Littleton v. Commissioner of Social Security
Filing
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Memorandum Opinion and Order: The Court ACCEPTS the Report and Recommendation ("R&R") of Magistrate Judge White and for the reasons stated herein, AFFIRMS the decision of the Commissioner. Judge Patricia A. Gaughan on 11/19/13. (LC,S) re 13
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
Judy K. Littleton,
Plaintiff,
Vs.
Commissioner of Social Security,
Defendant.
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CASE NO. 5:12 CV 2756
JUDGE PATRICIA A. GAUGHAN
Memorandum of Opinion and Order
INTRODUCTION
This matter is before the Court upon the Report and Recommendation of Magistrate
Judge Greg White (Doc. 13) recommending that the decision of the Administrative Law Judge
(“ALJ”) be affirmed. Plaintiff filed objections. For the reasons that follow, the Court
ACCEPTS the Report and Recommendation (“R&R”) and, for the reasons stated herein,
AFFIRMS the decision of the Commissioner.
FACTS
The facts of the case are largely undisputed. Plaintiff was diagnosed with trigeminal
neuralgia in 1993. As a result, she feels burning and electrical shock-like symptoms in her face.
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She experiences pain “constantly” with intense pain episodes occurring two to four times per day
and lasting a few minutes each. In 2004, plaintiff underwent a left-sided microvascular
(posterior fossa) decompression, which was a surgical procedure designed to improve her
trigeminal neuralgia. Shortly after the procedure, plaintiff’s symptoms worsened. She then
underwent radiofrequency with glycerol rhizotomy at Johns Hopkins Medical Center. She
continued to have pain after this second surgical procedure and, therefore, began treating with
Dr. Casanova, a board certified neurologist. Dr. Casanova attempted to treat her condition with
certain medicals, but those were discontinued due to their side effects. By 2008, plaintiff had
“severe occipital pain radiating into her palatal region, which was along the left greater occipital
nerve distribution.” The ALJ noted that “with continued facial and occipital pain that was
becoming more and more intolerable,” plaintiff was referred to University Hospitals. At her
appointment, plaintiff noted that the burning and intermittent electrical shock-like pain was
exacerbated by eating, touching, cold wind, or brushing her teeth. On April 21, 2009, plaintiff
elected to proceed with “Gamma Knife” surgery. Plaintiff, however, continued to experience
pain and, in fact, developed “anesthesia dolorosa” in the second division of her left trigeminal
nerve.
Plaintiff also reported headaches to Dr. Cassanova. In a Headache Questionnaire
completed by Dr. Casanova, he opined that plaintiff suffered from “severely intense” headaches
on a “daily basis.” He further indicated that this pain would “constantly” interfere with her
attention and concentration. As a result, Dr. Casanova opines that plaintiff will miss work “more
than three times per month.” His treatment notes indicate that plaintiff reported the headaches to
him on December 7, 2009. In the treating notes, Dr. Casanova notes that the headache is a
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“possible medication overuse headache” and suggests that plaintiff discontinue Motrin. In
subsequent treatment notes, there is no further mention of headaches.
The ALJ held a hearing on this matter at which plaintiff and a vocational expert testified.
The ALJ concluded that plaintiff could perform her past relevant work and, therefore, was not
disabled. This appeal followed.
The Magistrate Judge recommends that the decision of the ALJ be affirmed. According
to the Magistrate Judge, the ALJ properly applied the treating physician rule. The Magistrate
Judge further determined that Dr. Casanova’s opinion that plaintiff would be unable to work at
least three days per month is not a “medical opinion” and is therefore not entitled to any
deference. The Magistrate Judge concluded that this “opinion” goes beyond a “pure medical
finding” and instead reaches questions expressly reserved to the Commissioner. The Magistrate
Judge further recommends that the ALJ did not err in assessing plaintiff’s credibility.
Plaintiff objects to the R&R. According to plaintiff, the ALJ failed to follow the treating
physician rule and further failed to properly assess plaintiff’s credibility. Plaintiff argues that
Dr. Casanova’s opinion “on how often [plaintiff] will be absent from work and how frequently
her symptoms will interfere with attention and concentration” are medical opinions. Each issue
will be addressed in turn.
1. Treating physician rule
Under Sixth Circuit law, the opinion of a treating physician is given controlling weight if
such opinion (1) “is well-supported by medically acceptable clinical and laboratory diagnostic
techniques” and (2) “is not inconsistent with the other substantial evidence in [the] case record.”
Meece v. Barnhart, 192 F. App'x 456, 560 (6th Cir. 2006) (quoting 20 C.F.R. § 404.1527(d)(2)).
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In the event the ALJ concludes that the medical opinion is inconsistent with other substantial
evidence, the opinion may be given less than controlling weight, but should not be rejected.
Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 408 (6th Cir. 2009) (Soc. Sec. Rul. 96-2p).
Furthermore, “[t]reating source medical opinions are still entitled to deference and must be
weighed using all of the factors provided in 20 C.F.R. § 404.1527 and 416.927.” Id. In the event
the treating physician’s opinion is not given controlling weight, the ALJ must determine how
much weight is appropriate for the opinion and must consider: (1) the length, frequency, nature,
and extent of the treatment relationship; (2) consistency of the physician’s conclusions; and (3)
any specialization of the treating physician. Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 242
(6th Cir. 2007).
Upon review, the Court finds that the ALJ did not err in applying the treating physician
rule in analyzing plaintiff’s disability claim. The ALJ noted that Dr. Casanova opined on the
headaches questionnaire that plaintiff’s daily severe pain would “constantly” interfere with her
attention and concentration and that her headaches would preclude her from basic work activities
and cause her to be absent from work “more than three times a month.” The ALJ noted that he
assigned “little weight” to these opinions because nothing in the medical record supports such
extreme restrictions. In fact, as noted by the ALJ, plaintiff saw Dr. Daoud, her primary care
physician, a number of times throughout the treatment period. With regard to her pain scale,
plaintiff reported to Dr. Daoud a “0/10” on a number of occasions. As noted by the ALJ, there is
no mention of any severe pain issues in any of Dr. Dauod’s treatment notes. In addition, with
regard to the headaches, Dr. Daoud regularly noted “no headaches” on his treatment notes. The
ALJ further points out that plaintiff presented to her appointments with Dr. Daoud in “no acute
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distress...fully oriented with a normal psychiatric affect and mood, and showed no overt signs of
pain behavior.” The Court further notes that Dr. Daoud’s treatment notes routinely show that
plaintiff suffers from “no decrease in ability to concentrate.” In fact, within one week of
reporting “daily” headaches to Dr. Casanova, plaintiff reported “no headaches” to Dr. Daoud. In
addition, after noting that plaintiff may suffer from “medication overuse headaches,” and
advising plaintiff to quit Motrin, there is no further mention of headaches in Dr. Casanova’s
notes. In sum, the ALJ did not err in assigning less than controlling weight to the opinion of Dr.
Casanova as it was inconsistent with other substantial evidence in the record.
The Court further rejects plaintiff’s argument that the ALJ erred in assessing the weight
he did assign to Dr. Casanova’s opinion. Here, the ALJ noted that plaintiff began treatment with
Dr. Casanova in February of 2007 and further noted that plaintiff last saw Dr. Casanova on
November 30, 2010. In addition, the ALJ expressly indicated that Dr. Casanova is a neurologist
who specifically treated plaintiff for her neurological disorders and headaches. The ALJ
extensively analyzed the opinions of Dr. Casanova and compared them to the overall medical
record as well as Dr. Casanova’s own treatment notes. For example, the ALJ noted that Dr.
Casanova reported that plaintiff suffered from severe daily headaches. Yet, after he suggested
that plaintiff discontinue Motrin, there is no further indication in his notes that plaintiff suffered
from any headaches, let alone those as debilitating as he describes in the Headache
Questionnaire. Accordingly, the Court finds that the ALJ did not err in assigning “little weight”
to the opinions of Dr. Casanova. The ALJ properly noted the nature and extent of the treating
history, noted Dr. Casanova’s specialty, and indicated that Dr. Casanova’s opinions were not
supported by his own treatment notes or the medical records provided by Dr. Daoud. For
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example, in or around June of 2009, Dr. Casanova opined that plaintiff suffered from “daily
headaches.” The treatment notes indicate that a colleague of Dr. Casanova treated plaintiff for
headaches in 2000 and Dr. Cassanova treated plaintiff on December 7, 2009. Yet a number of
treatment notes both before and after June of 2009 make no mention of headaches.
The Magistrate Judge recommends that the Court finds that Dr. Casanova’s opinion as to
plaintiff’s “need” to miss work more than three times per month is not a medical opinion. The
Court finds that it need not reach this issue as no party raised it in the briefing before the
Magistrate Judge. Regardless, the Court finds that, assuming arguendo, the opinion is a
“medical opinion,” the ALJ properly analyzed the opinion under the treating physician rule. As
set forth above, the ALJ assigned this opinion “little weight” because it is not consistent with the
treatment notes of plaintiff’s primary care physician and is inconsistent with Dr. Casanova’s own
treatment notes both before and after the date of his opinion. As set forth above, treatment notes
from Dr. Daoud consistently indicate “no headaches” and a pain scale of “0/10.” In addition,
after recommending that plaintiff discontinue Motrin and begin a different medication, there are
no further treatment notes discussing headaches. Therefore, even if this opinion is a “medical
opinion,” the ALJ properly weighed it under the treating physician rule.
The Court is careful to note that the ALJ did conclude that plaintiff suffered from
medically determinable impairments. In addition, the ALJ noted plaintiff’s excellent work
history and the surgical interventions plaintiff underwent. This Court may not substitute its own
judgment for that of the ALJ. Thus, provided substantial evidence supports the ALJ’s
determination, the Court cannot reverse the decision even if substantial evidence would also
support the alternative conclusion.
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2. Credibility
Plaintiff objects to the Magistrate Judge’s conclusion that the ALJ did not err in assessing
plaintiff’s credibility. Upon review, the Court rejects the argument. Plaintiff points to no
specific legal error made by the ALJ. Rather, plaintiff simply presents disagreements with the
findings. For example, plaintiff argues that “nothing in the record contradicts a conclusion that
she has constant, unremitting pain with periods of acute pain...” This, however, is simply not
true. The records from Dr. Daoud demonstrate that plaintiff reported “0/10” on a pain scale on a
number of occasions. This medical evidence supports a conclusion that plaintiff’s statement that
she suffers from a constant state of pain are less than credible. Simply put, there is nothing in
plaintiff’s argument that demonstrates any error in the ALJ’s assessment of plaintiff’s credibility.
CONCLUSION
For the foregoing reasons, the Court ACCEPTS the Report and Recommendation
(“R&R”) of Magistrate Judge White and for the reasons stated herein, AFFIRMS the decision of
the Commissioner.
IT IS SO ORDERED.
/s/ Patricia A. Gaughan
PATRICIA A. GAUGHAN
United States District Judge
Dated: 11/19/13
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