Murphy v. Colvin
Filing
23
Judge George A. O'Toole, Jr: ORDER AND OPINION entered denying 15 Motion for Order Reversing Decision of Commissioner; granting 20 Motion for Order Affirming Decision of Commissioner (Halley, Taylor) Modified on 9/27/2016 (Halley, Taylor).
UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
CIVIL ACTION NO. 15-11548-GAO
DEBORAH MURPHY,
Plaintiff,
v.
CAROLYN COLVIN,
Defendant.
OPINION AND ORDER
September 27, 2016
O’TOOLE, D.J.
The plaintiff, Deborah Murphy, appeals the denial of her application for Social Security
Disability Insurance and Supplemental Security Income benefits by the Commissioner of the
Social Security Administration. Before the Court are Murphy’s Motion for Order Reversing the
Commissioner’s Decision (dkt. no. 15) and the Commissioner’s Motion for Order Affirming the
Decision of the Commissioner (dkt. no. 20). The court now affirms the Commissioner’s decision
because there is substantial evidence in the administrative record to support the decision, and no
error of law was made.
I.
Procedural History
Murphy protectively applied for benefits on February 18, 2010 claiming that she had been
unable to work since November 1, 2008. (Administrative Tr. at 198–208 [hereinafter R.].)1
Murphy’s applications were initially denied on July 23, 2010 and again upon reconsideration on
1
The administrative record has been filed electronically (dkt. no. 13). In its original paper form,
the administrative record’s pages are numbered in the lower right-hand corner of each page.
Citations to the record are to the pages as originally numbered rather than to the numbering
supplied by the electronic docket.
December 30, 2010. (R. at 112–15, 137–51.) On February 23, 2011, Murphy filed a written request
for a hearing before an Administrative Law Judge (“ALJ”). (Id. at 154–55.)
On December 14, 2011, a video hearing was held before ALJ John S. Lamb. (Id. at 85–
111.) At the video hearing, Murphy provided oral testimony and was represented by attorney
Russell R. Bowling. (Id.) In addition to Murphy, ALJ Lamb heard oral testimony from vocational
expert Mark Leaptrot. (Id. at 106–11.) On February 3, 2012, ALJ Lamb issued a written decision
finding that although Murphy was unable to perform any of her past relevant work as an
“administrative clerk and customer service worker,” she could perform other work that exists in
significant numbers in the national economy based on her “age, education, work experience, and
residual functional capacity” (“RFC”). (Id. at 125–26.) Accordingly, ALJ Lamb found that
Murphy was not disabled pursuant to the Social Security Act and therefore was not entitled to
benefits. (Id. at 127.)
On March 21, 2012, Murphy requested a review of ALJ Lamb’s decision by the Appeals
Council. (Id. at 157.) Upon review, the Appeals Council vacated ALJ Lamb’s decision and
remanded the case for further consideration of Murphy’s RFC, her mental impairments, and the
medical opinions of record. (Id. at 132–36.) As a result, on June 3, 2013, a second hearing occurred
before ALJ M. Dwight Evans. (Id. at 43–84.) At the hearing, Murphy again gave oral testimony
and was again represented by Bowling. (Id. at 43–74.) ALJ Evans also heard testimony from
vocational expert Theresa Manning. (Id. at 74–81.) On July 12, 2013, ALJ Evans issued a written
decision finding that Murphy was not disabled because she was “capable of performing past
relevant work as a secretary.” (Id. at 37–38.) In response, on September 10, 2013, Murphy
requested an Appeals Council review of ALJ Evans’s decision (Id. at 19–20.) On February 5, 2013,
the Appeals Council denied Murphy’s request for review rendering ALJ Evans’s decision the final
2
decision of the Commissioner. (Id. at 1–6.) Having therefore exhausted her administrative
remedies, Murphy timely filed this civil action.
II.
Background
Murphy was born on July 29, 1962, and has a high school education. (Id. at 47–48, 90.)
Murphy alleges that she was diagnosed with Raynaud’s disease at the age of twenty-nine, and that
the onset date of her disability was November 1, 2008. (Id. at 100, 90.) Raynaud’s is a circulatory
disease that results in the narrowing of the “smaller arteries that supply blood to your skin” causing
affected areas, such as the fingers and toes, to become “numb and cold.” Mayo Clinic, Diseases
and Conditions: Raynaud’s Disease, http://www.mayoclinic.org/diseases-conditions/raynaudsdisease/basics/definition/con-20022916 (last visited May 12, 2016). Prior to the alleged onset date
Murphy worked as a secretary, but allegedly found it increasingly difficult to be effective as her
Raynaud’s purportedly worsened over time. (Id. at 52–53.) Murphy claims that her Raynaud’s
limits her ability to work. (Id. at 53–58.)2
A.
Medical History
i.
Dr. Ashok K. Joshi
On February 2, 2010, Murphy began seeing Dr. Ashok K. Joshi, M.D. as her primary care
physician. (Id. at 353.) The purpose of Murphy’s first visit was to obtain a referral from Dr. Joshi
to a vascular surgeon for possible treatment of her reportedly severe Raynaud’s. (Id.) Dr. Joshi
described Murphy as presenting with joint pain in multiple joints, joint stiffness, swelling in the
small joints of her hand, and discoloration in her fingers. (Id.) Dr. Joshi reported that Murphy
2
During the administrative proceedings, Murphy argued that she suffered from several limiting
mental impairments in addition to her Raynaud’s. ALJ Evans held that her mental impairments
were non-severe, and Murphy has not challenged his decision in this action. (R. at 53–54, 94–95,
31.)
3
denied suffering from gout, rheumatoid arthritis (though he indicated an interest in follow-up),
fatigue, rash, malar rash, or that she was taking any medications. (Id.) Dr. Joshi’s examination of
Murphy’s rheumatology revealed a normal range of motion in her cervical spine, normal forward
and lateral bending in her lumbar spine, normal range of motion of all joints in her upper extremity,
normal range of motion of all joints in her lower extremity, and “puffy/swollen” hands with normal
proximal interphalangeal joints. (Id. at 354.) Dr. Joshi noted that Murphy described smoking half
a pack of cigarettes per day for the past twenty years, drinking alcohol on social occasions, and
drinking one to two cups of coffee per day. (Id.)
On April 1, 2010, Murphy visited Dr. Joshi again for an annual physical exam. (Id. at 356.)
During the visit, Dr. Joshi performed a routine medical exam and evaluated Murphy’s Raynaud’s
and nicotine addiction. (Id.) Dr. Joshi described Murphy as having no appreciable disease, alert,
and oriented. (Id. at 357.) Dr. Joshi reported that Murphy’s skin was “unremarkable” with “no
suspicious lesions,” but that her hands and feet had a “bluish discoloration” caused by her
Raynaud’s. (Id. at 357–58.) To treat Murphy’s Raynaud’s, Dr. Joshi stated that she should continue
to take cilostazol tablets two times per day, and ordered a battery of lab tests. (Id. at 356.) In
addition, to combat her Raynaud’s, Dr. Joshi recommended that Murphy stop smoking cigarettes
and “wear gloves in cold weather.” (Id.)
On October 19, 2010, Murphy visited Dr. Joshi for a follow up to review her test results.
(Id. at 362.) Dr. Joshi reported that Murphy’s chief complaint was a year of “constant pain” that
she rated a “10/10” in her elbows and knees for which she was taking ibuprofen. (Id.) Dr. Joshi
reported that Murphy described the pain in her elbow as bilateral, lateral, and exacerbated by lifting
and holding things. (Id.) Murphy denied any radiation of the pain, redness, swelling, tingling, or
numbness, or that it was caused by trauma or injury. (Id.) Dr. Joshi examined her elbow and found
4
there was no swelling, redness, or deformities, but that there was moderate tenderness on the lateral
epicondyle. (Id.) Dr. Joshi opined that Murphy’s range of motion was unremarkable with “normal
flexion and extension,” and strength was within normal limits. (Id.) Dr. Joshi performed a
neurovascular examination and determined that Murphy had normal sensation and pulses. Based
on the tests and Dr. Joshi’s examination, he indicated that Murphy had tennis elbow, abnormal
liver function tests (“LFT”), macrocytosis, alcoholic fatty liver, and proteinuria. (Id.) To treat the
tennis elbow, Dr. Joshi referred Murphy to two rehabilitation facilities for physical therapy, and
recommended that she begin a home exercise program. (Id. at 362–63.) For Murphy’s abnormal
LFTs and macrocytosis, Dr. Joshi ordered additional tests. (Id. at 363.) In light of her Raynaud’s,
Dr. Joshi referred Murphy to Dr. Joseph Rossacci, a specialist in nephrology, for her proteinuria.
(Id.)
ii.
Dr. Paul M. Burke, Jr.
On April 1, 2010, Murphy was examined by Dr. Paul M. Burke, Jr., M.D. Dr. Burke
described Murphy’s “long-standing history of Raynaud’s,” her attempts to treat the condition, and
the challenges it has caused in her life, particularly in her ability to work. (Id. at 350.) Dr. Burke
conducted a physical examination of Murphy describing her as “resting comfortably,” but with
diminished temperature in both hands with no discoloration, thickened skin potentially related to
“chronic skin nutritional changes,” intact motor functioning, and slightly depressed sensory
functioning. (Id.)
Based on his examination, Dr. Burke told Murphy that it was imperative that she quit
smoking immediately, and that she take cold avoidance measures such as moving to a warmer
climate. (Id.) Dr. Burke opined that Murphy was suffering from “one of the worst cases of
Raynaud’s I have ever witness[ed]” and that she suffered from “classic symptoms.” (Id.) Dr. Burke
5
prescribed Pletal “to see if that will improve her distal perfusion,” and advised Murphy that he
would see her again as needed. (Id.) As far as appears from the record, Dr. Burke had no further
encounter with Murphy.
iii.
Dr. Mary Connelly
On July 22, 2010, Dr. Mary Connelly, M.D. completed a Physical Residual Functional
Capacity Assessment (“RFCA”) based on a review of the medical records generated from
Murphy’s visits with Drs. Joshi and Burke. (Id. at 384.) In her RFCA, Dr. Connelly reported that
Murphy could occasionally lift twenty pounds, frequently lift ten pounds, stand and/or walk for
“about 6 hours in an 8-hour workday,” sit for “about 6 hours in an 8-hour workday,” and push
and/or pull unlimitedly. Additionally, Dr. Connelly opined that Murphy had no postural, visual, or
communicative limitations, that she had an unlimited ability to reach in all directions, finger, and
feel, but that she had a limited ability to handle and was “limited to occ[assional] twisting and
grasping.” (Id. at 384–87.) In terms of environmental limitations, Dr. Connelly asserted that
Murphy should “avoid all exposure” to extreme cold, but that she had an unlimited capacity for
exposure to extreme heat, wetness, humidity, noise, vibration, fumes, odors, dusts, gases, poor
ventilation, and hazards such as heights and machinery. (Id. at 387.) To contend with Murphy’s
environmental limitations, Dr. Connelly recommended that Murphy “wear gloves when exposed
to cold” and that she cease smoking. (Id.)
iv.
Dr. Dorothy Linster
On December 20, 2010, Dr. Dorothy Linster, M.D. issued a Physical RFCA based on her
evaluation of Murphy’s medical records from Drs. Joshi and Burke. (Id. at 398.) With regard to
exertional limitations, Dr. Linster averred that Murphy could occasionally lift and/or carry fifty
pounds, frequently lift twenty-five pounds, stand and/or walk “about 6 hours in an 8-hour
6
workday,” sit for “about 6 hours in an 8-hour workday,” and push and/or pull unlimitedly. (Id. at
392.) Dr. Linster stated that Murphy had no postural, visual, or communicative limitations. (Id. at
393–95.) As to manipulative limitations, Dr. Linster asserted that Murphy had an unlimited
capacity for reaching in all directions, fingering, and feeling, but that she was limited to frequent,
but not continuous, handling because of her “hand pain/Raynaud’s.” (Id. at 394.) Finally, in regards
to environmental limitations Dr. Linster opined that Murphy should “avoid even moderate
exposure” to extreme cold, but that she could be exposed to an unlimited amount of extreme heat,
wetness, humidity, noise, vibration, fumes, odors, dusts, gases, poor ventilation, and hazards. (Id.
at 395.)
v.
Dr. Isabella Pasniciuc
On July 29, 2010, Murphy was examined by Dr. Isabella Pasniciuc, M.D. for bilateral
elbow pain. (Id. at 418.) According to Dr. Pasniciuc, Murphy had been experiencing progressive
elbow pain for six months “to the point that she could not carry anything with her arms.” (Id.)
Murphy described the pain to Dr. Pasniciuc as radiating up to her shoulder, worse in the morning
and in her right elbow, and aggravated by bending. (Id.) Murphy also discussed experiencing
“diffuse numbness and tingling in her forearms and hands,” regular coldness in her fingers, and
pain in her lower back. (Id.) Murphy told Dr. Pasniciuc that the pain had escalated to such an
intolerable level during the prior week that she went to the emergency room to seek relief. (Id.)
During her emergency room visit, Murphy was prescribed Motrin, which Murphy stated was
ineffective. (Id.) Dr. Pasniciuc noted that Murphy had a “scattered macular rash” on her chest,
neck, abdomen, and lower legs that had “been there for a while” and had gone largely ignored.
(Id.) Dr. Pasniciuc reported that previous testing had so far ruled out the possibility that Murphy
was suffering from rheumatoid arthritis, systemic lupus erythematosus, or scleroderma. (Id.)
7
Dr. Pasniciuc’s examination of Murphy’s extremities revealed that Murphy’s range of
motion was “severely limited by pain” particularly on the right side and when bending, that she
was experiencing tenderness in both elbows, that there were “hardened and thickened [illegible]
on fingers on both hands,” and that she had a papular rash on her palms. (Id. at 419.) Dr. Pasniciuc
indicated that Murphy was “in mild distress due to pain,” but that she was “alert and oriented x3”
with “good judgment and insight” during the examination. (Id.) Based on her examination, Dr.
Pasniciuc stated that Murphy had bilateral elbow pain, and provided her with a prescription for
Voltaren Gel and 50 mg of Tramadol. (Id.) Dr. Pasniciuc advised Murphy to avoid cold weather
and to obtain an x-ray of both elbows. (Id.) Dr. Pasniciuc also informed Murphy that she might be
suffering from a “systemic connective tissue disease,” and that “she might need to see a
rheumatologist.” (Id.)
One week later, on August 5, 2010, Murphy visited Dr. Pasniciuc again to follow up on
her “persistent bilateral elbow pain.” (Id. at 416.) Dr. Pasniciuc reported that the “x-rays of the
elbow were negative.” (Id.) According to Dr. Pasniciuc, Murphy reported that the “Voltaren gel
helps a little bit,” but that her fingers continued to turn cold and purple in cold climates. (Id.)
During the examination, Dr. Pasniciuc noted that Murphy’s condition appeared to have improved
since her previous visit, but that she had “bilateral swollen hands,” rashes on her palms, papules
on her palms and neck, and purple discoloration on the tips of several of her fingers. (Id.) Dr.
Pasniciuc indicated that she believed Murphy’s elbow pain was related to her Raynaud’s, that she
should see a rheumatologist, and that if the pain continued she would “need to come back to have
a local steroid injection.” (Id.) Dr. Pasniciuc repeated her advice to Murphy that she avoid cold
weather, and provided her with a prescription for Nifedipine. (Id.)
8
vi.
Dr. Stephen Burgess
On September 14, 2011, Dr. Stephen Burgess, M.D., Ph.D. conducted a physical medical
consultative examination of Murphy at Tri-State Occupational Medicine, Inc. (Id. at 401.) Dr.
Burgess described Murphy as “a reliable historian” during his examination, and reported that they
had discussed Murphy’s history of Raynaud’s and the personal and professional difficulties it has
caused in her life. (Id.) Dr. Burgess opined that Murphy “has no specific limitations if she is
warm.” (Id.) Dr. Burgess further averred that when warm, Murphy is “able to stand, sit, walk,
climb stair[s] or ladders, squat, kneel, bend, twist, carry, lift, and push or pull without limitations.”
(Id.) In addition, Dr. Burgess found that when warm, Murphy could “perform housework such as
sweeping, mopping, doing laundry, vacuuming, washing dishes, cooking, dusting, making beds,
mow[ing], and weed[ing].” (Id. at 401–02.) However, Dr. Burgess noted that when exposed to
cold, Murphy’s “hands become numb and stiff very quickly and she is unable to use her hands
until she warms up” which prevents her from performing rudimentary tasks such as the lifting of
“light items such as a cup.” (Id. at 402.) Dr. Burgess noted that when Murphy’s hands are cold she
cannot “perform any sort of fine motor activity . . . this includes typing, writing, buttoning buttons,
and so forth.” (Id.)
Generally, Dr. Burgess described Murphy as “well developed and well nourished.” (Id.)
Dr. Burgess reported that Murphy was attempting to quit but was still smoking “two or three
cigarettes a day,” drinking one glass of alcohol per day, and was not taking any street drugs. (Id.)
Dr. Burgess indicated that Murphy “ambulates with a normal gait, which is not unsteady, lurching,
or unpredictable,” and does not need the assistance of a handheld device. (Id.) Dr. Burgess opined
that Murphy “has a normal stance and appears stable at station and comfortable in the supine and
sitting positions.” (Id.) According to Dr. Burgess, Murphy’s intellectual functioning and hearing
9
appeared normal. (Id.) Dr. Burgess noted that Murphy was cooperative and that her memory for
recent and remote medical events was good. (Id.)
Dr. Burgess examined Murphy’s upper extremities and noted that her shoulders, elbows,
and wrists were non-tender with no “redness, warmth, swelling or nodules.” (Id. at 403.) Dr.
Burgess indicated that Murphy was capable of forward flexion of her extended arms to 180 degrees
bilaterally, “abduction of both extended arms in a sideways arc in the coronal plane of the body .
. . to 180 degrees bilaterally,” flexion of her elbows “to 150 degrees bilaterally with extension
normal to 0 degrees bilaterally,” and extension of her wrists “to 70 degrees bilaterally with flexion
to 80 degrees bilaterally.” (Id.) Dr. Burgess noted that his examination of her hands revealed “some
redness, swelling, and tenderness . . . fairly globally.” (Id.) Additionally, Dr. Burgess opined that
Murphy’s hands had no atrophy, Heberden or Bouchard’s nodes, ulnar deviation or synovial
thickening, and she could “make a fist bilaterally,” could “write and pickup coins with either hand
without difficulty,” and had normal “range of motion of the joints of the fingers of both hands.”
(Id.) Dr. Burgess examined Murphy’s lower extremities noting that there was “no tenderness,
redness, warmth, swelling, fluid, crepitus or laxity of the knees, ankles, or feet,” and “no calf
tenderness, redness, warmth, cord sign, or Homans sign.” (Id.) Dr. Burgess stated that Murphy was
capable of knee extension to zero degrees and flexion to 150 degrees bilaterally. (Id.) Dr. Burgess
opined that Murphy’s “ankle joints demonstrate plantar flexion of 40 degrees bilaterally and
dorsiflexion of 20 degrees bilaterally.” (Id.) Dr. Burgess’s examination of Murphy’s skin revealed
“significant splotchiness of the palms bilaterally with tiny macules which appear to be no larger
than one to two millimeters in diameter, some of which are blanching and some of which are not,”
but otherwise her skin was “grossly unremarkable with no ulceration on the skin or fingertips.”
(Id. at 404.)
10
Dr. Burgess stated that Murphy had “severe Raynaud’s phenomenon which affects her
ability to work in any sort of cold or cool environment.” (Id.) In addition, Dr. Burgess stated that
he found “some indication on the hand of possible autoimmune disease or even vasculitis.” (Id.)
Dr. Burgess noted that Murphy would benefit from a follow-up with a rheumatologist, but that it
was “probably not necessary” for the purposes of his evaluation. (Id.) In sum, Dr. Burgess opined
that Murphy appeared “to be episodically moderately impaired” in her capacity “to perform workrelated activities such as bending, stooping, lifting, walking, crawling, squatting, carrying,
traveling, pushing and pulling heavy objects, as well as the ability to hear or speak” because of her
observed medical issues. (Id.) Dr. Burgess concluded that Murphy’s “insight into and description
of [her] limitations” was consistent with his objective evaluation. (Id. at 405.)
In conjunction with his physical examination of Murphy, Dr. Burgess submitted a Medical
Source Statement of Ability to Do Work-Related Activities (Physical) (“MSS”). (Id. at 406–11.)
In his MSS, Dr. Burgess reported that Murphy could lift and carry up to twenty pounds
continuously, fifty pounds frequently, and 100 pounds occasionally; sit for four hours, stand for
two hours, and walk for one hour without interruption; sit for eight hours, stand for eight hours,
and walk for eight hours in an eight-hour workday without the use of a cane; reach overhead
frequently, and reach in all other directions, handle, finger, feel, push and pull with her hands
continuously; operate foot controls continuously; climb stairs, ramps, ladders, and scaffolds
continuously; balance, stoop, kneel, crouch, and crawl continuously; be exposed to unprotected
heights, moving mechanical parts, humidity, wetness, dusts, odors, fumes, pulmonary irritants, and
extreme heat continuously; operate a motor vehicle continuously; be exposed to vibrations
occasionally and be exposed to very loud noises, but that she must never be exposed to extreme
cold. (Id. at 406–10.) Dr. Burgess explained that his assessment of Murphy’s limitations was
11
predicated on her “well documented Raynaud’s Disease, which absolutely precludes working in
extremely cold environments.” (Id. at 410 (emphasis in original).) Dr. Burgess elaborated further
that “working in temperatures below 70° can have [a] deleterious effect” based on Murphy’s
history, medical records, and Dr. Burgess’s physical evaluation. (Id.) Dr. Burgess stated that, based
on Murphy’s physical impairments, she could “perform activities like shopping,” travel
unaccompanied, ambulate without an assistive device, “walk a block at a reasonable pace on rough
or uneven surfaces,” use public transportation, “climb a few steps at a reasonable pace with the
use of a single hand rail,” cook a “simple meal and feed herself,” care for her personal hygiene,
and “sort, handle, or use” papers and files. (Id. at 411.)
vii.
Dr. Kenneth P. Reeder
On October 18, 2011, Dr. Kenneth P. Reeder, Ph.D. conducted a comprehensive clinical
psychological evaluation of Murphy for the North Carolina Department of Health and Human
Services. (Id. at 412–14.) Dr. Reeder described Murphy as “alert and fully oriented to person,
place, time, and situation.” (Id. at 414.) According to Dr. Reeder, Murphy “denied having difficulty
performing her activities of daily living” which consisted of watching the news, cooking, cleaning,
doing laundry, shopping, and going to the library, but that it was taking her increasingly more time
to perform them. (Id. at 413.)
Dr. Reeder opined that Murphy’s memory of “recent and remote events was good,” but
that she had “some concentration difficulties” which were ameliorated when she slowed down and
focused. (Id. at 414.) Dr. Reeder estimated that, based on Murphy’s education and previous
vocation, her intellectual functioning was “in or around the average range.” (Id.) Dr. Reeder stated
that Murphy displayed no “evidence of hallucinations or delusions,” and “performed relatively
well on a judgment task, but displayed significant difficulty interpreting abstract
12
sayings/proverbs.” (Id.) Dr. Reeder diagnosed Murphy with Major Depressive Disorder and
Alcohol Dependence in remission. (Id.) Based on this diagnosis, Dr. Reeder opined that it seemed
“likely that she would be able to understand, retain, and follow instructions,” and although it might
take her more time to learn things, her “mental status results suggest that she should be able to
learn information over time.” (Id.) Dr. Reeder indicated that Murphy might be capable of
performing repetitive tasks, but the “pain from her Raynaud’s disease and her difficulty
manipulating objects might interfere with” her performance. (Id.) In addition, Dr. Reeder stated
that Murphy was capable of tolerating work-related stress based on her demonstrated capacity for
mitigating stress in the past, and that she is capable of acquiring needed knowledge over time
through repetition even if she has “significant concentration problems that will likely decrease her
efficiency.” (Id.) In conclusion, Dr. Reeder asserted that Murphy “should be able to independently
manage benefits that she might obtain.” (Id.)
viii.
Dr. David B. Rawlings
On May 8, 2013, Dr. David B. Rawlings, Ph.D. performed a general intellectual and
clinical psychological evaluation of Murphy at the behest of the Office of Disability
Determinations of the Florida Department of Health. (Id. at 426.) According to Dr. Rawlings, at
the time of his examination, Murphy’s “hands were cold to the touch” and were discolored to a
“reddish blue.” (Id. at 427) Dr. Rawlings reported that Murphy complained of bladder incontinence
four to five times per week, intermittent tingling sensations and numbness in her hands and to a
lesser degree in her feet, “lightheadedness with postural changes,” and low blood pressure. (Id.)
Dr. Rawlings described Murphy as “ambulatory without assistance” with no observable
gait deviations, no difficulty standing once seated, and no retropulsion when standing. (Id. at 429)
Dr. Rawlings noted that Murphy was “casually dressed and appropriately groomed,” looked her
13
age, wore reading glasses when reading up close, did not appear to require a hearing aid, and did
not have any perceivable or reported hygiene problems. (Id.) Dr. Rawlings reported that he found
it easy to establish a rapport with Murphy and that “her behavior suggested full cooperation.” (Id.)
Dr. Rawlings noted that Murphy’s mood and affect were “functionally intact,” and that she was
not “guarded, defensive, paranoid, suspicious. . . . overtly depressed, or emotionally labile,” but
that “she seemed to be overtly anxious” at times. (Id. at 429–30.) According to Dr. Rawlings,
Murphy’s speech seemed “somewhat pressured and harried” and it was necessary to restrain her
“from time to time as she was verbally disinhibited.” (Id. at 430.) Dr. Rawlings did not observe
any “obvious word finding difficulties or paraphasic errors” during their conversation. (Id.) Dr.
Rawlings noted that Murphy’s “[a]uditory comprehension was functionally intact” with no
perceptible hearing problems. (Id.) Dr. Rawlings reported that Murphy did not complain of pain
or exhibit “overt pain behaviors,” and did not express “other indications of abnormal thought
content.” (Id.)
ix.
Dr. A. Neil Johnson
On May 10, 2013, Dr. A. Neil Johnson, M.D. performed a medical evaluation of Murphy
based on a referral by the Office of Disability Determinations of the Florida Department of Health.
(Id. at 436.) Dr. Johnson reported that Murphy’s chief complaints were for Raynaud’s and
depression. (Id.) Dr. Johnson noted that Murphy reported “that she doesn’t really like to be in
temperature below 80.” (Id.) According to Dr. Johnson, Murphy cannot lift items heavier than a
gallon, use a hammer, use a screwdriver, peel potatoes, or “open a tight jar lid.” (Id.) According to
Dr. Johnson, Murphy described experiencing difficulty “with buttons or picking up a coin or doing
snaps” and cannot perform the tasks at all “if her hands are cold.” (Id.) Dr. Johnson noted that
Murphy can use utensils to eat, walk a quarter of a mile even though her feet turn purple because
14
of her Raynaud’s, and “sit or stand satisfactorily.” (Id.) Dr. Johnson noted that in regards to
Murphy’s mental health she “had a history of significant depression,” suffered from sexual abuse
as a young child, underwent divorce twice, and “has been diagnosed with ADHD, depression and
post-traumatic stress disorder.” (Id.) Dr. Johnson reported that Murphy was on no medications at
the time. (Id.)
Dr. Johnson opined that Murphy “was very loquacious,” somewhat anxious, and had “to
be directed” to elicit her history. (Id. at 437.) Dr. Murphy reported that Murphy “can hear
conversational speech without limitation,” has clear speech, can walk “normally without the use
of an assistive device,” and experiences “no difficulty tandem walking or squatting.” (Id.) Dr.
Johnson examined Murphy’s skin, eyes, neck, chest, heart, and abdomen with no indication of any
abnormalities. (Id.) Dr. Johnson reported that Murphy did not have clubbing or cyanosis in her
extremities, the peripheral pulses were intact, there was no peripheral edema, and no varicose
veins. (Id.) However, Dr. Johnson reported that all of Murphy’s fingers and toes were “essentially
purple” and cool to the touch. (Id.) Dr. Johnson indicated that he could feel her radial and foot
pulses bilaterally, but that they were “somewhat decreased.” (Id.) Dr. Johnson noted that Murphy
had full range of motion in her “shoulders, elbows, wrists, fingers, knees, and ankles,” no
ulcerations, and “no sign of rheumatoid arthritis.” (Id.) Dr. Johnson reported that Murphy
experienced difficulty buttoning, picking up a coin, snapping her clothing, and writing. (Id.) Dr.
Johnson’s neurological examination resulted in his finding Murphy negative in regards to the
Romberg’s Test, with intact sensation, 5/5 motor strength, symmetrical reflexes, and no
disorientation. (Id. at 439.)
Dr. Johnson concluded that Murphy suffered from “severe Raynaud’s” that “distinctly
interferes with hand function,” decreases her strength, and decreases her dexterity. (Id.) Dr.
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Johnson noted that Murphy’s Raynaud’s was not being treated at the time because she could not
“afford any treatment,” and that she had found past treatments ineffective. (Id.) Dr. Johnson opined
that Murphy could not type and write for extended periods of time “as might be expected as a
secretary.” (Id.) Dr. Johnson also reiterated that Murphy had “dealt with significant depression,
post-traumatic stress disorder, and ADHD” ever since she was sexually abused. (Id. at 440.)
Based on his physical examination of Murphy, Dr. Johnson composed a MSS report. (Id.
at 441–46.) Dr. Johnson reported that Murphy could occasionally lift and carry up to ten pounds,
but she could never lift or carry more than that. (Id. at 441.) Dr. Johnson indicated she could sit
and stand for two hours at a time, walk for one hour at a time, and that in an eight hour workday
she could sit for eight hours, stand for six hours, and walk for four hours. (Id. at 442.) Dr. Johnson
noted she did not need a cane to walk. (Id.) According to Dr. Johnson, Murphy could continuously
reach in all directions, and occasionally handle, finger, feel, push, and pull with both her right and
left hand, and occasionally operate foot controls, climb stairs and ramps, climb ladders or
scaffolds, balance, stoop, kneel, crouch, and crawl. (Id. at 443–44.) Dr. Johnson reported that
Murphy’s hearing and vision were not impaired. (Id. at 444.) In regards to environmental
limitations, Dr. Johnson noted that Murphy could be exposed frequently to the operation of a motor
vehicle and loud noise, occasionally to moving mechanical parts, dust, odors, fumes, pulmonary
irritants, vibrations, and never to unprotected heights, humidity, wetness, and extreme cold. (Id. at
445.) Dr. Johnson opined that Murphy could not “perform activities like shopping,” but that she
was capable of traveling unaccompanied, ambulating without an assistive device, “walk[ing] a
block at a reasonable pace on rough or uneven surfaces,” using public transit, climbing “a few
steps at a reasonable pace without the use of a single hand rail,” preparing a meal, caring for her
personal hygiene, and sorting and handling papers and files. (Id. at 446.)
16
B.
Relevant Testimony
i.
The First Hearing: December 14, 2011
(1)
Murphy
On December 14, 2011, Murphy testified for the first time in a video hearing before ALJ
Lamb. (Id. at 90–106.) Murphy testified that since the age of twenty-nine she has suffered
Raynaud’s attacks during which her arteries spasm causing her hands and fingers to become cold,
purple, numb, swollen, and stiff. (Id. at 104, 92.) Murphy further explained that her Raynaud’s
causes ulcerations on her fingers and prevents her brain from being properly oxygenated which
interferes with her ability to concentrate. (Id. at 92–93, 102–03.) As a result, Murphy testified that
she is unable to function in any type of cold atmosphere making it difficult to work in an officesetting because of the prevalence of air conditioning. (Id. at 102, 93.) For example, she stated that
she was disciplined at her prior job because she had “to keep stepping outside” to warm up, and
that her concentration is so impaired that she cannot effectively read or watch a movie without
losing her focus. (Id. at 101.) Furthermore, Murphy described the ways in which Raynaud’s
complicates her ability to complete various activities of daily living such as zipping her pants,
fastening buttons, tying her shoes, retrieving change from her purse, shopping in food stores, and
completing household chores in a timely fashion. (Id. at 105, 93.)
According to Murphy, her Raynaud’s is “something that’s never going to go away. There’s
no cause and there’s no cure.” (Id. at 93.) In addition, Murphy testified that her lack of insurance
has prevented her from seeing a rheumatologist or consistently treating her Raynaud’s, but that
none of the various treatments she has pursued in the past, such as taking nitroglycerine, blood
thinners, or moving to the warmer climate of the South have adequately alleviated her symptoms.
(Id. at 92–94, 100–01.)
17
(2)
Vocational Expert Leaptrot
During the hearing, vocational expert Mark Leaptrot (“VE Leaptrot”) provided testimony
regarding Murphy’s prior work history and her capacity for future employment. (Id. at 107–10.)
VE Leaptrot testified that Murphy had previously worked as an administrative clerk and as a
customer service clerk as defined by the Dictionary of Occupational Titles (“DOT”). (Id. at 107.)
VE Leaptrot testified that a hypothetical individual with an RFC for medium work but who must
avoid all exposure to extreme cold and is “limited to simple, routine, repetitive tasks with low
stress” could not return to Murphy’s past work activities because they were semiskilled positions.
(Id.) However, VE Leaptrot stated that such an individual could participate in unskilled light or
sedentary work such as that of a routing clerk, office mail clerk, telephone information clerk,
surveillance system monitor, or carding machine operator. (Id. at 108.) Based on a hypothetical
posed by Bowling, VE Leaptrot testified that an individual with the same age, education, and past
relevant work history as Murphy who was limited to light work, occasional use of her hands and
fingers, and occasional concentration would be precluded from all work. (Id. at 109–10.)
ii.
The Second Hearing: June 3, 2013
(1)
Murphy
On remand, Murphy testified before ALJ Evans. Similar to her testimony before ALJ
Lamb, Murphy described her history of Raynaud’s, the limitations it imposed on her professionally
and personally, her history of mental impairments, and her history of treatments. (Id. at 52–74.)
According to Murphy, she was diagnosed with Raynaud’s at the age of twenty-nine at which time
her doctor advised her to leave her “job because of medical reasons” and she moved to Florida.
(Id. at 53, 72.) Murphy stated that except for one day of work at a Costco, she had not worked
since November 2008. (Id. at 52.) Murphy testified that prior to November 2008 she worked as a
18
secretary. (Id. at 52, 60–62.) According to Murphy, she struggled in this position because her
Raynaud’s caused her hands to turn purple and go numb if exposed to cold or stress which made
it difficult for her to type, concentrate, write by hand, and manage files. (Id. at 52, 56.) Murphy
further stated that she was often reprimanded for repeatedly going outside to warm up. (Id. at 52,
56, 60.) Murphy testified that after approximately one year of employment, she was discharged
from her position at the same time a few of her coworkers were laid-off prior to the business’s
closure. (Id. at 60–62.) Murphy testified that after her discharge she received unemployment
benefits for a period of time, but since then has depended on $200 worth of food assistance and
her ability to live with a friend. (Id. at 59, 55, 58.) In addition, Murphy testified that she visited a
vocational rehabilitation center three or four times and sought work online to no avail. (Id. at 63–
64.)
In regards to her activities of daily living, Murphy testified that she spends most of her time
reading, watching movies, taking occasional walks, and tending to household chores. (Id. at 68–
71.) Murphy averred that she could cook, sweep, do laundry, and clean the dishes, but that these
tasks take her an inordinately long time to accomplish. (Id. at 58, 69–70.) Murphy stated that she
does not vacuum, iron, garden, provide childcare, participate in volunteer work, or affiliate with
any community organizations. (Id. at 70–71.) Murphy further stated that her impairments interfere
with her ability to get dressed, go shopping, open lids, and complete tasks in a timely fashion. (Id.
at 57–58.) Murphy testified that she can drive and has not been in a car accident in over a decade.
(Id. at 65, 59.)
Murphy testified that she did not have medical insurance and as a result was not receiving
any form of medical treatment for her Raynaud’s or her alleged mental impairments. (Id. at 54,
66–67, 73–74.) Murphy stated that when she was living in North Carolina she was sponsored by
19
Pfizer which allowed her to take Procardia to treat her Raynaud’s, but that she had not found it
particularly effective and had ceased taking it when she moved back to Florida. (Id. at 66.)
(2)
Vocational Expert Manning
After Murphy, vocational expert Theresa Manning (“VE Manning”) provided ALJ Evans
with testimony regarding Murphy’s prior and potential work activities. (Id. at 74–81.) VE Manning
testified that Murphy’s prior work was the sedentary and skilled work of a secretary as defined by
the DOT. (Id. at 74–75.) Based on three hypotheticals posed by ALJ Evans, VE Manning testified
that an individual of Murphy’s same age, education, and work experience with a RFC equal to
those described in the MSS of Dr. Burgess and the RFCAs of Drs. Linster and Connelly could
perform Murphy’s prior work as a secretary. (Id. at 75–78.) However, VE Manning testified that
a similarly situated individual with a RFC as described by Dr. Johnson’s MSS could not perform
Murphy’s prior work or any other job that exists “in significant numbers in the local, regional, or
national economy.” (Id. at 78–79.) Finally, based on a hypothetical posed by Murphy’s attorney
Bowling, VE Manning testified that a similarly situated individual who could not “concentrate and
sustain attention for up to two hour periods. . . . due to severe levels of depression and moderate
anxiety,” who was limited to occasional lifting and carrying of up to ten pounds, occasional
handling, fingering, feeling, pushing, pulling, climbing of stairs, ramps, ladders, and scaffolds,
balancing, stooping, kneeling, crouching, and crawling, who could never be exposed to
unprotected heights, humidity, wetness, and extreme cold would be precluded from all work. (Id.
at 80–81.)
III.
Disability Determination Process
The Social Security Act defines “disability” as an “inability to engage in any substantial
gainful activity by reason of any medically determinable physical or mental impairment which can
20
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). An individual is considered disabled if her:
Physical or mental impairment or impairments are of such severity that [she] is not
only unable to do [her] previous work but cannot, considering [her] age, education,
and work experience, engage in any other kind of substantial gainful work which
exists in the national economy, regardless of whether such works exists in the
immediate area in which [she] lives, or whether a specific job vacancy exists for
[her], or whether [she] would be hired if [she] applied for work.
42 U.S.C. § 423(d)(2)(A).
To determine whether an individual qualifies as disabled, the Social Security
Administration has promulgated a five-step sequential evaluation process. 20 C.F.R. §§
404.1520(a), 416.920(a). Every claimant does not proceed through all five steps, as a
determination of disability can be reached at each. Id. During the process, the claimant bears “the
burden of production and proof at the first four steps.” Freeman v. Barnhart, 274 F.3d 606, 608
(1st Cir. 2001). If the claimant successfully carries their burden, at the fifth step, the burden shifts
to the Commissioner to provide “evidence of specific jobs in the national economy” that the
claimant is capable of performing. Id.
ALJ Evans’s decision after remand adhered to the five-step sequential evaluation process.
(R. at 28–29.) At step one, ALJ Evans averred that Murphy had “not engaged in substantial gainful
activity since November 1, 2008, the alleged onset date.” (Id. at 29)
At step two, ALJ Evans determined that Murphy’s Raynaud’s constituted a severe
impairment that resulted in “limitations that significantly affect the claimant’s ability to perform
basic work activities.” (Id. at 29–30.)
At step three, ALJ Evans found that Murphy did “not have an impairment or combination
of impairments that meets or medically equals the severity of one of the listed impairments in 20
C.F.R. Part 404, Subpart P, Appendix 1.” (Id. at 32.) ALJ Evans found that, based on Murphy’s
21
medical record and hearing testimony, she did not have the requisite “degree of symptoms and the
documentation and continuity of medical treatment” necessary to establish an impairment as
severe as those listed. (Id.) As a result, ALJ Evans proceeded to evaluate Murphy’s RFC in
anticipation of step four. (Id.) The RFC represents the most the claimant can do in terms of the
“physical, mental, sensory, and other requirements of work,” despite the limitations imposed by
her impairment and its resultant symptoms. 20 C.F.R. §§ 404.1545, 416.945. ALJ Evans
determined that Murphy possessed the RFC “to perform the full range of medium work as defined”
by 20 C.F.R. § 404.1567(c) and § 416.967(c), with the ability to do various work-related activities
on a regular and continuing basis as described in Dr. Burgess’s MSS. (R. at 32.) In support of this
conclusion, ALJ Evans asserted that he considered all of the symptoms associated with Murphy’s
Raynaud’s and found that Murphy’s contentions in regards to the “intensity, persistence and
limiting effects” of the symptoms were “not entirely credible” because of the activities of daily
living Murphy described to Dr. Reeder, her “relatively infrequent trips to the doctor for the
allegedly disabling symptoms,” and Evans’s his holistic review of the record. (Id. at 33–34.)
At step four, ALJ Evans found that based on his RFC evaluation, Murphy was “capable of
performing past relevant work as a secretary, DOT #201.362-030, sedentary with an SVP of 6
(skilled).” (Id. at 37.) ALJ Evans explained that he based this decision on testimony from VE
Manning that a hypothetical person with Murphy’s RFC could perform the work of a secretary,
and his own comparison of Murphy’s RFC “with the physical and mental demands of the work.”
(Id.) Specifically, ALJ Evans found that based on Murphy’s RFC, her exertional capabilities
exceeded the demands of sedentary secretarial work, and “she does not have a mental impairment
or other nonexertional limitations that preclude her from performing skilled work.” (Id.) As a
result, ALJ Evans determined that Murphy had not been disabled from her onset date of November
22
1, 2008 to the date of his decision on July 12, 2013. (Id.) Consequently, ALJ Evans did not proceed
to step five, and Murphy’s application for benefits was denied. (Id. at 37–38.)
IV.
Standard of Review
Pursuant to 42 U.S.C. § 405(g), an individual may seek review of any final decision by the
Commissioner within sixty days. 42 U.S.C. § 405(g) (2015). Upon review, a district court may
affirm, modify, or reverse the decision based “upon the pleadings and transcript of the record.” Id.
However, the court’s review is pointedly circumscribed. Ward v. Comm’r of Soc. Sec., 211 F.3d
652, 655 (1st Cir. 2000). The court’s review is limited to an evaluation as to whether the “ALJ
used the proper legal standards and found facts upon the proper quantum of evidence.” Id. An
ALJ’s findings in regards to any facts are conclusive “if supported by substantial evidence.” Id.
Where there is substantial evidence to support the Commissioner’s decision it must be affirmed
“even if the record arguably could justify a different conclusion.” Rodriguez Pagan v. Sec’y of
Health & Human Servs., 819 F.2d 1, 3 (1st Cir. 1987). Substantial evidence requires “more than a
mere scintilla,” and exists when there is sufficient relevant evidence that a “reasonable mind,
reviewing the evidence in the record as a whole, could accept it as adequate to support [the ALJ’s]
conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971). When reviewing the record, the
ALJ, not the court, is responsible for drawing factual inferences, making credibility
determinations, and resolving evidentiary conflicts. Irlanda Ortiz v. Sec’y of Health & Human
Servs., 955 F.2d 765, 769 (1st Cir. 1991).
V.
Discussion
On appeal, Murphy argues that ALJ Evans’s determination should be overturned for lack
of substantial evidence and legal error because ALJ Evans did not properly weigh the medical
opinion evidence. (Pl.’s Br. in Supp. of a Social Security Appeal 12–13 (dkt. no. 16) [hereinafter
23
Pl.’s Br.].) Specifically, Murphy contends that ALJ Evans inadequately weighed the medical
opinion evidence in two ways: (1) by giving “great weight” to Dr. Burgess’s opinion but not
“adequately address[ing] the limitations expressed in that opinion” in his RFC determination and
colloquy with VE Manning, and (2) by not giving the opinions of Drs. Joshi and Burke controlling
weight as treating physicians. (Id. at 13–17.)
A.
Opinion of Dr. Burgess
i.
RFC Determination
Murphy alleges that ALJ Evans committed legal error by attributing “great weight” to the
opinion of Dr. Burgess, but not adopting all of the limitations articulated in Dr. Burgess’s opinion
in his RFC determination. (Id. at 13.) More specifically, Murphy maintains that ALJ Evans erred
by not incorporating a limitation in his RFC which reflects Dr. Burgess’s finding that “even
working in temperatures below 70°F can have [a] deleterious effect” on Murphy. (Id. at 14 (citing
R. at 410.))
It is the exclusive prerogative of the ALJ, as the designee of the Commissioner, to
determine a claimant’s RFC based on the ALJ’s assessment of the entirety of the record. 20 C.F.R.
§§ 404.1545, 416.945. While conducting his appraisal, the ALJ must consider each medical
opinion in the record and determine what weight it will be given. 20 C.F.R. §§ 404.1527, 416.927,
404.1520b, 416.920b. Unless a treating source is given “controlling weight,” the weight attributed
to all other medical opinions is to be determined by the ALJ based on the application of the
following factors: (1) whether the source examined and/or treated the claimant; (2) the length and
frequency of the treatment relationship; (3) the “nature and extent of the treatment relationship;”
(4) the strength and sufficiency of the evidence relied upon in the formation of the opinion; (5) the
consistency of the opinion with the record as a whole; (6) the specialty, if any, of the source; and
24
(7) any other factors brought to the ALJ’s attention by the claimant. 20 C.F.R. §§ 404.1527(c),
416.927(c). Finally, when issuing his RFC assessment the ALJ “must include a narrative
discussion describing how the evidence supports each conclusion, citing specific medical facts
(e.g., laboratory findings) and nonmedical evidence (e.g., daily activities, observations).” SSR 968p, 1996 WL 374184 at *7 (July 2, 1996).
Murphy’s argument is ultimately unpersuasive because she does not cite to, nor do I find,
any First Circuit precedent indicating that once an ALJ has ascribed “great weight” to a medical
opinion he is then bound to incorporate the totality of that doctor’s opinion into their RFC
determination. On the contrary, the First Circuit has expressly rejected the idea that “there must
always be some super-evaluator,” and instead has held that ALJs are permitted “to piece together
the relevant medical facts from the findings and opinions of multiple physicians.” Evangelista v.
Sec’y of Health and Human Servs., 826 F.2d 136, 144 (1st Cir. 1987). Furthermore, unlike
“controlling weight,” the label “great weight” is not a legal term of art. In fact, the term is never
mentioned in the regulations which set forth how the ALJ is to evaluate opinion evidence. See 20
C.F.R. §§ 404.1527, 416.927, 404.1520b, 416.920b.
ALJ Evans explained that he attributed “great weight” to Dr. Burgess’s opinion because he
found that the doctor:
[P]resented relevant evidence to support his opinion, and he provided a good
explanation for his opinion. (20 C.F.R. 404.1527(d)). Furthermore, his opinion is
consistent with and supported by the medical evidence as a whole including
claimant’s own self-reported activities of daily living and claimant’s relatively
normal physical examinations that showed minimal limitations overall.
(R. at 36.)
While perhaps brief, ALJ’s Evans’s description of his rationale for affording “great weight”
to the opinion of Dr. Burgess demonstrates that his determination was based on his overall
evaluation of the record, and that he applied the required regulatory factors. See 20 C.F.R. §§
25
404.1527, 416.927. Accordingly, ALJ Evans has not committed legal error, and his determination
cannot be disturbed if supported by substantial evidence.
In the absence of legal error, the operative question becomes whether it was reasonable for
ALJ Evans’s not to have incorporated Dr. Burgess’s remark into his RFC determination. (Pl.’s Br.
14 (citing R. at 410.)) Revealingly, the notation at issue was offered as a response to the MSS
form’s prompting to “identify the particular medical or clinical findings . . . which support your
assessment or any limitations and why the findings support the assessment.” (R. at 410.) Given
this context, and the permissive language of Dr. Burgess’s notation (“can have [a] deleterious
effect”), it is reasonable for ALJ Evans to have read the comment not as an additional limitation,
but as an identification by Dr. Burgess of a finding that supports his assessment that Murphy could
never be exposed to extreme cold. (See id.) As such, there was substantial evidence to support ALJ
Evans’s decision to include only the limitation that Murphy never be exposed to extreme cold. (Id.
at 410, 32, 36.)
Furthermore, surveying the record as a whole, there was substantial evidence to support
ALJ Evans’s decision not to include Dr. Burgess’s notation in his RFC assessment. No other
medical opinion in the record included a precise proscription regarding exposure to temperatures
below seventy degrees. While Drs. Joshi, Burke, Connelly, Linster, Pasniciuc, and Johnson all
advised Murphy to avoid cold temperatures, only Dr. Burgess indicated that Murphy’s threshold
for exposure could be around seventy degrees. (Id. at 356, 350, 387, 395, 419, 445.) In fact, Dr.
Johnson noted that Murphy “doesn’t really like to be in temperatures below 80.” (Id. at 436.) Given
the lack of consistency, it is reasonable for ALJ Evans to have elected not to incorporate Dr.
Burgess’s seventy degree notation, and to have instead decided that a limitation that Murphy avoid
all exposure to extreme cold accurately represented her RFC based on the record.
26
ii.
Colloquy with VE Manning
According to Murphy, ALJ Evans erred by not providing “VE Manning with an accurate
depiction of [Murphy’s] limitations” as expressed in Dr. Burgess’s opinion, and that as a result VE
Manning’s testimony could not constitute substantial evidence. (Pl.’s Br. 14–15.) To qualify as
substantial evidence, a vocational expert’s opinion must be based on a hypothetical posed by the
ALJ that accurately depicts the claimant’s limitations. Cohen v. Astrue 851 F. Supp. 2d 277, 282
(D. Mass. 2012) (citing Arocho v. Sec’y of Health & Human Servs., 670 F.2d 374, 375 (1st Cir.
1982).
Murphy advances two arguments in support of her contention that ALJ Evans did not
accurately portray Murphy’s limitations during his colloquy with VE Manning. First, Murphy
argues that ALJ Evans erred by not including the limitation that Murphy “has well documented
Raynaud’s Disease, which absolutely preclude working in extremely cold, environments, even
working in temperatures below 70°F can have deleterious effect.” (Pl.’s Br. 14 (citing R. at 410.))
At the outset, this argument ignores the fact that ALJ Evans explicitly included the limitation that
Murphy could not be exposed to extreme cold in his hypothetical to VE Manning. (R. at 76.)
Moreover, for the same reasons addressed above, ALJ Evans was not legally bound to incorporate
every notation within Dr. Burgess’s opinion, and acted within his authority when he appraised the
record as a whole and chose not to include the seventy degree limitation in his RFC determination.
Second, Murphy contends that ALJ Evans committed error by not including “Dr. Burgess’s
restriction that Plaintiff would experience symptoms of Raynaud’s Phenomenon in air conditioned,
temperature controlled environments (such as an office setting)” in his RFC determination. This
argument is unpersuasive for two reasons. First, it is not clear that Dr. Burgess ever proffered such
a restriction. In his evaluation notes, Dr. Burgess opined that Murphy’s Raynaud’s “affects her
27
ability to work in any sort of cold or cool environment,” but when Dr. Burgess set forth his opinion
on Murphy’s specific limitations in his MSS he included only a limitation that Murphy never be
exposed to extreme cold. (Id. at 404, 410.) As a result, it was reasonable for ALJ Evans to decide
that Dr. Burgess believed Murphy could work in an air conditioned environment or office setting
so long as she was not exposed to extreme cold. Second, there is substantial evidence to support
the RFC determination ALJ Evans posed to VE Manning. While ALJ Evans found that Murphy
was indeed limited in regards to her capacity for exposure to extreme cold, he also explained that
he found Murphy’s “statements concerning the intensity, persistence, and limiting effects of [her]
symptoms are not entirely credible.” (Id. at 32, 34.) ALJ Evans explained that he based his
credibility determination on the entirety of the medical opinion evidence, Murphy’s self-reported
activities of daily living, the infrequency of her medical treatment, her ability to work in an office
environment prior to being discharged, and her certification that she was “ready, willing and able
to work” when she applied for unemployment benefits. (Id. at 33–37.) Although ALJ Evans’s
determination might not be the only conclusion which could have been reached, the determination
was nevertheless reasonable and soundly within his province as the trier of fact. See Rodriguez
Pagan, 819 F.2d 1 at 3.
B.
Opinions of Drs. Joshi and Burke
Murphy further avers that ALJ Evans erred by not properly weighing the opinions of Drs.
Joshi and Burke in accordance with the so-called “Treating Physician Rule,” and by relying on her
activities of daily living as a reason not to ascribe them controlling weight. (Pl.’s Br. 15–17.) In
general, an ALJ will give greater weight to a treating source opinion because they are likely able
to provide “a detailed, longitudinal picture of” the claimant’s medical impairment, and their
opinions benefit from a unique perspective unshared by “objective medical findings alone or from
28
reports of individual examinations, such as consultative examinations or brief hospitalizations.”
20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). Accordingly, if the ALJ finds that a treating source’s
opinion regarding the “nature and severity” of the claimant’s impairment is “well-supported by
medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the
other substantial evidence” in the record it is to be given “controlling weight.” Id. However, the
ALJ remains at liberty to ascribe less than controlling weight to the opinion of a treating physician.
C.F.R. §§ 404.1527(e)(1), 416.927(e)(1). When attributing less than controlling weight to a
treating source’s opinion, the only constraint is that the ALJ must “give good reasons” for his
decision based on consideration of: (1) the length, frequency, nature, and extent of the treatment
relationship; (2) the supportability of the opinion; (3) the consistency of the opinion with the record
as a whole; (4) the treating physician’s specialization in the relevant area of medicine; and (5)
other factors brought to the ALJ’s attention. 20 C.F.R. §§ 402.1527(c)(2)–(6), 416.927(c)(2)–(6).
Initially, Murphy maintains that “Drs. Joshi and Burke were treating sources whose
opinions, under the regulations were entitled to dispositive weight.” (Pl.’s Br. 17.) Murphy’s
argument is unavailing for three reasons, namely, it incorrectly classifies Dr. Burke as a treating
physician, exaggerates the amount of deference an ALJ is compelled to give the opinion of a
treating source, and ignores the substantial evidence underpinning ALJ Evans’s decision.
First, Murphy mischaracterizes Dr. Burke as a treating physician whose opinion is entitled
to more weight. The opinion of a treating source will only be accorded greater weight when the
source has seen the claimant “a number of times and long enough to have obtained a longitudinal
picture” of the claimant’s impairment. 20 C.F.R. §§ 404.1527(c)(2)(i), 416.927(c)(2)(i). According
to the record, Dr. Burke saw Murphy only once. (R. at 350.) As a result, Dr. Burke’s consulting
opinion lacked the unique depth and perspective which warrants the assignation of greater weight
29
to his opinion. Accordingly, ALJ Evans was not constrained by the “Treating Physician Rule” and
properly determined what weight to attribute Dr. Burke’s opinion based on his analysis of the
record as a whole. See 20 C.F.R. §§ 404.1527(c)(4), 416.927(c)(4).
Second, Murphy’s argument overstates the level of deference an ALJ must afford a treating
source’s opinion. The opinion of a treating physician is not “entitled to dispositive weight.” It is
up to the ALJ to decide whether a treating physician’s opinion merits “controlling weight” based
on whether or not it comports with accepted clinical evidence and the other substantial evidence
in the record. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2).
Third, Murphy’s argument overlooks the substantial evidence ALJ Evans described in
support of his decision. In conformity with the regulations, ALJ Evans considered the opinions of
Drs. Joshi and Burke in light of the record as a whole, and determined that they would be granted
“limited weight” and partial “significant weight” respectively. (R. at 34.) ALJ Evans explained
that he assigned the opinion of Dr. Joshi only limited weight because he found it to be “inconsistent
with the majority of the medical record,” and with Murphy’s self-reported ability to engage in her
activities of daily living. (Id.) In regards to the opinion of Dr. Burke, ALJ Evans stated that he
ascribed “significant weight” to his diagnosis concerning “the severity of [Murphy’s] longstanding
impairment,” but “little weight” to his opinion regarding Murphy’s ability to work and his belief
that Murphy “has one of the worst cases of Raynaud’s he had ever witnessed.” (Id.) ALJ Evans
stated that he attributed “little weight” to this portion of Dr. Burke’s opinion because he found it
incongruent with other evidence in the record which demonstrates that she was “not significantly
limited in her ability to attend to her activities of daily living, personal hygiene, and has worked
with the condition since it was diagnosed when she [w]as in her 20’s.” (Id.) Consequentially, since
30
ALJ Evans’s determination was supported by substantial evidence in the record it cannot be
overturned.
Finally, Murphy argues that ALJ Evans’s evaluation of the opinions of Drs. Joshi and
Burke was inappropriate because ALJ Evans relied on Murphy’s activities of daily living to infer
that she had the ability to engage in full-time work. (Pl.’s Br. 17.). According to Murphy, all of
her activities of daily living took place in her home where she “is plainly able to control the
temperature.” (Id.) However, ALJ Evans explained that his decision was based on Murphy’s
reported ability to engage in activities both inside and outside the home such as shopping and
going to the library. (R. at 35, 413.) Although there is conflicting evidence as to whether or not
Murphy could go shopping in stores where the temperature is often quite low, (Id. at 57, 105, 411,
413.), it is the ALJ’s responsibility, not this Court’s, to resolve evidentiary conflicts and to draw
factual inferences, see Irlanda Ortiz, 955 F.2d 765, 769 (1st Cir. 1991). Since ALJ Evans set out
specific findings, supported by the evidence in the case record, his determination must be upheld,
even if the evidence could reasonably have justified a different conclusion.
VI.
Conclusion
For the reasons stated herein, Murphy’s Motion for Order Reversing the Commissioner’s
Decision (dkt. no. 15) is DENIED, and the Commissioner’s Motion for Order Affirming the
Decision of the Commissioner (dkt. no. 20) is GRANTED. The ALJ’s decision is AFFIRMED.
It is SO ORDERED.
/s/ George A. O’Toole, Jr.
United States District Judge
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