Garcia v. Colvin
ORDER affirming SSA's decision, by Judge Lewis T. Babcock on 9/30/2015. (ebuch)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO
LEWIS T. BABCOCK, JUDGE
Civil Case No. 14-cv-02631-LTB
CAROLYN W. COLVIN, Acting Commissioner of Social Security,
Plaintiff Maricela Garcia appeals the final decision of Acting Commissioner of Social
Security Carolyn W. Colvin (“SSA”) denying her application for disability insurance benefits
under Title II of the Social Security Act, 42 U.S.C. § 401, et seq., and for supplemental security
income under Title XVI of the act, 42 U.S.C. § 1381, et seq. I have considered the briefs
[Docs. # 18, 19, 20] and the administrative record [Doc. # 13] (“AR”). Oral argument would not
materially assist me in determining this appeal.
Ms. Garcia asserts that the administrative law judge’s (“ALJ”) residual functional
capacity assessment is not supported by substantial evidence because it does not limit her to
occasional handling and fingering and does not address her need for ready access to restroom
facilities. She alleges that the errors tainted the ALJ’s conclusion that she can perform jobs that
exist in significant numbers in the national economy and therefore is not disabled. As I explain
below, these arguments are without merit. Accordingly, I AFFIRM SSA’s decision.
I. Procedural History
On February 22, 2011, Ms. Garcia filed her claim for benefits with SSA, alleging that she
became disabled on January 1, 2010. AR 19. SSA denied her claim initially on June 9, 2011.
Id. Ms. Garcia requested a hearing, which took place on January 31, 2013, before an ALJ. Id.
In a decision dated February 12, 2013, the ALJ concluded that Ms. Garcia was not disabled and
denied her claim. AR 30. Ms. Garcia sought review by SSA’s Appeals Council. On July 31,
2014, the Appeals Council denied review, making the ALJ’s decision the final decision of SSA.
AR 1; Doyal v. Barnhart, 331 F.3d 758, 759 (10th Cir. 2003). On September 23, 2014, Ms.
Garcia timely filed the instant appeal [Doc. # 1]. The Court has jurisdiction pursuant to 42
U.S.C. § 405(g).
II. Legal Standards
A. SSA’s Five-Step Process for Determining Whether a Claimant Is “Disabled”
A claimant is “disabled” under Title II and Title XVI of the Social Security Act if she is
unable to “engage in any 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 12 months.” 42 U.S.C.
§§ 423(d)(1)(A), 1382c(a)(3)(A); see also Bowen v. Yuckert, 482 U.S. 137, 140 (1987). SSA has
established the following five-step sequential evaluation process for determining whether a
claimant is disabled and thus entitled to benefits. The process applies to Title II and Title XVI
claims alike. See 20 C.F.R. §§ 404.1520, 416.920.
At step one, SSA asks whether the claimant is presently engaged in “substantial gainful
activity.” Id. §§ 404.1520(b), 416.920(b). If she is, benefits are denied and the inquiry stops.
Id. At step two, SSA asks whether the claimant has a “severe impairment,” or one that
“significantly limits [her] physical or mental ability to do basic work activities.” Id. §§
404.1520(c), 416.920(c). If she does not, benefits are denied and the inquiry stops. Id. If she
does, SSA moves on to step three, where it determines whether the claimant’s impairment(s)
“meet or equal” one of the “listed impairments”—impairments so severe that SSA has
determined that a claimant who has them is conclusively disabled without regard to the
claimant’s age, education, or work experience. Id. §§ 404.1520(d), 416.920(d). If not, SSA goes
to step four.
At step four, SSA determines the claimant’s residual functional capacity (“RFC”), i.e.,
what she is still able to do despite her impairments, and asks whether the claimant can do any of
her “past relevant work” given that RFC. Id. §§ 404.1520(e), 416.920(e). If not, SSA goes to
fifth and final step, where SSA has the burden of showing that the claimant’s RFC allows her to
do other work in the national economy in view of her age, education, and work experience. Id.
§§ 404.1520(g), 416.920(g). At this step, SSA’s “grid rules” may mandate a finding of disabled
or not disabled without further analysis based on the claimant’s age, education, and work
experience. 20 C.F.R. Pt. 404, Subpt. P, App. 2; 20 C.F.R. § 416.969. In contrast with step five,
the claimant has “the burden of establishing a prima facie case of disability at steps one through
four.” Doyal, 331 F.3d at 760.
B. Standard for Reviewing SSA’s Decision
My review is limited to determining whether SSA applied the correct legal standards and
whether its decision is supported by substantial evidence in the record. Williamson v. Barnhart,
350 F.3d 1097, 1098 (10th Cir. 2003); White v. Barnhart, 287 F.3d 903, 905 (10th Cir. 2001);
Qualls v. Apfel, 206 F.3d 1368, 1371 (10th Cir. 2000). With regard to the law, reversal may be
appropriate when SSA either applies an incorrect legal standard or fails to demonstrate reliance
on the correct legal standards. See Winfrey v. Chater, 92 F.3d 1017, 1019 (10th Cir. 1996).
With regard to the evidence, I must “determine whether the findings of fact . . . are based upon
substantial evidence, and inferences reasonably drawn therefrom. If they are so supported, they
are conclusive upon [this] court and may not be disturbed.” Trujillo v. Richardson, 429 F.2d
1149, 1150 (10th Cir. 1970). “Substantial evidence is more than a scintilla, but less than a
preponderance; it is such evidence that a reasonable mind might accept to support the
conclusion.” Campbell v. Bowen, 822 F.2d 1518, 1521 (10th Cir. 1987) (citing Richardson v.
Perales, 402 U.S. 389, 401 (1971)). I may not re-weigh the evidence or substitute my judgment
for that of the ALJ. See Casias v. Secretary of Health & Human Servs., 933 F.2d 799, 800 (10th
Cir. 1991); Jozefowicz v. Heckler, 811 F.2d 1352, 1357 (10th Cir. 1987); Cagle v. Califano, 638
F.2d 219, 220 (10th Cir. 1981).
III. The ALJ’s Decision
The ALJ followed the five-step analysis outlined above. At step one, the ALJ found that
Ms. Garcia had not engaged in substantial gainful activity since the alleged onset date of her
conditions, January 1, 2010. AR 21. At step two, the ALJ found the following severe
impairments: history of ulcerative colitis, inflammatory polyarthritis, and chronic headaches. Id.
At step three, the ALJ concluded that Ms. Garcia did not meet or equal any listed impairment.
AR 22. At step four, the ALJ determined that Ms. Garcia’ RFC allowed her “to perform light
work as defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b),” except that she could lift and/or
carry 20 pounds occasionally and 10 pounds frequently; stand and/or walk for no more than 30
minutes at a time without the opportunity to stand and stretch for 1 to 2 minutes; sit for no more
than 60 minutes at a time; and frequently handle and finger with the bilateral upper extremity.
AR 22-28. The ALJ further determined that she could not perform forceful gripping or grasping
with the bilateral upper extremity and was limited to routine and repetitive tasks. Id. The ALJ
determined that Ms. Garcia’s RFC did not allow her to perform any past relevant work. AR 28.
At step five, the ALJ concluded that Ms. Garcia’s age, education, work experience, and RFC
allowed her to perform jobs that exist in significant numbers in the national economy,
specifically the jobs of assembler of small products, officer helper, and route aide. AR 29-30.
The ALJ therefore determined that Ms. Garcia was not disabled. Id.
A. Ms. Garcia’s Claimed Limitations as to Handling and Fingering
As noted above, one of the severe impairments found by the ALJ is inflammatory
polyarthritis. AR 21. At the hearing, Ms. Garcia testified that her “hands get stiff when [she],
like, open[s] up cans or brush[es] [her] teeth” and that she has to “wait until they, you know, get
un-stiff and just drop things when they get un-stiff.” AR 48. Ms. Garcia takes no issue with the
ALJ’s finding that she cannot perform forceful gripping or grasping with the bilateral upper
extremity, but argues that the ALJ erred in finding that she can frequently—rather than only
occasionally—handle and finger. AR 22. At the hearing, a vocational expert testified that
altering the ALJ’s RFC assessment to allow only occasional handling and fingering would result
in a “[v]ery limited” number of jobs that she could perform. AR 62-63.
Ms. Garcia primarily relies upon opinions provided by her primary care provider,
physician assistant Paige LeBlanc, PA-C. In December 2012, Ms. LeBlanc indicated in a
questionnaire that Ms. Garcia could handle and finger with both hands only occasionally, i.e., for
up to one-third of a 40-hour workweek, among various other work-related limitations not at issue
here. AR 461. Ms. LeBlanc noted that Ms. Garcia’s hands became stiff and she needed to
stretch them after five minutes of handling and fingering. Id. The ALJ gave “little weight” to
Ms. LeBlanc’s opinion. AR 28. The ALJ stated that she is not “an acceptable medical source”
and, “[m]ore importantly,” that her opinion was “inconsistent with the objective clinical
evidence.” AR 28. The ALJ explained that “there was no objective evidence of inflammation
except for tenderness and occasional swelling” and that “[n]one of her doctors endorsed extreme
functional limitation of her hands.” AR 24.
The ALJ discussed several aspects of Ms. Garcia’s medical history in support of this
assessment. First, the ALJ noted that, in March 2011, Ms. Garcia’s rheumatologist noted no
synovitis on physical examination and opined that her claimed joint pain was likely a side effect
of steroid withdrawal. AR 25 (citing AR 290). In addition, x-rays of the hands taken at the same
visit were unremarkable. Id. (citing AR 285-88). Second, the ALJ noted that a follow-up visit to
the rheumatologist in August 2011 was unremarkable except for tenderness to palpation in the
upper extremities. AR 26 (citing AR 430). Third, the ALJ noted that, in December 2012, Ms.
Garcia’s rheumatologist observed no inflammation of the joints. AR 27 (citing AR 434).
Fourth, the ALJ noted the generally conservative treatment that Ms. Garcia had received for her
joint pain, noting that Ms. Garcia was “merely advised to relieve pain with Tylenol” at the
March 2011 rheumatology visit, was told to “manage her symptoms with pain medication
prescribed by her primary care physician” at the August 2011 rheumatology visit, and was
“conservatively treated with Humira” at the December 2012 visit. AR 25-27 (citing AR 290,
430, 434). Fifth, the ALJ noted Ms. Garcia’s testimony at the hearing that her rheumatologist
was “puzzled” because her “joints are not inflamed” despite her complaints of pain. AR 23, 48.
As the ALJ noted, and as Ms. Garcia does not dispute, Ms. LeBlanc is not considered an
“acceptable medical source” because she is a physician assistant and not, for example, a
physician like the rheumatologists who treated Ms. Garcia. See SSR 06-03P, 2006 WL 2329939,
at *2 (Aug. 9, 2006). Opinions from non-acceptable medical sources are not entitled to
controlling weight. Id. at *2, 5. Their opinions “cannot establish the existence of a medically
determinable impairment,” although they may “provide insight into the severity of the
impairment(s) and how it affects the individual’s ability to function.” Id. The ALJ “generally
should explain the weight given” the opinion “or otherwise ensure that the discussion of the
evidence in the determination or decision allows a claimant or subsequent reviewer to follow the
adjudicator’s reasoning, when such opinions may have an effect on the outcome of the case.” Id.
Under SSA’s regulations, the ALJ properly considered the extent to which Ms. LeBlanc’s
opinion was consistent with the record as well as the nature of the treatment Ms. Garcia had
received. See 20 C.F.R. §§ 404.1527(c)(4), 416.927(c)(4) (in evaluating medical opinions, “the
more consistent an opinion is with the record as a whole, the more weight” SSA gives the
opinion); 20 C.F.R. §§ 404.1529(c)(3)(v), 416.929(c)(3)(v) (SSA considers treatments received
in evaluating a claimant’s symptoms); see also White, 287 F.3d at 909-10 (noting that claimant’s
admission that medication relieved some of her pain supported ALJ’s finding that impairments
were not as disabling as claimed); Wall v. Astrue, 561 F.3d 1048, 1069 (10th Cir. 2009) (noting
that claimant “received remarkably conservative treatments for her pain”). Moreover, I conclude
that the evidence discussed above provides substantial support for the ALJ’s decision to discount
Ms. LeBlanc’s opinion based on these considerations.
Ms. Garcia highlights certain comments in the medical records that support Ms.
LeBlanc’s opinion. For example, she points to an October 2012 record from a rheumatology
office visit indicating that her inflammatory polyarthritis was “uncontrolled.” AR 440. She also
notes that, at the December 2012 rheumatology visit, discussed above, the doctor stated that she
continued to have severe arthralgias and recommended that she take Humira. AR 434. The ALJ
acknowledged and discussed these records, however. See AR 27 (describing Humira treatment
as “conservative” and noting that the rheumatologist observed no inflammation of the joints at
the December 2012 visit); AR 28 (citing evidence received “subsequent to June 2011” in
discounting opinions of state agency physician who recommended no manipulative limitations at
all). In any event, the isolated comments that Ms. Garcia cites are not sufficient to undermine
the substantial evidence that supports the ALJ’s findings.
B. Ms. Garcia’s Claimed Need for “Ready Access to Restroom Facilities”
As noted, another of the severe impairments found by the ALJ was a “history of
ulcerative colitis.” AR 21. At the hearing, Ms. Garcia testified that her colitis was “more or less
under control” and that, while she was having “some” symptoms, they were “[n]ot too bad” and
occurred “[m]aybe twice a week.” AR 44. She testified that, when symptoms do occur, she
“need[s] to get [herself] to the bathroom right away” and will experience “really bad diarrhea
and pain and blood in [her] stools.” Id. Ms. Garcia now relies on this testimony to argue that,
“[b]ecause [she] cannot predict when she might have a flare-up, she must have ready access to
restroom facilities” and that the ALJ erred by failing to include such a requirement in her RFC
assessment or to discuss the issue in her decision. Opening Br. at 8 [Doc. # 18]. Neither Ms.
Garcia’s counsel nor the ALJ explored the issue of restroom access at the hearing. And the
parties’ briefs in this Court identify no record evidence that addresses her needs relative to
restroom access, save for medical records that generally describe her complaints of loose stools
An ALJ is not required to discuss every aspect of a claimant’s testimony so long as the
record demonstrates that the ALJ considered all of the testimony. See Clifton v. Chater, 79 F.3d
1007, 1009-10 (10th Cir. 1996). In her decision, the ALJ did not specifically address the issue of
restroom access, but referenced the testimony in question more generally, making clear that she
considered it. Specifically, she noted that Ms. Garcia “admitted her abdominal problems were
under control as she experienced fewer flare-ups.” AR 24; see also AR 23 (noting Ms. Garcia’s
testimony that she had “experienced an improvement in her ulcerative colitis symptoms”). The
ALJ also addressed the medical evidence regarding Ms. Garcia’s ulcerative colitis extensively in
her decision, ultimately finding that there was “insufficient evidence to show that the claimant’s
history of ulcerative colitis reduces her exertional capacity below the light level.” AR 24.
For example, the ALJ cited a statement by Ms. Garcia’s gastroenterologist in a July 2010
record that an ulcerative colitis flare-up that Ms. Garcia experienced was “not terribly severe.”
AR 25 (citing AR 330). The ALJ noted that the same record indicated that she had stopped
taking her prescribed ulcerative colitis medications for a year. Id.; AR 24 (citing AR 330). In
addition, the ALJ noted that, “[a]t various times, [Ms. Garcia] admitted she felt better and
acknowledged her symptoms of diarrhea, vomiting, and nausea had either resolved or improved
with medication.” AR 25 (citing AR 296, 309). Further, the ALJ noted that, from November
2011 to August 2012, Ms. Garcia “made less frequent visits to see a doctor regarding ulcerative
colitis symptoms.” AR 26 (citing AR 401-57). The ALJ’s decision therefore demonstrates that
she considered not only the testimony in question but all other evidence in the record regarding
Ms. Garcia’s ulcerative colitis. Further, the records and Ms. Garcia’s testimony provide
substantial support to the ALJ’s RFC assessment with respect to Ms. Garcia’s ulcerative colitis
With regard to Ms. Garcia’s argument that the RFC assessment should have specifically
addressed restroom access, I note that the testimony in question—which included statements that
her flare-ups were “more or less under control” and “not too bad,” AR 44— was equivocal at
best and did not suggest that her restroom access needs would materially impact her RFC. See
Hawkins v. Chater, 113 F.3d 1162, 1167 (10th Cir. 1997) (noting that an ALJ’s duty to develop
the record arises only where there is “some objective evidence in the record suggesting the
existence of a condition which could have a material impact on the disability decision requiring
further investigation”). I cannot conclude that, standing alone, it gave rise to a duty for the ALJ
to further develop the record as to restroom access or address the issue in her RFC assessment,
particularly because Ms. Garcia’s counsel did not pursue the issue at the hearing. See id. (noting
that “the ALJ should ordinarily be entitled to rely on the claimant’s counsel to structure and
present claimant’s case in a way that the claimant’s claims are adequately explored”). In any
event, as discussed above, I am confident that the ALJ fully considered the evidence regarding
Ms. Garcia’s ulcerative colitis—including the testimony in question—and reasonably accounted
for it in determining her RFC.
For the foregoing reasons, SSA’s decision is AFFIRMED.
30 , 2015, at Denver, Colorado.
BY THE COURT:
s/Lewis T. Babcock
LEWIS T. BABCOCK, JUDGE
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