Mousa v. Commissioner of Social Security

Filing 22

OPINION; signed by District Judge Paul L. Maloney (Judge Paul L. Maloney, cmc)

UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION

MOHAMED M. SAEED MOUSA,
Plaintiff,

Case No. 1:16-CV-352

v.
HON. PAUL L. MALONEY
COMMISSIONER OF SOCIAL
SECURITY,

Defendant,
/
OPINION
This is a social security action brought under 42 U.S.C. § 405(g) to review a final
decision of the Commissioner of Social Security denying Plaintiff’s claim for Disability Insurance
Benefits (DIB) under Title II of the Social Security Act. Section 405(g) limits the Court to a review
of the administrative record, and provides that if the Commissioner’s decision is supported by
substantial evidence, it shall be conclusive.
STANDARD OF REVIEW
The scope of judicial review in a social security case is limited to determining
whether the Commissioner applied the proper legal standards in making her decision and whether
there exists in the record substantial evidence supporting that decision. See Brainard v. Sec’y of
Health & Human Servs., 889 F.2d 679, 681 (6th Cir. 1989). The Court may not conduct a de novo
review of the case, resolve evidentiary conflicts, or decide questions of credibility. See Garner v.
Heckler, 745 F.2d 383, 387 (6th Cir. 1984). It is the Commissioner who is charged with finding the
facts relevant to an application for disability benefits, and her findings are conclusive provided they

are supported by substantial evidence. See 42 U.S.C. § 405(g).
Substantial evidence is more than a scintilla, but less than a preponderance. See
Cohen v. Sec’y of Health & Human Servs., 964 F.2d 524, 528 (6th Cir. 1992) (citations omitted).
It is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.
See Richardson v. Perales, 402 U.S. 389, 401 (1971); Bogle v. Sullivan, 998 F.2d 342, 347 (6th Cir.
1993). In determining the substantiality of the evidence, the Court must consider the evidence on
the record as a whole and take into account whatever evidence in the record fairly detracts from its
weight. See Richardson v. Sec’y of Health & Human Servs., 735 F.2d 962, 963 (6th Cir. 1984). The
substantial evidence standard presupposes the existence of a zone within which the decision maker
can properly rule either way, without judicial interference. See Mullen v. Bowen, 800 F.2d 535, 545
(6th Cir. 1986) (citation omitted). This standard affords to the administrative decision maker
considerable latitude, and indicates that a decision supported by substantial evidence will not be
reversed simply because the evidence would have supported a contrary decision. See Bogle, 998
F.2d at 347; Mullen, 800 F.2d at 545.
PROCEDURAL POSTURE
Plaintiff was fifty-four years of age as of his date last insured. (PageID.39, 96.) He
was born in Yemen and reported he is able to speak and understand English, but not read and
understand English. (PageID.67, 215.) He previously worked as a machine operator. (PageID.71.)
Plaintiff applied for benefits on December 4, 2013, alleging that he had been disabled since January
10, 2005, due to back and neck problems. (PageID.96, 178–184.) Plaintiff’s application was denied
on February 25, 2014, after which time he requested a hearing before an Administrative Law Judge

2

(ALJ).1 (PageID.108–114.) On May 12, 2015, Plaintiff appeared with his counsel before ALJ Paul
W. Jones for an administrative hearing at which time both Plaintiff (through an interpreter) and a
vocational expert (VE) testified. (PageID.56–81.) At the hearing, Plaintiff also amended his alleged
onset date to July 16, 2005. (PageID.210.) In a written decision dated May 22, 2015, the ALJ
determined that Plaintiff was not disabled. (PageID.39–55.) On February 10, 2016, the Appeals
Council declined to review the ALJ’s decision, making it the Commissioner’s final decision in the
matter. (PageID.33–37.) Plaintiff subsequently initiated this action under 42 U.S.C. § 405(g).
Plaintiff’s insured status expired on March 31, 2010. (PageID.96.) Accordingly, to
be eligible for DIB under Title II of the Social Security Act, Plaintiff must establish that he became
disabled prior to the expiration of his insured status. See 42 U.S.C. § 423; Moon v. Sullivan, 923
F.2d 1175, 1182 (6th Cir. 1990).
ALJ’S DECISION
The social security regulations articulate a five-step sequential process for evaluating
disability. See 20 C.F.R. § 404.1520(a-f).2 If the Commissioner can make a dispositive finding at
1

Plaintiff also applied for Title XVI benefits. That application resulted in a favorable determination dated
February 25, 2014. (PageID.83.) Accordingly, Plaintiff contests only the Commissioner’s Title II decision.
2

1.

An individual who is working and engaging in substantial gainful activity will not be found to be
“disabled” regardless of medical findings (20 C.F.R. § 404.1520(b));

2.

An individual who does not have a “severe impairment” will not be found “disabled” (20 C.F.R. §
404.1520(c));

3.

If an individual is not working and is suffering from a severe impairment which meets the duration
requirement and which “meets or equals” a listed impairment in Appendix 1 of Subpart P of
Regulations No. 4, a finding of “disabled” will be made without consideration of vocational factors
(20 C.F.R. § 404.1520(d));

4.

If an individual is capable of performing work he or she has done in the past, a finding of “not
disabled” must be made (20 C.F.R. § 404.1520(e));

5.

If an individual’s impairment is so severe as to preclude the performance of past work, other factors

3

any point in the review, no further finding is required. See 20 C.F.R. § 404.1520(a). The regulations
also provide that if a claimant suffers from a nonexertional impairment as well as an exertional
impairment, both are considered in determining the claimant’s residual functional capacity (RFC).
See 20 C.F.R. § 404.1545.
Plaintiff has the burden of proving the existence and severity of limitations caused
by his impairments and that he is precluded from performing past relevant work through step four.
Jones v. Comm’r of Soc. Sec., 336 F.3d 469, 474 (6th Cir. 2003). At step five, it is the
Commissioner’s burden “to identify a significant number of jobs in the economy that accommodate
the claimant’s residual functional capacity (determined at step four) and vocational profile.” Id.
ALJ Jones determined Plaintiff’s claim failed at step four. At step one the ALJ found
that Plaintiff had not engaged in substantial gainful activity during the period between his amended
alleged disability onset date of July 16, 2005, and his date last insured of March 31, 2010.
(PageID.44.) At step two, the ALJ found that Plaintiff suffered from the severe impairment of a right
thumb amputation.

(PageID.44.)

The ALJ also determined that Plaintiff had non-severe

impairments of typhoid, irritable bowel syndrome, gastritis, and neck and back pain. (PageID.45.)
At step three, the ALJ found that Plaintiff did not have an impairment or combination of
impairments that met or equaled the requirements of the Listing of Impairments found in 20 C.F.R.
Pt. 404, Subpt. P, App. 1. (PageID.46.) At step four, the ALJ determined Plaintiff retained the RFC
based on all the impairments through his date last insured to perform:
a full range of work at all exertional levels, but was non-exertionally
limited to: occasional handling and fingering of objects with the

including age, education, past work experience, and residual functional capacity must be considered
to determine if other work can be performed. (20 C.F.R. § 404.1520(f)).

4

dominant right hand; in occupations that do not require written
communication in English.
(PageID.46.) Continuing with the fourth step, the ALJ determined that Plaintiff was capable of
performing his past relevant work. This past relevant work did not require the performance of
work-related activities precluded by Plaintiff’s RFC. (PageID.48–49.)
Although unnecessary, the ALJ included an alternative step five determination based
on the testimony of the VE. The VE testified that Plaintiff could perform other work as a dealer
accounts investigator (45,000 positions), counter clerk (31,000 positions), and school bus monitor
(5,000 positions). (PageID.75–78.) Based on this record, the ALJ found that Plaintiff was capable
of making a successful adjustment to work that exists in significant numbers in the national
economy. (PageID.50.)
Accordingly, the ALJ concluded that Plaintiff was not disabled from July 16, 2005,
the amended alleged onset date, through March 31, 2010, Plaintiff’s date last insured. (PageID.50.)
DISCUSSION
As noted above, in order to succeed in this DIB claim, Plaintiff must establish that
he became disabled prior to the expiration of his insured status. See 42 U.S.C. § 423. “[I]nsured
status is a requirement for an award of disability insurance benefits.” Garner v. Heckler, 745 F.2d
383, 390 (6th Cir. 1984). Since Plaintiff’s insured status for purposes of receiving DIB expired on
March 31, 2010, he cannot be found disabled unless he can establish that a disability existed on or
before that date. Id. “Evidence relating to a later time period is only minimally probative.” Jones
v. Comm’r of Soc. Sec., No. 96–2173, 1997 WL 413641 at *1 (6th Cir. July 17, 1997) (citing Siterlet
v. Sec’y of Health & Human Servs., 823 F.2d 918, 920 (6th Cir. 1987)). Evidence of a claimant’s

5

medical condition after the last insured date is only considered to the extent it illuminates that
condition before the expiration of the claimant’s insured status. Higgs v. Bowen, 880 F.2d 860, 863
(6th Cir. 1988).
At the administrative hearing, Plaintiff testified that he was born in Yemen, but since
1973, he spent seventy to eighty percent of the time in the United States. (PageID.67.) His last
employment ended in 2004 when the factory he was working at shut down. (PageID.68.) After
experiencing back pain, Plaintiff testified he returned to Yemen for treatment. (PageID.69–70.) He
did not receive treatment in the United States between his alleged onset date and his date last
insured. Though he asserted he was incapable of working even in 2010, Plaintiff admitted his
condition has continued to degenerate. (PageID.70.)
As his counsel stated at the hearing, however, all the records relating to Plaintiff’s
treatment while in Yemen were lost when the hospital he treated at was bombed. (PageID.64.)
Consequently, as the ALJ observed, there were few records relating to the relevant time period, and
most of the records are dated between 2013 and 2015, well after his date last insured. Noting this
fact, the ALJ found only three records addressed the relevant time period.3 The first, completed by
Dr. Abdul Hameed AL-Riashy was written when Plaintiff was fifty-eight years old.4 The doctor
stated Plaintiff was first seen on June 30, 2006, for complaints of lower back pain that radiated to
both legs and which caused Plaintiff to be unable to walk or even stand. Plaintiff also had neck pain
upon flexion. (PageID.283.) An X-Ray found degenerative changes. Plaintiff was treated with

3

The ALJ’s decision properly addressed the entire record, however, including those records dated after
Plaintiff’s date last insured.
4

These records are undated, but the reference to Plaintiff’s age indicates they were written well after Plaintiff’s
date last insured.

6

medication and prescribed three weeks of therapy. Though the doctor stated Plaintiff was seen
“many times,” the next record discussed is one from August 21, 2013. This record demonstrates
Plaintiff sought treatment, complaining of back pain radiating to his legs. (PageID.283.) An MRI
completed that same date revealed straightening of the lumbar column and moderate degenerative
changes at L3-L4 and L4-L5. Plaintiff was again treated with medication and prescribed physical
therapy. (PageID.283.)
The second report was completed by Dr. Raed Al-Sofy when Plaintiff was fifty-nine
years old. It is clear that English is not the doctor’s first language, and portions of the statement are
difficult to comprehend. Nevertheless it appears Plaintiff was seen by the doctor between March 1,
2005 and June 2, 2006. Plaintiff was “suffering from high fever, sweating, muolgia [sic], [and]
disarray helicobacter.” (PageID.284.) A reference to orthopedic surgery is mentioned, but it is
unclear in what context it was raised. Plaintiff does not claim he was ever advised to undergo
surgery, and the most the Court can surmise from the record is that it was discussed sometime
between August 2013 and March 1, 2015, well after the date last insured (PageID.284.) In any
event, Plaintiff apparently received little benefit from treatment. (PageID.284.)
The last record was also completed by Dr. Al-Sofy when Plaintiff was fifty-nine years
old. (PageID.285.) It references a March 1, 2005, treatment where Plaintiff was “suffering frome
[sic] weakness and muolgia [sic] in upper limbs and lower limbs, gastritis, uncontrolled urin, [sic]
by analysis: show he was have [sic] H,pylory [sic] positive, urin [sic] infection, typhoid fever,
anexity, [sic], [and] IBS.” (PageID.285.) Plaintiff was treated with medication. Dr. Al-Sofy further
indicated Plaintiff was treated through June 20, 2006, and that there was improvement “in
Abdomenal [sic].” (PageID.285.)

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Most of the arguments raised by Plaintiff depend on the above records. For the
reasons stated below, the Court finds the ALJ’s decision is supported by substantial evidence and
accordingly remand is not warranted.
1.

The ALJ’s Failure to Classify Certain Conditions as Severe Impairments
Was At Most Harmless Error.

Plaintiff first contends that the ALJ erred by failing to find that his degenerative disc
disease, weakness, and myalgia in his upper and lower limbs were not severe impairments.
(PageID.406.) At step two of the sequential disability analysis articulated above, the ALJ must
determine whether the claimant suffers from a severe impairment. A severe impairment is defined
as “any impairment or combination of impairments which significantly limits your physical or
mental ability to do basic work activities,” 20 C.F.R. § 404.1520(c), and which lasts 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 impairment “can be considered not severe only if it is a slight abnormality that
minimally affects work ability regardless of age, education, and experience.” Rogers v. Comm’r of
Soc. Sec., 486 F.3d 234, 243 n.2 (6th Cir. 2007) (quoting Higgs, 880 F.2d at 862); see also
Williamson v. Sec’y of Health & Human Servs., 796 F.2d 146, 151 (6th Cir. 1986) (an impairment
is less than severe only if it is a “slight abnormality which has such a minimal effect on the
individual that it would not be expected to interfere with the individual’s ability to work, irrespective
of age, education and work experience”).
Step two of the sequential disability process is considered a “de minimis hurdle”
designed to subject to dismissal only those claims which are “totally groundless” from a medical
standpoint. Rogers, 486 F.3d at 243 n.2; Higgs, 880 F.2d at 860. “[T]his lenient interpretation of the
severity requirement in part represents the courts’ response to the Secretary’s questionable practice
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in the early 1980s of using the step two regulation to deny meritorious claims without proper
vocational analysis.” Long v. Apfel, 1 F. App’x 326, 331 (6th Cir. Jan. 9, 2001) (quoting Higgs, 880
F.2d at 862).
Despite this low bar, the record does not support a determination that prior to his date
last insured, Plaintiff suffered from additional severe impairments. The records relied on by Plaintiff
do not demonstrate impairments that significantly interfere with Plaintiff’s ability to perform basic
work activities. At most they list Plaintiff’s subjective complaints and then provide a litany of
diagnosis. “[T]he mere diagnosis of an impairment does not render an individual disabled nor does
it reveal anything about the limitations, if any, it imposes upon an individual.” McKenzie v. Comm’r
of Soc. Sec., No. 99–3400, 2000 WL 687680 at *5 (6th Cir. May 19, 2000) (citing Foster v. Bowen,
853 F.2d 488, 489 (6th Cir.1988)); see, e.g., Higgs, 880 F.2d at 863 (“[t]he mere diagnosis of
arthritis, of course, says nothing about the severity of the condition”).
But even if the ALJ erred, the Sixth Circuit has held that where the ALJ finds the
presence of a severe impairment at step two and proceeds to continue through the remaining
steps of the analysis, the alleged failure to identify as severe some other impairment constitutes
harmless error so long as the ALJ considered the entire medical record in rendering his decision. See
Maziarz v. Sec’y of Health & Human Servs., 837 F.2d 240, 244 (6th Cir. 1987); Anthony v. Astrue,
266 F. App’x 451, 457 (6th Cir. 2008) (citing Maziarz, 837 F.2d at 244); Fisk v. Astrue, 253 F.
App’x 580, 583–84 (6th Cir. 2007) (same).
Here, the ALJ determined that Plaintiff suffered from a severe impairment at step two
of the sequential analysis and continued with the remaining steps thereof, considering in detail the
evidence of record. Thus, even if the Court assumes that the ALJ erred in failing to find

9

that Plaintiff suffered from additional severe impairments such does not call into question the
substantiality of the evidence supporting the ALJ’s decision. See Heston v. Comm’r of Soc. Sec.,
245 F.3d 528, 535–36 (6th Cir. 2001) (recognizing that remand to correct an error committed
by the ALJ unnecessary where such error was harmless); Fisher v. Bowen, 869 F.2d1055,1057 (7th
Cir. 1989) (“no principle of administrative law or common sense requires us to remand a case in
quest of a perfect opinion unless there is reason to believe that the remand might lead to a different
result”).
Plaintiff properly asserts that the ALJ was required to consider both his severe and
non-severe impairments when crafting the RFC. (PageID.406–407.) The ALJ explicitly recognized
this obligation. (PageID.43.) The ALJ’s discussion of the medical evidence in step two adequately
explains his reasons for finding Plaintiff was not as limited as alleged. At step three, the ALJ
expressly identified Listing 1.00, the listing for musculoskeletal impairments. (PageID.46.) At step
four, the ALJ considered records relating to Plaintiff’s non-severe impairments, including those
dated after his date last insured. Despite Plaintiff’s testimony that his impairments have only gotten
worse, the ALJ noted records demonstrating normal musculoskeletal and physical examinations,
with normal extremity movements. (PageID.47.) In this, the ALJ gave adequate consideration to
Plaintiff’s non-severe impairments. Accordingly, the Court finds no reversible error here.
2.

The ALJ’s Step Four Determination is Supported by Substantial
Evidence.

Plaintiff asserts that he is illiterate and unable to communicate in English. He notes
that he required an interpreter at the hearing and testified that he learned work procedures from
arabic speaking coworkers. (PageID.409.) As such, he claims the ALJ’s step four and five
determinations are unsupported by substantial evidence. Plaintiff begins by referencing regulations
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relating to the Commissioner’s determination at step five. Plaintiff’s claim failed at step four. It is
well settled that if the Commissioner determines that a claimant “can still do [his] past work . . . [w]e
will not consider [the claimant’s] vocational factors of age, education, and work experience.” 20
C.F.R. § 1560(b)(3). Thus, if the ALJ’s step four determination is supported by substantial evidence,
any error in the ALJ’s alternative step five determination is harmless. Proceeding, then, to Plaintiff’s
step four argument, Plaintiff contends the ALJ failed to consider his illiteracy and ability to
communicate when determining he was capable of performing his past relevant work and, as such,
the decision suffers from the same fatal flaw that was present in Pinto v. Massanaro, 249 F.3d 840,
846–847 (9th Cir. 2001). The Court disagrees.
It is the claimant’s burden at the fourth step of the sequential evaluation to show an
inability to return to any past relevant work. Allen v. Califano, 613 F.2d 139, 145 (6th Cir. 1980).
To support a finding that a claimant can perform his past relevant work, the Commissioner’s
decision must explain why the claimant can perform the demands and duties of the past job as
actually performed or as ordinarily required by employers throughout the national economy. See
Studaway v. Sec’y of Health & Human Servs., 815 F.2d 1074, 1076 (6th Cir. 1987).
A VE’s testimony is not required when the ALJ determines that a claimant is not
disabled at step four of the sequential evaluation. See Banks v. Massanari, 258 F.3d 820, 827 (8th
Cir. 2001) (vocational expert testimony is not required until step five of the sequential analysis);
Parker v. Sec’y of Health & Human Servs., 935 F.2d 270, 1991 WL 100547 at *3 (6th Cir. 1991);
Rivera v. Barnhart, 239 F. Supp.2d 413, 421 (D. Del. 2002). However, the ALJ may use a
vocational expert’s services in determining whether a claimant can perform his past relevant work.
20 C.F.R. § 404.1560(b)(2) (a VE “may offer relevant evidence within his or her expertise or

11

knowledge concerning the physical and mental demands of a claimant's past relevant work, either
as the claimant actually performed it or as generally performed in the national economy”); see, e.g.,
Dukes v. Barnhart, 436 F.3d 923, 928 (8th Cir. 2006) (observing that the ALJ may use a VE’s
“expert advice” to assist him in deciding whether the claimant can perform his past relevant work
at step four of the evaluation).
When the ALJ obtains vocational evidence through the testimony of a VE, the
hypothetical questions posed to the VE must accurately portray the claimant’s physical and mental
limitations. See Webb v. Comm’r of Soc. Sec., 368 F.3d 629, 632 (6th Cir. 2004); Varley v. Sec’y of
Health & Human Servs., 820 F.2d 777, 779 (6th Cir. 1987). However, a hypothetical question need
only include those limitations which the ALJ accepts as credible. See Blacha v. Sec’y of Health and
Human Services, 927 F.2d 228, 231 (6th Cir.1990).
The language Plaintiff depends on can easily be distinguished. In Pinto, the
claimant’s RFC allowed for only occasional stooping, climbing, and balancing. Pinto, 249 F.3d at
843. It was “uncontroverted” that the claimant’s past work as actually performed required constant
stooping and bending. Id. at 844. Thus the court determined that as actually performed, this work
required abilities in excess of those accounted for in the RFC and accordingly the claimant could not
perform her past work as actually performed. Id. at 845. The question then became whether Plaintiff
was able to perform her work as generally performed. The Ninth Circuit found that claimant could
not. The court found the ALJ did not explain how the claimant could return to her past work as it
was generally performed given her illiteracy and the description of the position in the Dictionary of
Occupational Titles (DOT), which required a greater ability to communicate. Id. at 846–847. Here,
Plaintiff does not assert the DOT description of the machine operator position requires greater

12

communicative abilities than the ALJ found. But even assuming there was an inconsistency, such
is irrelevant, as the ALJ found Plaintiff was able to perform the duties of his past work as it was
actually performed.
Moreover, substantial evidence supports the ALJ’s determination that Plaintiff was
able to communicate in English. Plaintiff reported he could speak and understand English, but not
read and understand English. (PageID.215.) The ALJ’s RFC is consistent with this report as it
limited Plaintiff from occupations requiring written communication in English. (PageID.46.) Given
this limitation, the VE testified Plaintiff would be able to return to his past relevant work.
(PageID.74.) Plaintiff claims his need for an interpreter demonstrates he could not adequately speak
and understand English. Perhaps, but it is also possible that given the gravity of the situation the
ALJ, out of an abundance of caution, ordered an interpreter. In any event, to the extent Plaintiff
points to conflicting records, it was the ALJ’s role to resolve this inconsistency. See Blair v. Comm’r
of Soc. Sec., No. 98–3581, 1999 WL 196497, *2 (6th Cir. March 26, 1999). Accordingly, this claim
of error is denied.
3.

Substantial Evidence Supports the ALJ’s Step Three Determination.

The gist of Plaintiff’s next claim is that the ALJ failed to properly address Listing
1.04A. (PageID.410–412.) A claimant bears the burden of demonstrating that he meets or equals
a listed impairment at the third step of the sequential evaluation. Evans v. Sec’y of Health & Human
Servs., 820 F.2d 161, 164 (6th Cir. 1987). In order to be considered disabled under the Listing of
Impairments, “a claimant must establish that his condition either is permanent, is expected to result
in death, or is expected to last at least 12 months, as well as show that his condition meets or equals
one of the listed impairments.” Id. An impairment satisfies the listing only when it manifests the

13

specific findings described in the medical criteria for that particular impairment. 20 C.F.R. §
416.925(d). A claimant does not satisfy a particular listing unless all of the requirements of the
listing are present. See Hale v. Sec’y of Health & Human Servs., 816 F.2d 1078, 1083 (6th Cir.
1987); see, e.g., Thacker v. Soc. Sec. Admin., 93 F. App’x 725, 728 (6th Cir. 2004) (“[w]hen a
claimant alleges that he meets or equals a listed impairment, he must present specific medical
findings that satisfy the various tests listed in the description of the applicable impairment or present
medical evidence which describes how the impairment has such equivalency”). If a claimant
successfully carries this burden, the Commissioner will find the claimant disabled without
considering the claimant’s age, education and work experience. 20 C.F.R. § 404.1520(d).
Listing 1.04A provides as follows:
1.04

Disorders of the spine (e.g., herniated nucleus pulposus,
spinal arachnoiditis, spinal stenosis, osteoarthritis,
degenerative disc disease, facet arthritis, vertebral fracture),
resulting in compromise of a nerve root (including the cauda
equina) or the spinal cord. With:
A.

Evidence of nerve root compression
characterized by neuro-anatomic distribution
of pain, limitation of motion of the spine,
motor loss (atrophy with associated muscle
weakness or muscle weakness) accompanied
by sensory or reflex loss and, if there is
involvement of the lower back, positive
straight-leg raising test (sitting and supine);

20 C.F.R. Pt. 404, Subpt. P, App. 1, § 1.04. Plaintiff bears the burden of demonstrating that he
meets a listed impairment. Kirby v. Comm’r of Soc. Sec. Admin., 37 F. App’x 182, 183 (6th Cir.
2002).
Plaintiff has failed to meet his burden. In support of his claim, Plaintiff first appears
to argue the statements from his physicians in Yemen demonstrate his impairments are medically
14

equivalent to this listing. (PageID.410–411.) While a more detailed analysis of these statements is
provided below, here it is sufficient to note that none of these statements claim that Plaintiff’s
impairments are equivalent to any listing, or otherwise describe how Plaintiff’s impairments are
equivalent in any respects to any of the listing’s requirements. Thus Plaintiff has failed to satisfy his
burden of demonstrating equivalency. See Thacker, 93 F. App’x at 728.
Plaintiff also argues she meets the requirements of Listing 1.04A. (PageID.412.) He
claims his inability to ambulate effectively demonstrates evidence of nerve root compression, that
he had a positive straight-leg raising test, and that his radiating pain is proof of sciatic nerve damage.
(PageID.452.) There are a number of problems with this assertion. First of all, several of the
records–including the MRI and straight leg raise test–were in August 2013, well after his date last
insured of March 31, 2010. There is no indication they reflect Plaitniff’s condition during the
relevant period. Moreover, Plaintiff’s lay interpretation of this medical evidence, i.e., that the MRI
studies demonstrated nerve root compression as required under Listing 1.04, is not sufficient to
establish the requirements of the listing. See, e.g., Garcia v. Colvin, No. 14 C 4865, 2015 WL
4658283, at *6 (N.D. Ill. Aug. 5, 2015) (noting the claimant’s “lay interpretation of a diagnostic
image, coupled with her own testimony, [was] insufficient to establish the existence of a
cardiovascular impairment” under Listing 4.00).
Here, the ALJ observed that despite the severity of Plaintiff’s complaints, his
treatment appeared to be routine and conservative in nature. (PageID.45.) Later in the decision the
ALJ noted records dated in November and December of 2014 that found normal musculoskeletal
examinations with normal movements of all extremities and no swelling, tenderness or muscle
spasms. (PageID.47.) All this is inconsistent with the requirements of Listing 1.04A. In sum, the

15

ALJ’s decision that Plaintiff did not meet or equal a listed impairment, including Listing 1.04A, is
supported by substantial evidence.
4.

The ALJ’s Analysis of Plaintiff’s Physicians from Yemen Did Not
Violate the Treating Physician Rule.

In his decision, the ALJ provided a lengthy discussion of the medical records from
Yemen. He closed by noting that “although I considered the treatment statements from Yemen, I
note these statements are not acceptable medical source statements as the physicians who allegedly
prepared them are not licensed in United States and are not acceptable for the purposes of Social
Security rules and regulations.” (PageID.45.) Plaintiff’s final argument is that the ALJ violated the
treating physician rule in discounting the statements from his physicians in Yemen. He claims the
ALJ erred in finding them to be unacceptable medical sources for the sole reason they were not
licensed in the United States. (PageID.413.) He further claims that even if they were not entitled
to controlling weight, the ALJ failed to undertake a proper analysis by using the factors set forth in
20 C.F.R. 404.1527. (PageID.413–414.) The Court disagrees.
By way of background, the treating physician doctrine recognizes that medical
professionals who have a long history of caring for a claimant and his maladies generally possess
significant insight into his medical condition. See Barker v. Shalala, 40 F.3d 789, 794 (6th Cir.
1994). An ALJ must, therefore, give controlling weight to the opinion of a treating source if: (1) the
opinion is “well-supported by medically acceptable clinical and laboratory diagnostic techniques”
and (2) the opinion “is not inconsistent with the other substantial evidence in the case record.”
Gayheart v. Comm’r of Soc. Sec., 710 F.3d 365, 375–76 (6th Cir. 2013) (quoting 20 C.F.R. §
404.1527).
Such deference is appropriate, however, only where the particular opinion “is based
16

upon sufficient medical data.” Miller v. Sec’y of Health & Human Servs., 1991 WL 229979, at *2
(6th Cir. Nov. 7, 1991) (citing Shavers v. Sec’y of Health & Human Servs., 839 F.2d 232, 235 n.1
(6th Cir. 1987)). The ALJ may reject the opinion of a treating physician where it is unsupported by
the medical record, merely states a conclusion, or is contradicted by substantial medical evidence.
See Cohen, 964 F.2d at 528; Miller, 1991 WL 229979 at *2 (citing Shavers, 839 F.2d at 235 n.1);
Cutlip v. Sec’y of Health & Human Servs., 25 F.3d 284, 286–87 (6th Cir. 1994).
If an ALJ accords less than controlling weight to a treating source’s opinion, the ALJ
must “give good reasons” for doing so. Gayheart, 710 F.3d at 376. Such reasons must be
“supported by the evidence in the case record, and must be sufficiently specific to make clear to any
subsequent reviewers the weight the adjudicator gave to the treating source’s medical opinion and
the reasons for that weight.” Id. This requirement “ensures that the ALJ applies the treating
physician rule and permits meaningful review of the ALJ’s application of the rule.” Id. (quoting
Wilson v. Comm’r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004)). Simply stating that the
physician’s opinions “are not well-supported by any objective findings and are inconsistent with
other credible evidence” is, without more, too “ambiguous” to permit meaningful review of the
ALJ’s assessment. Id. at 376–77.
Furthermore, if a treating physician’s opinion is given less than controlling weight,
the ALJ must still determine the weight to be afforded such. Gayheart, 710 F.3d at 375–76. In
doing so, the ALJ must consider the following factors: (1) length of the treatment relationship and
frequency of the examination, (2) nature and extent of the treatment relationship, (3) supportability
of the opinion, (4) consistency of the opinion with the record as a whole, (5) the specialization of the
treating source, and (6) other relevant factors. Id. (citing 20 C.F.R. § 404.1527). While the ALJ is

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not required to explicitly discuss each of these factors, the record must nevertheless reflect that the
ALJ considered those factors relevant to his assessment. See, e.g., Oldham v. Astrue, 509 F.3d 1254,
1258 (10th Cir. 2007); Undheim v. Barnhart, 214 F. App’x 448, 450 (5th Cir. 2007).
As an initial matter, Plaintiff asserts the above statement from the ALJ is “proof of
a basic misunderstanding of medical opinion evidence and may be an indication of a prejudice
against Arabic speaking people in general.” (PageID.414.) Plaintiff’s conclusory statement does not
approach the proof of actual bias necessary to overcome the presumption that the ALJ was impartial.
The ALJ is presumed to have exercised his powers with honesty and integrity, and Plaintiff has the
burden of overcoming the presumption of impartiality “with convincing evidence that a risk of actual
bias or prejudgment is present.” Collier v. Comm’r of Soc. Sec., 108 F. App’x 358, 364 (6th Cir.
2004) (citing Schweiker v. McClure, 456 U.S. 188, 196 (1982) and Navistar Int’l Transp. Corp v.
EPA, 941 F.2d 1339, 1360 (6th Cir. 1991)); see also Bailey v. Comm’r of Soc. Sec., 413 F. App’x
853, 856 (6th Cir.2011) (“We presume that judicial and quasijudicial officers, including ALJs, carry
out their duties fairly and impartially.”). Plaintiff has the burden of providing “convincing evidence
that a risk of actual bias or prejudgment is present.” See Bailey, 413 F. App’x at 856; Collier, 108
F. App’x at 364. For the alleged bias to be disqualifying, it must “stem from an extrajudicial source
and result in an opinion on the merits on some basis other than what the judge learned from his
participation in the case.” United States v. Grinnell Corp., 384 U.S. 563, 583 (1966); see also Miller
v. Barnhart, 211 F. App’x 303, 305 n. 1 (5th Cir. 2006). “[A]ny alleged prejudice on the part of the
decisionmaker must be evident from the record and cannot be based on speculation or inference.”
Carrelli v. Comm’r of Soc. Sec., 390 F. App’x 429, 436–37 (6th Cir. 2010). The court finds no
evidence that the ALJ was biased against Plaintiff, much less the convincing evidence of actual bias

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that is necessary to overcome the presumption of impartiality.
Turning to the merits of the argument, the Commissioner argues there are several
facts standing in the way of the application of the treating physician rule. First, she argues that the
ALJ properly considered the records from Yemen as statements, not opinions, as they contained little
by way of opinions on Plaintiff’s ability to work. (PageID.427.) Second, the Commissioner argues
that the records do not establish the type of ongoing treating relationship necessary to consider the
opinions as coming from a treating source. (PageID.427–428.) Finally, the Commissioner argues
that assuming the doctors offered an opinion, the fact that the physicians were not licensed in the
United States was not the ALJ’s sole reason for discounting their statements. (PageID.428–429.)
Accordingly, the Commissioner contends that even if the ALJ erred in classifying the physicians’
as nonacceptable sources, his analysis still complies with the regulations for considering medical
opinions. (PageID.429.) Plaintiff provides little by way of response, other than reasserting that the
physicians qualified as treating sources who offered medical opinions and that the ALJ solely relied
on the fact that the physicians were not licensed in the United States to discount the opinions.
(PageID.439.)
The Court agrees that the records from Yemen do not contain medical opinions.
“Medical opinions are statements from physicians and psychologists or other acceptable medical
sources that reflect judgments about the nature and severity of your impairment(s), including your
symptoms, diagnosis and prognosis, what you can still do despite impairment(s), and your physical
or mental restrictions.” 20 C.F.R. § 404.1527(a)(2).5 Records regarding Plaintiff’s June 30, 2006,
5

Here, the Court will assume the ALJ erred in finding the physicians were not acceptable sources as even if
Plaintiff is correct, it does not change the result that the Commissioner’s decision should be upheld. Though not
identified by either party, the Court also notes that appears the agency’s Program Operations Manual (POMS) directs
that the examiner should “[a]ssume in the absence of any indication to the contrary that a foreign medical report was

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visit include a recitation of his complaints, a statement that X-Rays showed degenerative changes,
and a statement of the medications he was prescribed. (PageID.283.) There is nothing here
reflecting judgements on what Plaintiff could still do despite these impairments. As such, any error
here is harmless as the statement is entirely consistent with the ALJ’s decision. Similarly, the next
record contains diagnoses of “high fever, sweating, muolgia [sic], disarray helicobacter” and states
that Plaintiff has not experienced any benefit from treatment. (PageID.284.) Again, there is nothing
inconsistent between this report and the ALJ’s decision. The third record again contains only
diagnoses and medication prescriptions. (PageID.285.) Indeed, the only note that could be
considered an opinion is Dr. Al-Riashy’s statement on August 21, 2013, that Plaintiff’s pain
increases with activities and walking. (PageID.283.) This statement comes well after Plaintiff’s date
last insured, and nothing indicates it related to the relevant period. Moreover, it still is not
inconsistent with the ALJ’s ultimate determination. Accordingly the ALJ’s error, at most, is
harmless. Bradford v. Comm’r of Soc. Sec., No. 1:07-CV-50, 2008 WL 398281, at *3 (W.D. Mich.
Feb. 11, 2008) (stating that the failure to follow the treating physician rule is “harmless where the
Commissioner adopts the opinion of the treating source or makes only findings that are consistent
with the opinion.”) (internal quotations and citations omitted).
Moreover, it is not the case, as Plaintiff claims, that the ALJ discounted the
physician’s statements on the sole basis that the doctors were not licensed in the United States. Even
completed by or based upon the report of a qualified medical practitioner.” SSA POMS DI 43510.010. POMS, however,
is an internal agency manual. Its guidelines have no legal force, and failure to follow the POMS is not legal error. See
Davis v. Sec’y of Health & Human Servs., 867 F.2d 336, 340 (6th Cir.1989) (“POMS is a policy and procedure manual
that employees of the Department of Health & Human Services use in evaluating Social Security claims and does not
have the force and effect of law.”); see also Wells v. Astrue, No. 09–32, 2009 WL 3400911, at * 4 (E.D. Ky. Oct. 20,
2009) (“The POMS contains a disclaimer indicating that it ‘states only internal SSA guidance’ and ‘is not intended to,
and does not, and may not be relied upon to create any rights enforceable by law by any party in a civil or criminal
action.’”) (quoting POMS, disclaimer, https://secure.ssa.gov/apps10/poms.nsf/aboutpoms). POMS guidelines, where
applicable, provide persuasive authority. Davis, 867 F.2d at 340.

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taking into consideration the fact that Plaintiff’s records were lost, the ALJ noted that the records
demonstrate significant gaps in treatment, and such treatment was routine and conservative in nature.
(PageID.45). These were appropriate considerations to make. 20 C.F.R. § 404.1527.
For all the above reasons, this claim of error is denied.
CONCLUSION
For the reasons set forth herein, the Commissioner’s decision is supported by
substantial evidence and therefore will be AFFIRMED.
A separate judgment shall issue.

Dated: January 18, 2017

/s/ Paul L. Maloney
PAUL L. MALONEY
United States District Judge

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