfortunately, it appears that doctors prescribed this medication on
only one occasion.
Plaintiff also failed to seek out emergency treatment for her alleged
fibromyalgia pain, further suggesting it was not as disabling as alleged.
Mentally speaking, the record is devoid of any significant treatment for mental
impairments. During an evaluation ordered by the Administration, Dr. Hobby stated she would
likely be unable to persist on appropriate skill level work-like tasks for an eight-hour workday due
to her reported mental fatigue from fibromyalgia. Interestingly, he also indicated that she could
understand, remember, and carry out basic work-like tasks; respond adequately to work pressures;
attend to and sustain concentration on basic work-like tasks; and perform at an adequate and steady
pace to complete basic work-like tasks. Further, he assessed her with a GAF score indicative of
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only moderate limitations. Therefore, it appears that Dr. Hobby’s assessment actually detracts
from her credibility more than it supports it.
Additionally, Plaintiff never voiced any complaints to her doctor concerning mental
fatigue. The record does reveal some treatment for situational depression related to deaths in the
family and her move to Arkansas, but she denied a history of formal mental health treatment or
hospitalization for her symptoms. See Kirby v. Astrue, 500 F.3d 705, 709 (8th Cir. 2007) (lack of
formal treatment by a psychiatrist, psychologist, or other mental health professional is a significant
consideration when evaluating Plaintiff’s allegations of disability due to a mental Impairment).
Plaintiff did report a prior prescription for Cymbalta, but discontinued it due to side effects. There
is, however, no evidence to indicate doctors prescribed any other anti-depressants.
Plaintiff’s daily activities also call her credibility into question. She admitted caring for
her cats, performing light housework, watering her plants, deep cleaning whenever necessary,
preparing simple meals, shopping for groceries, walking, handling finances, reading, playing
computer games, watching television, going to the beauty salon monthly, visiting friends twice
weekly, having breakfast with her neighbors weekly, and going out to eat twice weekly. Tr. 133140. When considered in conjunction with the medical records, these activities do not support the
level of restriction the Plaintiff has alleged. Clearly, an individual who is capable of performing
these activities can perform some work-related activities.
The Plaintiff asserts that her strong work history entitles her to substantial credibility. We
disagree. Work history is but one of the factors to be considered in the credibility analysis.
Unfortunately, in this case, her favorable work history does not outweigh the medical evidence or
inconsistencies outlined above. Accordingly, we find that substantial evidence supports the ALJ’s
credibility findings.
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B.
Develop the Record:
The Plaintiff also argues that the ALJ should have developed the record with regard to her
fibromyalgia. The ALJ owes a duty to a claimant to develop the record fully and fairly to ensure
his decision is an informed decision based on sufficient facts. See Stormo v. Barnhart, 377 F.3d
801, 806 (8th Cir. 2004). However, the ALJ is not required to function as the claimant’s substitute
counsel, but only to develop a reasonably complete record. Whitman v. Colvin, 762 F.3d 701, 707
(8th Cir. 2014) (quoting Clark v. Shalala, 28 F.3d 828, 830-31 (8th Cir. 1994). While “[a]n ALJ
should recontact a treating or consulting physician if a critical issue is undeveloped,” “the ALJ is
required to order medical examinations and tests only if the medical records presented to him do
not give sufficient medical evidence to determine whether the claimant is disabled.” Johnson v.
Astrue, 627 F.3d 316, 320 (8th Cir. 2010) (quotation, alteration, and citation omitted).
Plaintiff asserts that the ALJ should have contacted Dr. Camp for additional information
concerning his diagnosis of fibromyalgia. We disagree. Dr. Camp’s exams were very thorough.
His failure to document any objective findings to support his statement of “life-style limiting”
fibromyalgia, coupled with his assessment of no limitations speaks volumes. Dr. Camp is a
cardiologist who in all probability was merely reciting a diagnosis based entirely on the Plaintiff’s
subjective reports. His mere recitation of her subjective complaints is not a sufficient basis for
remand. See Kirby v. Astrue, 500 F.3d 705, 709 (8th Cir. 2007) (holding that the ALJ may give
less weight to a medical opinion that is based largely on subjective complaints rather than on
objective medical evidence). Accordingly, we find sufficient evidence upon which the ALJ could
have based his determination that the Plaintiff is not disabled.
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C.
RFC:
Plaintiff also contends that the record does not support the ALJ’s RFC assessment. RFC
is the most a person can do despite that person’s limitations. 20 C.F.R. '' 404.1545, 416.945.
The United States Court of Appeals for the Eighth Circuit has held that a “claimant’s residual
functional capacity is a medical question.” Miller v. Colvin, 784 F.3d 472, 479 (8th Cir. 2015)
(citing Lauer v. Apfel, 245 F.3d 700, 704 (8th Cir. 2001). Therefore, medical evidence that
addresses the claimant’s ability to function in the workplace must support the ALJ’s RFC
determination. Perks v. Astrue, 687 F.3d 1086, 1092 (8th Cir. 2012).
The Plaintiff insists that she is unable to perform light work because she experiences
coronary artery spasms several times per day causing increased blood pressure and shortness of
breath; fibromyalgia with constant pain radiating into her arms, neck, back, and legs; obesity; and,
two episodes of vertigo per month with accompanied vomiting. However, as addressed in the first
section of our opinion, the objective evidence does not support the Plaintiff’s allegations. Her
treating cardiologist noted improvement, opined that her prognosis was “excellent,” and assessed
no limitations. Further, although doctors diagnosed her with fibromyalgia, the record provides no
objective evidence to support this diagnosis. None of the examining doctors documented the
requisite tender points for a fibromyalgia diagnosis. Further, the Plaintiff took no prescribed
medications for this impairment and required no emergent treatment. In fact, she took no pain
medication whatsoever. In addition, despite diagnosing Plaintiff with severe fibromyalgia, Dr.
Camp assessed her with no limitations.
The ALJ also noted that the Plaintiff suffered from obesity. Because obesity is no longer
a stand-alone impairment, he properly considered it in combination with her other impairments.
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We agree that the record makes no mention of any additional restrictions or limitations imposed
by her obesity. Thus, even in combination with her impairments, her obesity is not disabling.
Additionally, as stated above, we do not find the Plaintiff’s mental impairment to be severe.
She reported a history of situational depression, caused by deaths in her family and a move to
Arkansas. Although she was prescribed Cymbalta, Plaintiff does not take it due to alleged side
effects. Dr. Hobby did diagnose her with adjustment disorder with depressed mood, but he
assessed her with a GAF score of 51-60, which is indicative of only moderate symptomology. See
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS IV-TR 34 (4th ed. 2000). He also
opined that her GAF for the previous year had been 61-70, indicating only mild symptoms. Id.
Dr. Christal Janssen, a non-examining consultant, found Plaintiff’s mental impairment to
be non-severe. Based on her failure to seek out mental health treatment or voice ongoing
complaints of her alleged mental impairments, we agree.
Therefore, although we note Dr. Hopkins assessment of medium level work, giving the
Plaintiff the benefit of the doubt, we find substantial evidence to support the ALJ’s RFC
assessment. We do believe that the combination of Plaintiff’s fibromyalgia, chest pain, left knee
pain, and obesity would limit her to light work involving no climbing or work near heights.
D.
Step Five:
In her final issue, the Plaintiff disputes the hypothetical questions posed to the VE.
However, “[t]he ALJ’s hypothetical question to the vocational expert needs to include only those
impairments that the ALJ finds are substantially supported by the record as a whole.” Martise v.
Astrue, 641 F.3d 909, 927 (8th Cir. 2011) (citing Lacroix v. Barnhart, 465 F.3d 881, 889 (8th Cir.
2006)). Here, the ALJ’s hypothetical question included all the limitations found to exist by the
ALJ and set forth in the ALJ’s RFC determination. Id. Based on our previous conclusion that
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substantial evidence supports that ALJ’s RFC findings, we hold that the hypothetical question was
proper, and the VE’s answer constituted substantial evidence supporting the Commissioner’s
denial of benefits. Id., see also Lacroix, 465 F.3d at 889.
V.
Conclusion:
Having carefully reviewed the record, the undersigned finds substantial evidence
supporting the ALJ’s decision denying the Plaintiff benefits, and affirms the decision. The
undersigned further directs that the Plaintiff’s Complaint be dismissed with prejudice.
DATED this 7th day of August, 2015.
/s/ Mark E. Ford
HONORABLE MARK E. FORD
UNITED STATES MAGISTRATE JUDGE
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