Ciaramitaro v. Astrue

Filing 14

ORDER entered by Judge Ortrie D. Smith. The Commissioner's decision is affirmed. (Matthes, Renea)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF MISSOURI
CENTRAL DIVISION
TONIA CIARAMITARO,

)
)
Plaintiff,
)
)
v.
)
)
CAROLYN W. COLVIN,
)
Acting Commissioner of Social Security, )
)
Defendant.
)

Case No. 13-4016-CV-C-ODS-SSA

ORDER AND OPINION AFFIRMING
COMMISSIONER’S FINAL DECISION DENYING BENEFITS
Plaintiff brings this suit challenging the Commissioner’s final administrative
decision denying her application for supplemental security income under Title XVI of the
Social Security Act, 42 U.S.C. §§ 1381-1383f. The Commissioner’s decision is
affirmed.

I. BACKGROUND
Plaintiff was born November 11, 1966, and completed the tenth grade. Plaintiff ‘s
prior work experience includes work as a painter. She alleges she became disabled on
June 1, 2006, due to right and left shoulder problems, sleeping problems, hand
problems, depression, and headaches.
Plaintiff saw David Mook, M.D., on April 24, 2007, to establish care. R. 210. On
May 7, 2007, Dr. Mook diagnosed Plaintiff with impingement syndrome of the right
shoulder, tobacco abuse, and previous alcohol and drug abuse. R. 209. Dr. Mook
recommended ice and shoulder exercises. R. 209. On May 21, 2007, Plaintiff
underwent a bone density scan, which showed osteopenia of the left femur and lumbar
spine. R. 379.

Plaintiff began seeing Zaheda Nasreen, M.D., on December 3, 2007. R. 229.
Plaintiff saw Dr. Nasreen four times from December 3, 2007, to March 10, 2008. R.
223, 225, 227, 229. Dr. Nasreen diagnosed Plaintiff with depression, anxiety, right
shoulder pain, and neck pain. R. 223, 229.
Meanwhile, on December 4, 2007, imaging of Plaintiff’s right shoulder showed
“no definite pathology.” R. 214. On February 20, 2008, Plaintiff went to the emergency
room complaining of chest pain and weakness. R. 360. Plaintiff was diagnosed with
seizure activity and anxiety. R. 359. On March 10, 2009, imaging of Plaintiff’s left foot
showed “no acute radiographic abnormalities,” and imaging of her cervical spine was
unremarkable. R. 215-16.
On May 12, 2008, Corine Rao, M.D., examined Plaintiff and diagnosed her with
pharyngitis, acute bronchitis, right shoulder pain, tobacco use disorder, and seizure
disorder. R. 254. A magnetic resonance imaging (“MRI”) of Plaintiff’s right shoulder
showed severe tendinosis. R. 259.
On June 23, 2008, Plaintiff saw Jeffrey Jones, D.O., and complained of “some
pain with overhead activities.” R. 288. Dr. Jones stated that “[e]xamination of the
cervical spine reveal[ed] good mobility without reproduction of her pain.” R. 288. He
diagnosed Plaintiff with right shoulder impingement syndrome and administered an
injection into her right shoulder. R. 289. Plaintiff reported she had a “great day” on the
third day after the injection, but the pain returned when she washed her car. R. 278.
On January 6, 2009, Christine Cooper, M.A., L.P.C., examined Plaintiff and
observed that Plaintiff had an anxious and agitated behavior, depressed mood, and sad,
fearful, and flat affect. R. 445. Plaintiff had recent intact memory and perception within
normal limits. R. 445-46. Ms. Cooper diagnosed Plaintiff with depression and anxiety.
R. 447.
On February 10, 2009, Plaintiff presented to Medical Missions for Christ
Community Health center with depression, headaches, and shoulder pain. R. 388, 450.
She was diagnosed with depression, tension headache, degenerative joint disease, and
anxiety. R. 450.
On June 29, 2009, Jeffrey Woodward, M.D., performed a consultative
examination. R. 395. Plaintiff reported bilateral hand and shoulder pain with difficulty
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completing her activities of daily living and lifting objects. R. 395. On exam, Plaintiff
exhibited moderate impingement pain, diffuse joint pain, and moderate crepitus of the
right upper extremity. R. 398. Dr. Woodward assessed that Plaintiff could perform light
work at chest level or below but could not work above chest level. R. 400. He also
assessed that she could not climb, crawl, or balance. R. 400. He further assessed that
Plaintiff would not be able to operate machinery with the upper extremities. R. 400. He
observed that Plaintiff had diffuse pain in her shoulders and moderate impingement pain
but a normal gait, an ability to heel and toe walk, and no objective neurological deficits.
R. 398. He also observed that Plaintiff did not have any depression, anxiety, or
agitation. R. 398. Dr. Woodward opined that Plaintiff could frequently lift up to 10
pounds and occasionally lift up to 20 pounds from floor to chest level, sit without
restrictions, and stand or walk 6 hours in a day. R. 400.
On January 14, 2010, a nurse practitioner diagnosed Plaintiff with menopause,
anxiety, a history of seizures, and shoulder pain. R. 442. Dr. Barry diagnosed Plaintiff
with depression, seizures by history, and right shoulder pain on January 19, 2010. That
same day, Ms. Cooper noted that Plaintiff had a sad, deflated, and anxious mood and
affect but thought patterns within normal limits. R. 439. She diagnosed Plaintiff with
marked depression, anxiety, and panic attacks with agoraphobia. R. 439.
On February 5, 2010, Plaintiff arrived in the emergency room stating that she had
ingested an unknown number of pills after an altercation with her boyfriend. R. 484.
Plaintiff was admitted to the hospital. R. 599. Medical staff noted that her “mood slowly
improved and her suicidal thoughts were resolved.” R. 600. Plaintiff was discharged on
February 11, 2010, with diagnoses of mood disorder secondary to a general medical
condition and alcohol dependence. R. 599.
On February 25, 2010, Plaintiff saw Matthew Smith, M.D., for complaints of
shoulder pain. R. 586. X-rays of Plaintiff’s shoulders and cervical spine were
unremarkable. R. 589, 593.
On March 2, 2010, Dr. McDonald diagnosed Plaintiff with a seizure, chronic
shoulder pain, and anxiety/depression. R. 438. That same day, Plaintiff saw Ms.
Cooper. R. 437. Plaintiff reported that she had been admitted to the hospital because
she “inadvertently took too many of her pills” when she forgot she had already taken
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them. R. 437. Ms. Cooper noted that this explanation was not the same one she gave
to hospital staff. R. 437.
On May 21, 2010, Jennifer Stevens, Psy.D., evaluated Plaintiff for the Camden
County Family Support Division. R. 419. Plaintiff complained of psychological
symptoms including not wanting to leave her house and being fearful to be in public
places. R. 419. Dr. Stevens observed Plaintiff had deficits in immediate memory. R.
420. She also observed that Plaintiff had intact quality of thinking, abstract conceptual
reasoning, and social judgment skills. R. 420. She diagnosed Plaintiff with dysthymic
disorder, social phobia, and generalized anxiety disorder. R. 421. Dr. Stevens
concluded that Plaintiff was “[m]edically eligible in terms of [w]orking [d]isabled” for
medical assistance. R. 421.
Plaintiff complained of leg pain on June 1, 2010. R. 433. Dr. McDonald
diagnosed Plaintiff with right knee pain and chronic right shoulder pain. R. 433. On
June 7, 2010, Ms. Cooper reported that Plaintiff’s speech was loud, angry, and
demanding. R. 431. Her mood and affect was agitated, sad, angry, and helpless. R.
431. On June 15, 2010, Plaintiff complained of panic attacks. R. 432.
On July 6, 2010, Dr. McDonald diagnosed Plaintiff with panic attacks, developing
phobia, and seizures. R. 430. An MRI of Plaintiff’s right knee on July 21, 2010, showed
a cyst and minimal edema. R. 471.
On October 5, 2010, Plaintiff presented to Pathways Outpatient for assessment.
R. 557. Plaintiff reported experiencing panic attacks, paranoia, difficulty concentrating,
occasional suicidal thoughts, and auditory hallucinations. R. 557. Plaintiff was
diagnosed with major depressive disorder and post-traumatic stress disorder (“PTSD”).
R. 560.
Richard White, M.D., examined Plaintiff’s shoulders on October 13, 2010. R.
575. An x-ray of Plaintiff’s shoulder showed no facture, dislocation, or significant
degenerative changes. R. 578. Dr. White said it did not “sound like this would be a
surgical issue at this point” and that he believed the problem was “more likely to be
coming from her neck.” R. 576-77.
On November 3, 2010, Mahal Satnam, M.D., noted Plaintiff was “fidgety and
restless” and had “difficulty concentrating and focusing on task.” R. 565. However, he
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indicated that Plaintiff had normal flow of thought. R. 565. Dr. Satnam diagnosed
Plaintiff with recurrent major depressive disorder, PTSD, and a history of alcohol and
methamphetamine abuse. R. 565
Imaging of Plaintiff’s abdomen and pelvis taken on November 4, 2010, revealed
a lesion and cyst in the liver and “mild compression deformity.” R. 469. On November
15, 2010, imaging of the abdomen showed a lesion in the liver “most likely representing
a benign hemangioma.” R. 467. Plaintiff also underwent a bone density study that
same day that showed osteopenia in Plaintiff’s lumbar spine and left femoral neck. R.
465-66.
On November 16, 2010, Tom Reinsel, M.D., examined Plaintiff. R. 570. Dr.
Reinsel opined that Plaintiff’s “neck disability index score today [was] 85% indicating
complete disability. R. 470. He opined that Plaintiff had “normal range of motion in her
neck,” a normal gait, and an ability to “walk on her heels and toes without difficulty.” R.
571. He noted that an MRI of Plaintiff’s cervical spine showed “some minor multilevel
disc changes, but nothing really substantial.” R. 571-72.
On November 23, 2010, Plaintiff presented again to Pathways Outpatient. R.
528. Plaintiff presented with extreme anxiety and reported that she experienced
frequent panic attacks. R. 528. She also stated that she did not like to be home alone
due to paranoia. R. 528.
On December 9, 2010, Dr. McDonald completed a medical source statement—
physical to assess Plaintiff’s physical limitations. R. 517. He opined that Plaintiff could
occasionally and frequently lift 5 pounds, stand or walk less than 1 hour in an 8-hour
day, and sit 1 hour in an 8-hour day. R. 517. Dr. McDonald indicated that Plaintiff could
frequently see, speak, and hear but never climb, balance, stoop, kneel, crouch, crawl,
reach, handle, finger, or feel. R. 518. He stated that Plaintiff must avoid moderate
exposure to dust and fumes and any exposure to extreme cold, extreme heat, weather,
wetness, humidity, vibration, hazards, and heights. R. 518. Dr. McDonald opined that
Plaintiff needed to lie down or recline for 30 to 45 minutes every 3 to 4 hours. R. 518.
The administrative hearing was held on January 21, 2011. Plaintiff testified that
she could not work because she experienced panic attacks, seizures, and shoulder
pain, and she was scared to go anywhere by herself. R. 37. Plaintiff also reported
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difficulty focusing, memory problems, crying spells, and hearing voices. R. 37-38, 5354.
The administrative law judge (“ALJ”) rendered his decision on April 25, 2011. R.
20. At step one of the five-step sequential process, the ALJ determined that Plaintiff
had not engaged in substantial gainful activity since February 12, 2009, the application
date. R. 13. At step two, the ALJ determined Plaintiff had the following severe
impairments: dysthymic disorder, depression, anxiety, shoulder impingement syndrome,
and hand pain. R. 13. At step three, the ALJ found Plaintiff did not have a listed
impairment. R. 13. For steps four and five, the ALJ concluded that Plaintiff has the
residual functional capacity to
perform light work as defined in 20 CFR 416.967(b). She can lift ten pounds
frequently, but is unable to work above chest level, which would also preclude
overhead reaching. She can stand and/or walk six hours total in an eight-hour
workday. She has no sitting limitations. She is unable to operate heavy
equipment or machinery and may not climb, crawl or balance. She is limited to
no more than occasional interaction with the public, coworkers and supervisors.
R. 14. Next, the ALJ found, based the vocational expert’s testimony, that considering
Plaintiff’s age, education, work experience, and RFC, there are jobs that exist in
significant numbers in the national economy that Plaintiff could perform such as a
production assembler and small products assembler. R. 19. Finally, the ALJ concluded
Plaintiff had not been under a disability. R. 19.

II. STANDARD
“[R]eview of the Secretary’s decision [is limited] to a determination whether the
decision is supported by substantial evidence on the record as a whole. Substantial
evidence is evidence which reasonable minds would accept as adequate to support the
Secretary’s conclusion. [The Court] will not reverse a decision “simply because some
evidence may support the opposite conclusion.” Mitchell v. Shalala, 25 F.3d 712, 714
(8th Cir. 1994) (citations omitted). Substantial evidence is “more than a mere scintilla”
of evidence; rather, it is relevant evidence that a reasonable mind might accept as
adequate to support a conclusion. Gragg v. Astrue, 615 F.3d 932, 938 (8th Cir. 2010).

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III. DISCUSSION
A. The ALJ Properly Weighed Dr. McDonald’s Opinion

The Court finds that the ALJ properly assigned little weight to Dr. McDonald’s
opinion.
The ALJ has the responsibility to assess a claimant’s RFC based on all the
relevant evidence. Roberts v. Apfel, 222 F.3d 466, 469 (8th Cir. 2000). A treating
physician’s opinion will be given controlling weight if it is not inconsistent with the other
substantial evidence in the record and is well-supported by medically acceptable clinical
and laboratory diagnostic techniques. Woods v. Astrue, 780 F.Supp.2d 904, 912 (E.D.
Mo. 2011) (citing Kelley v. Callahan, 133 F.3d 583, 589 (8th Cir. 1998)). “While a
treating physician’s opinion is usually entitled to great weight, the Eighth Circuit has
cautioned that it ‘does not automatically control, since the record must be evaluated as
a whole.’”

Id. (quoting Bentley v. Shalala, 52 F.3d 784, 785-86 (8th Cir. 1995)).

Accordingly, a treating physician’s opinion can be discounted where other medical
assessments are supported by better or more thorough medical evidence, or where a
treating physician renders inconsistent opinions that undermine the credibility of such
opinions. Prosch v. Apfel, 201 F.3d 1010, 1013 (8th Cir. 2000). The ALJ must give
“good reasons” for the particular weight given to a treating physician’s evaluation. 20
C.F.R. § 404.1527(d)(2).
Plaintiff argues the ALJ incorrectly stated that Dr. McDonald “may have seen
[her] on about two occasions.” R. 18. Plaintiff contends that Dr. McDonald examined
Plaintiff “on numerous occasions” and that because “[t]he ALJ’s characterization of
[Plaintiff’s] treatment relationship was flawed, [it] showed that he did not properly
consider Dr. McDonald’s opinion.” The Court disagrees. Defendant points out that the
Record shows that Dr. McDonald likely examined Plaintiff five times and that treatment
notes from those visits appear to contain handwriting from two different people. R. 429,
433, 436, 438, 450. The ALJ did note that Dr. McDonald “may have seen [Plaintiff] on
about two occasions,” but he also stated that Dr. McDonald “supervised nurse
practitioners treating [Plaintiff].” R. 18. The ALJ acknowledged that Dr. McDonald
directed Plaintiff’s treatment. The ALJ was not required to recontact Dr. McDonald for
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clarification as Plaintiff suggests. See Stormo v. Barnhart, 377 F.3d 801, 806 (8th Cir.
2004) (noting that an ALJ does not “have to seek additional clarifying statements from a
treating physician unless a crucial issue is undeveloped.”). Further, the weight assigned
to Dr. McDonald’s opinion was not based on the number of times Dr. McDonald
examined Plaintiff. Instead, the ALJ concluded that Dr. McDonald’s opinion deserved
little weight because it was inconsistent with the record evidence, including Dr.
McDonald’s own treatment notes. R. 18. The ALJ also noted that Plaintiff had not
complained of such extreme limitations prior to her examination by Dr. McDonald. R.
18.
In addition to the inconsistencies with his own treatment records, Dr. McDonald’s
opinion that Plaintiff suffered from extreme limitations—such as the ability to stand
and/or walk a total of less than an hour and sit only 1 hour in an 8-hour day—was not
consistent with other evidence in the Record. A February 2010 x-ray of Plaintiff’s
shoulders and cervical spine were unremarkable. R. 589, 593. In November 2010, Dr.
Reinsel noted that Plaintiff had “normal range of motion in her neck,” a normal gait, and
an ability to “walk on her heels and toes without difficulty.” R. 571. He noted that an
MRI of Plaintiff’s cervical spine showed “some minor multilevel disc changes, but
nothing really substantial.” R. 571-72. Many of Plaintiff’s doctors’ appointments were
for shoulder pain. However, a shoulder problem would not appear to limit other abilities,
such as sitting or standing. The Court concludes the ALJ properly assigned little weight
to Dr. McDonald’s opinion.

B. The ALJ Properly Assessed Plaintiff’s RFC

Plaintiff also argues that the ALJ erred in formulating her mental RFC by failing to
consider all of her relevant impairments and limitations and failing to fully develop the
record. The Court disagrees.
First, Plaintiff contends the ALJ failed to consider her limitations in concentration
and focus. By omitting any limitation with respect to concentration and focus, the ALJ
obviously concluded that Plaintiff was not limited in this respect. The question then
becomes whether there is substantial evidence in the record to conclude that Plaintiff
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did not have any limitations relating to concentration and focus. Plaintiff points to
evidence that she exhibited mood swings, fearful and anxious behavior, and auditory
hallucinations. Plaintiff’s Brief, at 15. Plaintiff also notes that she was hospitalized after
an intentional overdose, that she was easily overwhelmed, and had some paranoid
thinking. Plaintiff’s Brief, at 15. Unfortunately for Plaintiff, this evidence does not
suggest that she is limited in the areas of concentration and focus. After a thorough
review of the Record, the Court found the following evidence relating to concentration
and focus: on January 6, 2009, Ms. Cooper observed that Plaintiff had intact memory
and perception within normal limits. R. 445-46. On January 19, 2010, Ms. Cooper
noted that Plaintiff’s thought patterns were within normal limits. R. 439. On May 21,
2010, Dr. Stevens observed that Plaintiff had deficits in immediate memory, but had
intact quality of thinking and abstract conceptual reasoning. R. 420. On November 3,
2010, Dr. Satnam noted that Plaintiff had difficulty concentrating and focusing on task.
R. 565. However, he also indicated that Plaintiff had a normal flow of thought. R. 565.
The only other references to concentration and focus were Plaintiff’s self-reporting at an
appointment and testimony at the administrative hearing that she had difficulty
concentrating and difficulty focusing and remembering things. R. 38, 557. The ALJ
found that Plaintiff’s own reports about her mental symptoms were not fully credible,
and this finding was relevant to the RFC. Although there are two single occasions in
which Dr. Stevens and Dr. Satnam opined that Plaintiff had deficits in memory,
concentration, and focusing, considering the Record as a whole, there is substantial
evidence to support a finding that Plaintiff was not limited in the areas of concentration
and focus.
Next, Plaintiff argues the ALJ failed to properly consider Plaintiff’s inability to
handle normal everyday stressors. Plaintiff points to evidence showing: she was unable
to shop alone because she was too afraid of the store; she became physically and
emotionally exhausted if she had to interact with people; she became tearful when
discussing her stress; and she was emotional during appointments. Plaintiff’s Brief, at
16. However, the RFC accounted for this by limiting Plaintiff to no more than
occasional interaction with the public, coworkers, and supervisors. This limitation

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accounts for Plaintiff’s inability to handle everyday stressors and the Court finds no
error.
Finally, Plaintiff argues the ALJ erred in not sending Plaintiff for a further
consultative examination due to an alleged lack of medical opinion evidence related to
Plaintiff’s mental limitations. The Court disagrees. “While an ALJ has a duty to develop
the record, this duty is not never-ending and an ALJ is not required to disprove every
possible impairment.” McCoy v. Astrue, 648 F.3d 605, 612 (8th Cir. 2011). “The ALJ is
required to order additional examinations only if the medical records presented to him
do not give sufficient medical evidence to determine whether the claimant is disabled.”
Id. Here there is substantial evidence documenting Plaintiff’s mental health, and the
ALJ’s decision that Plaintiff was only limited to no more than occasional interaction with
the public, coworkers, and supervisors—and no other mental limitations—was
supported by substantial evidence.
The Court concludes that there is substantial evidence in the Record to support
the ALJ’s RFC determination.

IV. CONCLUSION
There is substantial evidence in the Record to support the ALJ’s decision. The
Commissioner’s final decision is affirmed.

IT IS SO ORDERED.

/s/ Ortrie D. Smith
ORTRIE D. SMITH, SENIOR JUDGE
UNITED STATES DISTRICT COURT

DATE: October 28, 2013

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