Sanchez v. Colvin

Filing 15

ORDER denying 11 Motion to Reverse; granting 13 Motion. to Affirm the Commissioner. Signed by U.S. District Judge Karen E. Schreier on 6/26/2015. (KC)

UNITED STATES DISTRICT COURT
DISTRICT OF SOUTH DAKOTA
SOUTHERN DIVISION
ROSE E. SANCHEZ,

4:14-CV-4071-KES

Plaintiff,
vs.
CAROLYN W. COLVIN, Acting
Commissioner, Social Security
Administration,

MEMORANDUM OPINION AND
ORDER AFFIRMING THE DECISION
OF COMMISSIONER

Defendant.
Plaintiff, Rose E. Sanchez, seeks review of the decision of the
Commissioner of the Social Security Administration denying her claim for
disability insurance benefits. The Commissioner opposes the motion and moves
the court to affirm the denial. For the following reasons, the court affirms the
decision of the Commissioner.
PROCEDURAL HISTORY
Sanchez applied for benefits on June 14, 2011, alleging disability since
August 15, 2010. AR 156-62.1 The Social Security Administration (SSA) denied
Sanchez’s application initially on August 18, 2011, and again upon
reconsideration on January 25, 2012. AR 23, 78-83. Sanchez then requested
an administrative hearing and appeared with counsel before Administrative
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record.

All citations to “AR” refer to the appropriate page of the administrative

Law Judge James Olson (ALJ) on January 30, 2012. See AR 38-54. Thereafter,
the ALJ issued an unfavorable decision finding that Sanchez retained the
residual functional capacity (RFC) to perform past relevant work. AR 20-32.
Accordingly, the ALJ determined Sanchez was not disabled. AR 32. Sanchez
timely appealed the ALJ’s decision and requested review by the Appeals
Council. Her request was denied on April 8, 2013.2 AR 1-7, 18. On May 8,
2014, Sanchez commenced this action seeking judicial review of the
Commissioner’s denial of her claim. Docket 1.
FACTUAL BACKGROUND
Sanchez was born on September 25, 1957. AR 156. Sanchez obtained
her GED in June 1991. AR 203. She completed CNA job training in June 2000.
Id. Sanchez reported working three jobs from 1995 until the time of her
application. She worked at a factory, a nursing home, and most recently at a
convenience store as a deli cook. Id. Sanchez testified that her responsibilities
from her most recent job included using ovens and fryers, cooking, and
cleaning. AR 42. Sanchez stated she had not worked since August 15, 2010,
due to anxiety. Id. Sanchez also testified that she suffered from a heart attack
in November 2010. Id. According to Sanchez, after the heart attack she was
unable to perform daily functions and was limited by the side effects of her
medications. AR 42-51. Sanchez testified she still had constant pain and

Because the Appeals Council denied Sanchez’s request for review, the
ALJ’s decision represents the final decision of the Commissioner for purposes
of judicial review. 42 U.S.C. § 405(g).
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fatigue despite changes in her diet and exercise, along with assistance from her
husband. AR 51.
I.

Coronary Artery Disease and Peripheral Vascular Disease
On November 22, 2010, Sanchez experienced symptoms of a heart attack

and was airlifted to Wyoming Medical Center. AR 272-73, 283.3 Sanchez
underwent a left ventriculogram, coronary angiography, and left heart
catheterization on November 23, 2010. AR 291-93. On November 26, 2010,
Sanchez underwent a coronary bypass graft times four. AR 294-95. Sanchez
was discharged on December 1, 2010, with diagnoses of angina, left main and
triple vessel coronary artery disease, diabetes mellitus, myocardial infarction,
hypertension, hypercholesterolemia, tobacco abuse, peripheral vascular
disease, depression, and anxiety. AR 272.
On December 16, 2010, Sanchez began treating with James Walder,
M.D., a cardiologist at Regional Heart Doctors in Rapid City, South Dakota. AR
266. Sanchez was doing well after her surgeries, with no reports of chest
discomfort or panic attacks since being discharged, and seemed to “be on the
right medications.” Id. Dr. Walder recommended, however, that Sanchez return
to the Wyoming Medical Center to follow up with her surgeon. Id. The next day,
Sanchez was seen by Eric Webb, PA-C, at the Wyoming Medical Center for

It is unclear from the record whether Sanchez experienced similar
symptoms before. Sanchez denied previous episodes of similar pain upon
admittance at Wyoming Medical Center, AR 283, but the discharge summary
notes she may have experienced similar symptoms that had gotten worse over
the past year. AR 273.
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treatment of her surgical wound which had opened due to Sanchez “moving,
doing a lot of walking and carrying items.” AR 280.
On March 22, 2011, Sanchez presented to Douglas Everson, M.D., a
Family Medicine/General Practitioner, with a left ear complaint. AR 362.
Sanchez had been hospitalized with an infection and was receiving intravenous
antibiotics. Id. At her appointment, Sanchez claimed her symptoms from her
heart condition were improving, and that she was not experiencing dyspnea4 or
chest discomfort with daily activities. Id.
Sanchez was again seen by Dr. Everson on April 18, 2011, for a bilateral
ear complaint. AR 360. Sanchez did not report any changes in symptoms
related to her heart condition. Id. On May 27, 2011, Sanchez saw Dr. Everson
for a physical and medication refills, and reported dyspnea on exertion, but all
other symptoms remained unchanged. AR 358. Dr. Everson ordered an
electrocardiogram (EKG) and chest x-ray. The chest x-ray showed no acute
cardiopulmonary abnormalities. AR 367. He indicated Sanchez needed to see a
cardiologist and have a stress test performed. AR 359.
On July 1, 2011, Sanchez met with Dr. Everson for diabetic control and
medication refills. AR 412. Sanchez reported chest discomfort and dyspnea
with household activities and yard work. Id. Upon a lung examination,
Dr. Everson concluded there was no dyspnea. AR 414. Dr. Everson once again
indicated Sanchez needed an appointment with a cardiologist and to have a
Dyspnea is shortness of breath. Mayo Clinic, http://www.mayclinic.
org/symptoms/shortness-of-breath/basics/definition/sym-20050890 (last
visited June 17, 2015).
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stress test completed. Id. Dr. Everson did not note any changes on July 15,
2011, but ordered an echocardiogram (Echo) for July 21, 2011, and a stress
test with Dr. Vanmarel on August 4, 2011. AR 409, 411.
At a follow-up appointment for her stress test on August 5, 2011,
Sanchez reported her symptoms were worsening. She continued to experience
chest discomfort and dyspnea with household activities and yard work. AR
406. Dr. Everson noted the nuclear medicine stress test was abnormal. Id.
Sanchez was scheduled to see Dr. Walder for a consultation. AR 408.
On August 10, 2011, Sanchez reported to Dr. Walder that she was still
having problems with chest discomfort and shortness of breath. AR 383.
Dr. Walder confirmed the findings of the stress test, and determined Sanchez
needed cardiac catheterization with coronary and graft angiography. AR 385.
Dr. Walder placed two cardiac stents on August 18, 2011. AR 376-79.
On August 25, 2011, Sanchez met with Dr. Everson and continued to
report chest discomfort and dyspnea with household activities and yard work,
despite the two cardiac stents placed on August 18. AR 403. Dr. Everson
ordered a same-day chest x-ray, which came back as stable and unremarkable.
AR 415. On September 1, 2011, Sanchez met with Dr. Everson for a medication
review and to continue diabetic treatment, and again reported chest discomfort
and dyspnea despite attending cardiac rehab. AR 399.
Sanchez met with Dr. Walder on September 14, 2011, for a one-month
post-hospital visit. AR 421. Sanchez reported she was unable to take deep
breaths when walking and had taken nitroglycerin three times for chest
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tightness, which was separate from her inability to take deep breaths. Id.
Sanchez reported the chest tightness sensation occurred when she exercised or
did housework like cleaning, laundry, or dishes. Id. Sanchez continued to
attend cardiac rehab and could walk for about twelve minutes on a treadmill
before experiencing the inability to take a deep breath. Id. Dr. Walder’s report
concluded with:
After talking with [Sanchez] at some length, I am not as concerned
that she is having a lot of angina as I was when I heard about her
situation from cardiac rehab and from telephone conversations
with our nurses. The discomfort she gets on deep inspiration and
on bending over probably is less related to her surgery and may
not have changed a lot since then. The chest tightness on the other
hand may well represent angina, but it is pretty infrequent.
AR 424.
Sanchez returned to Dr. Walder on October 5, 2011, for a stress test. AR
426. The scans returned normal and were “reassuring” as the results did not
indicate ischemia. AR 427. Despite the normal scans and continued attendance
at cardiac rehab, Sanchez still reported chest discomfort and dyspnea to
Dr. Everson at an October 20, 2011, appointment for treatment of depression.
AR 395.
On October 24, 2011, Sanchez had a follow-up visit with Julie Smyser, a
Family Nurse Practitioner, on behalf of Dr. Walder. AR 429. Sanchez reported
doing very well and denied any symptoms of dizziness, dyspnea, edema,
palpitations, syncope, or near syncope. Id. Sanchez did experience occasional
chest tightness while cleaning her house. Id. The episodes occurred only one or
two times per month and were rarely comparable to the pain she experienced
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during her heart attack. Id. Smyser advised Sanchez to monitor these episodes
and report if there was any increase in frequency or severity, and to schedule a
follow-up appointment in six months. AR 432.
On November 4, 2011, Sanchez met with Dr. Everson. She continued to
report episodes of chest discomfort and dyspnea with household activities and
yard work despite attending cardiac rehab. AR 465. Dr. Everson noted Sanchez
had an appointment with her cardiologist in three weeks. AR 461. Ten days
later, on November 14, 2011, Sanchez reported to Dr. Everson that her
symptoms were improving, and she denied any chest pain, dyspnea, fatigue, or
use of her nitroglycerin. AR 470. Sanchez continued with her cardiac rehab. Id.
On December 9, 2011, Sanchez saw Dr. Everson and reported she had
recently been seen in an emergency room in Spearfish, South Dakota, for
symptoms similar to a heart attack. AR 475. Sanchez complained of chest pain,
but not with daily activities, and she reported use of her nitroglycerin. Id.
Sanchez also reported she had completed cardiac rehab. Id.
At a January 24, 2012, appointment with Dr. Everson, Sanchez denied
chest discomfort, dyspnea, fatigue, or use of her nitroglycerin. AR 480. Sanchez
made the same statements at her appointments with Dr. Everson from
February to June 2012. AR 485, 491, 495, 500, 505.
Sanchez met with Dr. Walder on July 6, 2012 for a routine follow-up. AR
521. Dr. Walder noted Sanchez was doing reasonably well. Id. Sanchez still
reported dyspnea on exertion but not too much trouble with chest tightness or
angina. Id. Dr. Walder also noted Sanchez was walking at least a block a day
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and also up and down stairs at her daughter’s house for exercise. Id.
Dr. Walder considered Sanchez to be doing very well from the cardiac
standpoint with no clear-cut angina or congestive heart failure. AR 523. Dr.
Walder recommended a follow-up in six months, and if Sanchez decided to go
through with bariatric surgery, a repeat stress test and Echo would be ordered.
AR 524.
A.

Dr. Walder’s Cardiac Impairment Questionnaire

On April 2, 2012, Dr. Walder completed a Cardiac Impairment
Questionnaire covering his treatment of Sanchez from December 16, 2010, to
October 24, 2011. AR 433-37. Dr. Walder diagnosed Sanchez with diabetes
mellitus and coronary artery disease status-post quadruple coronary artery
bypass grafting supported by the clinical findings of chest pain, shortness of
breath, and fatigue. AR 433. Dr. Walder relied on the November 23, 2010, and
August 18, 2011, operation reports, lipid studies, and Sanchez’s blood sugar
levels. AR 434. No side effects were noted from any of Sanchez’s medications.
AR 435.
Dr. Walder stated Sanchez’s main symptoms were chest pain, dyspnea
on exertion, and fatigue, which he believed were reasonably consistent with
Sanchez’s impairments. AR 434. Sanchez’s symptoms varied in frequency,
depended on activity, and were contributed to by emotional stress. Dr. Walder
opined the symptoms would increase if Sanchez were to be placed in a
competitive work environment. AR 434-35. Dr. Walder believed the symptoms
and limitations probably began on November 23, 2010. AR 437.
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Based on a five-day work week, at eight hours per day, Dr. Walder
opined Sanchez could sit for two to three hours at a time, stand or walk for
zero hours, be able to frequently lift zero to five pounds and occasionally lift
five to ten pounds, and occasionally be able to carry zero to five pounds. AR
435-36. Sanchez would be unable to push, pull, kneel, bend, or stoop at a
regular job. AR 437. According to Dr. Walder, Sanchez’s impairments would
result in good and bad days, and it would be likely that Sanchez would be
absent from work more than three times per month due to the impairments or
treatment. AR 436. Dr. Walder also opined the symptoms were severe enough
to frequently interfere with Sanchez’s attention and concentration, and that
Sanchez was incapable of handling low stress. Id. This finding was based on
Dr. Walder’s in-office observations, along with reports from Sanchez and her
husband. AR 437.
B.

Dr. Everson’s Multiple Impairment Questionnaire

Dr. Everson completed a Multiple Impairment Questionnaire on June 28,
2012, for his monthly treatment of Sanchez from July 15, 2011, through
June 28, 2012.5 AR 506-13. Dr. Everson opined that Sanchez’s prognosis with
her diagnoses of coronary artery disease and diabetes mellitus type-2 was fair.
AR 506. He based his opinion on clinical findings that Sanchez experienced
dyspnea on exertion with poor exercise tolerance and that Sanchez’s blood
glucose levels remained over 300 despite good effort with her diet. AR 506.
Dr. Everson used the information from the Multiple Impairment
Questionnaire to compose a narrative dated December 25, 2012. AR 525. The
information in the Questionnaire is identical to the narrative.
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Dr. Everson identified Sanchez’s primary symptoms as fatigue, shortness
of breath, and poor exercise tolerance. AR 507. He opined these symptoms
were reasonably consistent with Sanchez’s impairments and likely started in
November 2010. AR 507, AR 512. Dr. Everson also stated that Sanchez
reported constant pain from neuropathy in both legs, precipitated by diabetes.
AR 507-08. He rated Sanchez’s pain as moderately severe and her fatigue as
severe. AR 508. Dr. Everson reported he had been unable to completely relieve
the pain with medication without unacceptable side effects. Id.
Based on a five-day work week, at eight hours per day, Dr. Everson
opined Sanchez could sit for one hour, stand or walk for zero to one hour, and
indicated it would be necessary or medically recommended for Sanchez not to
sit, stand, or walk continuously. AR 508-09. Dr. Everson stated Sanchez could
frequently lift zero to five pounds, and occasionally lift five to ten pounds. AR
509. He also indicated Sanchez could carry zero to five pounds frequently and
occasionally carry five to ten pounds. Id. Dr. Everson did not believe Sanchez
had any limitations on repetitive movements. Id.
Dr. Everson opined Sanchez’s symptoms would increase if she were
placed in a competitive work environment. AR 510. Sanchez’s pain, fatigue or
other symptoms were constantly severe enough to interfere with her attention
and concentration. AR 511. Sanchez would have to miss work more than three
times per month due to her impairments or treatments. AR 512. Unlike
Dr. Walder, Dr. Everson noted Sanchez would be able to tolerate low stress in
the workplace. AR 511. Dr. Everson did not note any other limitations that
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would affect Sanchez’s ability to work at a regular job on a sustained basis. AR
512.
II.

Diabetes Mellitus
Prior to being seen at the Wyoming Medical Center on November 22,

2010, Sanchez had been diagnosed with diabetes mellitus type-2.6 At her
March 22, 2011, appointment with Dr. Everson, Sanchez reported her home
blood sugar readings were within the normal range. AR 362. The same was
reported to Dr. Everson from April through August 2011. AR 360, 358, 412,
409, 406, 403.
On September 1, 2011, Sanchez reported to Dr. Everson that her home
blood sugar readings were high. AR 400. Dr. Everson increased Sanchez’s
medication to get her levels to a normal range. AR 402. At a September 14,
2011, appointment with Dr. Walder, Sanchez reported her blood sugar levels
had gone over 500 and she had been sent to the emergency room. AR 421.
Dr. Walder recommended seeing Dr. John Palmer, D.O., as soon as possible to
get her blood sugar under control. AR 424.
On October 11, 2011, Sanchez met with Dr. Palmer for recommendations
regarding poorly controlled type-2 diabetes. AR 390. Dr. Palmer noted Sanchez
had significant insulin resistance with only a couple episodes of minor
hypoglycemia. AR 393. Dr. Palmer advised normalizing Sanchez’s insulin levels

The medical records do not indicate when Sanchez was initially
diagnosed with diabetes mellitus type-2 or which provider gave that diagnosis.
There are no records of treatment for diabetes mellitus prior to November 22,
2010.
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and assisting with dietary restrictions. Id. On October 24, 2011, Sanchez met
with Julie Smyser, FNP, and reported that Dr. Palmer had prescribed more
medications to get her diabetes under control, but denied any changes in
exercise or diet to assist in controlling her diabetes. AR 429.
From October 20, 2011, until June 21, 2012, Sanchez reported high
blood sugar readings to Dr. Everson. AR 395, AR 465, AR 470, AR 475, AR
480, AR 485, AR 495, AR 500, AR 505. Dr. Everson increased Sanchez’s
medication multiple times in an attempt to get her levels to a normal range. AR
461, AR 466, AR 481. In December 2011, Sanchez’s glucose levels were slowly
improving despite the reported high at-home readings. AR 471.
In March of 2012, after needing to stop a medication the prior month due
to side effects, Sanchez expressed interest in an insulin pump. AR 481, AR
491. Dr. Everson adjusted Sanchez’s insulin level and told her to continue the
treatment plan implemented by Dr. Palmer. AR 486. In April and May 2012,
Dr. Everson noted Dr. Palmer was switching Sanchez to different medications
and advised Sanchez to follow Dr. Palmer’s treatment plan. AR 492, AR 496.
On June 21, 2012, Sanchez reported to Dr. Everson that her readings were still
high despite the new medications. AR 505.
Dr. Palmer completed a Diabetes Mellitus Impairment Questionnaire on
July 12, 2012. AR 514. Dr. Palmer indicated Sanchez had vascular and
neuropathic complications with her diabetes, and that she suffered side effects
of retinopathy, excessive thirst, fatigue, and general malaise from treatment.
AR 515-16. Dr. Palmer opined the impairments would last at least twelve
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months and were impacted by emotional factors, but deferred any questions
related to Sanchez’s residual functional capacity to her primary care provider.
AR 517-18. He relied on Sanchez’s elevated hemoglobin levels to support the
diagnosis, and opined that Sanchez’s history of coronary artery disease,
arthritic complaints, and neuropathy was likely related to her diabetes. AR
439. Dr. Palmer denied having to switch Sanchez’s medications due to adverse
side effects, and again deferred questions regarding Sanchez’s physical
limitations to her primary care provider. AR 439-40.
ALJ DECISION
On April 8, 2013, the ALJ issued a decision denying Sanchez’s
application for benefits. AR 20-32. In doing so, the ALJ used the sequential
five-step evaluation process.7 At step one, the ALJ determined that Sanchez

An ALJ must follow “ ‘the familiar five-step process’ ” to determine
whether an individual is disabled. Martise v. Astrue, 641 F.3d 909, 921 (8th
Cir. 2011) (quoting Halverson v. Astrue, 600 F.3d 922, 929 (8th Cir. 2010)). 20
C.F.R. § 404.1520(a)(4)(i)-(v) provides that “(i) [a]t the first step, we consider
your work activity, if any. If you are doing substantial gainful activity, we will
find that you are not disabled. . . . (ii) At the second step, we consider the
medical severity of your impairment(s). If you do not have a severe medically
determinable physical or mental impairment that meets the duration
requirement of § 404.1509, or a combination of impairments that is severe and
meets the duration requirement, we will find that you are not disabled. . . . (iii)
At the third step, we also consider the medical severity of your impairment(s). If
you have an impairment(s) that meets or equals one of our listings in appendix
1 of [subpart P of part 404 of this chapter] and meets the duration
requirement, we will find that you are disabled. . . . (iv) At the fourth step, we
consider our assessment of your residual functional capacity and your past
relevant work. If you can still do your past relevant work, we will find that you
are not disabled. . . . (v) At the fifth and last step, we consider our assessment
of your residual functional capacity and your age, education, and work
experience to see if you can make an adjustment to other work. If you can
make an adjustment to other work, we will find that you are not disabled. If
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had not engaged in substantial gainful activity since August 15, 2010. AR 25.
At step two, the ALJ found that Sanchez was suffering from several severe
impairments, namely: coronary artery disease, peripheral vascular disease,
diabetes mellitus, and obesity.8 Id. The ALJ further determined, however, that
Sanchez’s depression and high anxiety did not qualify singly or in combination
as severe. Id. At step three, the ALJ determined that Sanchez did not have an
impairment or combination of impairments that met or medically equaled a
listed impairment. AR 26-28. At step four, the ALJ found that Sanchez had the
RFC to perform a full range of light work. AR 28-31. Based on this RFC
determination, the ALJ concluded that Sanchez could perform past relevant
work as a deli cook. AR 32. Accordingly, the ALJ found that Sanchez did not
qualify for benefits under the Social Security Act.
STANDARD OF REVIEW
The court must uphold the ALJ’s decision if it is supported by
substantial evidence in the record as a whole. 42 U.S.C. § 405(g) (“The findings
of the Commissioner as to any fact, if supported by substantial evidence, shall
be conclusive . . . .”); Teague v. Astrue, 638 F.3d 611, 614 (8th Cir. 2011).
“Substantial evidence is ‘less than a preponderance, but is enough that a
reasonable mind would find it adequate to support the Commissioner's
you cannot make an adjustment to other work, we will find that you are
disabled.”
The ALJ found that Sanchez’s obesity is a severe medically
determinable impairment and considered her obesity when evaluating whether
Sanchez’s other impairments met or equaled a listed impairment. Sanchez did
not challenge the ALJ’s consideration of her obesity.
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conclusion.’ ” Pate-Fires v. Astrue, 564 F.3d 935, 942 (8th Cir. 2009) (quoting
Maresh v. Barnhart, 438 F.3d 897, 898 (8th Cir. 2006)). The court considers
evidence that both supports and detracts from the ALJ’s decision. Moore v.
Astrue, 623 F.3d 599, 605 (8th Cir. 2010). If the Commissioner’s decision is
supported by substantial evidence in the record as a whole, the court may not
reverse it merely because substantial evidence also exists in the record that
would support a contrary position or because the court would have determined
the case differently. Krogmeier v. Barnhart, 294 F.3d 1019, 1022 (8th Cir. 2002)
(citing Woolf v. Shalala, 3 F.3d 1210, 1213 (8th Cir. 1993)).
In determining whether the Commissioner’s decision is supported by
substantial evidence in the record as a whole, the court reviews the entire
administrative record and considers six factors: (1) the ALJ’s credibility
determinations; (2) the claimant’s vocational factors; (3) medical evidence from
treating and consulting physicians; (4) the claimant’s subjective complaints
relating to activities and impairments; (5) any third-party corroboration of
claimant’s impairments; and (6) a vocational expert’s testimony based on
proper hypothetical questions setting forth the claimant’s impairment(s).
Stewart v. Sec’y of Health & Human Servs., 957 F.2d 581, 585-86 (8th Cir.
1992) (citing Cruse v. Bowen, 867 F.2d 1183, 1184-85 (8th Cir. 1989)).
The court also reviews the Commissioner’s decision to determine if an
error of law has been committed, which may be a procedural error, the use of
an erroneous legal standard, or an incorrect application of the law. Collins v.
Astrue, 648 F.3d 869, 871 (8th Cir. 2011) (citations omitted). Issues of law are
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reviewed de novo with deference accorded to the Commissioner’s construction
of the Social Security Act. Id. (citing Juszczyk v. Astrue, 542 F.3d 626, 633 (8th
Cir. 2008)).
DISCUSSION
Before an ALJ moves to step four, the ALJ must determine the claimant's
RFC. 20 C.F.R. § 404.1520(a)(4). A claimant's RFC “is the most [she] can still
do [in a work setting] despite [her] limitations.” 20 C.F.R. § 404.1545(a)(1). The
RFC assessment is an indication of what the claimant can do on a “regular and
continuing basis” given the claimant's limitations. 20 C.F.R. § 404.1545(b).
“ ‘The ALJ should determine a claimant's RFC based on all the relevant
evidence, including the medical records, observations of treating physicians
and others, and an individual's own description of [her] limitations.’ ” Lacroix v.
Barnhart, 465 F.3d 881, 887 (8th Cir. 2006) (quoting Strongson v. Barnhart,
361 F.3d 1066, 1070 (8th Cir. 2004)). The RFC must include the limitations
from all medically determinable impairments, regardless of whether they are
considered severe. See SSR 96–8p, 1996 WL 374184 at *5 (SSA 1996) (“In
assessing RFC, the adjudicator must consider limitations and restrictions
imposed by all of an individual's impairments, even those that are not
‘severe.’ ”).
In determining Sanchez’s RFC, the ALJ considered Sanchez’s heart
attack in November 2010 that resulted in a coronary artery bypass surgery, her
past medical history of diabetes and hypertension, anxiety, depression, and
medications. AR 28-30. The ALJ made findings on Sanchez’s credibility, and
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considered medical opinions from Dr. Walder and Dr. Everson as well as
several state agency physicians. AR 28-32. The ALJ ultimately determined
Sanchez had the RFC to perform the full range of light work as defined in 20
C.F.R. § 404.1567(c).
I.

Sanchez’s Credibility
Before the ALJ can make a determination on a claimant’s RFC, “the ALJ

must determine the applicant’s credibility, as [her] subjective complaints play a
role in assessing [her] RFC.” Ellis v. Barnhart, 392 F.3d 988, 995-96 (8th Cir.
2005) (citing Pearsall v. Massanari, 274 F.3d 1211, 1217-18 (8th Cir. 2001)).
“[W]hen evaluating a claimant’s credibility, in addition to considering the
absence of objective medical evidence to support complaints of pain, an ALJ
should consider a claimant’s reported daily activities, the duration, frequency
and intensity of his or her pain, precipitating and aggravating factors,
medication, and functional restrictions.” Steed v. Astrue, 524 F.3d 872, 875 n.4
(8th Cir. 2008) (citing Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984)); see 20
C.F.R. § 404.1529(c)(3). “The ALJ is not required to discuss methodically each
Polaski consideration, so long as [the ALJ] acknowledged and examined those
considerations before discounting [Sanchez’s] subjective complaints.” Steed,
524 F.3d at 876 (internal quotation omitted). An ALJ must make express
credibility determinations detailing reasons for discounting a claimant’s
subjective complaints of pain. Dipple v. Astrue, 601 F.3d 833, 837 (8th Cir.
2010). An ALJ’s credibility determination is entitled to deference because the

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ALJ is in a better position than a reviewing court to gauge credibility. Travis v.
Astrue, 477 F.3d 1037, 1042 (8th Cir. 2007).
Sanchez argues the ALJ erred in concluding that Sanchez was not
working due to reasons unrelated to her medical conditions. Docket 12 at 15.
The record of Sanchez’s summary earnings showed she did not work during the
years 1983-1988, 1990-1992, 2011, and 2012. AR 170. Even when Sanchez
did work, her yearly earnings ranged from $128.00 to $7,688.59. Id. This
record supports the ALJ’s conclusion that Sanchez had a record of poor work
history “showing [Sanchez] worked only sporadically prior to the alleged
disability onset date[.]” AR 28. The ALJ was within reason to question whether
Sanchez’s unemployment was actually due to disability. Id. See Wright v.
Colvin, No. 14-2834, 2015 WL 3650732, at *5-6 (8th Cir. June 15, 2015)
(finding claimant’s credibility lacking where claimant did not file for disability
until two years after leaving last employer); Ellis 392 F.3d at 996 (citing Woolf,
F.3d at 1214 (noting that a sporadic work history is relevant to the ALJ’s
credibility analysis); Polaski, 739 F.2d at 1322 (noting work history as one
factor to consider in credibility determination)).
Next, Sanchez argues the ALJ erred in finding Sanchez’s heart surgery
relieved her symptoms. Docket 12 at 15. Sanchez relies on her progress notes
post-heart surgery that indicate persistent chest pain, dyspnea, and
restrictions on daily living, along with a contradiction to the ALJ’s finding that
Sanchez did not suffer from significant fatigue. Id. The ALJ observed that the
objective medical evidence did not support Sanchez’s testimony of pain and
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inability to work. AR 28-29 (noting the medical findings did not match
Sanchez’s “testimony at the hearing that she experiences such severe
limitations as pain, tiredness and fatigue, and her allegation that she
experiences side effects of ‘grogginess’ from her medication”). Inconsistency
with objective medical evidence is a valid reason to discount a claimant’s
subjective complaints. See Ellis, 392 F.3d at 996 (holding “[w]hile the ALJ may
not discount [claimant’s] complaints solely because they are not fully
supported by objective medical evidence, [the] complaints may be discounted
based on inconsistencies in the record as a whole.”) (citing Lowe v. Apfel, 226
F.3d 969, 972 (8th Cir. 2000)). The court agrees with the ALJ that the medical
evidence is inconsistent with Sanchez’s testimony during the hearing.
Sanchez also argues the ALJ erred in finding that her treatment regime
was conservative and that her symptoms were manageable with medication. A
pattern of conservative treatment is a proper factor for the ALJ to consider in
evaluating a claimant’s credibility. See Gowell v. Apfel, 242 F.3d 793, 796 (8th
Cir. 2001). Sanchez argues her medical history of a quadruple heart bypass
and a second procedure to insert two stents is not conservative treatment.
Docket 12 at 16. But Sanchez fails to dispute that within one month of her
quadruple heart bypass she reported to be doing well and only needed followup for treatment of her surgical wound due to “moving, doing a lot of walking
and carrying items.” AR 266, 280.
The record further shows that, in addition to standard check-up
procedures, Dr. Walder and Dr. Everson routinely ordered stress tests, chest x19

rays, and EKGs to determine her various manifestations of pain. See AR 359,
411, 414, 415, 426. These tests found no abnormalities. Any pain that Sanchez
was unable to handle was addressed by use of nitroglycerin. See AR 421. The
ability to successfully control pain with medication can be inconsistent with an
allegation of disabling pain. Moore v. Astrue, 572 F.3d 520, 525 (8th Cir. 2009).
If an impairment can be controlled through treatment or medication, it cannot
be considered disabling. Id. (citing Kisling v. Chater, 105 F.3d 1255, 1257 (8th
Cir. 1997)). Thus, Sanchez may disagree with the ALJ’s characterization of her
treatment as conservative, but that observation is supported by the record. The
ALJ therefore did not err in concluding that Sanchez’s allegations of pain were
not fully credible based on her treatment history.
Finally, Sanchez argues that the ALJ did not provide a detailed analysis
for each Polaski criteria. For example, Sanchez notes that the ALJ did not
include a specific finding as to her testimony on symptoms and resulting
limitations, her limited activities of daily living, and her lack of significant
improvement with treatment. The ALJ is not required to explicitly discuss each
Polaski factor, so long as the framework is acknowledged before discounting
Sanchez’s subjective complaints. Steed, 524 F.3d at 876. The ALJ specifically
discussed Sanchez’s daily activities; the duration and frequency of her
symptoms; and Sanchez’s functional restrictions. Polaski, 739 F.2d at 1322.
The ALJ also expressly made a credibility finding. Goff v. Barnhart, 421 F.3d
785, 791 (8th Cir. 2005). The issue before this court is not whether the ALJ’s
credibility finding is unassailable, but whether it is supported by substantial
20

evidence. Guilliams v. Barnhart, 393 F.3d 798, 801 (8th Cir. 2005); Pearsall,
274 F.3d at 1218 (“The credibility of a claimant’s subjective testimony is
primarily for the ALJ to decide, not the courts.”). Based on the record as a
whole, the ALJ’s credibility determination is supported by substantial evidence.
II.

Medical Opinion Evidence
A treating physician’s opinion on the nature and severity of the

claimant’s impairments is entitled to controlling weight if it is “well-supported
by medically acceptable clinical and laboratory diagnostic techniques and is
not inconsistent with the other substantial evidence in [the] case record.” 20
C.F.R. § 404.1527(c)(2). “A treating physician’s opinion ‘do[es] not
automatically control, since the record must be evaluated as a whole.’ ” Reed v.
Barnhart, 399 F.3d 917, 920 (8th Cir. 2005) (quoting Bentley v. Shalala, 52
F.3d 784, 786 (8th Cir. 1995)). An ALJ may “discount or even disregard the
opinion of a treating physician 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) (citations omitted). If a treating
physician’s opinion is not given controlling weight, the ALJ should consider
several factors in weighing it and any other medical opinions in the record,
such as the length of the treatment relationship and the frequency of
examination, the nature and extent of the treatment relationship, the
supportability of the opinion, the consistency of the opinion, and the
specialization of the source. 20 C.F.R. § 404.1527(c). The ALJ must always give
good reasons for the weight afforded to a treating physician’s evaluation. 20
21

C.F.R. § 404.1527(c)(2); Singh v. Apfel, 222 F.3d 448, 452 (8th Cir. 2000). The
ALJ will also consider opinions from non-examining sources. 20 C.F.R.
§ 404.1527(e).
A.

Treating Physicians

Dr. Walder completed a Cardiac Impairment Questionnaire on April 2,
2012. AR 433-37.9 According to Dr. Walder, Sanchez could sit for two to three
hours at a time, stand or walk for zero hours, and would be able to frequently
lift zero to five pounds, occasionally lift five to ten pounds, and occasionally be
able to carry zero to five pounds. AR 435-36. Sanchez would not be able to
push, pull, kneel, bend, or stoop while working at a regular job. AR 437.
The ALJ observed Sanchez was doing well as of her first appointment
with Dr. Walder in December 2010. She did not report any chest discomfort or
panic attacks, and Dr. Walder noted she was being treated with the proper
medication. AR 266. Although Sanchez suffered a setback in the course of
treatment, which required an additional surgery, she reported one month later
that the sensations of chest tightness she experienced came from exercising or
doing housework like cleaning, laundry or dishes. AR 421. Dr. Walder was not
concerned about angina at that point, and Sanchez was instructed to meet
with Dr. Walder’s nurse practitioner at her next appointment. AR 424, 429.
Sanchez reported to the nurse practitioner that she continued to experience

Dr. Palmer completed a Diabetes Mellitus Impairment Questionnaire on
July 12, 2012. AR 514-19. Dr. Palmer provided responses in relation to
Sanchez’s symptoms and impairments, but deferred any questions relating to
Sanchez’s physical limitations to her primary care providers. AR 517-18.
9

22

chest tightness, but it occurred when Sanchez cleaned her house. AR 429.
During the last reported visit with Dr. Walder, Sanchez reported to be doing
well, was walking at least a block a day, and was also walking up and down
stairs for exercise. AR 521. Dr. Walder considered Sanchez to be doing well
from a cardiac standpoint and was not worried about angina or congestive
heart failure. AR 523.
Dr. Everson completed a Multiple Impairment Questionnaire on June 28,
2012. AR 506-13. According to Dr. Everson, based on a normal 40-hour work
week, Sanchez could sit for one hour, stand or walk for zero to one hour, and
indicated it would be necessary or medically recommended for Sanchez not to
sit, stand, or walk continuously. AR 508-09. Sanchez could frequently lift zero
to five pounds, and occasionally lift five to ten pounds. AR 509. She would also
be able to carry zero to five pounds frequently and occasionally carry five to ten
pounds. Id. Additionally, Dr. Everson opined there would be no restrictions on
repetitive movements. Id.
The ALJ noted Sanchez did not report any complaints about her heart
symptoms to Dr. Everson until May 2011. AR 358. Dr. Everson ordered an
EKG and chest x-ray. Neither showed any abnormalities. AR 359, 367. Again,
in July, Sanchez reported discomfort, but Dr. Everson’s lung examination
concluded there was no dyspnea. AR 412, 414. Sanchez again met with
Dr. Everson one week after having two stents placed and reported chest
discomfort and dyspnea, which occurred with household activities and yard
work. AR 403. Although Sanchez reported that she would use medication to
23

cure any chest discomfort, those complaints completely subsided in 2012. AR
480, 485, 491, 495, 500, 505.
The ALJ discounted the portions of Dr. Walder’s and Dr. Everson’s
reports based on the subjective reports by Sanchez. AR 31. The Eighth Circuit
has recognized that an ALJ may discount a treating physician’s conclusions
when those conclusions are largely based on the subjective reports of the
claimant. McDade v. Astrue, 720 F.3d 994, 999 (8th Cir. 2013). Furthermore,
the ALJ found that the treatment records and clinical findings of Dr. Walder
and Dr. Everson conflicted with the extreme limitations they suggested in their
reports. AR 31; see Choate v. Barnhart, 457 F.3d 865, 870 (8th Cir. 2006)
(finding that the ALJ was permitted to disregard claimant's treating physician's
opinion when it was unsupported by other evidence in the record, specifically
when treating physician failed to place any limitations on claimant's activities
prior to disability filing).
Sanchez faults the ALJ’s decision for not explicitly articulating the
factors set forth in 20 C.F.R. § 404.1527(c). Sanchez argues both Dr. Walder
and Dr. Everson regularly treated Sanchez since at least the time of her heart
attack in November 2010, that the nature of that treatment was focused on
Sanchez’s heart and diabetic conditions, that both doctors provided support for
their opinions, and those findings are consistent and do not conflict with any
treatment records or testing. Docket 12 at 13.
First, the record does not support Sanchez’s claim that Dr. Walder and
Dr. Everson had treated Sanchez since her November 2010 heart attack. While
24

Dr. Walder had treated Sanchez since shortly after the heart attack
(December 2010), her first appointment with Dr. Everson was not until March
2011. AR 266, 362. Second, although Sanchez discussed her heart condition
with Dr. Everson, that condition was not the basis of their treatment
relationship. Her first appointment with Dr. Everson was for an ear complaint.
Id. Other appointments were for physicals, medication refills, and other
unrelated medical conditions. See, e.g., AR 358, 362, 395.
Third, the support Sanchez claims both doctors used for their opinions
was not well established in the record. The questionnaires filled out by
Dr. Walder and Dr. Everson provided little context or reasoning for why they
believed the specific limitations assigned to Sanchez were appropriate. The
Eighth Circuit has explained that such evaluations do not carry much
evidentiary value. See Anderson v. Astrue, 696 F.3d 790, 794 (8th Cir. 2012)
(agreeing “that a conclusory checkbox form has little evidentiary value when it
cites no medical evidence, and provides little to no elaboration.”) (quotation
omitted); see also Wildman v. Astrue, 596 F.3d 959, 964 (8th Cir. 2010) (finding
the ALJ was correct to discount a treating physician’s report that “consists of
three checklist forms, cites no medical evidence, and provides little to no
elaboration.”). The ALJ was therefore justified in giving less weight to the
questionnaires filled out by Dr. Walder and Dr. Everson.10 Metz v. Shalala, 49

Sanchez argues that the ALJ mistakenly concluded that Dr. Walder
based his opinions primarily on Sanchez’s subjective complaints. Docket 12 at
11-12; AR 31. The ALJ misconstrued question seventeen on Dr. Walder’s
Cardiac Impairment Questionnaire. AR 436-37 (“17. To what degree can your
10

25

F.3d 374, 377 (8th Cir. 1995) (finding the conclusory report from a treating
physician was not entitled to any more weight than another medical opinion).
Finally, Sanchez’s claim that Dr. Walder’s and Dr. Everson’s findings are
consistent and do not conflict with any treatment records or testing is not
supported by the record. Dr. Walder opined Sanchez would be able to stand or
walk for zero hours, and could sit for two to three hours at a time. AR 435-36.
Dr. Everson opined Sanchez would be able to sit for one hour, and stand or
walk for zero to one hour. AR 508-09. But in Sanchez’s Function Report, she
does not list walking or sitting as areas her conditions affect. AR 222. In fact,
Sanchez put in her Function Report and reported to Dr. Walder and
Dr. Everson that she was able to cook, walk around stores, walk around the
block, exercise, and do household chores for two to three hours at a time. AR
30, 51, 219, 220, 222, 521.
The ALJ found the severe limitations reported by Dr. Walder and
Dr. Everson to be inconsistent with the normal findings from the objective
medical tests. For example, the ALJ noted Sanchez had normal EKG readings,
along with normal heart sounds and no dyspnea with exertion or palpitations
patient tolerate work stress? . . . Please explain the basis for your
conclusions.”) The explanation was meant to refer to Dr. Walder’s analysis of
Sanchez’s ability to handle work place stress, not to Dr. Walder’s entire report.
Sanchez was not prejudiced by the ALJ’s mistake. See Van Vickle v. Astrue, 539
F.3d 825 (8th Cir. 2008) (holding there was “no indication the ALJ would have
decided differently had he read the hand-written notation to say ‘walk’ rather
than ‘work[.]’ ”). Thus, the ALJ’s error, if any, was harmless. Byes v. Astrue,
687 F.3d 913, 917 (8th Cir. 2012) (“Even if the ALJ had not erred, there is no
indication that the ALJ would have decided differently.”); see also Renstrom v.
Astrue, 680 F.3d 1057, 1068 (8th Cir. 2012); Hepp v. Astrue, 511 F.3d 798,
806 (8th Cir. 2008).
26

on multiple occasions. An ALJ may give less weight to a treating physician’s
opinion because it is not supported by the medical findings. Prosch, 201 F.3d
at 1013 (citations omitted). The ALJ did not err by giving less weight to the
treating physicians’ opinions as he still considered those opinions as part of the
record as a whole.
B.

State Agency Examiners

Dr. Whittle and Dr. Erickson are state agency physicians who evaluated
Sanchez’s physical limitations. Dr. Whittle completed his RFC assessment on
Sanchez’s initial claim on August 10, 2011. AR 56-64. Based on medical
records from November 2010 to May 2011, Dr. Whittle found that Sanchez
could occasionally lift and/or carry 20 pounds, and frequently lift and/or carry
10 pounds. AR 61. She could stand or walk about 6 hours in an 8-hour day,
and sit for about 6 hours in an 8-hour day. Id. Dr. Whittle found these
limitations were due to Sanchez’s heart problems and diabetes. Id. He also
found that Sanchez did not have postural, manipulative, visual,
communicative, or environmental limitations. AR 62. Dr. Whittle concluded
Sanchez’s symptoms were not substantiated by the objective medical evidence
alone, and the reports of activities of daily living within the medical records
were the most informative in assessing the credibility of Sanchez’s statements.
AR 60-61. Dr. Whittle determined that Sanchez could perform light work. AR
62.
Dr. Erickson completed his RFC assessment on January 23, 2012, with
regard to Sanchez’s claim at the reconsideration level. AR 66-75. He reviewed
27

medical records from November 2010 through December 2011. AR 67-70.
Dr. Erickson’s findings with regard to lifting, carrying, standing, walking, and
sitting were the same as Dr. Whittle’s findings. AR 72-73. He also found that
Sanchez did not have postural, manipulative, visual, communicative, or
environmental limitations. AR 73. Based on his assessment, Dr. Erickson
concluded Sanchez could perform light work. AR 74.
The ALJ chose to give the opinions of the state agency examiners greater
weight than the treating physicians. AR 31. A review of the record as a whole
supports the ALJ’s reliance on the state agency experts’ conclusions over those
given in Dr. Walder’s and Dr. Everson’s reports. Importantly, the ALJ
determined that Dr. Walder’s and Dr. Everson’s conclusions regarding
Sanchez’s limitations were not consistent or supported by either their own
records or the record as a whole. AR 31. By contrast, the ALJ determined
Dr. Erickson and Dr. Whittle’s findings were consistent with and supported by
the record. Id. Thus, the ALJ had good reasons to give Dr. Walder’s and
Dr. Everson’s reports less weight than the reports of the state agency
examiners.
Even though the state agency physicians were unable to review the entire
record, the ALJ considered the record as a whole and properly afforded more
weight to the state agency physicians. As reflected in the RFC, the ALJ
generally accepted the findings of Dr. Erickson and Dr. Whittle as consistent
with the medical record in order to establish Sanchez’s RFC. AR 30-31. And
although the state agency physicians did not have Sanchez’s records from
28

2012, the ALJ included Sanchez’s records from that time frame in the RFC. AR
30-32. See Barrows v. Colvin, No. C13-4087-MWB, 2014 WL 3339790, at *13
(N.D. Iowa July 1, 2014), (report and recommendation stating that “[s]imply
pointing to new evidence, without attempting to explain how that evidence
might undermine the ‘stale old’ opinions, is hardly persuasive.”), report and
recommendation adopted in part, rejected in part, 2015 WL 1510159 (N.D. Iowa
March 31, 2015). The weight ascribed to the medical opinion evidence as well
as the ALJ’s findings as they pertain to Sanchez’s physical limitations is
supported by substantial evidence.
CONCLUSION
Substantial evidence in the record as a whole supports the ALJ’s
determination of Sanchez’s residual functional capacity. The ALJ did not err in
his credibility determination, and the ALJ properly considered the medical
opinion evidence. Accordingly, it is
ORDERED that the decision of the Commissioner is affirmed.
Dated June 26, 2015.
BY THE COURT:
/s/ Karen E. Schreier
KAREN E. SCHREIER
UNITED STATES DISTRICT JUDGE

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