Coureton v. Colvin
MEMORANDUM - For the reasons set forth above, the decision of the Commissioner of Social Security is affirmed. An appropriate Judgment Order is issued herewith. Signed by Magistrate Judge David D. Noce on 6/27/14. (KJS)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
GEORGE R. COURETON,
CAROLYN W. COLVIN,
Acting Commissioner of Social Security,
No. 2:13 CV 68 DDN
This action is before the court for judicial review of the final decision of the
defendant Commissioner of Social Security denying the application of plaintiff George R.
Coureton for social security income benefits under Title XVI of the Social Security Act
(the Act), 42 U.S.C. §§ 401, 1381. The parties have consented to the exercise of plenary
authority by the undersigned United States Magistrate Judge pursuant to 28 U.S.C. §
636(c). For the reasons set forth below, the decision of the Administrative Law Judge is
Plaintiff was born on July 16, 1971.
He filed his application on
November 9, 2010, alleging an onset date of September 1, 2010, at age 39, and alleging
disability due to degenerative disc disease and lower back problems, anxiety, and
depression. (Tr. 16, 152, 177, 182.) His application was denied initially, and he requested
a hearing before an ALJ.1 (Tr. 97, 102.)
Plaintiff also applied for disability insurance benefits under Title II of the Act but did
not meet the insured status requirements.
On May 31, 2012, following a hearing, the ALJ issued an unfavorable decision.
(Tr. 5-21.) The Appeals Council denied plaintiff’s request for review. (Tr. 1.) Thus, the
decision of the ALJ stands as the final decision of the Commissioner.
II. MEDICAL AND OTHER HISTORY
On August 10, 2010, plaintiff saw Peter Koopman, M.D., his primary care provider
(PCP), for a second opinion on pain management options for worsening back pain,
specifically, obtaining a TENS unit or electrical stimulator implant. Dr. Koopman noted a
history of chronic back pain. Plaintiff was also seeing Dr. Alejandro Blachar, a pain
management doctor, near his home in Moberly, Missouri. Plaintiff reported that he had
been taking the same dosage of Duragesic and oxycodone, opioids used to treat moderate
to severe pain, for a year and a half, and that they were increasingly less effective. An
MRI showed degenerative changes in plaintiff’s lumbar spine with foraminal stenosis or
narrowing of the cervical disc space from disk bulging. Plaintiff’s most severe recent
complaints were muscle spasms. Upon examination, plaintiff had some tenderness and
mild paravertebral muscle spasm in his lower back, but good range of motion (ROM). Dr.
Koopman assured plaintiff that his current pain management regimen through his
physician in Moberly seemed appropriate. (Tr. 230-31.)
Plaintiff saw Jeffrey M. Tiede, M.D., a pain management doctor, for
comprehensive pain management on August 18, 2010 upon referral by Dr. Koopman.
Plaintiff reported at least a five year history of back pain with no specific inciting incident.
He reported his pain level was 4 on a 10-point scale. Upon examination, he appeared in
no acute distress and displayed no overt pathologic pain behavior during the appointment.
His body mass index (BMI) was 32.3. He transitioned slowly from sitting to standing and
his forward flexion was limited to 90 degrees. He had no tenderness in his low back and
no pain with hip motion. His reflexes were normal. His straight leg raises, a test done
during a physical examination to determine whether a patient with low back pain has an
underlying herniated disk, were negative. He had intact sensation and no strength deficits.
An MRI from June 1, 2010 showed spondylosis or cervical osteoarthritis with minimal
spondylolisthesis2 at the lumbosacral junction. His impression was spondylosis with
foraminal compression or narrowing of the cervical disc space. Dr. Tiede believed that
plaintiff’s pain was mechanical and that his two available options were referral for
surgical fusion or diagnostic medial branch blocks. Dr. Tiede referred plaintiff for a
surgical fusion consultation but did not think his medications needed to be changed. He
stressed the importance of core strengthening exercises. (Tr. 243-45.)
Plaintiff saw Alejandro Blachar, M.D., a pain specialist, at the Center for Pain
Management, on September 21, 2010. Plaintiff described his pain level as 3-4/10 and
reported that he was doing well on his current pain medication regimen.
examination, plaintiff appeared in no apparent distress.
Dr. Blachar had prescribed
Amrix, a skeletal muscle relaxant, at his last visit but he was unable to afford it. He had
intact strength in his arms and legs. Dr. Blachar continued his medications and instructed
him to follow up in three months. (Tr. 253-54.)
On October 27, 2010, plaintiff saw Joel Jeffries, M.D., a spinal orthopedic surgeon.
Plaintiff reported that physical therapy and steroid injections had provided some, albeit
temporary, relief in the past. He rated his pain level as 4-5/10. Plaintiff told Dr. Jeffries
that he had applied for disability although he had tried to work on some cars. On a
questionnaire form, plaintiff reported he was prevented from lifting heavy weights due to
this pain, but that he could lift light to medium weights if they were conveniently
positioned. (Tr. 277-81.)
Upon examination, plaintiff appeared in no acute distress. He had a “reasonably
normal” gait and could heel walk, toe walk, tandem walk, and perform a single-leg stand
without undue difficulty. He had globally and substantially diminished active ROM in his
lower back, but no dramatic midline or paraspinous tenderness or muscle spasm. He had
full motor strength in his legs, normal reflexes, and intact sensation. A sitting root test,
Spondylolisthesis is a condition in which one of the bones of the spine (vertebrae) slips
out of place onto the vertebra below it. clevelandclinic.org/disorders/back.../
hic_spondylolisthesis.aspx (last visited June 24, 2014).
used to determine possible sciatic nerve pain, was negative. Dr. Jeffries expressed his
concern about the amount of opioids plaintiff was taking and advised him that he would
perform surgery only if plaintiff detoxified. Otherwise, Dr. Jeffries believed that his
perioperative pain control would be virtually impossible.
He instructed plaintiff to
exercise and be active as tolerated. (Tr. 278-81.)
Plaintiff saw Dr. Blachar again on December 14, 2010 and described his pain level
as 2-3/10. He denied any side effects from his medications and said they provided
improved pain relief and helped with functioning. He reported that Dr. Jeffries did not
think he was a good candidate for surgery or a spinal stimulator and he was therefore not
interested in pursuing further invasive procedures. Plaintiff appeared to be in no apparent
distress. He had intact strength in his arms and legs. Dr. Blachar prescribed Requip, for
restless leg syndrome, and advised him to follow up in three months. (Tr. 255).
Plaintiff saw Dr. Blachar again on January 11, 2011 and reported his pain level as
2-3/10. His Requip was discontinued due to side effects. Upon examination, plaintiff
appeared to be in no apparent distress with normal strength. (Tr. 257.)
On April 5, 2011, plaintiff saw Dr. Blachar. Plaintiff described his pain as an achy
sensation, as well as a burning feeling, and rated his back pain as 3/10. He stated that his
pain improved with medications, as well as cold and heat, and that physical activity and
movement worsened his pain. He denied any new weakness or numbness in his arms or
legs. Upon examination, he appeared in no apparent distress and had intact strength in his
legs. Dr. Blachar increased plaintiff’s medications. (Tr. 304-05.)
Plaintiff saw Dr. Blachar again on June 28, 2011. He reported his pain as 3/10. He
reported that his medications provided improved pain relief and functioning and that he
did not want anything changed at that time. Upon examination, he appeared to be in no
apparent distress and had intact strength. (Tr. 306.)
Plaintiff saw Dr. Blachar on September 20, 2011 and rated his pain as 3/10. Upon
exam, he appeared to be in no apparent distress and his strength was intact. Plaintiff asked
Dr. Blachar to increase his Duragesic but he was declined. Plaintiff believed that his
current regimen of Duragesic, oxycodone, and Pamelor, an antidepressant, was the best
regimen he had had for quite a while. Dr. Blachar thought he was becoming tolerant to
the effects of his opioid medications. He prescribed Norflex, an antispasmodic, instead of
Flexaril, a muscle relaxant, which plaintiff could not afford. (Tr. 308.)
Plaintiff saw Dr. Blachar again on December 13, 2011. His condition was the
same, and he rated his pain as 2/10. Dr. Blachar discontinued the Norflex and prescribed
another antispasmodic, Zanaflex. (Tr. 310.)
Plaintiff saw Dr. Koopman on December 8, 2011 for back pain and erectile
dysfunction (ED). Upon exam of his back, plaintiff had some tenderness in his lumbar
spine, good ROM, except for when bending forward or backward.
prescribed Cialis, for ED, but declined to prescribe another controlled substance,
instructing plaintiff to follow up with his pain management doctor. (Tr. 283.)
On February 23, 2012, Dr. Koopman completed a Medical Assessment of Ability
to do Work Related Activities. He opined that plaintiff could not sustain sitting and lifting
or carrying, and could stand and walk for at least two hours in an 8-hour workday. He
stated plaintiff “constantly” experienced numbness in his arms and legs and that he would
need to rest for more than three hours during a normal workday. (Tr. 285.) Dr. Koopman
opined that plaintiff’s restrictions were severe. He noted that plaintiff had been receiving
disability for six years and that he based his responses on plaintiff’s self report of his
limitations. (Tr. 291-92.)
correspondence from 2009, stating that plaintiff’s current condition remained unchanged.
Dr. Koopman stated that he had been plaintiff’s PCP since February 2009. Plaintiff’s
back problems began when he was involved in a motor vehicle accident when he was five
years old and he had experienced back pain since that time. Plaintiff had been evaluated
in 2004-2005 by different doctors which showed spondylosis and degenerative disc
disease. On exam, plaintiff experienced daily pain and paresthesia, an abnormal sensation
of the body, such as numbness, tingling, or burning, as well as demonstrable right leg
Plaintiff had been to a chiropractor and had received physical therapy and
interventional pain treatments. Plaintiff was prescribed narcotics under the care of Dr.
Blachar, a pain management specialist. In the correspondence, Dr. Koopman noted that
Dr. Blachar had previously evaluated and documented plaintiff’s physical limitations. Dr.
Koopman opined that plaintiff’s physical limitations did exist as stated by Dr. Blachar and
were related directly to his known back disease. He thought that plaintiff’s limitations and
medications made it “extremely unlikely he would be able to hold any significant
employment without significant retraining.” (Tr. 302-03.)
Plaintiff saw Dr. Blachar on March 6, 2012 to ask him to complete disability
paperwork. Plaintiff rated his pain as 3/10 and appeared to be in no apparent distress with
intact strength. (Tr. 312.) Dr. Blachar completed a Physician’s Assessment for Social
Security Disability Claim form and a Medical Assessment of Ability to do Work Related
Activities form. He indicated plaintiff was restricted to lifting no more than 10 pounds,
as well as no stooping, climbing or balancing. The recommended or attempted treatment
was chronic pharmacological management with pain medications and previous therapeutic
injections and physical therapy without good relief. He indicated that plaintiff would need
to rest more than five hours and take multiple breaks in an eight-hour workday. He
believed plaintiff would be absent 3 to 4 times per week or 9 to 12 times per month
because of his pain complaints. Dr. Blachar believed that plaintiff had been significantly
restricted from doing a 40-hour work week, even at a sedentary level, because of his pain
complaints. He indicated that plaintiff could stand and walk at least 2 hours in an 8-hour
workday and that sustained sitting was not possible. Plaintiff’s pain level was so severe as
to interfere with the ability to maintain attention and concentration greater than 15% of the
day. (Tr. 272-73.)
Plaintiff was seen in the emergency room (ER) at Samaritan Hospital on March 19,
2012 for back pain. He said he needed a chiropractic manipulation, but his chiropractor
was deceased and Medicaid would not pay for one. He walked out of the ER with a slow,
limping gait, and declined a wheelchair and medications. (Tr. 286-87.)
Plaintiff returned to the ER the next day, asking to see an orthopedist for a back
manipulation or adjustment.
He appeared in no acute distress and walked without
difficulty. He stated he felt a little better than the day before and did not want medication.
Upon exam, he had no tenderness in his back, normal ROM, normal strength, and normal
sensation. Plaintiff was advised that orthopedists were not on call in the ER to do
manipulations and that he would need to find one on an outpatient basis.
diagnosed with low back pain and discharged. (Tr. 299-301.)
Plaintiff appeared and testified to the following at a hearing conducted by an ALJ
on April 4, 2012. He completed the 11th grade and obtained his GED in 2002 or 2003.
He lives in a one story home with his three youngest children, ages 12 through 16, and his
wife who is disabled. He and his wife have six children between the two of them. He is
five feet eleven inches tall and weighs a little over 230 pounds. He was involved in a car
accident when he was five years old and has had back problems since although his
condition has worsened considerably over the past ten years. He cannot work because of
pain when bending over and muscle spasms. His right leg feels like it is on fire all of the
time. His lower back pain feels like a dull toothache. He rated his daily pain as 2 or 3/10.
He sees Dr. Blachar, a pain specialist, every three months or more frequently as
At the time of the hearing, he was using a Duragesic patch and taking
Roxicodone, muscle relaxants, and Amitriptyline, an antidepressant. His back pain is
aggravated by bending over and sitting or riding in a car. He feels most comfortable lying
down. His doctor recommends exercise which he does at home. He is limited to lifting 010 pounds. Lifting or pulling aggravates his back pain. Lifting a gallon of milk causes
him pain. It is difficult for him to bend over to pull up the toilet seat. His medications
cause him to become emotional, forgetful, and have difficulty thinking clearly. He uses a
small electric neurostimulator on his back at night. He sleeps only two or three hours at a
time. He cannot work primarily due to his leg, back, and recent hip problem. He has
difficulty with talking and thinking clearly on a daily basis. He has had difficulty sleeping
for years and spends 99% of his time in bed as he has done long before he applied for
disability. He has difficulty getting dressed and using the bathroom because it requires
him to bend over. His children do all of the housework. On a good day, he can prepare
oatmeal, go to the restroom, and take a shower. He can walk 50 to 100 feet, maybe half a
block. He can watch TV but falls asleep during commercials. He has missed many of his
children’s activities due to his pain. He has difficulty with balance. He has more bad
days than good and has couple of good days per month. (Tr. 36-52.)
Francis McGrowski, Ph.D., vocational expert (VE), also testified to the following
at the hearing. Plaintiff’s past work as a car detailer and coffee sales person were
generally performed at the medium exertional level. The ALJ asked the VE whether a
hypothetical individual with plaintiff’s RFC, but who was also limited to simple
instructions, could perform any jobs existing in significant numbers in the national
The VE testified that such a person could perform the representative
occupations of parking lot cashier, order caller, and contribution solicitor.
The VE testified that the same hypothetical individual would not be able to work if
he was off task for an average of 20% of the workday. The VE testified that if a
hypothetical individual would not be able to work if he was absent 9 to 12 workdays per
month due to their impairments. The same hypothetical individual would be unable to
sustain substantial gainful work if he needed to rest between 4 to 5 hours in an 8-hour
workday. (Tr. 52-58.)
Decision of the ALJ
On May 31, 2012, the ALJ issued a decision finding that plaintiff was not disabled
under the Act. The ALJ found that plaintiff had the severe impairments of degenerative
disc disease and obesity. The ALJ found that plaintiff did not have an impairment or
combination of impairments that met or medically equaled the severity of one of the listed
impairments. The ALJ found that plaintiff had the RFC to perform light work as defined
except that plaintiff could only occasionally climb ramps and stairs and never climb
ladders, ropes, or scaffolding. The ALJ found that plaintiff could frequently balance, but
only occasionally stoop, kneel, crouch, or crawl. (Tr. 10-11.)
The ALJ gave little weigh to the opinion of plaintiff’s pain management physician,
Dr. Blachar, stating that his allegations were not supported by his own treatment notes or
the objective evidence. The ALJ also gave little weight to the opinion of Dr. Koopman
because his opinions appeared to be primarily based upon the plaintiff’s subjective
complaints. (Tr. 13.)
IV. GENERAL LEGAL PRINCIPLES
The court’s role on judicial review of the Commissioner’s decision is to determine
whether the Commissioner’s findings comply with the relevant legal requirements and are
supported by substantial evidence in the record as a whole. Pate-Fires v. Astrue, 564 F.3d
935, 942 (8th Cir. 2009). “Substantial evidence is less than a preponderance, but is
enough that a reasonable mind would find it adequate to support the Commissioner’s
conclusion.” Id. In determining whether the evidence is substantial, the court considers
evidence that both supports and detracts from the Commissioner's decision. Id. As long
as substantial evidence supports the decision, the court may not reverse it merely because
substantial evidence exists in the record that would support a contrary outcome or because
the court would have decided the case differently. See Krogmeier v. Barnhart, 294 F.3d
1019, 1022 (8th Cir. 2002).
To be entitled to disability benefits, a claimant must prove he is unable to perform
any substantial gainful activity due to a medically determinable physical or mental
impairment that would either result in death or which has lasted or could be expected to
last for at least twelve continuous months.
42 U.S.C. §§ 423(a)(1)(D), (d)(1)(A),
1382c(a)(3)(A); Pate-Fires, 564 F.3d at 942. A five-step regulatory framework is used to
determine whether an individual is disabled. 20 C.F.R. § 416.920(a)(4); see also Bowen
v. Yuckert, 482 U.S. 137, 140-42 (1987) (describing five-step process); Pate-Fires, 564
F.3d at 942 (same).
Steps One through Three require the claimant to prove (1) he is not currently
engaged in substantial gainful activity, (2) he suffers from a severe impairment, and (3)
his condition meets or equals a listed impairment. 20 C.F.R. § 416.920(a)(4)(i)-(iii). If
the claimant does not suffer from a listed impairment or its equivalent, the
Commissioner’s analysis proceeds to Steps Four and Five.
Step Four requires the
Commissioner to consider whether the claimant retains the RFC to perform past relevant
work (PRW). Id. § 416.920(a)(4)(iv). The claimant bears the burden of demonstrating he
is no longer able to return to his PRW. Pate-Fires, 564 F.3d at 942. If the Commissioner
determines the claimant cannot return to PRW, the burden shifts to the Commissioner at
Step Five to show the claimant retains the RFC to perform other work that exists in
significant numbers in the national economy. Id.; 20 C.F.R. § 416.920(a)(4)(v).
Plaintiff argues that the ALJ erred in rejecting the opinion of treating physicians
Drs. Blachar and Koopman and in failing to provide a basis for his RFC. He argues the
ALJ should have given both doctors’ opinions controlling weight because they are based
on objective observations and signs. He argues that the ALJ erred in forming his own
opinion of the medical evidence, instead of relying on the interpretation of his treating
sources, and in providing no specifics or explanation for his conclusions that the doctors’
opinions were not supported by the evidence. In support, he notes that there are no
conflicts among treating medical sources and in fact there are supportive findings from
several medical sources. He argues that the ALJ’s assessment of plaintiff’s ability to work
amounted to medical conjecture.
RFC is a medical question and the ALJ’s determination of RFC must be supported
by substantial evidence in the record. Hutsell v. Massanari, 259 F.3d 707, 711 (8th Cir.
2001); Lauer v. Apfel, 245 F.3d 700, 704 (8th Cir. 2001); Singh v. Apfel, 222 F.3d 448,
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451 (8th Cir. 2000). RFC is what a claimant can do despite his limitations, and it must be
determined on the basis of all relevant evidence, including medical records, physician’s
opinions, and a claimant’s description of his limitations. Donahoo v. Apfel, 241 F.3d
1033, 1039 (8th Cir. 2001); 20 C.F.R. § 416.945(a). While the ALJ is not restricted to
medical evidence alone in evaluating RFC, the ALJ is required to consider at least some
evidence from a medical professional. Lauer, 245 F.3d at 704. An “RFC assessment 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 96-8p, 1996 WL 374184, at *7 (1996).
Here, the ALJ determined that plaintiff had the severe impairments of degenerative
disc disease and obesity. The ALJ determined that plaintiff had the RFC to perform light
work as defined in the regulations. See 20 C.F.R. § 416.967(c). The ALJ found that
plaintiff could occasionally climb ramps and stairs, but never climb ladders, ropes, or
scaffolds. He found plaintiff could frequently balance, but only occasionally stoop, kneel,
crouch, or crawl.
The ALJ’s determination of plaintiff’s RFC reflected his conclusion that plaintiff’s
self-described limitations were not entirely credible. The ALJ stated in his decision that
he found plaintiff’s complaints not credible for several reasons. Specifically, plaintiff
made inconsistent statements concerning his level of pain, his limitations, his medication
side effects, and his work activity. (Tr. 12-15, 277, 279.) Plaintiff’s daily activities
included assisting his disabled wife and three children, preparing very simple meals,
bathing and performing personal hygiene, grocery shopping, and riding to the hearing for
an hour and a half without difficulty. (Tr. 12, 15, 28-29, 30, 43-44, 47, 72, 200-03.)
Plaintiff reported to his doctors that his pain medications generally worked and that his
pain was only at a level 2-3/10 on most occasions. (Tr. 12, 253, 255, 257, 279, 304, 306,
308, 310, 312.) The objective evidence, including imaging studies, showed only mild
abnormalities and mostly normal examination findings. (Tr. 11, 13, 230, 244, 253, 255,
257, 280, 283, 291, 299-300, 304, 306, 308, 310, 312. )
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Plaintiff does not dispute the ALJ’s conclusions regarding his credibility. Despite
finding plaintiff’s allegations to be less than fully credible, the ALJ credited the portions
he found to be consistent with the record evidence. For example, the ALJ’s finding that
plaintiff could perform light work, which generally involves lifting up to twenty pounds
occasionally, is consistent with plaintiff’s report to Dr. Jeffries that he could lift light to
medium weights. (Tr. 277.) Light work also involves sitting up to six hours a day and
standing or walking for up to a total of six hours a day. See 20 C.F.R. § 416.967(c). The
ALJ’s finding that plaintiff could sit for up to six hours is supported by plaintiff’s
statement that he was able to travel approximately an hour and a half in the car, at times
driving, without difficulty from pain. (Tr. 29-30.) Moreover, the ALJ’s finding that
plaintiff could stand or walk for up to six hours is supported by plaintiff’s examinations,
which revealed normal leg strength and normal gait on most occasions. (Tr. 244, 253,
255, 280, 287, 291, 299-300, 301, 304, 306, 308, 310, 312.) This is also supported by
plaintiff’s statements to his doctors that he did better walking than sitting and also by his
daily activities, which included shopping and preparing simple meals. (Tr. 200-03, 288.)
The ALJ’s RFC assessment also reflected the ALJ’s evaluation of the medical
opinions. Opinions from medical sources who have treated a claimant typically receive
more weight than opinions from one-time examiners or non-examining sources. See 20
C.F.R. § 416.927(c)(1)-(2). However, the rule is not absolute; a treating physician’s
opinion may be disregarded in favor of other opinions if it does not find support in the
record. See Casey v. Astrue, 503 F.3d 687, 692 (8th Cir. 2007). Likewise, an ALJ may
appropriately rely on non-examining opinions as part of his RFC analysis. See Hacker v.
Barnhart, 459 F.3d 934, 935, 939 (8th Cir. 2006) (ALJ’s RFC assessment was supported
by substantial evidence, including the opinions from non-examining doctors). Ultimately,
it is up to the ALJ to determine the weight each medical opinion is due. See Id., 459 F.3d
at 936 (ALJ’s task is to resolve conflicts in the evidence).
Here, the ALJ considered the opinion of Dr. Blachar, plaintiff’s pain management
doctor. (Tr. 12.) Although Dr. Blachar is a treating doctor, the ALJ gave Dr. Blachar’s
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opinion little weight for several reasons. The ALJ noted that Dr. Blachar’s opinion that
plaintiff could not lift more than ten pounds, stoop, climb, or balance was inconsistent
with his own treatment notes in which he repeatedly stated that plaintiff had normal
strength and appeared in no apparent distress. (Tr. 12, 253, 255, 257, 304, 306, 308, 310,
312.) See e.g., Raney v. Barnhart, 396 F.3d 1007, 1010 (8th Cir. 2005) (ALJ may
discount a treating source’s opinion when it is inconsistent with the source’s own
treatment notes; ALJ could properly discount therapist’s RFC when contemporaneous
treatment notes showed that claimant had “improved” and was “fair”).
The ALJ also discounted Dr. Blachar’s opinion because it appeared to be based on
plaintiff’s subjective complaints. (Tr. 12). See Gonzales v. Barnhart, 465 F.3d 890, 896
(8th Cir. 2006) (ALJ could give less weight to a medical opinion because it appeared to be
based solely on the claimant’s subjective complaints). Dr. Blachar believed that plaintiff
would have excessive absences from work “because of his pain complaints,” suggesting
that his opinion was based on plaintiff’s allegations of pain. (Tr. 12, 272). As set forth
above, the ALJ found plaintiff’s pain complaints to be less than fully credible for several
good reasons and was therefore justified in discounting Dr. Blachar’s opinion in this
Finally, the ALJ discounted Dr. Blachar’s opinion because it was not supported by
the objective evidence. (Tr. 13.) “While the opinion of a treating physician is entitled to
substantial weight, it is not conclusive because the record must be evaluated as a whole.”
Howe v. Astrue, 499 F.3d 835, 839 (8th Cir. 2007). The ALJ in this case noted plaintiff’s
imaging studies, which showed only a small disc protrusion and “minimal”
(Tr. 12, 244, 280.)
The ALJ also noted that other physical
examinations did not reveal abnormalities that would support Dr. Blachar’s extreme
limitations. (Tr. 12.) For example, Dr. Jeffries found plaintiff to have a normal gait and
that he could toe, heel, and tandem walk and also stand on one leg. (Tr. 12, 230.) While
plaintiff had reduced ROM, Dr. Jeffries noted that plaintiff had no dramatic tenderness or
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muscle spasm, full motor strength, normal reflexes, and intact sensation. A sitting root
test or straight leg raise was also negative. (Tr. 12, 280.)
Likewise, when Dr. Tiede examined plaintiff, he found no overt pathological pain
behavior. While plaintiff changed positions slowly and had trouble bending, he had no
tenderness in his lower back, normal reflexes, intact sensation, and no strength deficits.
He also had negative straight leg raises. (Tr. 244.) Examination in the ER in March 2012
revealed a normal ROM in plaintiff’s back, normal strength, and normal sensation.
Plaintiff was able to walk without difficulty and had no tenderness in his back. (Tr. 301.)
This evidence conflicts with Dr. Blachar’s opinion that plaintiff experienced constant
numbness. (Tr. 273.) Accordingly, the ALJ did not err in discounting Dr. Blachar’s
opinion because it conflicted with the other record evidence.
The ALJ also gave little weight to the opinion of Dr. Koopman, plaintiff’s PCP, in
making his RFC finding. The ALJ considered Dr. Koopman’s letter and his MSS, but
gave them little weight, citing several reasons. First, the ALJ found Dr. Koopman’s own
treatment notes did not reveal findings as to justify severe limitations, such that plaintiff
could only stand or walk for two hours total and do no sustained sitting. (Tr. 13, 285).
The ALJ noted that Dr. Koopman’s records showed plaintiff was generally doing well. In
August 2010, Dr. Koopman examined plaintiff and found only some tenderness and mild
muscle spasm in his lower back, but good ROM. (Tr. 13, 230.) At his next appointment
in December 2011, plaintiff again had some tenderness, but good ROM. (Tr. 283.) In
February 2012, plaintiff had some reduced ROM and muscle spasm, but was able to heel
and toe walk. (Tr. 291.) Dr. Koopman’s notes do not show extreme limitations or support
his opinion that plaintiff could hardly walk or sit.
The ALJ also gave little weight to Dr. Koopman’s opinion because it was based on
plaintiff’s less than credible subjective complaints. Here, Dr. Koopman specifically stated
that he based his opinion on plaintiff’s own reports of his symptoms. (Tr. 13, 292.)
Because the ALJ found plaintiff’s description of his symptoms was not credible, the ALJ
was justified in discounting Dr. Koopman’s opinion.
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Finally, the ALJ noted that Dr. Koopman’s opinion was not consistent with the
objective evidence or plaintiff’s own testimony. (Tr. 13.) Although Dr. Koopman opined
that plaintiff experienced constant numbness, the ALJ noted that the record evidence
consistently showed plaintiff had normal sensation. (Tr. 13, 244, 280, 285, 301.) Nor did
plaintiff complain of any numbness at the hearing. (Tr. 13, 27-61.) Additionally, Dr.
Koopman’s belief that plaintiff could do no sustained sitting conflicted with plaintiff’s
testimony that he was able to sit in a car for approximately one and a half hours without
any difficulty. (Tr. 30.)
The undersigned concludes that the ALJ properly determined that the opinions of
Drs. Blachar and Koopman were not entitled to controlling weight. See Brown v. Astrue,
611 F.3d 941, 951 (8th Cir. 2010) (while a treating physician’s opinion is generally
entitled to substantial weight such an opinion does not automatically control in the face of
other credible evidence on the record that detracts from that opinion). Here, the ALJ
considered all of the record evidence and provided good reasons for giving little weight to
the opinions of Drs. Blachar and Koopman. (Tr. 11-15.) Plaintiff did not cite any record
evidence that the ALJ failed to consider or that would cause the ALJ’s decision to be
unsupported by substantial evidence.
See 20 C.F.R. § 416.927.
undersigned concludes the ALJ’s analysis of the medical opinions is supported by
Plaintiff finally contends that the ALJ improperly substituted his own opinion for
that of Drs. Blachar and Koopman. The undersigned disagrees.
Assessing RFC is the
ALJ’s responsibility and in doing so, the ALJ must consider all of the evidence in the
record, not just the medical opinions. 20 C.F.R. § 416.927. The ALJ is not required to
rely entirely on a particular physician’s opinion or choose between the opinions of the
claimant’s physicians. Martise v. Astrue, 641 F.3d 909, 927 (8th Cir. 2011). The court
concludes that the ALJ properly evaluated all of the evidence and his analysis is supported
by substantial evidence.
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For the reasons set forth above, the decision of the Commissioner of Social
Security is affirmed. An appropriate Judgment Order is issued herewith.
S/ David D. Noce
UNITED STATES MAGISTRATE JUDGE
Signed on June 27, 2014
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