Hill v. Commissioner, Social Security Administration et al
Filing
20
MEMORANDUM OPINION AND ORDER by Magistrate Judge Nina Y. Wang on 11/9/2018. For the reasons stated herein, the court hereby AFFIRMS the Commissioner's final decision. (bwilk, )
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO
Civil Action No. 17-cv-02704-NYW
JAYME TRINETTE HILL,
Plaintiff,
v.
COMMISSIONER, SOCIAL SECURITY ADMINISTRATION,
Defendant.
MEMORANDUM OPINION AND ORDER
Magistrate Judge Nina Y. Wang
This civil action arises under Titles II and XVI of the Social Security Act (“Act”), 42 U.S.C.
§§ 401–33 and 1381–83(c) for review of the Commissioner of Social Security Administration’s
(“Commissioner” or “Defendant”) final decision denying Plaintiff Jayme Hill’s (“Plaintiff” or
“Ms. Hill”) applications for Disability Insurance Benefits (“DIB”) and Supplemental Security
Income (“SSI”). Pursuant to the Order of Reassignment dated March 29, 2018 [#18], this civil
action is before this Magistrate Judge for a decision on the merits. See 28 U.S.C. § 636(c); Fed.
R. Civ. P. 73; D.C.COLO.LCivR 72.2. Upon review of the Parties’ briefing, the entire case file,
the Administrative Record, and the applicable case law, this court respectfully AFFIRMS the
Commissioner’s decision.
PROCEDURAL HISTORY
This case arises from Plaintiff’s applications for DIB and SSI protectively filed on May 30,
2013. [#8-3 at 96, 97].1 Ms. Hill graduated from high school, obtained her associate’s degree in
1
When citing to the Administrative Record, the court utilizes the docket number assigned by the
CM/ECF system but the page number associated with the Record, found in the bottom right-hand
business, and worked as a customer service representative for Frontier Airlines, as a real estate
intern and then agent, as a customer service representative for Nextel, as a customer service
representative for TeleTech Customer Care Management, as a work-study participant for the
Community College of Aurora’s financial aid and administration department, and currently as a
driver for Lyft for roughly 20 hours per week. See [#8-2 at 39-43; #8-6 at 288; 312-15; #8-7 at
321-26, 330-34, 335, 364]. Ms. Hill alleges she became disabled on January 21, 2011 [#8-3 at
98], later amended to October 11, 2012 [#8-2 at 37], due to injuries to both her hands, chronic
regional pain syndrome (“CRPS”) of the right hand, and carpal tunnel syndrome of the left hand,
see [#8-7 at 349]. Ms. Hill was thirty-seven years-old on the amended alleged onset date of her
claimed disability.
The Social Security Administration denied Plaintiff’s application administratively on
February 11, 2014. See [#8-2 at 96, 97; #8-4 at 144-48]. Ms. Hill requested a hearing before an
Administrative Law Judge (“ALJ”), see [#8-4 at 152-54], which ALJ Patricia E. Hartman (the
“ALJ”) held on June 4, 2015, see [#8-2 at 63]. Following this hearing, the ALJ issued a decision
finding Ms. Hill not disabled. See [#8-3 at 123, 133]. Plaintiff requested Appeals Council review
of the ALJ’s decision, which the Appeals Council granted. See [id. at 139]. The Appeals Council
remanded Ms. Hill’s case back to the ALJ because the ALJ’s Residual Functional Capacity
(“RFC”) determination was “wholly inconsistent” with the opinion of John Sacha, M.D., who
opined that Ms. Hill could not maintain gainful employment, which the ALJ afforded great weight.
See [id. at 141]. The Appeals Council directed the ALJ on remand to “[g]ive further consideration
to the claimant’s maximum [RFC] and provide appropriate rationale with specific references to
corner of the page. For all other documents the court cites to the document and page number
generated by the CM/ECF system.
2
evidence of record in support of the assessed limitations” and “[i]f warranted by the expended
record, obtain evidence from a vocational expert to clarify the effect of the assessed limitations on
the claimant’s occupational base . . . .” [Id. at 141-42].
Following remand, the ALJ conducted a second hearing on November 22, 2016. [#8-2 at
32]. At the hearing, Ms. Hill proceeded through counsel, and the ALJ received testimony from
Plaintiff and Vocational Expert Pat W. Pauline (the “VE”). See [id. at 15, 36, 58]. Relevant here,
Plaintiff testified that her only reason for not working since 2012 was her hands. See [id. at 4344]; see also [id. at 46 (testifying that she does not have any mental ailments that preclude her
from working)]. She explained that she “got a cramp in [her] hand” while working for Frontier
Airlines in 2011, which was so severe that she could not move her hand and caused her to file a
worker’s compensation claim. [Id. at 42]. Plaintiff continued that Dr. Sacha informed her she had
CRPS, and that her CRPS only slightly responded to physical therapy, cortisone shots in her wrists,
“shots in her neck”, Gabapentin, and Motrin. [Id. at 44-45]. She also attested that her right wrist
was worse than her left wrist. [Id. at 47].
Plaintiff testified that while she currently works as a Lyft driver, her hours vary depending
“on how [her] hands are feeling.” [Id. at 39]. For instance, she testified that driving sometimes
causes her hands to swell, cramp to the point that she cannot move them, itch, and burn, causing
her to stop driving that day. See [id. at 40-41, 53]. Further, Plaintiff explained that someone else
washes her car because “[t]hat [would] kill her hands.” [Id. at 52]. Plaintiff’s issues with her
hands also prohibited her from maintaining employment as a caretaker for the elderly because she
had to push wheelchairs and transfer clients to and from bed, see [id. at 44], and as a real estate
agent because of the amount of typing required to draft real estate sales contracts, see [id. at 55].
Indeed, Ms. Hill testified that “sometimes writing, typing, [and] grabbing” make her hand pain
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worse, and that sleep “is the best thing for [the pain]” which is why she tries to nap on days when
the pain is the worst. [Id. at 47, 48]. Ms. Hill also testified that she did not have any issues
grooming herself, though her hair takes longer to “get done,” [id. at 48, 57], but that she avoids
clothes with buttons or zippers because they are too difficult to manipulate, [id. at 57].
The VE also testified at the hearing. The VE first summarized Plaintiff’s past relevant
work to include: a customer service representative, specific vocational preparation (“SVP”) level
5, sedentary; a reservation agent, SVP level 4, sedentary; an administrative clerk, SVP level 4,
light exertion; a table clerk, SVP level 4, sedentary; and a realtor, SVP level 5, light exertion. See
[#8-2 at 59].
The VE then considered the work an individual could perform who could perform light
work with the additional limitations of occasionally using hand controls, handling, fingering, and
feeling; frequently reaching in all directions; and no kneeling, crawling, climbing ladders or
scaffolds, or working at unprotected heights, with dangerous unprotected machinery, or with
vibrating tools. [#8-2 at 59-60]. The VE testified that this individual could perform only Ms.
Hill’s previous work as a customer service representative. [#8-2 at 60]. In addition, the VE
testified that, consistent with the Dictionary of Occupational Titles, this individual could also
perform sedentary jobs as a callout operator and surveillance system monitor, both SVP level 2
jobs. 2 [Id. at 60]. In response to Plaintiff’s counsel’s question, the VE also stated that employers
for these jobs would tolerate “no more than ten percent” of being off task. [Id. at 61].
2
Upon further questioning by the ALJ, the VE also identified jobs of investigator of dealer
accounts and counter clerk, but the VE could not identify the numbers of jobs that were available
in the national economy. [#8-2 at 61-62]. The ALJ ultimately did not rely on these two additional
jobs, and the court will not consider them.
4
On December 15, 2016, the ALJ issued a decision finding Ms. Hill not disabled under the
Act. [#8-2 at 25]. Plaintiff requested Appeals Council review of the ALJ’s decision, which the
Appeals Council denied, rendering the ALJ’s decision the final decision of the Commissioner [id.
at 1-3]. Plaintiff sought judicial review of the Commissioner’s final decision in the United States
District Court for the District of Colorado on November 13, 2017, invoking this court’s jurisdiction
to review the Commissioner’s final decision under 42 U.S.C. § 1383(c)(3).
STANDARD OF REVIEW
In reviewing the Commissioner’s final decision, the court is limited to determining whether
the decision adheres to applicable legal standards and is supported by substantial evidence in the
record as a whole. Berna v. Chater, 101 F.3d 631, 632 (10th Cir. 1996) (citation omitted); cf.
Thompson v. Sullivan, 987 F.2d 1482, 1487 (10th Cir. 1993) (“[I]f the ALJ failed to apply the
correct legal test, there is a ground for reversal apart from a lack of substantial evidence.” (internal
citation omitted)). The court may not reverse an ALJ simply because she may have reached a
different result based on the record; the question instead is whether there is substantial evidence
showing that the ALJ was justified in her decision. See Ellison v. Sullivan, 929 F.2d 534, 536
(10th Cir. 1990). “Substantial evidence is more than a mere scintilla and is such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion.” Flaherty v. Astrue, 515
F.3d 1067, 1070 (10th Cir. 2007) (internal citation omitted). But “[e]vidence is not substantial if
it is overwhelmed by other evidence in the record or constitutes mere conclusion.” Musgrave v.
Sullivan, 966 F.2d 1371, 1374 (10th Cir. 1992) (internal citation omitted). The court may not
“reweigh the evidence or retry the case,” but must “meticulously examine the record as a whole,
including anything that may undercut or detract from the ALJ’s findings in order to determine if
the substantiality test has been met.” Flaherty, 515 F.3d at 1070 (internal citation omitted).
5
ANALYSIS
I.
The ALJ’s Decision
An individual is eligible for DIB benefits under the Act if she is insured, has not attained
retirement age, has filed an application for DIB, and is under a disability as defined in the Act. 42
U.S.C. § 423(a)(1). Supplemental Security Income is available to an individual who is financially
eligible, files an application for SSI, and is disabled as defined in the Act. 42 U.S.C. § 1382. An
individual is determined to be under a disability only if her “physical or mental impairment or
impairments are of such severity that he is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage in any other kind of substantial
gainful work which exists in the national economy. . . .” 42 U.S.C. § 423(d)(2)(A). The disabling
impairment must last, or be expected to last, for at least 12 consecutive months. See Barnhart v.
Walton, 535 U.S. 212, 214–15 (2002). Additionally, the claimant must prove she was disabled
prior to his date last insured. Flaherty, 515 F.3d at 1069.
The Commissioner has developed a five-step evaluation process for determining whether
a claimant is disabled under the Act. 20 C.F.R. § 404.1520(a)(4)(v). See also Williams v. Bowen,
844 F.2d 748, 750–52 (10th Cir. 1988) (describing the five steps in detail). “If a determination
can be made at any of the steps that a claimant is or is not disabled, evaluation under a subsequent
step is not necessary.” Williams, 844 F.2d at 750. Step one determines whether the claimant is
engaged in substantial gainful activity; if so, disability benefits are denied. Id. Step two considers
“whether the claimant has a medically severe impairment or combination of impairments,” as
governed by the Secretary’s severity regulations. Id.; see also 20 C.F.R. § 404.1520(e). If the
claimant is unable to show that his impairments would have more than a minimal effect on his
ability to do basic work activities, he is not eligible for disability benefits. If, however, the claimant
presents medical evidence and makes the de minimis showing of medical severity, the decision
6
maker proceeds to step three. Williams, 844 F.2d at 750. Step three “determines whether the
impairment is equivalent to one of a number of listed impairments that the Secretary acknowledges
are so severe as to preclude substantial gainful activity,” pursuant to 20 C.F.R. § 404.1520(d). Id.
At step four of the evaluation process, the ALJ must determine a claimant’s Residual Functional
Capacity (“RFC”), which defines the maximum amount of work the claimant is still “functionally
capable of doing on a regular and continuing basis, despite his impairments: the claimant’s
maximum sustained work capability.”
Williams, 844 F.2d at 751; see also id. at 751–52
(explaining the decisionmaker must consider both the claimant’s exertional and nonexertional
limitations).
The ALJ compares the RFC to the claimant’s past relevant work to determine
whether the claimant can resume such work. See Barnes v. Colvin, 614 F. App’x 940, 943 (10th
Cir. 2015) (citation omitted). “The claimant bears the burden of proof through step four of the
analysis.” Neilson v. Sullivan, 992 F.2d 1118, 1120 (10th Cir. 1993).
At step five, the burden shifts to the Commissioner to show that a claimant can perform
work that exists in the national economy, taking into account the claimant’s RFC, age, education,
and work experience. Neilson, 992 F.2d at 1120. The Commissioner can meet her burden by the
testimony of a vocational expert. Tackett v. Apfel, 180 F.3d 1094, 1098–99, 1101 (9th Cir. 1999).
The ALJ found that Ms. Hill met the insured status requirements for DIB through
December 31, 2017, and had not engaged in substantial gainful activity since October 11, 2012.
[#8-2 at 18]. At step two the ALJ determined Ms. Hill had the following severe impairments:
obesity and bilateral carpal tunnel syndrome status post-surgical release on the right with a history
of CRPS. [Id. at 19]. At step three the ALJ determined that Plaintiff did not have an impairment
or combination of impairments that meets or medically equals the severity of one of the listed
impairments in Title 20, Chapter III, Part 404, Subpart P, Appendix 1 (20 C.F.R. §§ 404.1520(d),
7
416.920(d)). [Id.]. The ALJ then determined Plaintiff had the RFC to perform light work subject
to several limitations [id.], and concluded that Ms. Hill could perform her previous work as a
customer service representative [id. at 24]. Though the ALJ concluded that Ms. Hill was not
disabled under the Act at step four, she also concluded at step five that there existed two additional
jobs Ms. Hill could perform in the national economy. [Id. at 24-25].
Ms. Hill now appeals the ALJ’s decision to this court. In doing so, she raises just one issue:
“[t]he ALJ committed reversible error in failing to comply with the [Appeals Council’s] remand
order regarding further evaluation of Dr. Sacha’s opinion.” [#13 at 10]. I consider this argument
below.
II.
Compliance with Remand Order: Further Evaluation of Dr. Sacha’s Opinion
Pursuant to Social Security regulations, upon remand from the Appeals Council, “[t]he
[ALJ] shall take any action that is ordered by the Appeals Council and may take any additional
action that is not inconsistent with the Appeals Council’s remand order.” 20 C.F.R. § 404.977(b).
The United States Court of Appeals for the Tenth Circuit (“Tenth Circuit”) has construed this
regulation as allowing the ALJ to reevaluate her findings, including the claimant’s RFC, on
remand, because “[t]o hold otherwise would discourage [ALJs] from reviewing the record on
remand, checking initial findings of fact, and making corrections, if appropriate.” Campbell v.
Bowen, 822 F.2d 1518, 1522 (10th Cir. 1987); see also Hamlin v. Barnhart, 365 F.3d 1208, 1224
(10th Cir. 2004) (“It was certainly within the ALJ’s province, upon reexamining Mr. Hamlin’s
record [on remand], to revise his RFC category.”). Indeed, binding the ALJ to her prior decision
on remand would “‘constrain the ALJ in a manner not mandated by the regulations.’” Miller v.
Barnhart, 175 F. App’x 952, 956 (10th Cir. 2006) (quoting Campbell, 822 F.2d at 1522).
8
As mentioned, the Appeals Council remanded Ms. Hill’s case to the ALJ because the ALJ
placed great weight on the opinion of Dr. Sacha whose opinion that Plaintiff could not maintain
gainful employment was “wholly inconsistent” with the ALJ’s RFC determination. See [#8-3 at
141]. The Remand Order directed the ALJ to:
•
Give further consideration to the claimant’s maximum [RFC] and provide
appropriate rationale with specific references to evidence of record in support
of the assessed limitations . . . .
•
If warranted by the expended record, obtain evidence from a vocational expert
to clarify the effect of the assessed limitations on the claimant’s occupational
base . . . .
[#8-3 at 141-42]. Plaintiff argues that the ALJ failed to follow these directives because the ALJ
did not further consider Dr. Sacha’s opinion and “out right discounted the opinion” at the second
hearing. [#13 at 10]. Plaintiff further avers that Dr. Sacha’s opinion finding marked limitations
in most areas of functioning, see [#8-14 at 917-28], was not inconsistent with his earlier opinions
of more moderate functional restrictions, and that Dr. Sacha’s opinions were consistent with David
W. Yamamoto, M.D.’s opinion. See [#17 at 2-3]. According to Plaintiff, substantial evidence
does not support the ALJ’s findings concerning Dr. Sacha’s opinions.
In formulating a claimant’s RFC, the ALJ must address medical source opinions. The
Social Security regulations afford a treating source opinion controlling weight if it is “well
supported by medically acceptable clinical and laboratory diagnostic techniques and is not
inconsistent with other substantial evidence in [the] case record.” 20 C.F.R. § 416.927(c); see also
20 C.F.R. § 404.1527(b), (c). But even if the ALJ does not afford the treating source opinion
controlling weight, the ALJ owes that opinion deference and must weigh that opinion using all the
factors provided in 20 C.F.R. §§ 404.1527, 416.927. See Watkins v. Barnhart, 350 F.3d 1297,
1300 (10th Cir. 2003); SSR 96-2p, 1996 WL 374188, at *4. These factors include:
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1. the length of the treatment relationship and the frequency of examination;
2. the nature and extent of the treatment relationship, including the treatment
provided and the kind of examination or testing performed;
3. the degree to which the physician’s opinion is supported by relevant evidence;
4. consistency between the opinion and the record as a whole;
5. whether or not the physician is a specialist in the area upon which an opinion is
rendered; and
6. other factors brought to the ALJ’s attention which tend to support or contradict
the opinion.
Langley v. Barnhart, 373 F.3d 1116, 1119 (10th Cir. 2004) (quotation marks omitted). Neither
the regulation nor the court require a factor-by-factor recitation, but the ALJ’s findings must be
“sufficiently specific to make clear” the weight assigned to the treating source opinion and the
reasons for that weight. Oldham v. Astrue, 509 F.3d 1254, 1258 (10th Cir. 2007) (internal
quotation marks omitted); accord Watkins, 350 F.3d at 1301 (“if the ALJ rejects the opinion
completely, he must then give specific, legitimate reasons for doing so.” (internal quotation marks
omitted)).
The record contains several progress notes and impressions from Dr. Sacha. The ALJ
afforded significant weight to several of those opinions: (1) January 18, 2013, Dr. Sacha noted that
he had “not taken [Ms. Hill] off work specifically for the left upper extremity”, but that Plaintiff
had some work restrictions, [#8-14 at 875]; (2) February 21, 2013, Dr. Sacha assessed left upper
extremity work restrictions, consistent with his January 18, 2013 restrictions, of “no repetitive
activities . . . greater than 1 hour without a 10 min[ute] rest[,] no prolonged power grip/pinch, [and]
no lifting [more than] 10 [pounds],” [id. at 864]; (3) May 20, 2013, Dr. Sacha assessed left wrist
work restrictions of “only 15 minutes of repetitive activity before having a 15-minute break. She
can lift up to 15 pounds.” [id. at 856]; and (4) November 5, 2013, Dr. Sacha found reasonable Dr.
Yamamoto’s opinion that Ms. Hill had a 10% right upper extremity impairment and a 13% left
upper extremity impairment for a combined 22% whole person permanent impairment, [#8-12 at
10
702-03]. The ALJ explained that these opinions were “based on treatment or examination of the
claimant” and were generally consistent with the other medical source opinions and the medical
record “that documents substantial improvement in [Plaintiff’s] right hand/wrist and mostly mild
abnormalities of her hands and wrists.” [#8-2 at 23]. The ALJ further noted that Dr. Sacha’s work
restrictions applied only to Plaintiff’s left upper extremity, which suggested an ability to lift more
weight with both arms, and prohibited only repetitive manipulation, which supported frequent
reaching and occasional fingering, handling, and feeling. See [id.].
The ALJ found Dr. Sacha’s August 2014 opinions less persuasive, however. See [id.]. In
the CRPS Medical Source Statement, Dr. Sacha identified no leg issues and that Ms. Hill could sit
and stand for more than 2 hours at a time and for at least 6 out of 8 hours per day, but that Ms. Hill
required a job that permits shifting positions at will from sitting, standing, or walking. See [#8-14
at 918]. Dr. Sacha also opined that Plaintiff needed to walk around during the 8-hour work day
for 90 minutes, that she needed to walk for 10 minutes at a time, and that her muscle weakness,
pain/paresthesia, numbness, and chronic fatigue required frequent unscheduled breaks of 10
minutes. See [id. at 918-19]. Dr. Sacha noted that Plaintiff could only rarely lift less than 10
pounds, and that Ms. Hill’s pain/paresthesias, muscle weakness, limitation of motion, motor loss,
swelling, sensory loss/numbness, and medication side effects significantly limited Plaintiff’s
ability to reach, handle, and finger, such that Ms. Hill could do so for only 4% (right upper
extremity) and 10% (left upper extremity) of the time out of an 8-hour work day. See [id. at 919].
Dr. Sacha concluded that Plaintiff would be off task 25% or more of the time because of her
symptoms and that she would miss more than 4 days per month; Dr. Sacha represented that
Plaintiff’s impairments were reasonably consistent with her symptoms and limitations. See [id. at
920].
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Then, in the General RFC Questionnaire, Dr. Sacha identified Ms. Hill’s symptoms as
bilateral arm pain/swelling, right arm hyperpathia/allodynia, left arm numbness/weakness, and lost
grip and pinch strength. [Id. at 923]. He then identified positive objective signs for reduced range
of motion in both arms, sensory loss, reflex change, tenderness, crepitus, swelling, muscle atrophy,
and muscle weakness; Dr. Sacha represented that Ms. Hill’s impairments were reasonably
consistent with the symptoms and functional limitations assessed. [Id.]. Dr. Sacha continued that
Ms. Hill could lift less than 10 pounds on an occasional basis but no amount of weight on a frequent
basis; that Ms. Hill had no limits sitting, standing, or walking, including no walking around or
needing to sit down after periods of walking or standing; that Ms. Hill could frequently twist,
stoop, crouch, occasionally climb stairs, and never climb ladders; that for both arms Ms. Hill could
rarely reach over her head, never reach forward, never handle (gross manipulation) or finger (fine
manipulation), and rarely feel; that Ms. Hill would never need to lie down at unpredictable
intervals; that Ms. Hill would miss more than 3 days per month because of her impairments; and
that Ms. Hill should largely avoid extreme cold and heat, wetness, humidity, and hazardous
machinery, heights, etc. See [id. at 924-27].
The ALJ concluded that these “rather extreme limitations” were “markedly inconsistent”
with Dr. Sacha’s prior work restrictions regarding Plaintiff’s ability to sit, stand, or walk and did
not find support in the medical record. See [#8-2 at 23]. The ALJ continued that these restrictions
were inconsistent with Ms. Hill’s testimony that her hands posed the only functional limitations
and that she had no issues standing, sitting, or walking (which she did for exercise). [Id.]. The
ALJ also found that Dr. Sacha’s marked limitations were inconsistent with the medical evidence
that documented improvement in Ms. Hill’s right hand/wrist with mostly mild abnormalities, and
that his opinion regarding the severity of Ms. Hill’s symptoms was “markedly inconsistent” with
12
the medical evidence that suggested no allodynia or skin temperature, texture, or color changes,
largely normal strength (aside from two instances where Ms. Hill did not put forth full effort), and
mild and infrequent swelling. See [id. at 23-24]. I respectfully agree with the Commissioner that
the ALJ’s discussion of Dr. Sacha’s opinions satisfied the Remand Order’s directive and
sufficiently explained the weight assigned to Dr. Sacha’s August 2014 opinions. See Oldham, 509
F.3d at 1258.
In addition, I find that substantial evidence supports the ALJ’s determination. Beginning
in 2013—the year in which the ALJ placed great weight on the opinions of Dr. Sacha—medical
records reveal that Ms. Hill’s condition remained largely unchanged. For instance, February 25,
2013 treatment notes of Dr. Alijani indicate that Ms. Hill reported that driving, lifting heavy
objects, and any repetitive use of her hands exacerbates her symptoms, that she wakes 4 times per
night with hand numbness, and that rest and avoiding repetitive use of her hands provides the best
relief. [#8-12 at 689]. But physical exams revealed no acute distress; that her right upper extremity
was negative for Tinel’s sign (nerve irritation), Phalen’s test (carpal tunnel syndrome), and
Adson’s test (thoracic outlet syndrome), and that her sensation, skin, and vascular exams were
normal; that her left upper extremity exam revealed no tenderness, swelling, deformities,
instability, weakness, subluxations, atrophy, decreased range of motion, or pain in her shoulder,
elbow, forearm, and hand, and that her sensation, skin, and vascular exams were normal; and that
her left wrist had full range of motion, no pain or crepitance, but was positive for median nerve
compression and carpal tunnel syndrome. [Id.]. Dr. Alijani’s treatment notes dated April 8, 2013
revealed the same physical exam results as from February 25, 2013. [Id. at 687]. Relatedly,
Colorado Pain and Rehabilitation, PLLC treatment notes dated March 14 to March 27, 2013
indicated that Plaintiff reported a pain level of 3-4 out of 10, that her pain is present 1-4 hours per
13
day depending on the activity, and that she could not write, type, or grip for more than 15 minutes.
See [id. at 680-86]. But physical exams revealed no “pain behaviors or signs of distress and
nonphysiological pain signs”, “mild swelling over the distal forearm”, “some very mild swelling
on the extensor portion in the same region”, “decreased extension”, “discomfort with some focal
pain along the radiocarpal complex”, “full faculty and finger strength with some aggravation”,
“good strength without any myotomal weakness through the flexor and extensor muscles”,
“[s]ensation is intact with some hyperesthesia along the carpal tunnel and traverse carpal arch”,
“some mild median nerve tension signs”, and “normal reflexes”. [Id. at 685].
Dr. Sacha’s progress notes are largely similar to the findings above. On January 14, 2013,
Dr. Sacha reported no swelling of Ms. Hill’s upper left extremity, some mild tenderness over the
carpal row, positive carpal tunnel compression test, positive Tinel’s test over the median nerve but
negative ulnar Tinel’s test, and no allodynia, hyperpathia, or skin trophic changes. [#8-14 at 88186]. Dr. Sacha saw Plaintiff again on January 22, 2013, when Ms. Hill reported pain in her right
wrist and shoulder, but Dr. Sacha noted no other changes in her symptoms; Dr. Sacha also reported
some mild tenderness of the right upper extremity, some mild crepitus on range of motion of wrist,
a positive carpal tunnel compression test, a normal shoulder exam, as well as no nerve root pain,
allodynia, hyperpathia, swelling, or skin trophic changes. [Id. at 873]. On February 5, 2013, Dr.
Sacha conducted a reevaluation of Ms. Hill following corticosteroid injections in her left wrist and
noted that Ms. Hill reported 90% relief from symptoms for 4 days before her symptoms returned,
and her physical exam was largely normal, revealing a positive carpal tunnel compression on the
left wrist, but no swelling, allodynia, hyperpathia, skin trophic changes, or nerve pain. [Id. at 867].
Progress notes dated March 5, 2013 again revealed a positive carpal tunnel compression on the left
wrist with nerve irritation, some mild pain and tenderness, but no allodynia, hyperpathia, or skin
14
trophic changes. [Id. at 860]. Dr. Sacha’s April 2, 2013 Progress Report indicated that Ms. Hill
reported no improvement in her left wrist symptoms following conservative treatments, but that
she has minimal pain behaviors, walks with a normal gait, some minimal edema in both upper
extremities, mild tenderness over wrist, no crepitus, decreased sensation in median nerve
distribution on the left, and 5/5 grip strength. [Id. at 857]. Dr. Sacha then noted a 15-minute
restriction on repetitive tasks and a 10-pound lifting restriction on a Physician’s Report of
Worker’s Compensation Injury. [Id. at 859].
Plaintiff returned to Dr. Sacha on May 20, 2013, and Dr. Sacha noted that Ms. Hill decided
against surgery on her left upper extremity and that Ms. Hill’s case was appropriate for closure
because she completed all conservative care. [#8-14 at 855]. Dr. Sacha’s physical exam noted
some swelling in both upper extremities but no allodynia, hyperpathia, or skin trophic changes,
and that there was some diminished range of motion in left wrist, positive carpal tunnel
compression on the left wrist, and some mild tenderness. [Id.]. Dr. Sacha opined that Plaintiff
had a 4% range of motion impairment for her upper left extremity coupled with a 4% sensory loss
impairment for a total 5% whole person permanent impairment due to her upper left extremity
symptoms. [Id. at 856].
Due to continued pain (rated at a 5 out of 10) in her right hand, Ms. Hill returned to Dr.
Sacha on July 23, 2013. See [#8-14 at 853]. Dr. Sacha reported that Ms. Hill displayed no apparent
distress, that her bilateral upper extremity range of motion was good, that her right wrist had edema
with pain and tenderness to palpation, but that she showed no erythema, no allodynia, no skin
trophic changes; Dr. Sacha also noted equal temperature in both hands, 5/5 muscle strength and
within functional range of motion, pain at the wrist but no positive pain symptoms in hands or
fingers bilaterally, no tenderness to palpation at the medial or lateral epicondyles, and negative for
15
nerve pain. See [id. at 853]. On September 24, 2013, Dr. Sacha reported mild swelling in both
hands, but no allodynia, hyperpathia, or skin trophic changes. [Id. at 851]. On October 22, 2013,
Dr. Sacha reported minimal edema in both hands with no allodynia, hyperpathia, or skin trophic
changes bilaterally, but that Ms. Hill was still positive for carpal tunnel compression on the left
greater than the right with some mild tenderness on the left. [Id. at 849]. On November 5, 2013,
Dr. Sacha’s skin examination revealed no peripheral edema, swelling, erythema, allodynia,
hyperpathia, or trophic changes. [#8-12 at 702].
Beginning in 2014, Dr. Sacha noted on January 7, 2014 that Ms. Hill’s symptoms “are
about the same” from his last exam, that she exhibited a “slight increase in pain behaviors” and
bilateral carpal tunnel compression, but no allodynia, hyperpathia, or skin trophic changes. [#812 at 700]. In a letter dated February 4, 2014 regarding Ms. Hill’s worker compensation claim,
Dr. Sacha indicated that Ms. Hill likely needed roughly 3-5 more years of treatment and that CRPS
was not a lifelong ailment, though its duration was unpredictable. See [#8-14 at 840-41]. In
another letter dated April 15, 2014, Dr. Sacha expressed his disagreement with the results of Dr.
Sollender’s Independent Medical Exam, proclaiming that Ms. Hill’s condition appeared worse
from February to March 2014 and that he believed she needed continued maintenance care above
simply prescribing medication. See [id. at 838]. Then, as discussed in detail above, Dr. Sacha
opined on August 4, 2014 that Ms. Hill suffered from severe functional limitations that precluded
any gainful employment. See [id. at 917-28]. But in a follow-up appointment on September 9,
2014, Dr. Sacha noted that Ms. Hill reported intermittent flare ups of her symptoms, which was
not uncommon, and that there was “nothing out of the ordinary with no new findings or
complaints.” [#8-15 at 1011]. He continued that Ms. Hill had mild swelling in the wrist, some
mild allodynia in the right hand, decreased sensation greater in the right than left hand of the
16
median nerve distribution, motor strength was 5/5 “with some decreased effort”, and positive
carpal tunnel compression greater on the left than right. [Id.].
The court agrees with the ALJ’s conclusion that Dr. Sacha’s marked limitations in August
2014 were “wholly inconsistent” with the medical evidence, including Dr. Sacha’s own progress
notes from 2013 and 2014 recounted above. 3 Indeed, the last objective medical evidence is an
October 3, 2016 bone scintigraphy scan that returned negative for CRPS. See [#8-15 at 1015]. To
the extent there is conflicting evidence, Plaintiff has not directed the court to it and
it is for the ALJ to resolve such conflicts, see Allman v. Colvin, 813 F.3d 1326, 1333 (10th Cir.
2016), as this court may not “displace the agency’s choice between two fairly conflicting views”,
Zoltanski v. FAA, 372 F.3d 1195, 1200 (10th Cir. 2004) (brackets omitted). The same is true of
any conflicts between Dr. Sacha’s opinions and that of other medical sources: the ALJ, not the
court, is responsible for resolving any inconsistencies between medical source opinions. See Smith
v. Colvin, 821 F.3d 1264, 1268 (10th Cir. 2016).
CONCLUSION
For the reasons stated herein, the court hereby AFFIRMS the Commissioner’s final
decision.
DATED: November 9, 2018
BY THE COURT:
_________________________
Nina Y. Wang
United States Magistrate Judge
3
I also note the inconsistencies with Dr. Sacha’s August 2014 opinions in his CRPS Medical
Source Statement—that Ms. Hill needed to walk for 90 minutes at 10-minute intervals throughout
the day and needed a job that allowed for shifting positions at will to sitting, standing, or walking—
and his General RFC Questionnaire—that Ms. Hill had no limits on her ability to sit, stand, or
walk and did not need to change positions at all within an 8-hour window. Compare [#8-14 at
918] with [id. at 924-25].
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