Robertson v. Colvin

Filing 20

MEMORANDUM - For the reasons set forth above, the decision of the Commissioner of Social Security is affirmed. An appropriate Judgement Order is issued herewith.. Signed by Magistrate Judge David D. Noce on 2/11/16. (KKS)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
BRENETT ROBERTSON,
Plaintiff,
v.
CAROLYN W. COLVIN,
Acting Commissioner of Social Security,
Defendant.

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No. 4:15 CV 2 DDN

MEMORANDUM
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 Brenett
Robertson for disability insurance benefits under Title II of the Social Security Act (the
Act), 42 U.S.C. § 401, et seq. 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 Commissioner is affirmed.

I. BACKGROUND
Plaintiff was born on January 15, 1968. (Tr. 241.) She filed her application for
Disability Insurance Benefits on October 17, 2011. (Tr. 156.) She alleged an onset date
of October 6, 2011. (Tr. 204.) She alleged that she was unable to work due to spasms in
the arteries, heart attacks, asthma, and chest pain. (Id.) The claim was denied on
February 27, 2012. (Tr. 12.) Thereafter, plaintiff filed a written request for a hearing
before an Administrative Law Judge on April 10, 2012. (Id.)
ALJ Ritter held a hearing on April 25, 2013 and issued an unfavorable decision on
September 24, 2013. (Tr. 9, 11.) The Appeals Council denied the plaintiff’s request for

review on November 24, 2014. (Tr. 1.) The decision of the ALJ therefore is the final
decision of the Commissioner. 20 C.F.R. § 404.984(d).

II. MEDICAL AND OTHER HISTORY
On October 6, 2011, plaintiff had a heart attack for which she was hospitalized at
DePaul Health Center. (Tr. 336.) Cardiac catheterization showed a three-vessel coronary
artery spasm in the right coronary artery and an ejection fraction of 25 percent. Plaintiff
had stents inserted.    (Tr. 354-55.) A later cardiac catheterization showed successful
stenting of the left anterior descending artery. (Tr. 358.) She was discharged on October
12, 2011, and was advised to lose weight, follow a low fat/low sodium diet, regularly
exercise, abstain from smoking, and to take all prescribed medications. (Tr. 338.)
On January 5, 2012, plaintiff followed up with her cardiologist Sundeep Das,
M.D., who summarized a series of tests showing ejection fraction from July of 2009 to
November of 2011. (Tr. 384.) These were as follows: July 13, 2009 (60 percent),
January 7, 2011 (60 percent), October 7, 2011 (25 percent), October 27, 2011 (50
percent), and November 22, 2011 (55 percent). At this follow up she denied being in
pain, however, she did have two episodes of intermittent chest pain since her October
2011 hospitalization. (Tr. 384-85.)
On January 30, 2012, plaintiff visited the DePaul emergency room complaining of
chest pain and was admitted. (Tr. 401.) An endoscopy revealed that she had hiatal
hernia. Plaintiff was started on a PPI (proton pump inhibitor) which resolved her chest
pain and she was discharged. (Tr. 402.)
On March 13, 2012, plaintiff returned to the emergency room complaining of
chest pain, describing it as a “sharp discomfort” with some symptom relief from her
Nitroglycerin.1 (Tr. 440.) She also said she was experiencing shortness of breath, but

1

Nitroglycerin, an organic nitrate, is a vasodilator which has effects on both arteries and veins.
The principal pharmacological action of nitroglycerin is a relaxation of vascular smooth muscle,
producing a vasodilator effect on both peripheral arteries and veins with more prominent effects
on the latter. Nitrolingual Pumpspray, Physician’s Desk Reference 1246 (55th ed. 2001) (PDR).
2

denied arm pain, jaw pain, nausea, or vomiting. (Tr. 463.) Plaintiff was discharged on
March 16, 2012. (Tr. 468.)
In a letter dated March 21, 2012, Dr. Das stated that plaintiff’s main problem was
intractable coronary artery spasm. In his opinion, due to her intractable symptoms and
inability to predict the symptoms in a reliable fashion, she should be on long term
disability. (Tr. 439.)
On April 12, 2012, plaintiff followed up with Dr. Das who noted that her weight
increased from 210 to 221 pounds. (Tr. 491.) She complained of intermittent chest pains
and asthma exacerbation. She had been undergoing ECP therapy but denied it had any
effect on her chest pain. (Tr. 492.) Dr. Das recommended implanting a spinal cord
stimulator and referred her to pain management. (Tr. 493.)
On August 14, 2012, plaintiff’s visit noted intermittent resting palpitations,
racing/skipping heartbeats, and chest pain. (Tr. 487-88.) The physical examination was
normal. (Tr. 489.) Dr. Das recommended a new medication subject to whether her
insurance would pay for it. (Id.)
On November 19, 2012, plaintiff returned complaining of a lot of fatigue. (Tr.
482-83.) Dr. Das ordered a repeat echo and a Holter to determine whether there was a
recurrent ischemia. (Tr. 485.) Her medications remained unchanged. (Tr. 485-86.) On
November 26, 2012, plaintiff underwent a transthoracic echocardiogram and Doppler
examination which showed a left ventricular ejection fraction between 45-50 percent and
“no significant valvular abnormalities.” (Tr. 497-98.)
On March 2, 2013, plaintiff spent one night in the hospital after going to the
emergency room reporting chest pain. (Tr. 469.) She was advised to follow a cardiac
diet and released to return to work after one day. (Tr. 475.) On March 18, 2013, plaintiff
followed up with Dr. Das and continued to report intermittent chest discomfort as well as
palpitations, fatigue, dizziness/lightheadedness, and shortness of breath when climbing
stairs and walking around her home. (Tr. 477.) She admitted that her recent trip to the
emergency room showed normal troponins.

Dr. Das noted that an echocardiogram

showed “some decline” in the left ventricle. (Tr. 479.)
3

On April 23, 2013, plaintiff underwent an exercise stress test which showed
“negligible” functional limitation which may be heart or perfusion related and a result of
“deconditioning.” (Tr. 510.)
Pulmonary blood flow pattern during the exercise was abnormal suggesting
impaired cardiac output (CO) response to exercise and abnormal pulmonary
perfusion during exercise. Resting PCO2 was normal suggesting adequate
resting pulmonary blood flow. Cardiopulmonary reserve and O2 transport
to tissues with exercise was mild/moderately impaired. (Id.)
On April 30, 2013, Dr. Das added a new medication, Tracleer (also referred to as
Bosentan). (Tr. 505, 508.) He noted possible improvement with Tracleer when plaintiff
returned for her June 3, 2013 visit. (Tr. 500, 503.) Dr. Das discontinued plaintiff’s use
of aspirin and noted that she would undergo a repeat Holter study prior to her next visit in
November 2013, at which time she would undergo a repeat echo. (Tr. 503, 504.) The
echo was conducted on November 5, 2013, in which no “significant valvular
abnormalities” were found. (Tr. 517.)
On December 26, 2013, plaintiff followed up complaining of worsening
hypertension and sporadic intermittent chest pains which last about a minute and then
resolve, usually one to two times a week. (Tr. 519.) Plaintiff had not been using her
cpap. (Id.) She was instructed to do so. (Tr. 522.)

III. ALJ HEARING
The ALJ held a hearing on April 25, 2013. (Tr. 30.) The plaintiff attended with
her counsel present and testified to the following facts. She was at the time 45 years old
and weighed 211 pounds. (Tr. 35.) She does not have any children living with her. Her
husband is employed and lives with her. (Tr. 36.) She lives home alone during the day
but her mother and sisters come over to spend time with her. (Tr. 36-37.) She drives her
motor vehicle “at times,” mostly twice a week. (Tr. 37.) Plaintiff puts in roughly an hour
to an hour and a half in household chores. (Tr. 38.) She has two years of college
experience in which her field of study was computer operations. (Tr. 39.) Plaintiff’s past
relevant work includes working in collections at a department store from 1996-1997, at a
4

bank in collections from 1997-1998, billing and collections at a hospital from 1999-2008,
and collections for a billing and collection company from 2009-2011.

These jobs

entailed desk work, telephone work, and inputting information into a computer about
bills. (Tr. 40.) She classified the work as sedentary and agreed that she did not have to
lift more than 10 pounds. (Tr. 41.)
Plaintiff had a heart attack on October 6th. She was admitted to the hospital and
held for three days, sent home, and returned a day later. (Tr. 41.) She had stents put in.
She admitted to having a long history of heart problems. She was treated by Dr. Das who
placed some restrictions on her including avoiding strenuous activity and stressful work.
She stated that Dr. Das does not want her working at all. (Tr. 42-43.) She worries about
her heart because she is unsure when it is a real problem and when it is not. For chest
pain, she takes three types of nitroglycerin including the patch, the pill, and the
emergency spray.2 (Tr. 43.) She gets a sharp stabbing pain in her chest which sometimes
feels like heartburn and sometimes feels like a tingling sensation.

(Tr. 44.)

The

emergency spray works well for her in those situations. (T. 44-45.) Within the last year
she had been to the hospital about three to four times and she was held overnight. (Tr.
45.) The most strenuous activity she recalls doing was washing clothes, although she
states that she does not engage in many activities because she is scared as she never
knows when she is going to have an attack. (Tr. 46.)
Plaintiff states that sometimes she feels chest pain walking up her basement steps
but other times she could be resting and gets chest pain. (Tr. 47.) These episodes of
chest pain occur roughly three to four times a week and last approximately five to seven
minutes. (Tr. 50.) Plaintiff takes nitroglycerin, which usually gives her headaches or
makes her nauseous. (Tr. 50.) If the nitroglycerin does not work by the second spray,
plaintiff usually goes to the emergency room. (Tr. 51.) Plaintiff also has asthma for
which she uses an albuterol inhaler. She has a nebulizer with albuterol and she also takes
Advair and Spiriva on a daily basis. She still gets asthma attacks despite the medication

2

The nitroglycerin spray is prescribed to patients for acute relief of an attack or prophylaxis of
angina pectoris due to coronary artery disease. See footnote 1.
5

at times. (Tr. 47.) She also gets upper respiratory tract infections throughout the year.
(Tr. 48.) Plaintiff claims that her asthma has gotten a little better since she stopped
working. (Id.) She has never been a smoker and she does not come in contact with
secondhand smoke.

Plaintiff’s primary conditions are her asthma, her heart, and

hypertension. She has not been treated by a doctor for anxiety or depression. She
believes she is depressed over her heart condition and probably needs treatment for that.
(Tr. 49.)
At the evidentiary hearing before the ALJ, George C. Oliver, M.D., a consulting
cardiologist Medical Expert, testified. (Tr. 53-80) (see below).
III. DECISION OF THE ALJ
On September 24, 2013, the ALJ found plaintiff not disabled. (Tr. 12-23.) At the
first step the ALJ found that plaintiff met the insured status requirements of Title II of the
Social Security Act through December 31, 2016, and had not been engaged in substantial
gainful activity since October 6, 2011, her alleged onset date. (Tr. 14.)
At the second step the ALJ found plaintiff did have severe impairments that have
more than minimal effect on her ability to engage in work: prinzmetal angina status post
insertion of six stents, hiatal hernia with complaints of heartburn (gastroesophageal reflux
disease or “GERD”), hypertension, and obesity. (Tr. 14.)
At step three the ALJ found plaintiff did not have an impairment or combination
of impairments that met or medically equaled the severity of one of the listed
impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525
and 404.1526). The ALJ found that medical evidence did not document listing-level
severity and no acceptable medical source mentioned findings equal in severity to the
criteria of any listed impairment. In addition, there are no specific listings for
hypertension or obesity. (Tr. 15.)
The ALJ then considered the entire record and determined plaintiff had the
residual functional capacity (RFC) to perform light work as defined in 20 CFR
404.1567(b) except no concentrated exposure to respiratory irritants such as fumes,
odors, dusts, gases, and poor ventilation. (Id.) At step four, the ALJ found plaintiff
6

capable of performing past relevant work in billing and collections as this work did not
require the performance of work-related activities precluded by the plaintiff’s RFC. (Tr.
22.) Subsequently, the ALJ found that plaintiff was not under a disability as defined in
the Social Security Act from October 6, 2011 through the date of this decision. (Tr. 22.)

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 that she is unable to
perform any substantial gainful activity due to a medically determinable physical or
mental impairment that would either result in a 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); Pate-Fires, 564 F.3d at 942. A five-step regulatory framework is used to
determine whether an individual is disabled. 20 CFR § 404.1520(a)(4); see also Bowen
v. Yuckert, 482 U.S. 137, 140-42 (1987) (describing the five-step process); Pate-Fires,
564 F.3d at 942 (same).
Steps One through Three require the claimant to prove (1) she is not currently
engaged in substantial gainful activity, (2) she suffers from a severe impairment, and (3)
her disability meets or equals a listed impairment. 20 C.F.R. § 404.1520(a)(4)(i)-(iii). If
the claimant does not suffer from a listed impairment or its equivalent, the
7

Commissioner’s analysis proceeds to Step Four and Five.

Step Four requires the

Commissioner to consider whether the claimant retains the RFC to perform past relevant
work (PRW). Id. § 404.1520(a)(4)(iv). The claimant bears the burden of demonstrating
she is no longer able to return to her 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. §

404.1520(a)(4)(v).
V. DISCUSSION
Plaintiff argues that the ALJ erred by discrediting the opinion of the treating
specialist while giving great weight to the opinion of the medical expert who testified at
plaintiff’s hearing, failed to consider the plaintiff’s subjective complaints under the
standards contained in Polaski, and failed to go through the Pfitzner analysis after finding
plaintiff had significant non-exertional impairments, but did not conduct vocational
expert testimony to that effect.
A. Plaintiff’s RFC
Plaintiff argues that the ALJ failed to articulate a legally sufficient rationale for the
weight accorded the various medical opinions in formulating the residual functional
capacity. Additionally, plaintiff argues that the ALJ erred in failing to give legally proper
weight to her treating physician’s opinion. (Pl.’s Br. 6, 8.)
RFC is a medical determination. Singh v. Apfel, 222 F.3d 448, 451 (8th Cir.
2000). The RFC is what a plaintiff can do despite her limitations, which is to be
“determined on the basis of all relevant evidence, including medical records, physician’s
opinions, and claimant’s description of her limitations.” Dunahoo v. Apfel, 241 F.3d
1033, 1039 (8th Cir. 2001); 20 C.F.R. § 404.1545(a)(1). Plaintiff’s treating physician is
given controlling weight if the opinion is “well supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent with the other
substantial evidence in [the] record.” Prosch v. Apfel, 201 F.3d 1010, 1012-13 (8th Cir.
8

2000); see also Turpin v. Colvin, 750 F.3d 989, 993 (8th Cir. 2014) (“The ALJ must
evaluate the record as a whole and while treating physicians’ opinions are ‘entitled to
special weight,’ they are not automatically controlling.”) (quoting Bentley v. Shalala, 52
F.3d 784, 785-86 (8th Cir. 1995)). The ALJ may give less weight to a conclusory or
inconsistent opinion by a treating physician. Samons v. Astrue, 497 F.3d 813, 818-19 (8th
Cir. 2007). Furthermore, pursuant to House v. Astrue, 500 F.3d 741, 745 (8th Cir. 2007),
“[a] treating physician’s opinion that a claimant is disabled or cannot be gainfully
employed gets no deference because it invades the province of the Commissioner to
make the ultimate disability determination.”
The RFC conclusions were reached by a non-examining State Disability
Determination Services physician, Kenneth Smith, M.D., who found plaintiff not
disabled. Dr. Smith’s opinion was given some weight particularly in a case like this
where it is possible to reach similar conclusions based on a number of reasons. Dr. Smith
found plaintiff was capable of sedentary work with occasional climbing of ramps and
stairs, but never ladders, ropes, and scaffolds; occasional stooping, kneeling, crouching,
and crawling; no concentrated exposure to extreme cold, extreme heat, and humidity; not
even moderate exposure to hazards (including moving machinery and unprotected
heights); and no exposure to pulmonary irritants such as fumes, odors, dusts, gases, and
poor ventilation. Dr. Smith’s opinion was based on plaintiff’s history of coronary artery
disease and asthma. On obesity, while there is no specific medical listing for obesity, the
ALJ noted that plaintiff is obese with a body mass index (BMI) of 32 (height of five feet
nine inches, weight of 220 pounds based on the stress test administered on April 23,
2013). (Tr. 20, 505, 510.) Social Security Ruling (SSR) 02-1p recognizes that obesity
can cause limitation of function and obesity combined with other impairments may be
greater than without obesity. Therefore, plaintiff’s obesity was taken into consideration
in the limitations assessed.
Dr. Oliver, the medical expert, testified at the hearing before the ALJ that there
was no reason to limit plaintiff’s physical activity because her chest pain was not
triggered by the activity. (Tr. 21.) Dr. Oliver testified that based on the record and from
9

plaintiff’s testimony, she could be sitting in a chair doing nothing or talking or reading a
book and get chest discomfort. Therefore, in Dr. Oliver’s opinion, activity is not a
provoking factor in plaintiff’s chest pain because she appears to get them at unpredictable
times, and she is frightened by them. (Tr. 66.)
Dr. Das, however, indicated in a letter dated March 21, 2012, that because of
plaintiff’s intractable symptoms and inability to predict the symptoms in a reliable
fashion, she should be on long-term disability as she is not going to be able to obtain any
reasonable employment of any capacity. (Tr. 439.) The ALJ gave no weight to this
opinion because the decision did not provide specific medical evidence on which the
determination was based. (Tr. 21.) In addition, the determination of whether or not
plaintiff is disabled under the Social Security Act rests exclusively with the
Commissioner. (Id.) Dr. Das also believed that plaintiff’s heart condition was a Class III
on the New York Heart Association’s Classification3 scale in a form dated April 24,
2013, which would result in “marked limitation of physical activity.” (Tr. 22.) The ALJ
gave Dr. Das’s opinion no weight, because Dr. Oliver testified that plaintiff’s condition
did not satisfy the requisites to be considered Class III because her symptoms seemed to
occur regardless of whether she was walking or sitting or any other physical exertion.
Furthermore, Dr. Oliver believed it was difficult to rate the plaintiff under the New York
Heart Association Classification, because at that particular time she did not undergo a
stress test. (Tr. 55.) The ALJ also found that Dr. Das’s opinion lacked specificity and
did not provide detailed objective findings to support his opinion for long-term disability.
(Tr. 22.)
Dr. Oliver testified there are a number of factors to consider in order to determine
the severity of the heart condition. (Tr. 56.) First, one looks to the stress test (conducted

3

New York Heart Association (NYHA) Functional Classification is the most commonly used
classification system. Class III: Patient symptoms include marked limitation of physical activity;
comfortable at rest; less than ordinary activity causes fatigue, palpitation, or dyspnea (shortness
of breath). Classes of Heart Failure, Heart.org, http://www.heart.org/HEARTORG/Conditions/
HeartFailure/AboutHeartFailure/Classes-of-Heart Failure_UCM_306328_Article.jsp#.
ViEo6yu_u8k.
10

on April 23, 2013-post hearing date)

(Tr. 510.)

Plaintiff’s stress test showed

“negligible” functional limitation which may be heart or perfusion related. (Id.) Second,
look at the ability of the heart muscle to pump blood which is measured by an ejection
fraction. Plaintiff had multiple measurements of her ejection fraction and most were
normal with the exception of one. However, during that measurement she was on a
catheterization table which was intentionally causing spams in the arteries that feed the
heart, thereby limiting the blood flow to the heart muscle. Under those circumstances,
Dr. Oliver testified, it is not surprising that her heart muscle was not pumping blood as
normal. (Tr. 56.) Third, look at the ability of the arteries to carry blood to the heart
muscle at rest and at the end of exercise. (Tr. 57.) This can be done using a stress test or
by heart catheterization. Plaintiff had several heart catheterizations and the results
indicated that plaintiff’s right coronary artery was in spasm and had a long area of spasm.
Plaintiff had three stents placed in the right coronary artery. A stent is a cylinder made of
mesh that is used to prop the artery open so it cannot narrow down. The procedure was
successful and the blood flow was excellent. Plaintiff had an additional set of three stents
placed in three other major arteries. This procedure was also successful. The arteries
were open and carrying blood normally. (Tr. 58-59.) Dr. Oliver testified that, based on
the chronology of plaintiff’s chest pains, the surgical application of the stents into her
arteries, the lack of cardiac ischemia, and plaintiff’s history of GERD, he could not say
what the cause of plaintiff’s chest pain was. (Tr. 62.) Dr. Oliver did not have the cardiac
catheterization report that was conducted in November 2012.

The ALJ read the

conclusion to him in order to obtain his opinion on the matter, however. (Tr. 74.) The
normal left ventricular ejection fraction is around 50 percent or above. The Social
Security disability figure is 30 percent or below. (Tr. 76.)
There is substantial evidence supporting the ALJ’s RFC finding. This evidence
includes: (a) plaintiff’s visit to Dr. Das only every three to four months; (b) results of the
April 23, 2013 exercise stress test; (c) successful treatment of her symptoms with stenting
and medication; (d) repeated objective medical testing that showed her chest pain was not
cardiac in nature; (e) plaintiff’s failure to follow recommendations made by her treating
11

physicians; (f) plaintiff’s ability to work prior to alleged onset date with the same
intensity of her cardiac symptoms; (g) opinion of the State agency medical consultant;
and (h) opinion of Dr. Oliver, the medical expert. (Tr. 22.) Dr. Das’s opinion, while
entitled to special consideration, was not automatically controlling in light of other
substantial evidence in the record.
B. Plaintiff’s subjective complaints
Plaintiff argues that the ALJ erred in failing to consider her subjective complaints
of unpredictable chest pains, complaints of anxiety and depression, and side effects of her
medication resulting in headaches and nausea under the standards contained in Polaski v.
Heckler, 739 F.2d 1320 (8th Cir. 1984). (Pl.’s Br. 11-12.)
In evaluating a plaintiff’s subjective symptoms using the Polaski factors, the ALJ
must make a credibility determination. See Ellis v. Barnhart, 392 F.3d 988, 995-96 (8th
Cir. 2005). These factors include: (1) the plaintiff’s daily activities; (2) the duration,
frequency, and intensity of the condition; (3) dosage, effectiveness, and side effects of
medication; (4) precipitating and aggravating factors; and (5) functional restrictions.
Polaski, 739 F.2d at 1322. The ALJ does not need to discuss each factor separately,
rather the court will review the record as a whole to ensure such evidence was not
disregarded by the ALJ. See McCoy v. Astrue, 648 F.3d 605, 615 (8th Cir. 2011).
Subjective complaints may be discounted if there are inconsistencies in the record as a
whole.

Polaski, 739 F.2d at 1322. The ALJ must make an express credibility

determination when rejecting plaintiff’s complaints of pain by giving reasons for
discrediting the testimony, stating the inconsistencies, and discussing the Polaski factors.
Singh v. Apfel, 222 F.3d 448, 452 (8th Cir. 2000).
Substantial evidence supports the ALJ’s finding that plaintiff’s chest pains were
not so severe in intensity or persistence that she could not perform light work. The
plaintiff’s treatment records between January 2011 and December 2013 reveal that she
described her chest pain as only moderate (4/10) in severity, she experienced chest pain
12

only a “few” or one or two times weekly, her chest pain generally resolved within
minutes by the intake of the nitroglycerin spray, and furthermore her pain was not
triggered by activity or exertion. (Tr. 18, 20, 241, 245, 249, 253, 313, 455, 463-64, 477,
482, 501, 519, 524, 530.) Plaintiff also testified at her hearing that her chest pain would
usually resolve by taking the nitroglycerin spray which “pretty much works” right away
or within a minute. (Tr. 43-45.) As far as plaintiff’s argument concerning side effects of
the medication are concerned, the record shows that plaintiff did not experience such side
effects in a manner which would render her disabled. Dr. Oliver’s testimony revealed
that headaches and nausea were possible side effects of nitroglycerin. (Tr. 18, 73.)
However, aside from plaintiff’s report of experiencing nausea with chest pain in her
emergency visit in October 2011, she did not report to nurses or doctors that she was
experiencing nausea or headaches as side effects to her medication. Plaintiff denied
experiencing headaches during doctor visits in January 2011, February 2011, March
2011, March 2012, and November 2013. (Tr. 245, 250, 413, 464-65, 531.) In addition,
she denied experiencing nausea on doctor visits in January 2011, February 2011, June
2011, March 2012, April 2013, June 2013, and November 2013. (Tr. 242, 250, 254, 327,
463-65, 478, 502, 531.)
Plaintiff testified at the ALJ hearing that she is depressed, however, she also
admitted that she had never been treated for depression or anxiety. (Tr. 49.) Plaintiff did
not indicate that she suffered from a mental impairment when she applied for disability,
listing only spasms in arteries, heart attacks, asthma, and chest pains. (Tr. 204.) In
addition, plaintiff consistently denied to her health care providers that she was
experiencing unusual stress, difficulty concentrating, anxiety, or depression. (Tr. 242,
246, 250, 254, 502.)
The ALJ lawfully discounted plaintiff’s subjective complaints because there were
several inconsistencies in the record which showed her chest pain was not as severe, the
pain usually resolved by the intake of her medication, and she did not report side effects
of the medication. In reaching this conclusion, the ALJ applied the Polaski factors to

13

plaintiff’s condition and detailed the reasons for discrediting her testimony regarding her
subjective complaints.
C. Vocational expert testimony
Plaintiff argues that once significant non-exertional impairments are shown to
exist, vocational expert testimony is required, and in its absence the ALJ’s decision is not
supported by substantial evidence.

Plaintiff argues that the ALJ made no explicit

findings with respect to the mental demands of plaintiff’s past work and only cited the
Dictionary of Occupational Titles to show the physical demands of her past relevant
work. See Pfitzner v. Apfel, 169 F.3d 566, 568-569 (8th Cir. 1999). Therefore, plaintiff
argues, the ALJ failed to go through the function by function analysis under Pfitzner.
(Pl.’s Br. 13).
The ALJ is required to make specific findings as to plaintiff’s RFC and past work
demands. Pfitzner, 169 F.3d at 569. Determining plaintiff’s RFC is not the only task
required at step four of the analysis, rather the “ALJ must also make explicit findings
regarding the actual physical and mental demands of the claimant’s past work.” Id.
(quoting Groeper v. Sullivan, 932 F.2d 1234, 1239 (8th Cir. 1991)). The ALJ may do so
by referring to the specific job descriptions in the Dictionary of Occupational Titles
associated with plaintiff’s past work. See Sells v. Shalala, 48 F.3d 1044, 1047 (8th Cir.
1995).
In Pfitzner, 169 F.3d at 567, plaintiff had been diagnosed by a psychiatrist as
suffering from major depression with anxiety. Plaintiff in the present case testified that
she had never been treated for depression or anxiety. (Tr. 49.) Plaintiff did not indicate
that she suffered from a mental impairment when she applied for disability, listing only
spasms in arteries, heart attacks, asthma, and chest pains. (Tr. 204.) In addition, plaintiff
consistently denied to her health care providers that she was experiencing unusual stress,
difficulty concentrating, anxiety, or depression.

(Tr. 242, 246, 250, 254, 502.)

Therefore, the ALJ lawfully concluded that plaintiff did not have a severe mental
impairment that would render her unable to return to her past work and as such the ALJ
14

was not required to consider the mental demands of plaintiff’s past work. Despite the
fact that plaintiff received various forms of treatment for disabling symptoms, the
treatment was generally successful in controlling these symptoms when administered.
Plaintiff visited her treating physician Dr. Das every three or four months.

While

plaintiff had a number of hospital admissions in the medical record, cardiac problems
were ruled out in almost every visit following the stent insertion in October of 2011. (Tr.
20.) Dr. Oliver confirmed that the results of the stenting were “wonderful.” (Tr. 59.) In
addition, the record showed that plaintiff failed to follow-up on recommendations made
by the treating doctor, suggesting that the symptoms perhaps were not as serious. For
example, plaintiff was advised multiple times to lose weight, follow a cardiac diet, and
maintain regular physical activity. The record showed that her weight remained constant
and her activity level was also very low. (Tr. 20.) Thus, plaintiff’s subjective complaints
of pain were discounted in light of the evidence as a whole.

VI. CONCLUSION
For the reasons set forth above, the decision of the Commissioner of Social
Security is affirmed. An appropriate Judgement Order is issued herewith.

S/ David D. Noce
UNITED STATES MAGISTRATE JUDGE

Signed on February 11, 2016.

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