Opinion
Case No. A4-02-65
April 11, 2003
MEMORANDUM AND ORDER
The Plaintiff, Jean M. Decoteau, seeks judicial review of the Social Security Commissioner's denial of her application for supplemental security income. For the reasons set forth below, the Commissioner's decision is affirmed.
I. PROCEDURAL HISTORY
The Plaintiff, Jean M. Decoteau ("Decoteau"), filed an application for supplemental security income [SSI] in February 2000, alleging that she has been disabled since December 10, 1999. (Tr. 82-87). Her application was denied initially and upon reconsideration. (Tr. 67-74). Decoteau subsequently requested a de novo hearing before an administrative law judge ("ALJ"). (Tr. 75). The ALJ conducted an administrative hearing on September 27, 2001. (Tr. 27). The ALJ issued his decision on November 14, 2001, wherein he concluded that Decoteau was not disabled within the meaning of the Social Security Act and was not entitled to SSI. (Tr. 12-20). The Appeals Council denied Decoteau's request for review and adopted the ALJ's decision as the Commissioner's final decision. (Tr. 5-6). Decoteau then filed a complaint on May 5, 2002, seeking judicial review of the Commissioner's decision.
II. BACKGROUND OF THE CASE
Jean M. Decoteau was born on December 2, 1964, and was 36 years old at the time of her administrative hearing. (Tr. 13, 82). She lives with two of her four dependent children in Belcourt, North Dakota. (Tr. 30, 82). She possesses an eighth grade education. (Tr. 31). She has no relevant work experience and has not engaged in any substantial gainful activity since December 10, 1999. (Tr. 31, 92).
Decoteau has a history of asthma, lung disease, depression, alcoholism, arthritis in her ankle, back problems, and obesity. (Tr. 333). She has a primary diagnosis of chronic obstructive pulmonary disease with a secondary diagnosis of affective disorder. (Tr. 65). She has been hospitalized twice since 1998, once for treatment of facial cellulitis and once with pneumonia. (Tr. 130-36, 194-95). Decoteau smoked up to 1 pack of cigarettes daily for approximately 19 years. (Tr. 55-56, 136, 172). She tried to quit smoking in late 1999 or early 2000, but was unsuccessful. (Tr. 55, 230, 309, 322, 328).
Decoteau has complained of memory loss, insomnia, headaches, dizzy spells, hearing loss in her left ear, and shortness of breath. Her lung problems have reportedly been aggravated following exposure to mold found in her home. At her administrative hearing, Decoteau testified that she suffers from occasional asthma attacks that leave her feeling lethargic, light headed, and numb throughout the entire right side of her body. (Tr. 36, 41). She also testified that she suffers from intense back, shoulder, and neck pain attributable to injuries she sustained in car accident. (Tr. 39).
Decoteau has been using oxygen continuously since December 1999. (Tr. 37). She has also been prescribed multiple medications and uses inhalers and nebulizers daily. As of February 2001, she was taking Oxycodone, Neurontin, Claritin, Amitryptyline, Effexor, Singulair, Remeron, Ambien, Clonazepam, Erythromycin, Flonase, Prilosec, Albuterol, and Pulmicort Respules. (Tr. 245). Records dated April 10 and 19, 2001, indicate at one time or another she has also taken Valium, Klonopin, Tylox, Zyrtec, Prednisone, Calcium Carbonate, Pseudoephedrine, and Brethine, and Betamethazone. (Tr. 303, 322). These medications reportedly leave her feeling nauseous and cause her to gain weight. (Tr. 45). By her estimate, Decoteau has gained approximately 100 pounds since taking her medications. (Tr. 30). She weighed approximately 253 pounds at the time of her administrative hearing.
Used for the management of moderate to severe pain. See Physicians' Desk Reference ("PDR"), 2913(56th ed. 2002).
An anticonvulsant used to treat seizures associated with epilepsy. (Tr. 214).
Indicated for relief of seasonal allergic rhinitis. See PDR, at 3102.
Used to treat depression and/or chronic pain. (Tr. 216).
Indicated for the treatment of depression. See PDR, at 3495.
Indicated for the chronic treatment of asthma. See PDR, at 2183.
Used to treat depression. (Tr. 223).
A sedative used for the short-term treatment of insomnia. (Tr. 218).
Used to treat seizures and panic disorders. (Tr. 219).
An antibiotic. See PDR, at 1285.
A nasal spray indicated for the management of allergic and non-allergic rhinitis. See PDR, at 1533.
Inhibits gastric acid secretions. See PDR, at 628.
Indicated for the prevention and relief of bronchospasms in persons with reversible obstructive airway disease. See PDR, at 3143.
An inhaled corticosteroid indicated for the maintenance treatment of asthma. See PDR, at 633-34.
Indicated for the treatment of panic disorders. See PDR, at 2983.
Indicated for the relief of moderate to moderately severe pain. See PDR, at 2597.
Indicated for the relief of symptoms associated with seasonal allergic rhinitis. See PDR, at 2757.
Indicated, for among other things, bronchial asthma. See PDR, at 3065.
Indicated for the treatment of allergies. See e.g., PDR, at 714.
Indicated for the prevention and reversal of bronchial spasms. See PDR, at 2313.
Indicated for treatment of, among other things, allergic states and respiratory diseases. See PDR, at 3099.
Decoteau no longer drives and has a very limited social life. (Tr. 48). Other than going to her appointments or visiting nearby friends, she gets out very little. (Tr. 48, 51). She depends upon her niece (April May Short) to help out around the house. She tires easily and can no longer exercise or go up and down stairs. Nevertheless, Decoteau remains capable of caring for her personal needs. (Tr. 47). She is also able to do a modest amount of mopping, dusting, and cooking. (Tr. 40, 48). She can remain seated for approximately half an hour and can stand for up to ten minutes before experiencing discomfort. (Tr. 50). To relax, she lies flat on the floor, propping her feet up with pillows. (Tr. 50-51).
Decoteau underwent a pulmonary function test and audiological evaluation in the spring of 2000 at the request of Social Security Disability Determination Services. The results of the pulmonary function test indicated the possible existence of a moderate obstructive disease. (Tr. 225-31). The results of the audiological evaluation suggested that Decoteau's hearing was normal at lower frequencies, but that she suffered from moderately severe to severe high frequency hearing loss in her right and left ears respectively. (Tr. 233).
Decoteau also underwent physical and mental residual functional capacity assessments. (Tr. 236, 277). The results of her physical residual functional capacity assessment indicated that she could occasionally lift 20 pounds, frequently lift 10 pounds, could stand and/or walk for about 6 hours in an 8-hour day, could sit for a total of 6 hours in an 8-hour day, was unlimited in her ability to push and/or pull, and suffered from occasional postural limitations. (Tr. 236-240). The results of her mental residual functional capacity assessment indicated that Decoteau was not significantly limited with respect to her understanding and memory, social interaction, and adaption, but was moderately limited with respect to her ability to carry out detailed instructions and maintain concentration. (Tr. 277-79).
Social Security Disability Determination Services referred Decoteau to Dr. Gregory Scott Volk for psychological exam. (Tr. 244). Dr. Volk, a licensed psychologist, examined Decoteau in February 2001. (Tr. 249). It was his opinion that Decoteau exhibited chronic features of mood disturbance and depressive symptoms that could exacerbate her physical health problems. (Tr. 247). However, he expressed his concern that adverse effects from Decoteau's medications could possibly affect her presentation. (Tr. 247).
Decoteau was also referred to the St. Andrew's Clinic for a disability exam. (Tr. 250). The exam report, which was prepared by Dr. William Straw, noted that Decoteau suffered from lung disease and most likely could not work productively given her previous work history and condition. (Tr. 251).
Based upon all of the evidence and accepting Decoteau's testimony as true, a vocational expert testified that a hypothetical person of the Decoteau's age, education, and work experience possessing the ability to occasionally lift 15 pounds and requiring postural relief on a regular basis could work if hooked up to oxygen. He also testified that such a person, if moderately limited in her ability to carry out detailed instructions, perform activities within a schedule, or complete work without interruption from psychologically based symptoms, should be capable of performing the light or sedentary work as long as she is able to manage her pain.
III. ALJ'S OPINION
The ALJ reviewed Decoteau's claim in accordance with the five-step sequential framework set forth in 20 C.F.R. § 404.1520. He dispensed with the first four steps before focusing on to the final step. The ALJ accepted Decoteau's statements and those of her supporters as generally consistent with the medical records and credible to the extent that Decoteau's condition restricted her from performing some work-related activities. (Tr. 14). However, the ALJ determined that Decoteau's allegations regarding her inability to perform all work-related activity on a sustained basis were out of proportion with the medical records and not entirely credible. (Tr. 14).
The Commissioner uses a following framework to determine disability: (1) whether the claimant is presently engaged in a substantial gainful activity, (2) whether the claimant has a severe impairment that significantly limits the claimant's physical or mental ability to perform basic work activities, (3) whether the claimant has an impairment that meets or equals a presumptively disabling impairment listed in the regulations, (4) whether the claimant has the residual functional capacity to perform his or her past relevant work, and (5) if the claimant cannot perform the past work, the burden then shifts to the Commissioner to prove that there are other jobs in the national economy that the claimant can perform.
The ALJ discounted the statements concerning Decoteau's ability to work made by Dr. Lowell B. Meier, Decoteau's treating physician. (Tr. 16). Dr. Meier, in letters written on Decoteau's behalf, had opined that Decoteau was not employable, was technically disabled, and required round-the-clock treatment. (Tr. 257-58). The ALJ noted Dr. Meier's acknowledgment that Decoteau's pulmonary function had shown improvement with treatment. (Tr. 15-16). He also emphasized that Dr. Meier had failed to place specific limitations on Decoteau's activities and had documented Decoteau's failure to follow through with his recommendations on occasion. (Tr. 15-16).
The ALJ afforded greater weight to the opinion offered by Social Security Disability Determination Service, finding its conclusions to be consistent with the record. (Tr. 16). The ALJ determined that from a physical standpoint, Decoteau was limited to lifting 10 to 15 pounds given condition and her need for oxygen. (Tr. 16-17). Nevertheless, the ALJ concluded that from a physical standpoint Decoteau was capable of performing work within the "light" exertional range. (Tr. 17).
When addressing Decoteau's mental condition, the ALJ stressed that Decoteau had not alleged an inability to work due to mental problems and had failed to follow through with recommended therapy. (Tr. 17). He accepted the assessment of Decoteau's mental condition "that she had mild restrictions of daily living, mild difficulties in maintaining social functioning, and moderate difficulties in maintaining concentration" as generally consistent with the record and concluded that Decoteau remained capable of performing light unskilled and routine work from a psychological standpoint as well. (Tr. 17-18).
IV. STANDARD OF REVIEW
The Court plays a limited role when reviewing the Commissioner's decisions. Wiseman v. Sullivan, 905 F.2d 1153, 1155 (8th Cir. 1990). The Court does not conduct a de novo review. Keller v. Shalala, 26 F.3d 856, 858 (8th Cir. 1994). Rather, it looks at the record as a whole to determine whether the decision is supported by substantial evidence. Upon review of the pleadings and transcript of the record, the Court can affirm, modify, or reverse the decision of the Commissioner, with or without remanding the case for a rehearing. 42 U.S.C. § 405(g). To affirm the Commissioner's decision, the Court must find that it is supported by substantial evidence appearing in the record as a whole. Cruse v. Bowen, 867 F.2d 1183, 1184 (8th Cir. 1989). "Substantial evidence is less than a preponderance, but enough so that a reasonable mind might find it adequate to support the conclusion." Robinson v. Sullivan, 956 F.2d 836, 838 (8th Cir. 1992). The review of the record is more than a search for evidence supporting the Commissioner's decision. The Court must also take into account matters that detract from the ALJ's findings and apply a balancing test to weigh evidence which is contradictory. Kirby v. Sullivan, 923 F.2d 1323, 1326 (8th Cir. 1991); Sobania v. Secretary of Health Human Services, 879 F.2d 441, 444 (8th Cir. 1989).
When conducting its review, the Court employs a "scrutinizing analysis" that balances the supporting and contradictory evidence on the record. Gavin v. Heckler, 811 F.2d 1195, 1199 (8th Cir. 1987). As noted, this requires more than a search for evidence that supports the Commissioner's decision. Id. The Court must review the entire record and weigh all evidence that fairly detracts from the Commissioner's findings. Cruse v. Bowen, 867 F.2d 1183, 1184 (8th Cir. 1989).
When determining whether there is substantial evidence to support the Commissioner's decision, the Court must consider:
1) the credibility findings made by the ALJ;
2) the plaintiff's vocational factors;
3) medical evidence from treating and consulting physicians;
4) the plaintiff's subjective complaints relating to exertional and non-exertional activities and impairments;
5) any corroboration by third parties of the plaintiff's impairments; and
6) the testimony of vocational experts that is based upon a proper hypothetical questions setting forth the plaintiff's impairment.
Baker v. Secretary of Health and Human Services, 955 F.2d 552, 555 (8th Cir. 1992).
The substantial evidence standard "allows for the possibility of drawing two inconsistent conclusions, thus it embodies a zone of choice within which the [Commissioner] may decide to grant or deny benefits without being subject to reversal on appeal." Culbertson v. Shalala, 30 F.3d 934, 939 (8th Cir. 1994). In other words, while the Court may weigh evidence differently, it cannot reverse a Commissioner's decision if there is sufficient evidence to support either outcome. Id.
Finally, it is well-established that a claimant for Social Security disability benefits has the burden of proving her disability by establishing a physical or mental impairment lasting at least twelve (12) months that prevents her from engaging in any substantial gainful activity. See Pearsall v. Massanari, 274 F.3d 1211, 1217 (8th Cir. 2001); 42 U.S.C. § 1382c(a)(3)(A). The Act defines "physical or mental impairment" as "an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." 42 U.S.C. § 1382c(a)(3)(C).
V. LEGAL DISCUSSION
Initially, Decoteau argues that the ALJ erred in finding her testimony lack credibility. Next, she asserts that the ALJ took statements of her treating physicians out of context and discounted their opinions without adequate explanation. She also states that the ALJ failed to clearly articulate Decoteau's limitations "her back problems and mental impairments" when posing hypotheticals to the vocational expert. Finally, she asserts that the ALJ failed to consider the impact of her mental impairments when rendering his decision.
A. DECOTEAU'S CREDIBILITY
When determining whether a claimant possesses the residual functional capacity to perform work activities in spite of her impairments, the ALJ must consider: (1) the claimant's daily activities, (2) the duration, frequency, and intensity of pain, (3) precipitating and aggravating factors, (4) dosage, effectiveness, and side effects of medication, and (5) residual functions. See Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984). The ALJ can discount subjective complaints when inconsistent with the evidence as a whole. See Hogan v. Apfel, 239 F.3d 958, 962 (8th Cir. 2001). Courts will generally defer to the ALJ's judgment if the ALJ explicitly discredits a claimant's testimony and gives a good reason for doing so. Id. The Court will not disturb the decision of an ALJ who seriously considers, but for good reason expressly discredits a claimant's subjective complaints, and those reasons are supported by substantial evidence on the record as a whole. See Haggard v. Apfel, 175 F.3d 591, 594 (8th Cir. 1999); Brockman v. Sullivan, 987 F.2d 1344, 1346 (8th Cir. 1993).
In the present case, the ALJ considered Decoteau's subjective complaints of disabling symptom, and concluded that they were not credible to the extent alleged (Tr. 14, 15, 16). The ALJ did not disregard Decoteau's subjective complaints solely because they were not supported by the medical evidence. See Polaksi v. Heckler, 751 F.2d 943, 948 (8th Cir. 1984). Instead, the ALJ gave consideration to Decoteau's complaints and concluded that they were not fully credible to the extent alleged. See Loving v. Department of Health Human Services, 16 F.3d 967, 971 (8th Cir. 1994). The Court concludes that the ALJ properly "considered the totality of the evidence" in making his credibility determination. See Burns v. Sullivan, 888 F.2d 1218, 1219 (8th Cir. 1989). The record as a whole substantially supports the ALJ's decision that Decoteau's subjective complaints of disabling symptoms were not credible to the extent alleged.
The record reveals that Decoteau was able to engage in significant daily activities. She cared for her own personal needs, performed household cleaning and other chores, cared for her children, and enjoyed crafts (Tr. 40, 46, 244, 309). The ALJ's credibility determination was supported by Decoteau's performance of significant daily activities. See McKinney v. Apfel, 228 F.3d 860, 864 (8th Cir. 2000). Decoteau was also non-compliant with regard to keeping her medical appointments. (Tr. 259-261). Decoteau's failure to follow her prescribed treatment regimen supported the ALJ's decision that Decoteau was not disabled.
Decoteau began smoking despite requiring oxygen 24 hours a day and her physician's admonition that she stop smoking. (Tr. 55, 309, 322). Again, the ALJ's credibility determination is supported by a failure to follow prescribed treatment. See Gowell v. Apfel, 242 F.3d 793, 797 (8th Cir. 2001) (Social Security disability claimant's refusal to follow recommendations of physicians may properly be considered when determining credibility); Wheeler v. Apfel, 224 F.3d 891, 895 (8th Cir. 2000) (despite complaints of asthma and medical advice to discontinue smoking, Social Security disability claimant smoked two packs of cigarettes daily. Given the inconsistencies in the record, the ALJ was permitted to disbelieve Decoteau's subjective complaints regarding her disabling limitations. See Pearsall v. Massanari, 274 F.3d 1211, 1218 (8th Cir. 2001) (ALJ may discount a Social Security disability claimant's subjective complaints if inconsistencies are apparent in the evidence as a whole).
B. OPINION'S OF TREATING PHYSICIANS
A treating physician's opinion is "normally entitled to great weight" but "does not automatically control, since the record must be evaluated to the whole." Prosch v. Apfel, 201 F.3d 1010, 1013 (8th Cir. 2000).
The record reveals that Decoteau had a severe breathing impairment and needed oxygen 24 hours per day and nebulizer treatments. The evidence was not challenged by the Commissioner. However, the presence of an impairment is not necessarily disabling. See Gross v. Heckler, 785 F.2d 1163, 1166 (4th Cir. 1986). The medical records reveal that Decoteau was noncompliant with keeping her appointments. (Tr. 259-262). Decoteau's failure to follow her prescribed treatment regimen supported the ALJ's decision that she was not disabled. See Wheeler v. Apfel, 224 F.3d 891, 895 (8th Cir. 2000); see also 20 C.F.R. § 416.930 (2002). The record also reveals that Decoteau's treatment regimen for her COPD provided significant improvement in her pulmonary functioning (Tr. 226, 252, 272, 331), which provided additional support for the ALJ's determination that Decoteau's condition was not disabling. See Estes v. Barnhart, 275 F.3d 722, 725 (8th Cir. 2002) (symptoms easily controlled or amenable to treatment are not disabling).
The record further reveals that Decoteau had a severe back impairment. However, repeated examinations failed to demonstrate any significant abnormalities. Decoteau's examinations consistently indicated normal sensation, with no evidence of weakness of the upper or lower extremities (Tr. 251, 323). The ALJ's decision that Decoteau was not disabled, and that she was capable of performing a range of sedentary to light work is supported by this lack of objective medical evidence of impairment or related functional loss. See Tennant v. Apfel, 224 F.3d 869, 870 (8th Cir. 2000); Wilson v. Apfel, 172 F.3d 539, 541-42 (8th Cir. 1999).
On March 8, 2001, a state agency medical consultant, an expert in the evaluation of medical issues in disability claims under the Act, determined that Decoteau was capable of lifting and carrying 20 pounds occasionally and 10 pounds frequently; and climbing, balancing, stooping, kneeling, crouching, and crawling occasionally; and that she had to avoid concentrated exposure to extreme cold and fumes, odors, gasses, and poor ventilation (Tr. 296-299). These findings support the ALJ's determination that Decoteau was capable of performing sedentary to light work. See Hunter v. Sullivan, 993 F.2d 31, 35 (4th Cir. 1992) (the Commissioner may rely on the report of a nontreating physician in denying a claim, even where it is contrary to the opinion of a treating physician).
The record also indicates that Decoteau was diagnosed with depression and anxiety (Tr. 247, 309), and was prescribed a treatment regimen of Effexor (Tr. 245). However, mental status examinations performed by Drs. Volk and Bell revealed normal speech and language skills, appropriate attention and concentration, normal thought process, and adequate memory (Tr. 245, 309). The ALJ's decision that Decoteau was not disabled, and that she was capable of performing unskilled work, is supported by this medical evidence.
C. HYPOTHETICALS
Decoteau maintains that the hypotheticals posed by the ALJ to the vocational expert at the administrative hearing were flawed in that they did not take back problems and mental impairments into consideration. However, a review of the record indicates that Decoteau's physical and psychological symptoms were taken into consideration. When framing his hypotheticals, the ALJ incorporated the limitations set forth in Decoteau's physical and residual functional assessment. To ensure that he did not overlook anything, the ALJ allowed Decoteau to question the vocational expert directly. Following inquiries by both the ALJ and Decoteau, the vocational expert stood by his assessment that Decoteau was capable of performing light work such as an information solicitor, telemarketer, assembler, and hand packager.
VI. CONCLUSION
The decision of the ALJ is supported by substantial evidence in the record as a whole. The Court sympathizes with Decoteau and the medical problems she has experienced and continues to experience. However, the Court cannot substitute its opinion for that of the ALJ in this instance. There is substantial evidence in the record to support the Commissioner's decision that the Plaintiff did not meet the disability requirements of the Act.
Accordingly, the Decoteau's Motion for Summary Judgment (Docket No. 8) is DENIED, and the Commissioner's Motion for Summary Judgment (Docket No. 7) is GRANTED. The Commissioner's decision in this matter is AFFIRMED.
IT IS SO ORDERED.