Houston v. Colvin

Filing 11

ORDER entered by Judge Nanette Laughrey. The Commissioner's decision is affirmed. (Cross, Ashley)

IN THE UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF MISSOURI
CENTRAL DIVISION
WILLIAM HOUSTON,
Plaintiff,
v.
CAROLYN W. COLVIN,
Acting Commissioner
of Social Security,
Defendant.

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Case No. 2:14-CV-04191-NKL

ORDER
Before the Court is Plaintiff William Houston’s appeal of the Commissioner of
Social Security’s final decision denying his application for disability insurance benefits
and supplemental security income under Titles II and XVI of the Social Security Act.
[Doc. 8]. For the following reasons, the Commissioner’s decision is affirmed.
I.

Background
Houston was born in 1966 and has some college education. He alleges he became

disabled on June 8, 2009. When he filed for disability benefits in July 2011, he alleged
disability from the combined effects of gastroesophageal reflux disease, arthritis in his
hips, shoulders, and knees, depression, stomach ulcers, heart palpitations, and high stroke
risk. [Tr. 207]. At a hearing in January 2013, Houston also alleged debilitating back pain
which began in late 2010 and which was worse than his knee pain. [Tr. 46, 49].
A. Medical History

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Because Houston does not challenge the ALJ’s conclusions related to his mental
impairments, the Court will focus on the medical history related to Houston’s physical
impairments. 1 Houston worked as a mall security officer until June 8, 2009, the day of
his alleged onset of disability. Houston testified that he quit his job because he was
having issues with coworkers, was required to work extra hours, and often had to do both
his job and that of his subordinates. [Tr. 40-41]. He testified that his foot patrol duties
added stress to his knee and that his paperwork duties were mentally stressful. [Tr. 41].
He stated he was “physically and mentally burned out” and could no longer handle the
burden of the job. [Tr. 41-42]. He suffered depression from being reprimanded by his
supervisors and was stressed because he was away from his family. [Tr. 42-43].
Houston’s primary physical complaints are related to knee pain and back pain. In
August 2010, Houston sought treatment for bilateral knee pain. [Tr. 278]. An MRI of
left knee revealed a complex grade tear of the posterior horn of the medial meniscus, a
grade 1 signal in the posterior horn of the lateral meniscus without any tear, and minimal
soft tissue edema anterior to the patellar tendon. [Tr. 277]. An MRI of the right knee
revealed changes in the lateral patellofemoral joint, suggestive of lateral femoral condyle
friction syndrome, a small grade 3 tear in the posterior horn of medial meniscus, and a
chronic tear of the femoral attachment of the anterior cruciate ligament. Id. Houston was
diagnosed with a right knee chronic anterior cruciate ligament tear, a medial meniscal
tear, and patellofemoral degenerative changes. Id. The left knee had a medial meniscal
tear. Id. Houston’s doctors opined that knee surgery was the best treatment option for
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Portions of the Parties’ briefs are adopted without quotation.
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him, but his surgery was cancelled due to uncontrolled hypertension and EKG changes.
[Tr. 270, 300-01]. Houston returned to a cardiology clinic on multiple occasions in
September and October 2010 for follow-up appointments regarding hypertension, but
was not cleared for surgery. [Tr. 289, 291, 298].
In November 2010, Houston complained of back pain and a headache. [Tr. 358].
Houston’s back was tense and tender on the left lower thorax. He was diagnosed with
thoracic back pain, neck pain, and a headache and prescribed medication. Id. In July
2011, Houston complained of chest, shoulder, and knee pain and headaches. [Tr. 33337]. Houston told his doctor that he stopped taking his blood pressure medication
because it was causing side effects and that he was still not cleared for knee surgery. [Tr.
356]. He was diagnosed with uncontrolled hypertension, anxiety, obesity, and bilateral
knee pain. He was prescribed a new blood pressure medication. In late July 2011,
Houston complained of shoulder and hip pain. Examination revealed decreased range of
motion in the shoulders. Houston’s doctor remarked that Houston’s insurance would not
pay for physical therapy for his shoulders and hips. [Tr. 354].
In August 2011, Houston complained of sleep apnea, anxiety, irritability, and pain
in his lower back and left hip. [Tr. 352]. An x-ray of the left hip and lumbar spine
revealed no abnormalities. [Tr. 520-21]. A sleep study revealed severe obstructive sleep
apnea, and it was recommended that Houston use a CPAP machine while sleeping. In
November 2012, Houston was diagnosed with lumbar foraminal stenosis with neurogenic
claudication, chronic pain syndrome, lumbar facet syndrome, depression, and insomnia
secondary to pain. [Tr. 586]. An MRI of the lumbar spine revealed mild to moderate
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lumbar spondylosis. [Tr. 594]. Houston was prescribed a front-wheeled walker at his
request. [Tr. 587].
In late November 2012, Houston’s primary care physician, Dr. Sarah Yong, M.D.,
completed a Medical Source Statement-Physical. [Tr. 497-98]. Dr. Yong opined that
Houston could frequently and occasionally lift and carry ten pounds, could stand or walk
continuously for fifteen minutes for a total of two hours in an eight hour day, and could
sit continuously for thirty minutes for a total of four hours in an eight hour day. [Tr.
497]. Houston was limited in his ability to push or pull (“he only does light
housework”). [Tr. 497]. Houston could never crawl or climb ladders. He could
occasionally climb stairs, balance, stoop, kneel, crouch, and reach. He could frequently
handle/grip, finger, feel, see, speak, and hear. [Tr. 498]. He should avoid any exposure
to extreme temperatures, weather, hazards, and heights. He should avoid moderate
exposure to dust/fumes, wetness/humidity, and vibration. Id. Dr. Yong opined that
Houston would need to lie down three times per day for one to two hours. She also stated
that Houston’s medication would cause a decrease in his persistence to finish a task and a
decrease in his pace. Id.
In December 2012, Houston reported pain in his posterior thigh which was
initiated by standing. [Tr. 575]. Houston also stated that once his pain has started, sitting
down did not bring relief and at times made the pain worse. Id. Houston’s hypertension
was still uncontrolled. [Tr. 570]. Houston was diagnosed with hyperlipidemia, bilateral
knee structural damage, L5-S1 lumbar foraminal stenosis with neurogenic claudication
and lumbar spondylosis, and left hip mild osteoarthritis with pain on the left. [Tr. 573].
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At his hearing in January 2013, Houston testified that he had been using a walker
for the past eight weeks to help him balance and to relieve back pain. [Tr. 37-38]. He
testified that his lower back caused him the most pain and that pain medication did not
help. [Tr. 46-47]. He testified that bending down, standing for periods of longer than
twenty minutes, and twisting caused the pain. [Tr. 47]. To relieve his back pain, sitting
down sometimes relieved the pain and lying on his stomach was one of the best ways to
relieve the pain. [Tr. 48]. His back pain started in late 2010, after he stopped working,
and became “really noticeable” in the summer of 2013. [Tr. 51].
As to his knees, Houston testified that both knees hurt, but that the right knee hurt
more. His right knee hurt while he was working, but his left knee started hurting after he
stopped working. [Tr. 49-50]. Houston testified that his back pain is “far worse” than his
knee pain. [Tr. 50]. He uses knee braces. [Tr. 51]. His knees hurts when he cleans,
helps the children clean the living room, and when he climbs steps. Id. His knees are not
bothered by being on his feet, standing, or walking. Id.
B. ALJ’s Decision
After a hearing, the ALJ concluded that Houston suffered from the following
severe impairments: degenerative joint disease of the knees, arthritis, obstructive sleep
apnea, obesity, and major depressive disorder. [Tr. 15]. The ALJ determined that
Houston had the residual functional capacity (RFC) to perform less than the full range of
sedentary work as defined in 20 C.F.R. §§ 404.1567(a) and 416.967(a). [Tr. 17].
Houston could not be exposed to hazards such as dangerous machinery or unprotected
heights. He could not climb ladders, ropes, or scaffolds. He could perform simple,
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routine tasks and could have no more than occasional interaction with supervisors, coworkers, and the public. Id.
In making his conclusion, the ALJ relied on Houston’s activities of daily living,
the Adult Function Reports filled out by both Houston and his wife, Houston’s failure to
comply with treatment recommendations, and the medical records, which included
various treatment notes and a Medical Source Statement-Physical completed by
Houston’s treating physician, Dr. Sarah Yong, M.D. The ALJ stated that despite
allegations of debilitating knee and back pain, Houston was able to take care of his three
children, clean a three bedroom, two bathroom apartment, make simple meals on a daily
basis, do laundry with the help of his children, go shopping approximately three times per
week for groceries and other needs, go to church, attend his children’s sporting events
and other social activities, and coach his son’s summer track team. [Tr. 16, 19]. The
ALJ also remarked that Houston’s doctors recommended physical therapy, but that
Houston did not seek out treatment. [Tr. 19]. The ALJ gave Dr. Yong’s opinion “partial
weight” because she limited Houston’s ability to sit to four hours a day and thirty minutes
continuously when neither Houston nor his wife reported any limitation in his ability to
sit. [Tr. 20]. The ALJ stated that Dr. Yong’s sitting limitation was inconsistent with
Houston’s own testimony and the record as a whole.
At the hearing, a vocational expert testified that a person with the same age,
education, work history, and RFC as Houston could perform jobs that exist in significant
numbers in the national economy, including as a surveillance systems monitor, assembler

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of small products, and microfilmer. [Tr. 64-65]. Based on this testimony, the ALJ
concluded that Houston was not disabled. [Tr. 23].
II.

Discussion
Houston alleges the Commissioner’s decision is not supported by substantial

evidence because the Commissioner failed to give controlling weight to his treating
physician, Dr. Yong, failed to provide a narrative statement linking the evidence in the
record to the RFC, and improperly discounted Houston’s credibility and subjective
allegations of pain.
A. Analysis of Treating Physician, Dr. Yong
Houston argues that the ALJ improperly discounted Dr. Yong’s opinion regarding
his ability to sit continuously for only thirty minutes and for a total of four hours in an
eight hour day. Specifically, Houston argues the ALJ only cited to the Adult Function
Reports filled out by him and his wife at the time of filing but failed to consider other
statements by Houston to his doctors. “A treating physician’s opinion is given
‘controlling weight’ if it is well-supported by medically acceptable clinical and
laboratory diagnostic techniques and is not inconsistent with the other substantial
evidence.” Goff v. Barnhart, 421 F.3d 785, 790 (8th Cir. 2005). An ALJ may disregard
or discount a treating physician’s opinion where other medical assessments are supported
by better or more thorough medical evidence or where the treating physician renders
inconsistent opinions. Id. In any case, the ALJ must provide good reasons for the weight
given to a treating source’s opinion. 20 C.F.R. § 416.927(c)(2); see also Brown v. Astrue,
611 F.3d 941, 951-52 (8th Cir. 2010).
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The ALJ determined that Houston could perform sedentary work, which requires
an ability to sit approximately six hours in an eight hour day. See SSR 83-10 (S.S.A.
1983). Houston’s treating physician, Dr. Yong, opined in a Medical Source Statement
that Houston was limited to sitting continuously for thirty minutes for a total of four
hours and that Houston would need to lie down three times a day for a total of three to six
hours in an eight hour day. [Tr. 498]. The ALJ gave several reasons why Dr. Yong’s
opinion was due “partial weight.” The ALJ stated that neither Houston nor his wife
reported any limitation in Houston’s ability to sit when Houston filed for disability, that
Houston reported to his doctor that sitting improved the pain, and that Houston’s doctor
observed that he did not appear uncomfortable at rest. [Tr. 18, 20]. These reasons are
supported by the record. In Adult Function Reports filled out by Houston and his wife,
“sitting” is not listed as a condition affected by his condition. [Tr. 232, 240]. At his
hearing, Houston testified that sitting sometimes relieved his back pain. [Tr. 48]. In
November 2012, Houston stated that the further he walks, the more pain and tingling in
his back and legs he feels, but that “[i]f he sits down, the tingling will eventually
improve.” [Tr. 422]. Also in November 2012, a pain prevention doctor observed that
Houston did “not appear to be uncomfortable at rest.” [Tr. 423]. The ALJ also stated
that allegations related to a sitting limitation were inconsistent with Houston’s daily
activities which included coaching his son’s summer track team, cleaning a three
bedroom apartment, shopping, and cooking daily for his family.
Houston argues that the ALJ’s opinion is based on only partial evidence because
one month after Houston stated that sitting sometimes relieved his pain, Houston told his
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doctor that his back pain was initiated by standing and that once the pain started, “sitting
down does not bring relief and at times has made the pain worse.” [Tr. 575]. Houston
also argues that while both he and his wife did not list “sitting” as a functional limitation,
both he and his wife stated that he had to rest often and lie down. While this evidence
may support a finding that Houston was limited in his ability to sit, substantial evidence,
discussed above, supports the ALJ’s decision to give only “partial weight” to Dr. Yong’s
opinion regarding the sitting limitation. See Mitchell v. Shalala, 25 F.3d 712, 714 (8th
Cir. 1994) (“[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 the Commissioner “simply because
some evidence may support the opposite conclusion.” Id. Nor will it reverse “merely
because substantial evidence would have supported an opposite decision.” Piepgras v.
Chater, 76 F.3d 233, 236 (8th Cir. 1996). Further, Dr. Yong gave no explanation for the
sitting limitation or for her opinion that Houston would need to lie down three to six
hours in an eight hour day. Houston pointed to no evidence in the record other than the
Medical Source Statement by Dr. Yong where any other doctor or treatment provider
opined that Houston could not sit for more than four hours and needed to lie down for
three to six hours a day. Houston did not point to any evidence within Dr. Yong’s own
records supporting this conclusion. See id. (“A treating physician’s opinion deserves no
greater respect than any other physician’s opinion when the treating physician’s opinion
consists of nothing more than vague, conclusory statements.”). The ALJ’s determination
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that Houston could sit approximately six hours a day and his determination that Dr.
Yong’s opinion was due “partial weight” is supported by substantial evidence.
B. Narrative Statement Linking Evidence to RFC
Houston also contends that even if the ALJ properly weighed Dr. Yong’s opinion,
the ALJ failed to explain the reasons for discrediting other limitations in Dr. Yong’s
opinion. Houston argues that the ALJ’s RFC differs from Dr. Yong’s opinion regarding
limitations in manipulation, pushing, pulling, environmental factors, and the need to lie
down, and that the ALJ failed to indicate how he considered these limitations or explain
why they were discarded. The RFC assessment must be based on all of the relevant
evidence in the record, including the claimant’s medical history and records, the effects
of treatment, activities of daily living, medical source statements, effects of symptoms,
and lay opinions. SSR 96-8P (S.S.A. 1996); Pearsall v. Massanari, 274 F.3d 1211 (8th
Cir. 2001). The RFC is a medical question, and as a result, the ALJ must consider some
supporting evidence from a medical professional. Lauer v. Apfel, 245 F.3d 700, 704 (8th
Cir. 2001). The ALJ must set forth specifically the claimant’s limitations and how those
limitations impact the RFC. Lewis v. Barnhart, 353 F.3d 642, 646 (8th Cir. 2003).
Contrary to Houston’s contention, the ALJ’s RFC determination is supported by
medical evidence. The ALJ gave Dr. Yong’s opinion “partial weight” but not
“controlling weight” because of the sitting restriction. However, many of the ALJ’s RFC
findings are consistent with the limitations opined by Dr. Yong and support a finding that
the ALJ relied on Dr. Yong’s opinion, in part, to determine Houston could perform
sedentary work. Sedentary work requires lifting no more than 10 pounds at a time and
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occasionally lifting or carrying articles like docket files, ledgers, and small tools. 20
C.F.R. §§ 404.1567(a), 416.967(a). A sedentary job usually involves sitting, but a
person may have to walk or stand occasionally. Id. A person performing sedentary work
can stand or walk no more than two hours in an eight hour day and sit approximately six
hours. SSR 83-10 (S.S.A. 1983). Sedentary work entails no significant stooping, but
requires good use of the hands and fingers for repetitive hand-finger actions. Id.

In the

Medical Source Statement, Dr. Yong stated that Houston could lift and carry ten pounds
frequently. [Tr. 497]. Houston could stand or walk for up to two hours. Id. He could
occasionally climb stairs, stoop, kneel, and crouch, but never crawl. [Tr. 498]. He could
frequently grip, finger, and feel. Id. Dr. Yong’s opinion supports a sedentary RFC.
Houston also argues that the ALJ’s RFC differs from Dr. Yong’s opinion
regarding environmental factors. Dr. Yong opined that Houston should avoid any
exposure to weather and extreme temperatures and hazards and heights. [Tr. 498]. The
RFC prohibits Houston from jobs that require exposure to hazards and heights. There is
no explanation from either the ALJ or Dr. Yong related to the weather and temperature
restrictions, but Houston’s testimony that he coaches his son’s summer track team is
inconsistent with a finding that he can never be subjected to the extreme temperature or
weather. See Scott ex rel. Scott v. Astrue, 529 F.3d 818, 822 (8th Cir. 2008) (“As a
general rule, . . . an ALJ’s failure to adequately explain his factual findings is not a
sufficient reason for setting aside an administrative finding where the record supports the
overall determination.”). Further, Houston does not explain how a weather restriction
precludes him from performing sedentary work such as a surveillance systems monitor,
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assembler of small products, or microfilmer.

The only significant difference between

Dr. Yong’s opinion and the RFC is the sitting restriction and Houston’s need to lie down
for up to six hours a day. As discussed above in Part II.A., substantial evidence supports
the ALJ’s rejection of the degree of limitation related to sitting and lying down opined by
Dr. Yong.
Houston also argues that the ALJ did not explain how other evidence in the record
supported the RFC. However, the ALJ specifically discussed Houston’s activities of
daily living, which included taking care of his three children, cleaning a three bedroom
apartment, making daily meals, doing laundry and dishes, vacuuming, shopping three
times per week for at least an hour, going to church, sporting events, and social groups,
coaching his son’s track team, and visiting the library. [Tr. 16-17, 19]. The ALJ stated
that Houston’s reported activities support the conclusion that Houston could do work at
the sedentary level. [Tr. 19]. Accordingly, the ALJ’s determination that Houston could
perform sedentary work is supported by Dr. Yong’s opinion, with the Social Security
Administration’s definition of sedentary work, and with other substantial evidence in the
record.
C. Credibility Analysis
Houston argues that the ALJ’s credibility analysis is based on a
mischaracterization of the record and is therefore, not supported by substantial evidence.
In determining that Houston’s complaints of subjective pain were not entirely credible,
the ALJ, among other considerations, stated that Houston’s primary care physician and
pain management doctor encouraged him to go to physical therapy, but that he had not
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done so. While this is true, a review of the record reveals that Houston could not attend
physical therapy because his insurance would not cover treatment. [Tr. 354]. Houston’s
inability to afford a recommended treatment option should not be construed as an
unwillingness to follow treatment recommendations. Nonetheless, the ALJ relied on
other evidence in the record to support his finding that Houston was not entirely credible.
Aside from treatment noncompliance, the ALJ discussed Houston’s activities of daily
living, the Adult Function Reports, and the medical records, which were inconsistent with
a finding that Houston needed to lie down for up to six hours per day.
While the record revealed a need for knee surgery, Houston testified that his knee
pain was caused by bending, cleaning, and climbing stairs, but that standing and walking
did not bother his knees. [Tr. 51]. As to his back, Houston testified that standing for
longer than twenty minutes, twisting, and bending caused pain. [Tr. 47]. Houston’s
testimony regarding his knee and back supports a finding that Houston may be limited in
his ability to do more exertional work, but it is consistent with a finding that Houston can
do sedentary work. Further, Houston has pointed to no evidence in the record that
supports a finding that sitting causes or exacerbates his knee and back pain. Houston told
a doctor that once pain starts – presumably from bending, cleaning, twisting, or standing
and walking for a prolonged period – sitting can make it worse. But a sedentary job
usually involves sitting with only occasional standing and walking not to exceed two
hours in an eight hour day, a time period consistent with Dr. Yong’s opinion.
While the ALJ’s reliance on Houston’s noncompliance with treatment
recommendations is not supported by substantial evidence, the ALJ relied on several
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other factors in determining Houston’s credibility. As discussed throughout this Order,
the ALJ’s reliance on those factors are supported by substantial evidence.
III.

Conclusion

For the reasons set forth above, the Commissioner’s decision is affirmed.

s/ Nanette K. Laughrey
NANETTE K. LAUGHREY
United States District Judge
Dated: March 9, 2015
Jefferson City, Missouri

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