Hilton v. Colvin

Filing 25

Memorandum Opinion and Order: The hearing decision is affirmed in all respects. (See order for specifics) (Ordered by Magistrate Judge David L Horan on 2/22/2016) (mcrd)

IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF TEXAS
DALLAS DIVISION
BRADLEY FELIX HILTON,

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§
Plaintiff,
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§
V.
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CAROLYN W. COLVIN,
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Acting Commissioner of Social Security, §
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Defendant.
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No. 3:15-cv-933-BN

MEMORANDUM OPINION AND ORDER
Plaintiff Bradley Felix Hilton seeks judicial review of a final adverse decision of
the Commissioner of Social Security pursuant to 42 U.S.C. § 405(g). For the reasons
explained below, the hearing decision is affirmed.
Background
Plaintiff alleges that he is disabled as a result of hepatitis C; obstructive sleep
apnea; sleep disorders from prior military service; neck and back pain; mental health
issues; concentration problems; and headaches. See Administrative Record, Dkt. Nos.
15-16 (“Tr.”) at 218. After his applications for disability insurance benefits and
supplemental security income (“SSI”) benefits were denied initially and on
reconsideration, Plaintiff requested a hearing before an administrative law judge
(“ALJ”). That hearing was held on August 29, 2014. See id at 35-52. At the time of the
hearing, Plaintiff was forty-seven years old. He is a high school graduate, attended
college for two years earning an Associate of Arts and Associate of Science and
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Respiratory, see id. at 39, and has past work experience as a respiratory therapist.
Plaintiff has not engaged in substantial gainful activity since January 11, 2014. See id.
at 13.
The ALJ found that Plaintiff was not disabled and therefore not entitled to
disability or SSI benefits. Although the medical evidence established that Plaintiff
suffered from hepatitis C, degenerative disc disease of the lumbar and cervical spine,
and affective disorder, the ALJ concluded that the severity of those impairments did
not meet or equal any impairment listed in the social security regulations. The ALJ
further determined that Plaintiff had the residual functional capacity to perform light
work as defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b) but could not return to his
past relevant employment. See id. at 23-28. Relying on a vocational expert’s testimony,
the ALJ found that Plaintiff was capable of working as a cleaner-housekeeper,
photocopy machine operator, and routing clerk – jobs that exist in significant numbers
in the national economy. See id. at 28-29. Given his age, education, and exertional
capacity for light work, the ALJ determined that Plaintiff was not disabled under the
Medical-Vocational Guidelines.
Plaintiff appealed that decision to the Appeals Council. The Council affirmed.
Plaintiff then filed this action in federal district court. In a single ground for
relief, Plaintiff contends that the ALJ failed to give proper weight to Plaintiff’s treating
psychiatrist.
The Court determines that the hearing decision must be affirmed in all respects.

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Legal Standards
Judicial review in social security cases is limited to determining whether the
Commissioner’s decision is supported by substantial evidence on the record as a whole
and whether Commissioner applied the proper legal standards to evaluate the
evidence. See 42 U.S.C. § 405(g); Copeland v. Colvin, 771 F.3d 920, 923 (5th Cir. 2014);
Ripley v. Chater, 67 F.3d 552, 555 (5th Cir. 1995). Substantial evidence is “more than
a mere scintilla. It means such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971);
accord Copeland, 771 F.3d at 923. The Commissioner, rather than the courts, must
resolve conflicts in the evidence, including weighing conflicting testimony and
determining witnesses’ credibility, and the Court does not try the issues de novo. See
Martinez v. Chater, 64 F.3d 172, 174 (5th Cir. 1995); Greenspan v. Shalala, 38 F.3d
232, 237 (5th Cir. 1994). This Court may not reweigh the evidence or substitute its
judgment for the Commissioner’s but must scrutinize the entire record to ascertain
whether substantial evidence supports the hearing decision. See Copeland, 771 F.3d
at 923; Hollis v. Bowen, 837 F.2d 1378, 1383 (5th Cir. 1988). The Court “may affirm
only on the grounds that the Commissioner stated for [the] decision.” Copeland, 771
F.3d at 923.
“In order to qualify for disability insurance benefits or [supplemental security
income], a claimant must suffer from a disability.” Id. (citing 42 U.S.C. § 423(d)(1)(A)).
A disabled worker is entitled to monthly social security benefits if certain conditions
are met. See 42 U.S.C. § 423(a). The Act defines “disability” as the inability to engage
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in substantial gainful activity by reason of any medically determinable physical or
mental impairment that can be expected to result in death or last for a continued
period of 12 months. See id. § 423(d)(1)(A); see also Copeland, 771 F.3d at 923; Cook v.
Heckler, 750 F.2d 391, 393 (5th Cir. 1985). The Commissioner has promulgated a fivestep sequential evaluation process that must be followed in making a disability
determination:
1.

The hearing officer must ascertain whether the claimant is
engaged in substantial gainful activity. A claimant who is working
is not disabled regardless of the medical findings.

2.

The hearing officer must determine whether the claimed
impairment is “severe.” A “severe impairment” must significantly
limit the claimant’s physical or mental ability to do basic work
activities. This determination must be made solely on the basis of
the medical evidence.

3.

The hearing officer must decide if the impairment meets or equals
in severity certain impairments described in Appendix 1 of the
regulations. The hearing officer must make this determination
using only medical evidence.

4.

If the claimant has a “severe impairment” covered by the
regulations, the hearing officer must determine whether the
claimant can perform his or her past work despite any limitations.

5.

If the claimant does not have the residual functional capacity to
perform past work, the hearing officer must decide whether the
claimant can perform any other gainful and substantial work in
the economy. This determination is made on the basis of the
claimant's age, education, work experience, and residual functional
capacity.

See 20 C.F.R. § 404.1520(b)-(f); Copeland, 771 F.3d at 923 (“The Commissioner
typically uses a sequential five-step process to determine whether a claimant is
disabled within the meaning of the Social Security Act. The analysis is: First, the
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claimant must not be presently working. Second, a claimant must establish that he has
an impairment or combination of impairments which significantly limit [her] physical
or mental ability to do basic work activities. Third, to secure a finding of disability
without consideration of age, education, and work experience, a claimant must
establish that his impairment meets or equals an impairment in the appendix to the
regulations. Fourth, a claimant must establish that his impairment prevents him from
doing past relevant work. Finally, the burden shifts to the Secretary to establish that
the claimant can perform the relevant work. If the Secretary meets this burden, the
claimant must then prove that he cannot in fact perform the work suggested.” (internal
quotation marks omitted)); Audler v. Astrue, 501 F.3d 446, 447-48 (5th Cir. 2007) (“In
evaluating a disability claim, the Commissioner conducts a five-step sequential
analysis to determine whether (1) the claimant is presently working; (2) the claimant
has a severe impairment; (3) the impairment meets or equals an impairment listed in
appendix 1 of the social security regulations; (4) the impairment prevents the claimant
from doing past relevant work; and (5) the impairment prevents the claimant from
doing any other substantial gainful activity.”).
The claimant bears the initial burden of establishing a disability through the
first four steps of the analysis; on the fifth, the burden shifts to the Commissioner to
show that there is other substantial work in the national economy that the claimant
can perform. See Copeland, 771 F.3d at 923; Audler, 501 F.3d at 448. A finding that the
claimant is disabled or not disabled at any point in the five-step review is conclusive

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and terminates the analysis. See Copeland, 771 F.3d at 923; Lovelace v. Bowen, 813
F.2d 55, 58 (5th Cir. 1987).
In reviewing the propriety of a decision that a claimant is not disabled, the
Court’s function is to ascertain whether the record as a whole contains substantial
evidence to support the Commissioner’s final decision. The Court weighs four elements
to determine whether there is substantial evidence of disability: (1) objective medical
facts; (2) diagnoses and opinions of treating and examining physicians; (3) subjective
evidence of pain and disability; and (4) the claimant’s age, education, and work history.
See Martinez, 64 F.3d at 174.
The ALJ has a duty to fully and fairly develop the facts relating to a claim for
disability benefits. See Ripley, 67 F.3d at 557. If the ALJ does not satisfy this duty, the
resulting decision is not substantially justified. See id. However, the Court does not
hold the ALJ to procedural perfection and will reverse the ALJ’s decision as not
supported by substantial evidence where the claimant shows that the ALJ failed to
fulfill the duty to adequately develop the record only if that failure prejudiced Plaintiff,
see Jones v. Astrue, 691 F.3d 730, 733 (5th Cir. 2012) – that is, only if Plaintiff’s
substantial rights have been affected, see Audler, 501 F.3d at 448. “Prejudice can be
established by showing that additional evidence would have been produced if the ALJ
had fully developed the record, and that the additional evidence might have led to a
different decision.” Ripley, 67 F.3d at 557 n.22. Put another way, Plaintiff “must show
that he could and would have adduced evidence that might have altered the result.”
Brock v. Chater, 84 F.3d 726, 728-29 (5th Cir. 1996).
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Analysis
Plaintiff contends that the ALJ improperly weighed the opinion of his treating
psychiatrist, Dr. Rachel Russo, that he is unable to work and has moderate episodes
of mental decompensation. See Dkt. No. 23 at 3.
The opinion of a treating physician who is familiar with the claimant’s
impairments, treatments, and responses should be accorded great weight in
determining disability. See Leggett v. Chater, 67 F.3d 558, 566 (5th Cir. 1995);
Greenspan, 38 F.3d at 237. A treating physician’s opinion on the nature and severity
of a patient’s impairment will be given controlling weight if it is “well-supported by
medically acceptable clinical and laboratory diagnostic techniques and is not
inconsistent with ... other substantial evidence.” Martinez, 64 F.3d at 175-76 (citing 20
C.F.R. § 404.1527(c)(2)). And “[t]he opinion of a specialist generally is accorded greater
weight than that of a non-specialist.” Newton v. Apfel, 209 F.3d 448, 455 (5th Cir.
2000).
But “the ALJ is free to reject the opinion of any physician when the evidence
supports a contrary conclusion” and when good cause is shown. Id. at 455. An ALJ may
show good cause “where the treating physician’s evidence is conclusory, is unsupported
by medically acceptable clinical, laboratory, or diagnostic techniques, or is otherwise
unsupported by the evidence.” Id. at 456.
20 C.F.R. § 404.1527(c)(2) requires the ALJ to consider specific factors “to assess
the weight to be given to the opinion of a treating physician when the ALJ determines

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that the opinion is not entitled to ‘controlling weight.’” Id. at 455-456 (internal
quotations omitted). Specifically, the ALJ must consider:
(1) the physician’s length of treatment of the claimant;
(2) the physician’s frequency of examination;
(3) the nature and extent of the treatment relationship;
(4) the support of the physician’s opinion afforded by the medical
evidence of record;
(5) the consistency of the opinion with the record as a whole; and
(6) the specialization of the treating physician.
Id. at 455; 20 C.F.R. § 404.1527(c)(2). But, in decisions construing Newton v. Apfel, the
United States Court of Appeals for the Fifth Circuit has explained that “[t]he Newton
court limited its holding to cases where the ALJ rejects the sole relevant medical
opinion before it.” Qualls v. Astrue, 339 F. App’x 461, 467 (5th Cir. 2009). Therefore,
where there are competing opinions of examining physicians, the ALJ need not
necessarily set forth his analysis of the Section 404.1527(c) factors when declining to
give controlling weight to a treating physician. See id. at 466-67.
The ALJ permissibly discounted Dr. Russo’s conclusory statement. See Tr. at 27.
Dr. Russo wrote that Plaintiff “is currently unable to work.” See Tr. at 15, 466,522,777778. Plaintiff argues that the ALJ should have given Dr. Russo’s statement controlling
weight because it is uncontroverted by other medical opinions. Dkt. 23 at 4. But
statements, like Dr. Russo’s, asserting that a claimant is unable to work, are legal
conclusions, not medical opinions, and are not entitled to any special significance and
may be discounted without the ALJ engaging in a Section 404.1527 (c)(2) analysis. See
20 C.F.R. § 416.927(d); see also Frank v. Barnhart, 326 F.3d 618, 620 (5th Cir. 2003).

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The Fifth Circuit has distinguished between the weight given to a treating physician’s
medical opinion on the nature and severity of an impairment and his opinion on
whether the patient is disabled and cannot work. See Miller v. Barnhart, 211 F. App’x
303, 305 (5th Cir. 2005). An ALJ is not required to justify a decision to give little
weight to a physician’s opinion that a patient is disabled or unable to work because the
ALJ need not give special weight to treating physicians’ opinions if they have no special
significance. See id. (citing Frank, 326 F.3d at 620). And “[a]mong the opinions by
treating doctors that have no special significance are determinations that an applicant
is ‘disabled’ or ‘unable to work.’ 20 C.F.R. § 404.1527(e)(1). These determinations are
legal conclusions that the regulation describes as ‘reserved to the Commissioner.’” Id.
The ALJ also had good cause to discount Dr. Russo’s decompensation opinion.
Again, Dr. Russo opined that Plaintiff’s depression caused moderate episodes of
decompensation in work or work-like settings. See id. at 18, 516, 1606.
Episodes of decompensation are exacerbations or temporary increases in
symptoms or signs accompanied by a loss of adaptive functioning [and]
may be inferred from medical records showing significant alteration in
medication; or documentation of the need for a more structured
psychological support system (e.g., hospitalizations, placement in a
halfway house, or a highly structured and directing household)....
20 C.F.R. Part 404, Subpart P, Appendix 1. The ALJ gave moderate weight to Dr.
Russo’s opinion because Plaintiff “largely had normal functioning during his alleged
period of disability ... [and his] mental status examinations have been largely normal.”
Tr. at 27; see also Dkt. No. 23 at 3. For instance, Dr. Johnson noted that Plaintiff had
no abnormal thought content. See Tr. at 18, 544. Further, although not examining
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physicians, Dr. Leela Reedy and Dr. Thomas Geary, state agency reviewing
psychiatrists, found that Plaintiff exhibited no episode of decompensation. See id. at
17, 19,58, 82. Because Dr. Russo’s opinion is inconsistent with substantial evidence in
the record, including the longitudinal record and Dr. Johnson’s examination report that
the ALJ cited, the ALJ properly gave Dr. Russo’s opinion less weight. See Newton, 209
F.3d at 458; Qualls, 339 F. App’x at 466-67.
Although Plaintiff’s brief also states that the ALJ found Dr. Russo’s “opinion of
moderate limitations in the domain of concentration, persistence or pace is not
supported by the record,” the Court understands that statement to be a typographical
error. Dkt. No. 23 at 3. The ALJ gave significant weight to Dr. Russo’s opinion
regarding Plaintiff’s moderate limitation in concentration, persistence, or pace, as
Plaintiff acknowledges in the preceding sentence in his brief. See id.; see also Tr. at 23,
27.
In sum, the ALJ was entitled to reject Dr. Russo’s conclusory statements
regarding Plaintiff’s inability to work and, based on substantial evidence in the record,
had good cause to discount her findings on Plaintiff’s episodes of decompensation.
Conclusion
The hearing decision is affirmed in all respects.
DATED: February 22, 2016

_________________________________________
DAVID L. HORAN
UNITED STATES MAGISTRATE JUDGE