REYNOLDS v. ASTRUE
Filing
13
MEMORANDUM AND OPINION re: [9, 11] Cross-Motions for Summary Judgment. Signed by Judge William L. Standish on 7/29/2011. (kms)
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF PENNSYLVANIA
KEVIN REYNOLDS,
Plaintiff,
Civil Action No. 10 1695
vs.
COMMISSIONER OF SOCIAL
SECURITY,
Defendant.
MEMORANDUM OPINION
I. INTRODUCTION
Plaintiff, Kevin Reynolds, seeks judicial review of a
decision of Defendant, Commissioner of Social Security ("the
Commissioner"), denying his applications for disability
insurance benefits ("DIB") and supplemental security income
("SSI") under Titles II and XVI, respectively, of the Social
Security Act, 42 U.S.C.
§§
401 433 and
§§
1381-1383f. 1
Presently
before the Court are the parties' cross-motions for summary
judgment pursuant to Fed.R.Civ.P. 56.
For the reasons set forth
below, Plaintiff's motion for summary judgment will be denied,
and the Commissioner's cross-motion for summary judgment will be
granted
The Social Security system provides two types of benefits based on an
inability to engage in substantial gainful activity: the first type, DIB,
provides benefits to disabled individuals who have paid into the Social
Security system through past employment, and the second type, SSI, provides
benefits to disabled individuals who meet low-income requirements regardless
of whether the individuals have ever worked or paid into the Social Security
system. With respect to Plaintiff's claim for DIB, his earnings record shows
that he has acquired sufficient quarters of coverage to remain insured
through March 31, 2012.
(R. 11).
1
1
II. PROCEDURAL HISTORY
On May 12, 2008, Plaintiff protectively filed applications
for DIB and SSI, alleging disability since August 1, 2005 due to
a neurological muscular disorder, back problems, heart problems,
high blood pressure, Crohn's disease, lupus or rheumatoid
arthritis.
(R. 9, 139-53, 207).
Plaintiff's applications were
denied and he requested a hearing before an administrative law
judge ("ALJ").
(R. 65-75, 76-86, 92-94).
Plaintiff, who was
represented by counsel, testified at the hearing which was held
on December 30, 2009.
testified.
A vocational expert ("VEil) also
(R. 26-48).
The ALJ issued a decision on January 6, 2010, denying
Plaintiff's applications for DIB and SSI based on his
determination that Plaintiff retained the residual functional
capacity ("RFC") to perform work existing in significant numbers
in the national economy.2
(R. 9-20).
Plaintiff's request for
review of the ALJ's decision was denied by the Appeals Council
on August 17, 2010.
(R. 1-5, 136-38).
Thus, the ALJ's decision
became the final decision of the Commissioner.
This appeal
followed.
The Social Security Regulations define RFC as the most a disability claimant
can still do despite his or her physical or mental limitations.
20 C.F.R.
§§ 404.1545 (a) and 416.945 (a) .
2
2
III. BACKGROUND
Plaintiff's testimony during the hearing before the ALJ may
be summarized as follows:
Plaintiff was born on September 5, 1966. 3
education, Plaintiff completed the ninth grade.
With respect to
While in
school, Plaintiff was placed in remedial math and reading
classes. 4
Plaintiff has a driver's licensej however, he drives
infrequently.
(R. 29-30, 42).
Between 1993 and 2006, Plaintiff
held jobs as a factory laborer and assembler.
janitorial work. 5
He also performed
(R. 32-33).
Plaintiff is unable to work because he has lupus 6 and
Crohn's diseasei 7 he requires frequent bathroom breaksi 8 he has
constant pain in his feet, legs and back due to arthritis; and
he has severe tremors in his hands.
3
Plaintiff takes Trazodone
Plaintiff was 43 years old at the time of the hearing before the ALJ.
(R.
29) .
4Although Plaintiff did not graduate from high school, he obtained a General
Equivalency Diploma in 1985.
(R.211).
5 With respect to Plaintiff's employment after his alleged onset date of
disability of August 1, 2005 1 the ALJ concluded that the work did not
constitute substantial gainful activity due to the amount of income Plaintiff
derived from the employment.
(R. 11).
6Lupus is an autoimmune disease which means the body's immune system
mistakenly attacks healthy tissue.
This leads to long-term (chronic)
inflammation. Lupus may affect the skin, joints, kidneys, brain and other
organs. www.ncbi.nlm.nih.gov/pubmedhealth.
Plaintiff testified that as a
result of lupus, he gets a rash allover his body when exposed to the sun.
(R.
41).
7Crohn's disease is chronic ileitis that typically involves the distal portion
of the ileum (the last division of the small intestine), often spreads to the
colon, and is characterized by diarrhea, cramping and loss of appetite and
weight with local abscesses and scarring. www.nlm.nih.gov/medlineplus
("Medlineplus") .
8 Plaintiff testified that he has to use the bathroom about five times a day
for 15 minutes at a time due to his bowel condition.
(R. 41).
3
for anxiety and to help him sleep.
A side effect of the
Trazodone is nausea which Plaintiff experiences several times a
week. 9
(R. 34 35).
chest pain.
(R.
Plaintiff also has been hospitalized for
38).
Plaintiff's ability to stand is limited to 45-60 minutes;
he can only walk for 25-30 minutes; he experiences numbness in
his legs from sitting; he can lift 20 pounds; he has difficulty
grasping objects due to the tremors in his hands; he cannot
stoop due to back pain; he has difficulty kneeling, crawling,
squatting, crouching and bending due to leg pain; his memory,
concentration and attention are impaired; and he has difficulty
relating to other people at times.
(R.
35-38).
with respect to activities of daily living, Plaintiff, who
lives alone, has no problem with self-care, such as dressing,
grooming and bathing.
Plaintiff uses a microwave oven to cook.
Cleaning is difficult for Plaintiff due to his leg pain.
Plaintiff does his laundry, although he sometimes forgets to put
the clothes in the dryer after they are washed.
not sweep or vacuum due to fatigue.
with his parents.
Plaintiff does
Plaintiff goes shopping
Plaintiff's only hobby is listening to music.
He does not belong to any clubs or organizations. 10
(R. 39-42).
9Trazodone is used to treat depression. Medlineplus.
lOIn a Function Report completed on June 30, 2008, Plaintiff described a
typical day as follows: "Eat breakfast, watch t.v., shower, talk to mom on
phone, go see mom and dad talk with them. Eat meals with them, talk on phone.
read. Go to store sometimes."
(R. 255).
4
IV. MEDICAL EVIDENCE
On June 21, 2005, Plaintiff was seen by Dr. Francis Meyers
of Chestnut Ridge Primary Care, Ltd., his primary care physician
("PCP")
at the time, for complaints of loss of energy, tremors
and calluses on his feet that hurt when he stood.
Plaintiff
also reported increased tension, feelings of restlessness and
hyperactivity.ll
Dr. Meyers' diagnoses were "benign essential
tremor, worsening" and anxiety, and the doctor prescribed Ativan
for Plaintiff. 12
(R. 383-85).
In an Employability Assessment
Form completed for the Pennsylvania Department of Public Welfare
("PA DPW") that day, Dr. Meyers rendered the opinion that
Plaintiff was temporarily disabled (June 18, 2005 to September
18, 2005) due to tremors, fatigue and anxiety.
(R. 388-89).
During a follow-up visit on July II, 2005, Dr. Meyers noted
Plaintiff's continuing tremors and described Plaintiff's
psychological complaints as "HYPERACTIVE, MILD MOOD SWINGS,
FEELINGS OF RESTLESSNESS, INCREASE IN TENSION, INCREASED
NERVOUSNESS."
Dr. Meyers gave Plaintiff a prescription for
Toprol,13 as well as a new prescription for Ativan.
(R. 391 92).
On July 13, 2005, a CT scan of Plaintiff's neck was
performed due to the presence of a palpable mass on the left
11 Despite his complaints, during this office visit, Plaintiff informed Dr.
Meyers that he exercised "fairly regularly and appropriately for age and
health.
(R. 383).
12Ativan is used to relieve anxiety. Medlineplu~.
13Toprol is used alone or in combination with other medications to treat high
blood pressure. Medlineplus.
If
5
side of his mandibular ramus (lower jaw).
The impression was
described as follows: "Palpable mass corresponds to somewhat
prominent superficial lobe of left parotid gland. 14
No evidence
of underlying mass lesion." (R. 393).
Plaintiff was seen by Dr. Meyers for a follow-up visit on
August 8, 2005.
Dr. Meyers noted that Plaintiff's tremors had
improved, and Plaintiff was given new prescriptions for Toprol
and Ativan.
(R. 396).
In an Employability Assessment Form
completed for PA DPW that day, Dr. Meyers opined that Plaintiff
was temporarily disabled (September 8, 2005 to December 8, 2005)
due to chronic anxiety and an enlarged parotid gland.
(R.
394
95) •
On August 18, 2005, Plaintiff was evaluated by Dr. August
Sotelo, an otolaryngologist (head and neck surgeon), for the
enlargement of the tail of his left parotid gland.
Dr. Sotelo's
examination of Plaintiff revealed marked inflammation of his ear
canals due to chronic cleaning with Q-tips for which the doctor
prescribed antibiotics.
Dr. Sotelo indicated that if there was
no reduction in the size of Plaintiff's left parotid gland in 3
to 4 weeks, he would perform an excision biopsy to rule out a
tumor.
(R.
397).
14 The paired parotid glands are the largest of the salivary glands.
They are
each found wrapped around the mandibular ramus, and secrete saliva into the
oral cavity to facilitate mastication and swallowing and to begin the
digestion of starches. http://en.wikipedia.org
6
During a follow up visit with Dr. Sotelo on September 16,
2005, Plaintiff's examination showed that the "firm enlarged
mass correspondent to the tail of the left parotid gland went
down in size considerably."
Dr. Sotelo noted that he would
continue to observe the mass. 15
(R. 400).
Plaintiff was seen by Dr. Meyers for a follow-up visit on
October 3, 2005.
Plaintiff reported feeling well, and his
weight and appetite were stable.
Plaintiff indicated that he
continued to have tremors, as well as mood swings and increased
nervousness and stress levels.
Dr. Meyers noted that Plaintiff
was in no acute distress; his respiratory effort was normal; his
heart rate and rhythm were regular with no murmurs, gallops,
rubs or abnormal heart sounds; his deep tendon reflexes were
normal and symmetrical; and his motor strength in the upper and
lower extremities was 5/5 with mild tremor.
Dr. Meyers
described Plaintiff's tremor as improved and he continued
Plaintiff on the Toprol.
(R. 398).
Plaintiff underwent a disability examination by Dr. Edward
Johnson on June 1, 2007, during which he complained of the
following conditions: (1) chest pains but no diagnosis of heart
disease;16 (2) diarrhea over the past year which was getting
An x-ray of Plaintiff's chest that had been ordered by Dr. Sotelo was
performed on November 4, 2005.
The impression was described as "normal."
15
(R.
371).
With regard to chest pain, Plaintiff told Dr. Johnson that he had never
undergone a stress test or heart catheterization; that his chest pain was not
16
7
progressively worse;17 (3) a worsening tremor; (4) back pain and
stiffness in the morning; (5) diffuse pain in his lower legs,
calves and knees which increased with ambulation; and (6)
multiple calluses on his feet which hurt when he walked.
Dr.
Johnson noted that Plaintiff's past medical history was
"significant for the possible diagnosis of IUpUS.,,18
was not taking any medications at this time.
Plaintiff
(R. 293-94).
Plaintiff's head and neck examination by Dr. Johnson was
"unremarkable;" his lungs were clear to auscultation; his heart
rate and rhythm were regular; his abdominal bowel sounds were
normal; his deep tendon reflexes were normal; his strength was
5/5 throughout; his straight leg raise test was negative
bilaterally in both the seated and supine positions; he could
walk on his heels and toes; he had no trouble getting on and off
the exam table: his gait was normal; and he showed no signs of
active synovitis such as joint swelling, redness or warmth. 19
Dr. Johnson indicated that Plaintiff should be evaluated for
coronary artery disease, although his atypical chest pain was
more likely related to mitral valve prolapse or an underlying
accompanied by diaphoresis (sweating), nausea or shortness of breath; and
that the pain did not radiate. (R. 293).
17 In connection with his complaint of diarrhea, Plaintiff told Dr. Johnson
that every time he ate, he had a bowel movement, "up to '70 times a day,'"
but that he had not seen a physician for this condition.
(R. 293).
18 As to his possible lupus diagnosis, Plaintiff told Dr. Johnson that his
knuckles swell and get red in the morning and he has a rash.
(R. 294).
19Synovitis is the medical term for inflammation of the membrane that lines
joints. Synovitis may occur in association with arthritis, lupus, gout and
other conditions. Synovitis causes joint tenderness or pain, swelling and
hard lumps called nodules.
http://en.wikipedia.org
8
anxiety disorder; that Plaintiff's diarrhea without weight loss
was likely due to irritable bowel syndrome and a
gastrointestinal ("GI") work-up was warranted; that Plaintiff's
subjective complaints of back pain were not supported by
objective findings on examination; that Plaintiff had a tremor
of the arm and head; and that, without active synovitis on exam
it was difficult to diagnose Plaintiff with lUpus.
1
(R. 294).
Dr. Johnson completed an assessment of Plaintiff/s ability
to perform work-related physical activities in which he opined
that Plaintiff could occasionally lift and carry 50 pounds and
frequently lift and carry 25 pounds; that Plaintiff had no
limitations with regard to standing and walking
l
sitting
l
pushing and pulling (other than shown under lifting and
carrying) and no environmental restrictions; that Plaintiff
could occasionally bend
l
kneel
stoop, crouch, balance and
l
climb; and that Plaintiff/s ability to handle items was affected
by his tremor
1
treatment."
(R. 297-98).
On June 25
although the tremor "likely would respond to
1
2007, a State agency medical consultant
completed a physical RFC assessment for Plaintiff based on a
review of his file.
In summary
1
the physician opined that
Plaintiff could occasionally lift and carry 20 pounds and
frequently lift and carry 10 pounds; that Plaintiff could stand
and/or walk about 6 hours in an 8-hour workday; that Plaintiff
9
could sit about 6 hours in an 8-hour workday; that Plaintiff's
ability to push and pull was unlimited (other than shown for
lifting and/or carrying)
i
and that Plaintiff had no postural,
manipulative, visual, communicative or environmental
limitations.
In reaching his conclusions, the physician found
Plaintiff's statements concerning the limiting effects of his
conditions to be "partially credible."
(R. 302-08).
On April 21, 2008, Plaintiff presented to the Emergency
Department of Latrobe Area Hospital complaining of chest pain. 20
The physician who initially examined Plaintiff noted that he was
"very anxious;" that he "supposedly" had a history of Crohn's
disease, although the physician could not find any documentation
to support the diagnosis; that he had been told "at one time"
that he had lUpUS;21 that he presented with left-sided sternal
chest pain radiating down his left arm, lasting several minutes
and associated with diaphoresis, nausea, lightheadedness and
shortness of breath; that he reported a 25-pound weight loss
Specifically,
The Court notes a significant gap in the medical evidence.
there are no records showing that Plaintiff received medical treatment
between October 3, 2005, when he saw his PCP for a follow-up visit (at which
time his physical examination was normal and his tremor had improved), and
April 21, 2008, when he presented to the hospital with chest pain - a gap of
2).5 years.
21With respect to Plaintiff's past medical history, the physician noted:
"Again, questionable history of lupus or rheumatoid arthritis, questionable
history of Crohn1s disease. Not a terribly insightful individual.
I am not
sure how much of this is actually factual."
(R. 312).
In this connection,
the Court notes that neither lupus nor Crohn's disease is mentioned in the
2005 office notes of Dr. Meyers, Plaintiff's PCP - the only evidence of
medical treatment in the record prior to Plaintiff's presentation to the
hospital with chest pain in April 2008.
(R. 383-85, 391-92 396, 398-99).
20
1
10
over the last couple of months; that he was not taking any
medications; that he had not seen a doctor in several years; and
that he was a smoker.
On physical examination
l
Plaintiff was
found to be in moderate distress; his lungs were "pretty clear
l
although there [were] some coarse breath sounds because of the
smoking history:
murmurs
I
II
his heart had a normal sinus rhythm without
rubs or gallops; his bowel sounds were normal: his
neurological exam was within normal limits; and his EKG showed
sinus tachycardia with very little changes. 22
Plaintiff was
admitted to the hospital for a thallium stress test which ruled
out cardiac etiology for the chest pain. 23
hospitalization
l
During his
Plaintiff was evaluated by Dr. C.R. Punukollu,
a gastroenterologist.
With regard to physical findings, Dr.
Punukollu noted that Plaintiff was comfortable, in no distress,
awake, alert and oriented; Plaintiff's cardiopulmonary and
abdomen examinations were unremarkable; and Plaintiff's
extremities showed no edema.
Dr. Punukollu described his
diagnoses as follows: 1. Noncardiac chest pain, cardiac etiology
ruled out; 2. Strong family history of coronary artery disease;
3. Suspected Crohn's disease; 4. Suspected rheumatoid arthritis;
22Tachycardia is a faster than normal heart rate.
www.mayoclinic.com.
23 A thallium stress test is a nuclear imaging method that shows how well blood
flows in the heart muscle, both at rest and during activity.
Medlineplus.
The impression of Plaintiff's thallium stress test was described as follows:
"1. Maximal exercise stress test which is electrocardiographically negative
for ischemia. 2. No exercise-induced chest pain."
(R. 338).
11
and 5. Noncardiac chest pain, rule out gastrointestinal etiology
including esophageal ulcer, esophagitis, Barrett's esophagus,
gastroesophageal reflux disease or peptic ulcer disease.
Upon
his discharge from the hospital on April 22, 2008, Plaintiff was
advised to take over-the-counter Prilosec on a daily basis for 2
weeksi 24 to see his PCP within the weeki and to obtain an upper
. GI evaluation, a small bowel series and a colonoscopy to confirm
the doctor's diagnoses.
(R.
309 64).
In an Employability Assessment Form completed for PA DPW on
May 6, 2008, an unidentified individual from Chestnut Ridge
primary Care, Ltd. rendered the opinion that Plaintiff was
temporarily disabled (April 22, 2008 to April 22, 2009) due to
Crohn's disease.
The form indicates that the opinion was based
solely on a review of Plaintiff's medical records. 25
(R. 452
53) •
On May 7, 2008, Dr. Punukollu's office sent a letter to Dr.
George Gavin, who succeeded Dr. Meyers as Plaintiff's PCP at
Chestnut Ridge Primary Care, Ltd., to advise him that upon
Plaintiff's discharge from the hospital on April 22, 2008, he
24Prilosec is used alone or with other medications to treat gastroesophageal
reflux disease, a condition in which backward flow of acid from the stomach
causes heartburn and possible injury of the esophagus (the tube between the
throat and stomach). Medlineplus.
25 It is not clear what records the unidentified individual from Plaintiff's
PCP practice relied upon to render the opinion that Plaintiff was disabled
for a year due to Crohn's disease. At this point in time, there is no
evidence of a definitive diagnosis of Crohn's disease.
In fact, in a
Disability Report completed on June 2, 2008, a month later, Plaintiff noted:
"THEY THINK I MAY HAVE CROHN'S DISEASE, NOT YET DIAGNOSED."
(R. 245).
12
was advised to schedule an upper endoscopy, a small bowel series
and a colonoscopy; and that despite several messages left on
Plaintiff's answering machine, he had never returned the calls
to schedule these tests.
(R. 407).
On May 13, 2008, Plaintiff was seen by Dr. Gavin to followup on his recent hospitalization for chest pain.
Plaintiff
reported chronic diarrhea and a history of Crohn's disease.
He
also reported a 2S-pound weight loss in the preceding 2-3
months.
With respect to Plaintiff's physical examination, Dr.
Gavin described Plaintiff as a " [h]ealthy appearing individual
in no distress," and the doctor noted that Plaintiff's
respiratory effort was normal; his heart rate and rhythm were
regular with no murmurs, gallops, rubs or abnormal sounds; he
had no edema in his extremitiesi his gait was normali his
cranial nerves were grossly intact; the motor strength in his
upper and lower extremities was S/Si but his Romberg test was
positive. 26
Dr. Gavin's assessment included unspecified chest
pain, vertigo and abnormal weight loss, and he referred
Plaintiff for tests.
(R. 410-11).
An MRr of Plaintiff's brain on May 23, 2008 showed no acute
intracranial findings.
A CT scan of Plaintiff's abdomen and
pelvis on the same day was negative for localized inflammatory
26During the Romberg test, the patient is asked to stand up with the feet
together and the eyes closed.
If the patient loses balance, this is a sign
that the sense of position has been lost and the test is considered positive.
Medlineplus.
13
process or fluid collection and negative for adenopathy.27
(R.
367 69).
During an office visit on May 27, 2008, Dr. Punukollu
noted, among other things, Plaintiff's history of suspected
rheumatoid arthritis and positive lupus screen.
Plaintiff's
complaints included chest pain (worse with breathing), joint
stiffness, weight loss of 25 pounds in the past 2 months, a
decreased appetite and watery diarrhea.
Dr. Punukollu's
impressions were (1) noncardiac chest pain,
(2) costochrondritis
in the lower sternal area,28 (3) history of Crohn's disease with
no work up,
(4) diarrhea and weight loss
colonic neoplasms,
rule out colitis and
(5) history of suspected rheumatoid
arthritis, and (6) antinuclear antibody fecally positive. 29
Dr.
Punukollu indicated that several tests would be ordered for
Plaintiff.
(R. 415).
27Adenopathy is the enlargement of lymph nodes anywhere in your body.
Lymph
nodes are a part of your immune system and are where immune cells mature to
fight illness.
Inflamed lymph nodes often indicate an infection or illness
nearby. www.bettermedicine.com.
28Costochondritis is an inflammation of the cartilage that connects a rib to
the breastbone (sternum).
It causes sharp pain where your ribs and
breastbone are joined by rubbery cartilage.
Pain caused by costochondritis
may mimic that of a heart attack or other heart conditions.
www.mayoclinic.com.
29 An ANA test detects proteins called antinuclear antibodies in your blood.
Your immune system normally makes antibodies to help you fight infection.
The antibodies detected in an ANA test are different.
They may attack your
body's own tissues. A positive ANA test indicates that your immune system
has launched a misdirected attack on your own healthy tissue - in other
words, an autoimmune reaction.
Because connective tissue is often the target
of autoimmune reactions, the resulting diseases are known as connective
tissue diseases.
Examples include lupus, rheumatoid arthritis and
s c 1 e rod e rma
~_,!,!.~.:.~~y.!?.~!.~.!!~.~.:..~.1!l'
14
Plaintiff underwent a small bowel series for his complaint
of diarrhea on June 11, 2008.
The impression was described as
follows: "Rapid transit, otherwise normal small bowel series.
(R. 365).
1I
Plaintiff was scheduled for an upper endoscopy by Dr.
Punukollu the next day.
However, he canceled the appointment
due to some family issue. 3o
(R. 417).
On July 15, 2008, a State agency psychological consultant
completed a Psychiatric Review Technique Form for Plaintiff
based on a review of his file.
The consultant described
Plaintiff's mental impairment as a "HX of Anxiety States.
1I
With
respect to functional limitations, the consultant opined that
Plaintiff had no limitations in activities of daily living and
social functioning; that Plaintiff had mild limitations in
concentration, persistence or pace; and that the evidence failed
to show repeated episodes of decompensation, each of extended
duration.
(R.
432-44).
On July 23, 2008, a second State agency medical consultant
completed a physical RFC assessment for Plaintiff based on a
review of his file.
The physician rendered the following
opinions: Plaintiff could occasionally lift and carry 20 pounds
and frequently lift and carry 10 poundsi Plaintiff could stand
30There is no evidence that Plaintiff ever rescheduled the endoscopy with Dr.
Punukollu.
In fact, there is no evidence that Plaintiff received any medical
treatment after June 2008.
Thus, at the time of the hearing before the ALJ
in December 2009, another significant gap existed in the medical evidence - a
gap of 1M years.
15
and/or walk about 6 hours in an 8-hour workday; Plaintiff could
sit about 6 hours in an 8-hour workday; Plaintiff's ability to
push and pull was unlimited (other than shown for lifting and/or
carrying); Plaintiff could only occasionally climb, balance,
stoop, kneel, crouch and crawl; and Plaintiff had no
manipulative, visual, communicative or environmental
limitations.
(R. 445-51).
On December 1, 2009, a month before the ALJ hearing,
Plaintiff underwent a psychological evaluation by Lindsey
Groves, PsyD, at the request of his attorney.
Following the
one-hour clinical interview, Dr. Groves diagnosed Plaintiff with
"Generalized Anxiety Disorder" and "Major Depressive Disorder,
Recurrent, Severe without psychotic Features."
Dr. Groves noted
that Plaintiff's PCPs had been managing his anxiety,31 and that
Plaintiff had never received formal mental health treatment.
Dr. Groves described Plaintiff's prognosis as follows: "Highly
guarded due to lack of counseling or psychiatric care - may
improve if he seeks formal MH treatment."
Dr. Groves opined
that Plaintiff had an 80% permanent disability, and that he
could not engage in employment on a regular, sustained,
competitive and productive basis.
Dr. Groves assigned a score
In this connection, the Court notes that the records of Dr. Meyers show
Plaintiff was treated for anxiety in 2005.
(R. 383-85, 391-92, 396-97, 398
99). However, the 2008 records of Dr. Gavin do not indicate that Plaintiff
complained of anxiety or that he received any treatment from Dr. Gavin for
this condition.
(R. 381, 410 11).
31
16
of 52 to Plaintiff on the Global Assessment of Functioning
( \\GAF") scale, indicating moderate symptoms. 32
Dr. Groves
described Plaintiff's limitation in activities of daily living
as "moderate," and his limitations in social functioning and
concentration, persistence and pace as "marked."
Dr. Groves
also indicated that Plaintiff had experienced four or more
episodes of decompensation, each of extended duration.
(R. 455
65) •
v.
ALJ'S DECISION
In order to establish a disability under the Social
Security Act, a claimant must demonstrate an inability to engage
in any substantial gainful activity due to a medically
determinable physical or mental impairment which can be expected
to result in death or which has lasted or can be expected to
last for a continuous period of not less than 12 months.
42 U.S.C.
§
423(d) (1).
A claimant is considered unable to
engage in any substantial gainful activity only if his physical
or mental impairment or impairments are of such severity that he
is not only unable to do his previous work but cannot,
The GAF scale is a numeric scale used by clinicians to report an
individual's overall level of functioning.
The scale does not evaluate
impairments caused by physical or environmental factors.
The GAF scale
considers psychological, social and occupational functioning on a
hypothetical continuum of mental health - illness.
The highest possible
score is 100, and the lowest is 1. A score of 52 denotes the following:
"moderate symptoms (e.g., flat affect and circumstantial speech, occasional
panic attacks) OR moderate difficulty in social, occupational, or school
functioning (e.g., few friends or conflict with peers or co-workers).
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision, at 32-34 (bold face in original) .
32
17
------------------
considering his age, education, and work experience, engage in
any other kind of substantial gainful work which exists in the
national economy.
42 U.S.C.
§
423(d) (2) (A).
When presented with a claim for disability benefits, an ALJ
must follow a sequential evaluation process.
§§
404.1520(a) (4) and 416.920(a) (4).
20 C.F.R.
The process was described
by the Supreme Court in Sullivan v. Zebley, 493 U.S. 521 (1990),
as follows:
*
*
*
Pursuant to his statutory authority to implement the
SSI Program, (footnote omitted) the Secretary has
promulgated regulations creating a five-step test to
determine whether an adult claimant is disabled. Bowen v.
Yuckert, 482 U.S. 137, 140 42 (1987).
(footnote omitted).
The first two steps involve threshold determinations that
the claimant is not presently working and has an impairment
which is of the required duration and which significantly
limits his ability to work. See 20 C.F.R. §§ 416.920(a)
through (c) (1989). In the third step, the medical evidence
of the claimant's impairment is compared to a list of
impairments presumed severe enough to preclude any gainful
work. See 20 C.F.R. pt. 404, subpt. P, App. 1 (pt.
A) (1989). If the claimant's impairment matches or is
"equal" to one of the listed impairments, he qualifies for
benefits without further inquiry. § 416.920(d). If the
claimant cannot qualify under the listings, the analysis
proceeds to the fourth and fifth steps. At these steps,
the inquiry is whether the claimant can do his own past
work or any other work that exists in the national economy,
in view of his agel education, and work experience. If the
claimant cannot do his past work or other work, he
qualifies for benefits.
493 U.S. at 525 26.
*
*
18
*
The claimant bears the burden of establishing steps one
through four of the sequential evaluation process for making
disability determinations.
At step five, the burden shifts to
the Commissioner to consider "vocational factors
ll
(the
claimant's age, education and past work experience) and
determine whether the claimant is capable of performing other
jobs existing in significant numbers in the national economy in
light of his or her RFC.
Ramirez v. Barnhart, 372 F.2d 546,
550-51 (3d Cir.2004) .
With respect to the ALJ's application of the five-step
sequential evaluation process in the present case, steps one and
two were resolved in Plaintiff's favor: that is, the ALJ found
that Plaintiff had not engaged in substantial gainful activity
since his alleged onset date of disability,33 and the medical
evidence established that Plaintiff suffers from the following
severe impairments: lupus erythemtosus, Crohn's disease,
rheumatoid arthritis, high blood pressure, major depressive
disorder, recurrent without psychotic features, and generalized
anxiety disorder.
(R. 11).
Turning to step three, the ALJ
found that Plaintiff's impairments were not sufficiently severe
to meet or equal the requirements of any impairment listed in 20
C.F.R., Pt. 404, Subpt. P, App. 1.
per se disabled.
33
(R. 12-13).
See footnote 5.
19
Therefore, Plaintiff was not
Before proceeding to step four, the ALJ assessed
Plaintiff's RFC, concluding that Plaintiff retained the RFC to
perform sedentary work with the following limitations: 34 (1) only
occasional balancing, crouching, crawling, squatting, kneeling
and climbing ramps and stairsi (2) only occasional interaction
with supervisors, co-workers and the public; (3) only simple,
work-related decisions and routine, repetitive tasks; (4) only
infrequent changes in the work setting; and (5) no constant
handling or use of the fingers.
(R. 14-18).
The ALJ then
proceeded to step four, finding that in light of Plaintiff's
RFC, he is unable to perform any of his past relevant work.
(R.
18) .
At the final step, considering Plaintiff's age, education,
work experience, RFC and the VE's testimony, the ALJ found that
Plaintiff could perform other work existing in the national
economy, including the sedentary jobs of a document preparer, a
surveillance system monitor and a telephone quotation clerk.
Thus, Plaintiff was not disabled for purposes of DIB and 55I.
(R. 18-19).
For purposes of Social Security disability claims, sedentary work ~involves
lifting no more than 10 pounds at a time and occasionally lifting or carrying
articles like docket files, ledgers, and small tools. Although a sedentary
job is defined as one which involves sitting, a certain amount of walking and
standing is often necessary in carrying out job duties.
Jobs are sedentary
if walking and standing are required occasionally and other sedentary
criteria are met.
20 C.F.R. §§ 404.1567(a) and 416.967(a).
J4
20
VI. STANDARD OF REVIEW
The Court's review of the Commissioner's decision is
limited to determining whether the decision is supported by
substantial evidence, which has been described as "such relevant
evidence as a reasonable mind might accept as adequate to
support a conclusion."
(1971).
Richardson v. Perales, 402 U.S. 389, 401
It consists of something more than a mere scintilla,
but something less than a preponderance.
Dobrowolsky v.
Califano, 606 F.2d 403, 406 (3d Cir.1979).
Even if the Court
would have decided the case differently, it must accord
deference to the Commissioner and affirm the findings and
decision if supported by substantial evidence.
Monsour Medical
Center v. Heckler, 806 F.2d 1185, 1190-91 (3d Cir.1986) .
VII. DISCUSSION
A
The listing of impairments in Part 404, Subpart P, Appendix
1 of the Social Security Regulations describes impairments for
each of the major body systems that the Social Security
Administration considers to be severe enough to prevent an
individual from doing any gainful activity, regardless of his or
her age, education or work experience.
and 416.925(a).
20 C.F.R.
§§
404.1525(a)
In step three of the sequential evaluation
process, the Commissioner evaluates whether the evidence
establishes that the claimant suffers from a listed impairment.
21
If so, the claimant is automatically eligible for Social
Security disability benefits.
416.920(d)
i
20 C.F.R.
§§
404.1520(d) and
Bowen v. Yuckert, 482 U.S. 137, 141 (1987) ("If the
impairment meets or equals one of the listed impairments, the
claimant is conclusively presumed to be disabled.") .
"For a claimant to show his impairment matches a listing,
it must meet all of the specified medical criteria.
An
impairment that manifests only some of those criteria, no matter
how severely, does not qualify."
See Jones v. Barnhart, 364
F.3d 501, 503 (3d Cir.2004), quoting, Sullivan v. Zebley, 493
U.S. 521, 530 (1990).
With respect to Plaintiff's physical impairments which the
ALJ found to be severe, i.e., lupus, Crohn's disease, rheumatoid
arthritis and high blood pressure, the ALJ in his decision
concluded that "[t]he medical evidence of record does not
contain the objective signs, symptoms, or findings, nor the
degree of functional restriction, necessary for the claimant's
impairments, considered singly or in combination, to meet or
medically equal in severity any section of the ... Listings.
(R. 12).
1I
Plaintiff asserts that the ALJ erred by failing to
find that his medical conditions meet Listings 5.06, 14.02 and
14.09.
After consideration, the Court does not agree.
Section 5.00 of the listing of impairments relates to
disorders of the digestive system.
22
To meet Listing 5.06, a
claimant must establish, among other things, inflammatory bowel
disease ("IBD/I) "documented by endoscopy, biopsy, appropriate
medically acceptable imaging, or operative findings./I
The
medical evidence in Plaintiff's file does not include a
diagnosis of IBD based on any of the enumerated tests or on
operative findings.
The first reference to Crohn's disease is
found in the records pertaining to Plaintiff's hospitalization
in April 2008 for chest pain.
Specifically, at the time of
admission, Plaintiff reported a history of Crohn's disease and
recent weight loss.
Due to a lack of documentation, the
admitting physician noted a "questionable history of Crohn's
disease."
(R. 312).
Subsequently, Dr. Punukollu evaluated
Plaintiff, included "suspected" Crohn's disease among
Plaintiff's diagnoses and advised Plaintiff to undergo various
tests.
While Plaintiff did undergo the small bowel series
recommended by Dr. Punukollu in June 2008, the impression was
described as "[r]apid transit, otherwise normal small bowel
series,/I and there is no evidence that Plaintiff ever
rescheduled the recommended endoscopy with Dr. Punukollu that he
cancelled in June 2008 or that he ever scheduled the recommended
colonoscopy.
In sum, the medical evidence submitted by
Plaintiff in support of his applications for DIB and SSI fails
to meet the initial requirements of Listing 5.06.
23
Therefore,
the ALJ's determination that he did not meet this listing was
not erroneous.
Section 14.00 of the listing of impairments pertains to
immune system disorders.
14.02
Listing 14.02 provides:
Systemic lupus erythematosus.
14.00D1.
As described in
With:
A. Involvement of two or more organs/body systems,
with:
1. One of the organs/body systems involved to at least
a moderate level of severitYi and
2. At least two of the constitutional symptoms or
signs (severe fatigue, fever, malaise, or involuntary
weight loss) .
or
B. Repeated manifestations of SLE, with at least two
of the constitutional symptoms or signs (severe fatigue,
fever, malaise, or involuntary weight loss) and one of the
following at the marked level:
1. Limitation of activities of daily living.
2. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner
due to deficiencies in concentration, persistence, or pace.
In support of the claim that he meets this listing,
Plaintiff asserts: "Plaintiff meets the A & B Criteria of
Listing Section 14.02 by having rheumatoid arthritis and Crohn's
Disease with malaise and involuntary weight loss.
At the marked
level, Dr. Groves opined that Plaintiff has marked difficulties
in maintaining social functioning and marked difficulties in
maintaining concentration, persistence or pace."
24
(Document No.
10, p. 13).
After consideration, the Court finds Plaintiff's
argument unpersuasive.
With respect to the first requirement of the A Criteria of
Listing 14.02, i.e., the involvement of two or more organs/body
systems with one of the organs/body systems involved to at least
a moderate level of severity, Plaintiff's "suspected" lupus or
rheumatoid arthritis and Crohn's disease are not confirmed by
the medical evidence submitted by Plaintiff in support of his
applications for DIB and 881.
Moreover, the sparse evidence of
medical treatment for these suspected conditions during the
relevant time period undermines a finding that any of the
conditions was of "moderate severity."
As to Plaintiff's claim that he meets the second
requirement of the A Criteria of Listing 14.02, i.e., at least
two of the constitutional symptoms or signs (severe fatigue,
fever, malaise, or involuntary weight), the only references to
complaints of malaise or fatigue by Plaintiff appear in the
office notes of visits with Dr. Meyers on June 21, 2005 and
August 8, 2005.
(R. 384, 396).
During his office visit with
Dr. Meyers on October 3, 2005, Plaintiff reported feeling well
(R. 398), and the only office notes of Dr. Gavin in the record,
which were completed in connection with Plaintiff's office visit
on May 13, 2008, do not mention a complaint of malaise or
fatigue.
In fact, Dr. Gavin described Plaintiff's general
25
appearance during that office visit as " [h]ealthy appearing
individual in no distress."
(R. 410).
With respect to weight
loss, Plaintiff did not experience the significant weight loss
until early 2008, shortly before his hospitalization for chest
pain.
Plaintiff's complaints of malaise or fatigue and weight
loss were separated by several years.
Under the circumstances,
Plaintiff also has failed to establish the second requirement of
the A Criteria of Listing 14.02.
with regard to the B Criteria of Listing 14.02, i.e.,
repeated manifestations of lupus with at least two of the
constitutional symptoms (severe fatigue, fever, malaise, or
involuntary weight loss), Plaintiff, again, has failed to submit
medical evidence from which a finding of repeated manifestations
of lupus and the presence of at least two of the constitutional
symptoms in close proximity could be found.
See Williams v.
Sullivan, 970 F.2d 1178, 1186 (3d Cir.1992) (Under the Social
Security Act, the burden is on the claimant to demonstrate by
medical evidence that he is unable to work).
Accordingly, the
ALJ did not err in finding that Plaintiff did not meet Listing
14.02.
Finally, Plaintiff contends that he meets the B Criteria of
Listing 14.09 which provides:
14.09 Inflammatory arthritis.
14.00D6.
With:
26
As described in
*
*
*
B. Inflammation or deformity in one or more major
peripheral joints with:
1. Involvement of two or more organs/body systems with
one of the organs/body systems involved to at least a
moderate level of severity; and
2. At least two of the constitutional symptoms or
signs (severe fatigue, fever, malaise, or involuntary
weight loss).
*
*
*
Plaintiff maintains that he meets Listing 14.09B for the
same reasons he alleges meeting the A Criteria of Listing 14.02,
i.e., rheumatoid arthritis and Crohn's disease with malaise and
involuntary weight loss.
For the reasons discussed above in
connection with the A Criteria of Listing 14.02, the Court
rejects this argument.
In addition, the Court notes that
Plaintiff has failed to submit evidence showing inflammation or
deformity in one or more of his major peripheral joints.
Under
the circumstances, the ALJ did not err in failing to find that
Plaintiff meets Listing 14.09.
One final point needs to be addressed with respect to
Plaintiff's listings argument.
Citing the decision of the Court
of Appeals for the Third Circuit in Burnett v. Commissioner of
Soc. Sec., 220 F.3d 112 (3d Cir.2000), Plaintiff also argues
that the ALJ's step three analysis was deficient because he
failed to identify and discuss specific listings.
10, p. 14).
The Court does not agree.
27
(Docket No.
In Burnett, the claimant contended, among other things, the
ALJ erred by making only a conclusory statement that he did not
meet any of the listed impairments without mentioning any
specific listed impairment or explaining his reasoning.
The
Third Circuit agreed, holding that the ALJ's conclusory
statement in that case was beyond meaningful judicial review.
As noted by the Commissioner, however, in Jones v.
Barnhart, 364 F.3d 501 (3d Cir.2004), a more recent decision,
the Third Circuit held that the failure of an ALJ to analyze a
specific listed impairment did not require a remand of the case
for further proceedings.
The Third Circuit stated:
*
*
*
To be sure, in Burnett v. Commissioner of Social Security
Administration we required "the ALJ to set forth the
reasons for his decision," and held that the ALJ's bare
conclusory statement that an impairment did not match, or
is not equivalent to, a listed impairment was insufficient.
220 F.3d 112, 119 20 (3d Cir.2000). Here, Jones does not
specifically challenge the ALJ's ruling on the grounds that
it fails the Burnett standard. Rather, Jones's only
reference to Burnett appears in a long list of citations in
support of the general proposition that "the ALJ must
analyze all the evidence in the record and provide an
adequate explanation for disregarding evidence.
In any
event, the ALJ's step three analysis in this case satisfies
Burnett. Burnett does not require the ALJ to use
particular language or adhere to a particular format in
conducting his analysis. Rather, the function of Burnett
is to ensure that there is sufficient development of the
record and explanation of findings to permit meaningful
review. See id. at 120. In this case, the ALJ's decision,
read as a whole, illustrates that the ALJ considered the
appropriate factors in reaching the conclusion that Jones
did not meet the requirements for any listing, including
Listing 3.02(A). The ALJ's opinion discusses the evidence
II
28
•••
pertaining to chronic obstructive and restrictive lung
disease, specifically referencing "[p]ulmonary function
studies ... consistent with moderately severe obstructive
and restrictive defects,1I but pointing to the lack of
pulmonary complications, and a finding that claimant's
lungs were clear. Also, the ALJ noted that claimant's
medical history showed no frequent hospitalization or
emergency treatments .... This discussion satisfies
Burnett's requirement that there be sufficient explanation
to provide meaningful review of the step three
determination.
*
*
364 F.3d at 504-05. 35
Similarly, in the present case, the ALJ's decision, read as
a whole, shows that he considered the appropriate factors in
concluding that Plaintiff did not meet the requirements of any
listed impairment in the Social Security Regulations.
Specifically, the ALJ noted the following:
(1) the failure of
Plaintiff's course of treatment to support his subjective
allegations of disabling symptoms (R. 16)
i
(2) Plaintiff's
normal physical examination by Dr. Johnson in June 2007 and the
consultative examiner's assessment of Plaintiff's ability to
engage in physical work-related activities (R. 15)
i
(3)
Plaintiff's alleged history of Crohn's disease "with no apparent
work up done thus far
ll
(R. 14)
i
(4) the records of Plaintiff's
hospitalization in April 2008 noting Plaintiff's "questionable"
See also Scuderi v. Commissioner of Soc. Sec., 302 Fed.Appx. 88, 90 (3d Cir.
2008) ("[A]n ALJ need not specifically mention any of the listed impairments
in order to make a judicially reviewable finding, provided that the ALJ's
decision clearly analyzes and evaluates the relevant medical evidence as it
relates to the Listing.").
35
29
history of Crohn's disease and lupus (R. 15); (5) Plaintiff's
essentially normal physical examination by Dr. Gavin in May 2008
(R. 14); (6) the normal results of the MRI of Plaintiff's brain
and the CT scan of Plaintiff's abdomen and pelvis in May 2008
(R. 14; (7) the normal small bowel series in June 2008 (R. 15);
(8) the cancellation of the endoscopy that had been scheduled
with Dr. Punukollu in June 2008 (R. 15); and (9) the routine and
conservative nature of Plaintiff's medical treatment (R. 16)
.36
In sum, the Court concludes that the ALJ's discussion of the
foregoing evidence satisfies Burnett's requirement of a
sufficient explanation to provide meaningful review of the ALJ's
step three determination.
B
Plaintiff also asserts that the ALJ erroneously assessed
his RFC and, therefore, the testimony of the VE in response to
the ALJ's hypothetical question which was based on the erroneous
RFC assessment does not constitute substantial evidence
supporting the denial of his applications for DIB and SSI.
Chrupcala v. Heckler, 829 F.2d 1269 (3d Cir.1987) (If an ALJ
poses a hypothetical question to a vocational expert that fails
to reflect "all of a claimant's impairments that are supported
The Court notes that the medical evidence submitted by Plaintiff also is
insufficient to show that the combination of his impairments is equivalent to
a listed impairment. To meet this burden, it was incumbent upon Plaintiff to
present medical findings equal in severity to all the criteria for the one
most similar listed impairment. See Sullivan v. Zebley, 493 U.S. at 531
(emphasis in original).
Clearly, he has not met this burden.
36
30
by the record, ... it cannot be considered substantial
evi dence . ") .
In his decision, the ALJ noted that Plaintiff has a
"moderate limitation in concentration, persistence or pace./I
(R. 13).
The ALJ's RFC assessment, and, consequently, his
hypothetical question to the VE, however, did not specifically
include this limitation.
Rather, the VE was asked to assume a
hypothetical person who is limited, in relevant part, to (1)
only occasional interaction with supervisors, coworkers and the
public; (2) work requiring only simple work-related decisions;
(3) work involving only routine, repetitive tasks; and (4) work
in a setting that did not change frequently.
Citing the Third
Circuit's decision in Ramirez v. Barnhart, 372 F.3d 546 (3d Cir.
2004), Plaintiff contends that the foregoing limitations do not
adequately account for the ALJ's determination that he suffers
from moderate limitations in concentration, persistence or pace.
Therefore, the ALJ's step five determination is not supported by
substantial evidence.
In Ramirez, the disability claimant's applications for DIB
and 88I were denied a second time by an ALJ following a remand
by the Appeals Council for further proceedings, and the district
court affirmed the Commissioner's decision.
On appeal, Ramirez
contended, among other things, that the ALJ's hypothetical
question to the VE on which the ALJ relied heavily in denying
31
Social Security benefits to Ramirez did not adequately
incorporate the ALJ's findings in the psychiatric Review
Technique Form ("PRTF") which was attached to the adverse
decision. 3 ?
Specifically, in the section of the PRTF entitled
"Functional Limitation and Degree of Limitation," the ALJ
indicated that Ramirez "often" experienced "deficiencies of
concentration, persistence, or pace resulting in a failure to
complete tasks in a timely manner (in work settings and
elsewhere)
.,,38
The ALJ's hypothetical question to the VE,
however, did not specifically include this limitation.
Based on
this omission, Ramirez asserted that the ALJ's adverse decision
which was based, in large part, on the VE's testimony that
Plaintiff could engage in work existing in the national economy
despite her impairments was not supported by substantial
evidence.
In opposition to Ramirez's argument, the Commissioner
asserted that the ALJ's inclusion in the hypothetical question
of a limitation to work involving "simple one to two step tasks"
was sufficiently descriptive to encompass the ALJ's finding in
the PRTF that Ramirez "often" experienced "deficiencies of
37Under the then-existing Social Security Regulations, a PRTF had to be
completed by an ALJ and attached to his or her decision in cases in which
claimants alleged mental impairments.
372 F.3d at 549.
38 In the PRTF, four broad areas of functioning, ~, (1) activities of daily
living, (2) social functioning, (3) concentration, persistence or pace and
(4) decompensation in work or work like settings, were rated on a five-point
scale of never, seldom, often, frequent and constant.
372 F.3d at 552.
32
concentration, persistence, or pace resulting in a failure to
complete tasks in a timely manner (in work settings and
elsewhere)."
The Third Circuit disagreed, vacated the district
court's decision and remanded the case to the Commissioner for
further proceedings.
In 2000, the Social Security Regulations pertaining to
mental impairments were revised and evaluation of the broad
functional area of concentration, persistence, or pace was
changed from the five-point "frequency" scale that had been
applicable at the time of the Ramirez decision, i.e. never,
seldom, often, frequent and constant, to a five-point "severity"
scale consisting of none, mild, moderate, marked and severe.
See Colon v. Barnhart, 424 F.Supp.2d 805, 811-12 (E.D.Pa.2006).
Noting cases holding that "often" and "moderate" fallon the
same point of the five-point scales utilized to evaluate
functional limitations in PRTFs and, therefore, can be
considered equivalent findings, Plaintiff asserts that the ALJ's
hypothetical question in this case was deficient under Ramirez.
(Document No. 10, pp. 14-16).
After consideration, the Court finds the Third Circuit's
decision in Ramirez distinguishable.
First, as noted above, the
ALJ's decision in Ramirez was rendered when the Social Security
Regulations required ALJs to complete PTRFs and attach them to
their decisions.
Thus, the ALJ herself specifically rendered
33
the opinion in a PTRF that Ramirez "often" experienced
"deficiencies of concentration, persistence, or pace resulting
in a failure to complete tasks in a timely manner."
549.
There is no such PRTF in this case.
372 F.2d at
Second, the
limitation set forth in the PRTF in Ramirez was more extensive
than the limitation noted in this case.
Specifically, the
limitation in the PRTF in Ramirez included deficiencies of
concentration, persistence or pace "resulting in a failure to
complete tasks in a timely manner (in work settings and
elsewhere)."
In this case, the ALJ's finding at issue is not as
broad; that is, it does not address the issue of completing
tasks in a timely manner.
Third, in Ramirez, the ALJ's finding
in the PRTF regarding the extent of the limitation in
Plaintiff's concentration, persistence or pace was consistent
with all of the opinions rendered by mental health
professionals, including a psychological evaluator, a State
agency psychologist and a Board certified psychiatrist.
In
contrast, the State agency psychological consultant in this case
rendered the opinion in a PRTF completed on July 15, 2008 that
Plaintiff's limitations with respect to concentration,
persistence or pace were "mild.
II
39
Fourth, the limitations
39Although Dr. Groves, who performed the consultative psychological evaluation
of Plaintiff on December I, 2009, indicated that Plaintiff had "marked"
limitations in concentration, persistence or pace, the ALJ adequately
explained his reason for rejecting her opinions.
Specifically, Dr. Grove's
opinions were contradicted by her own objective findings, including her GAF
34
relating to concentration, persistence or pace in the ALJ's
hypothetical question to the VE in this case were more extensive
than the limitation included in the ALJ's hypothetical question
in Ramirez.
Specifically, the hypothetical question in Ramirez
merely limited the claimant to "simple one to two step tasks,"
while the hypothetical question in this case limited Plaintiff
to (1) simple, work-related decisions,
tasks,
(2) routine, repetitive
(3) only occasional interaction with others, and (4)
infrequent changes in the work setting.
Based on the evidence
submitted by Plaintiff in support of her applications for DIB
and SSI, the foregoing limitations were adequate.
VIII. CONCLUSION
Although it is clear that Plaintiff suffers from severe
impairments, he simply has failed to submit sufficient medical
evidence to support a determination that he is disabled under
the Social Security Act.
Nothing precludes Plaintiff from
filing new applications for DIB and SSI if, and when, he
procures the necessary medical evidence.
•
Vp2;;x~'William L. Standish
United States District Judge
Date: July 29, 2011
score of 52 denoting moderate symptoms, the minimal objective findings,
Plaintiff's very conservative treatment and Plaintiff's range of daily
activities.
(R. IB).
35
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