Opinion
8:03CV275.
July 13, 2004
MEMORANDUM AND ORDER
INTRODUCTION
The plaintiff applied for supplemental security income (SSI) under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq. December 31, 2000. The plaintiff's applications were denied initially and on reconsideration. The plaintiff requested a hearing before an administrative law judge (ALJ), which was held on September 24, 2002. In a November 16, 2002, decision, the ALJ found that the plaintiff was not disabled. In May 2003, the Appeals Council of the Social Security Administration denied the plaintiff's request for review. Thus, the decision of the ALJ is the final decision of the commissioner and is subject to judicial review. See 42 U.S.C. § 1383(c)(3) (providing for judicial review of a final decision of the commissioner).
The plaintiff initially applied for SSI benefits as a child. He did not appeal from an unfavorable decision by the Appeals Council in November 2001, but instead applied for benefits as an adult. He is appealing from this second denial of benefits.
BACKGROUND
Medical Records. The plaintiff was born December 15, 1982, and was nineteen years old at the time of the hearing before the ALJ. He completed the tenth grade in an alternative education program. Filing No. 13, Transcript 161-171 (hereafter, "TR"). He has never held a job. TR 519; 522.
After an apparently healthy childhood and early adolescence, the plaintiff was diagnosed in November 1998 with a series of serious medical conditions. Initially, the plaintiff was diagnosed with glomerulonephritis, a kidney disease caused by inflammation of internal kidney structures. TR 193. The disease caused protein and blood to be found in the plaintiff's urine. In late 1998 and early 1999, the plaintiff experienced other episodes of mild acute renal failure secondary to acute glomerulonephritis, each episode following or contemporaneous with a cold.
Glomerulonephritis may be a temporary and reversible condition, or it may be progressive. Progressive glomerulonephritis may result in destruction of the kidney glomeruli and chronic renal failure and end stage renal disease. The disease may be caused by specific problems with the body's immune system, but the precise cause of most cases is unknown.
Damage to the glomeruli with subsequent impaired filtering causes blood and protein to be lost in the urine. Because symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during routine physical or examination for unrelated disorders. Glomerulonephritis can cause hypertension and may only be discovered as a cause of hypertension that is difficult to control.
It may develop after survival of the acute phase of rapidly progressive glomerulonephritis. In about one-fourth of people with chronic glomerulonephritis, there is no prior history of kidney disease, and the disorder first appears as chronic renal failure.
Medline Plus Medical Dictionary, http://www.nlm.nih.gov/medlineplus/ ency/article/000484.htm#Definition.
Just prior to undergoing a renal biopsy, the plaintiff was discovered also to have a hereditary bleeding disorder known as von Willebrand factor deficiency with platelet abnormality. This deficiency prevents his platelets from sticking to the blood vessel wall and to each other, thereby making normal clotting difficult. The plaintiff was evaluated at the Iowa Regional Hemophilia Center and his bleeding was found to respond to DDAVP (Stimate).
Von Willebrand's disease is the most common hereditary bleeding disorder. It affects both sexes approximately equally. Most cases are mild, and bleeding may occur after a surgical procedure or tooth extraction. The condition is worsened by the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Bleeding may decrease during pregnancy. The disease is very common, affecting at least 1% of the population. There are no racial or ethnic associations with this disorder. A family history of a bleeding disorder is the primary risk factor.
Medline Plus Medical Dictionary, http://www.nlm.nih.gov/medlineplus/ency/article/000544.htm#Definition. The plaintiff had a history of easy bruising and nosebleeds.
DDAVP is a brand name for desmopressin, a hormone taken through the nose, by mouth, or given by injection to treat some patients with certain bleeding problems such as hemophilia or von Willebrand's disease. Medline Plus Drug Information, http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202186.html. Stimate is also a brand name for desmopressin. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/ a682876.html.
A percutaneous renal biopsy was performed in early February 1999. Analysis by the Mayo Clinic showed IgA nephropathy with focal segmental glomerulosclerosis. TR 327. The plaintiff was placed on omega-3 fatty acids, 6 tablets a day. The plaintiff was also found to have hyerlipidemia and was placed on Lipitor and TriCor. He was also placed on Accupril for hypertension. Subsequent renal scans revealed reduced functioning in both kidneys. See, e.g., TR 430; 441.
IgA nephropathy is a kidney disorder characterized by blood in the urine; caused by inflammation of the internal kidney structures and deposits of IgA antibodies in the kidney mesangial tissue.
IgA nephropathy (Berger's disease) is a form of mesangial proliferative nephritis. Inflammation of the renal glomeruli occurs, and there are IgA (a type of antibody) deposits in the kidney. The disorder can appear as acute, rapidly progressive, or chronic glomerulonephritis; or as visible or microscopic hematuria (blood in the urine).
IgA nephropathy usually is discovered after one or more episodes of dark or bloody urine in a person with no other symptoms of kidney disorder. Bloody urine may begin during or soon after a respiratory infection. Acute nephritic syndrome or nephrotic syndrome (groups of symptoms associated with decreased kidney functioning) may result.
Risk factors include having a personal or family history of IgA nephropathy or Henoch Schonlein purpura (a form of vasculitis that affects many parts of the body, and may cause a kidney lesion that is identical to the lesion of Berger's disease).
IgA nephropathy can occur in persons of all ages, but most often affects males in their teens to late 30s.
Medline Plus Medical Encyclopedia, http://www.nlm.nih.gov/medlineplus/ency/article/000466.htm.
Hyperlipidemia is an excess of fats or lipids, such as cholesterol, in the blood. http://www.nlm.nih.gov/medlineplus/ency/article/000403.htm.
The TriCor was apparently replaced by Niaspan by November 2002. TR 517.
Although the record does not show any lengthy hospitalizations for renal failure after the biopsy, the plaintiff did have flare-ups of gross hematuria every two or three months that required brief stays in the hospital. TR 550. The plaintiff's physicians closely monitored his condition with frequent check-ups, as evidenced by voluminous treatment notes, lab test results, progress notes, outpatient reports, and consultation reports throughout 1999 and 2000. The treatment notes and consultation reports reflect that the plaintiff was generally asymptomatic between bouts of gross hematuria, but occasionally complained about nosebleeds. The nosebleeds could be controlled with Neosporin ointment or, when more persistent, with Stimate. See, e.g., TR 373; 437; 550; 557-560.
Hematuria is the presence of blood or blood cells in the urine. http://www2.merriam-webster.com /cgi-bin/mwmednlm?book=Medicalva=hematuria.
See, e.g., TR 378-79; 389; 403; 411; 418; 421; 430; 437; 440-48; 525-26; 529; 533; 537; 538-40; 543; 561; 564-67; 570-71; 572-73; 579-81; 582-84; 586-87; 589-592; 601-03; 605-06.
The plaintiff's doctors were concerned about the effect of the plaintiff's refusal or inability to lose weight on the progression of his disease. See, e.g., TR 408-409; 438; 532; 536; 540; 541-542; 577; 603; 610. The plaintiff is 5' 6½" tall, and the records show that during the time in question here his weight rose from 220 to 286 pounds. Dr. Craig Porter, M.D., writing in April 2000 to Dr. Liem Som Oei, M.D., the plaintiff's primary nephrologist, stated that the plaintiff
continues to follow a sedentary lifestyle. He is not particularly interested in changing this approach to life. He is not currently in school and is not actively planning to continue his education. . . . I again discussed, as I have on multiple occasions in the past, issues related to IgA nephropathy and hypertension and obesity. . . . I am moderately discouraged at his lack of motivation in general, and specifically with regard to weight control.
TR 546-47.
By the time the plaintiff applied for benefits as an adult in 2001, he was complaining of extreme fatigue in addition to nosebleeds, blood in his urine, problems with his blood clotting, decreased kidney function, and frequent colds. TR 493, 506, 510, 512, 514; 531. In a December 2001 letter written to the plaintiff's lawyer, Dr. Oei stated that the plaintiff's kidney function was in the low range of normal but that he continued to have persistent proteinuria. According to Dr. Oei, persistent proteinuria carries a "high risk for renal progresssion." The plaintiff's hypertension also increased the risk of worsening kidney function. He also stated that the plaintiff should not work in a hazardous environment due to his von Willebrand factor deficiency and platelet abnormality, since he faced a risk of serious bleeding if Stimate were not available. TR 630.
Proteinuria is the presence of excess protein in the urine. http://www2.merriam-webster.com/ cgi-bin/mwmednlm?book=Medicalva=proteinuria.
Medical Evaluations. In March 2001, Dr. P.L. Grossman, M.D., completed a childhood disability evaluation form. Dr. Grossman found that the plaintiff had a severe impairment or combination of impairments that did not meet, medically equal, or functionally equal the listings. TR 595. He noted that once the plaintiff was put on a medication regimen after the renal biopsy, his labs all fell within normal limits. Dr. Grossman stated that the plaintiff's inactivity "may be related to exogenous obesity and a disinclination for school and/or physical activities. Conditions are not life threatening and are under control/stable." TR 600.
Exogenous obesity is "caused by factors (as food or a traumatic factor) or an agent (as a diseaseproducing organism) from outside the organism or system." http://www2.merriam-webster.com/ cgi-bin/mwmednlm?book=Medicalva=exogenous.
In April 2001, Dr. Libbie Russo, M.D., a medical consultant for the defendant, reviewed the plaintiff's file and noted that it
did not document any functional problems related to his blood and kidney diseases, except perhaps that he may be more readily admitted for `observation' than some others may. It does not appear that any of the alleged and documented impairments would interfere with attending and completing tasks, acquiring information, or caring for self. The inactivity represented in 538 limitations for movement and health and physical wellbeing would, as stated in the 538 explanation, be due to personal predilections. The claimant has non-severe impairments of Von Willibrand's, IgA nephropathy, and obesity.
TR 604.
Finally, in November 2001, Dr. Glen Knosp, M.D., a medical consultant for the defendant, conducted a physical residual functional capacity assessment of the plaintiff. Dr. Knosp stated that after April 2000, the plaintiff appeared to be "doing well" other than occasional nosebleeds that were controlled by medication. TR 626. A physical examination of the plaintiff was "essentially unremarkable except for morbid obesity." TR 629. He found that the plaintiff had a few exertional limitations. The plaintiff could occasionally lift twenty pounds and frequently lift ten pounds; could stand, sit, or walk about six hours in an eight-hour day; should not climb ladders, ropes, or scaffolds; and should avoid concentrated exposure to extreme cold and hazards such as machinery or heights. TR 619, 620, 622. Dr. Knosp wrote that the plaintiff's "allegations [are] not fully credible. Treatment [with] DDAVP has been successful. Renal function is not primary impairment[;] appears to be morbid obesity [with] deconditioning related in part to inactivity." TR 623. He found that the plaintiff "does not meet or equal any listing and appears fully capable of work as outlined in the RFC." TR 627.
The plaintiff's weight at this examination was 286 pounds.
Hearing Testimony. The plaintiff appeared before the ALJ on September 24, 2002, accompanied by his mother and his attorney. The plaintiff testified that he had completed tenth grade at the Boys and Girls Home, an alternative school, where he had been placed because of behavioral problems. TR 92. He is planning on completing his GED. TR 101. He said that while he was in school, he was getting sick all the time; once he quit school and stayed at home, he wasn't sick as much. TR 93-4. His "biggest symptom" is fatigue, leading him to sleep twelve to thirteen hours at night and to nap during the day; he is awake only eight hours a day. TR 93; 98. Increased activity, even short walks or doing "a little weights," only make him more tired. TR 94. At home, he performs one chore a day, vacuuming, washing the dishes, or cleaning the bathroom. TR 98-9. He will occasionally have friends over after school and occasionally fishes on the weekend. TR 98.
The plaintiff indicated that his weight problem was related to fluid retention. TR 95. He said that he gets nosebleeds "all the time" because of his bleeding disorder. TR 96. The nosebleeds occur two or three times a week. TR 102. The bleeding disorder also causes him to avoid activities that might increase his chances of bruises or cuts. TR 96-7. He described his episodes of hematuria as "extremely painful." TR 97. These episodes are triggered by a cold or the flu.
I mean, if I get sick, I'm instantly in hospital, less than 24 hours. . . . I'll get really sick, can't eat nothing. Then I'll start urinating blood, and then my kidney will — my back will start pain, it's so uncomfortable, you can't sit in one spot, with the pain in your back, and then, I'll pass a — well, it feels like a kidney stone, but it's only passing clot through your urine, and then, which it does — tears up your insides and you bleed really bad. The last time I was in the hospital for it, I had to have 12 units of platelets, because it was nonstop bleeding, and it's finally, after three days, it finally stopped bleeding, my insides, which was really painful at the time.
TR 100-01.
The plaintiff's mother testified that the plaintiff sleeps nine to twelve hours a day, but still "seems tired all the time. No oomph to him." TR 105. She explained that the plaintiff's kidneys "will only continue to deteriorate until he — the kidneys shut down, or he goes on dialysis and hopefully for a kidney transplant some day, but with his bleeding disorders, that's what they quoted me was a risky, risky business." Id. She described his nosebleeds as daily occurrences in extremely hot or cold weather. TR 106. The plaintiff spends his days on the Internet, playing video games, occasionally going out fishing with a friend. TR 106-07.
A vocational expert also testified. The ALJ asked her about the ability of a young claimant with limited education to work if the claimant is limited to twenty pounds occasional lifting, ten pounds frequent lifting; cannot use ladders or work at heights; cannot work in cold or excessively dry areas; cannot work in hazardous areas, "whether it was a chance of getting cut or bruised because of moving, hazardous machinery, chance of dehydration because of the heat"; and cannot work in close contact to the public or crowds. TR 107-08. The vocational expert said that such a claimant could perform several types of light or sedentary jobs found in significant numbers in Nebraska, including general office clerk, administrative support, cleaner, usher, sorter, and hand packager. TR 108. However, the vocational expert also testified that if a claimant "would fatigue after short periods of activity, and could possibly need to sleep for parts of the day," the claimant could not perform any of the listed jobs. Id. In response to questions from the plaintiff's attorney about whether her answer to the ALJ's hypothetical would change if a limitation of twenty-minute nosebleeds were added in, the vocational expert answered no; the claimant could still work. TR 109. If the nosebleeds lasted one hour, however, the claimant "wouldn't be able to sustain work." TR 110.
LEGAL STANDARD
A disability is the "inability to engage in any substantial gainful activity by reason of any 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 twelve months." 42 U.S.C. § 423(d)(1)(A); 20 C.F.R. § 404.1505. A claimant is disabled when the claimant is "not only unable to do his previous work but cannot, considering . . . his age, education and work experience, engage in any other kind of substantial gainful work which exists in [significant numbers in] the national economy . . . either in the region in which such individual lives or in several regions of the country." 42 U.S.C. § 432(d)(2)(A).
An ALJ evaluates a disability claim according to a five-step sequential analysis prescribed by Social Security regulations. The ALJ examines
any current work activity, the severity of the claimant's impairments, the claimant's residual functional capacity and age, education and work experience. See 20 C.F.R. § 404.1520(a); Braswell v. Heckler, 733 F.2d 531, 533 (8th Cir. 1984). If a claimant suffers from an impairment that is included in the listing of presumptively disabling impairments (the Listings), or suffers from an impairment equal to such listed impairment, the claimant will be determined disabled without considering age, education, or work experience. See Braswell, 733 F.2d at 533. If the Commissioner finds that the claimant does not meet the Listings but is nevertheless unable to perform his or her past work, the burden of proof shifts to the Commissioner to prove, first, that the claimant retains the residual functional capacity to perform other kinds of work, and second, that other such work exists in substantial numbers in the national economy. See Nevland v. Apfel, 204 F.3d 853, 857 (8th Cir. 2000). A claimant's residual functional capacity is a medical question. See id. at 858.Singh v. Apfel, 222 F.3d 448, 451 (8th Cir. 2000).
Using this analysis, the ALJ concluded that the plaintiff was not disabled within the meaning of the Social Security Act, TR 34, ¶ 7, and hence not eligible for benefits, Id., ¶ 8. The plaintiff's medically determinable impairments that impose more that slight limitations on his ability of function include IgA nephropathy; von Willibrand's disease; focal segmental glomerulosclerosis; hypertension; hyperlipidemia; and obesity. Id., ¶ 2. These impairments, either singly or collectively, do not meet and are not medically equivalent to the listings in found in the Social Security regulations. TR 34, ¶ 3. The plaintiff has never worked. TR 33-4, ¶¶ 1, 4. Nevertheless, and despite the plaintiff's limitations resulting from his medically determinable impairments, the ALJ found that the plaintiff has the residual functional capacity for other work which exists in the national and regional economies in significant numbers. TR 34, ¶ 5. Finally, the ALJ found that the record did not reflect the testimony from the plaintiff and his mother about the plaintiff's symptoms and limitations. Id. ¶ 6.
A person who can perform "other work" is not disabled. 20 C.F.R. § 416.902 (2003).
When reviewing the decision not to award disability benefits, the district court does not act as a fact-finder or substitute its judgment for the judgment of the ALJ or the Commissioner. Bates v. Chater, 54 F.3d 529, 532 (8th Cir. 1995). Rather, the district court will affirm the Commissioner's decision to deny benefits if it is supported by substantial evidence in the record as a whole. Eback v. Chater, 94 F.3d 410, 411 (8th Cir. 1996). Under this standard, substantial evidence means something "less than a preponderance" of the evidence, Kelley v. Callahan, 133 F.3d 583, 587 (8th Cir. 1998), but "more than a mere scintilla," Richardson v. Perales, 402 U.S. 389, 401 (1971); accord Ellison v. Sullivan, 921 F.2d 816, 818 (8th Cir. 1990). "Substantial evidence is that which a reasonable mind would find as adequate to support the ALJ's decision." Brown v. Chater, 87 F.3d 963, 964 (8th Cir. 1996) (citing Baumgarten v. Chater, 75 F.3d 366, 368 (8th Cir. 1996)). In determining whether the evidence in the record as a whole is substantial, the court must consider "evidence that detracts from the Commissioner's decision as well as evidence that supports it." Warburton v. Apfel, 188 F.3d 1047, 1050 (8th Cir. 1999). If the court finds that the record contains substantial evidence supporting the Commissioner's decision, the court may not reverse the decision because the record also contains substantial evidence that supports a different outcome or because the court would have decided the case differently. Holley v. Massanari, 253 F.3d 1088, 1091 (8th Cir. 2001).
DISCUSSION
According to the plaintiff, the ALJ erred in finding that the plaintiff's subjective complaints lacked credibility. Under Eighth Circuit law, the ALJ may discredit a claimant's subjective allegations of pain, discomfort, or disabling limitations when they are inconsistent with the record as a whole. Polaski v. Heckler, 751 F.2d 943, 948 (8th Cir. 1984) (subsequent history omitted). In evaluating a claimant's subjective complaints, the ALJ must consider the claimant's prior work record and observations by third parties and treating and examining physicians about 1) the claimant's daily activities; 2) the duration, frequency and intensity of the pain; 3) precipitating and aggravating factors; 4) dosage, effectiveness and side effects of medication; and 5) functional restrictions. Id. at 948.
Specifically, the plaintiff contends that the ALJ failed to give the proper weight to the plaintiff's subjective complaints 1) when determining the plaintiff's residual functional capacity, and 2) by failing to include in the hypothetical questions posed to the vocational expert the objective medical evidence about the plaintiff's fatigue, the illnesses he suffers as a result of kidney disease, and the dangers of his being cut and bleeding. As recounted above, the vocational expert concluded that a claimant could work if, in addition to the limitations expressed in the ALJ's first hypothetical, the claimant also had occasional halfhour nosebleeds, but not if the nosebleeds lasted one hour. Further, the vocational expert also testified that a claimant could not work if the claimant became fatigued after short periods of activity and needed to sleep for parts of the day.
In response, the defendant points out that the ALJ discounted the plaintiff's subjective complaints about the severity of his impairments not merely because the record lacked objective medical evidence to support those allegations, but also because the plaintiff's complaints are inconsistent with the medical evidence actually found in the record. Nothing in the record, for example, supports the plaintiff's claim about the disabling frequency and duration of his nosebleeds; the record only reveals that the plaintiff suffered from occasional nosebleeds, which were controlled by medication. Given this inconsistency, the ALJ correctly discounted the plaintiff's subjective testimony about his nosebleeds.
In addition, the ALJ properly discounted the plaintiff's subjective testimony about the severity of his kidney ailments based on inconsistent evidence in the record. The record establishes that the plaintiff does in fact have a serious kidney ailment, but it also shows that the plaintiff goes for extended periods without symptoms or treatment other than prescribed medications. If a condition can be controlled with medication or treatment, it cannot be disabling. Estes v. Barnhart, 275 F.3d 722, 725 (8th Cir. 2002) ( citing Roth v. Shalala, 45 F.3d 279, 282 (8th Cir. 1995)).
The ALJ also properly discounted the plaintiff's complaints of disabling fatigue as inconsistent with the medical record because the plaintiff only once complained of fatigue to a physician, back in August 1999. The plaintiff's hearing testimony about his fatigue, standing alone without supporting medical evidence, is not enough to establish a severe impairment or disability. While "an ALJ may not disregard a claimant's subjective complaints of pain or other subjective symptoms [such as fatigue] solely because there is no objective medical evidence to support them," Dornack v. Apfel, 49 F. Supp.2d 1129, 1139 (D. Minn. 1999), an ALJ may nevertheless discount those subjective complaints if they are inconsistent with the record as a whole. Taylor v. Chater, 118 F.3d 1274, 1277 (8th Cir. 1997). Here, the ALJ found the plaintiff's subjective complaints of fatigue incredible because the record as a whole contained no substantiating medical evidence of fatigue.
The ALJ also properly analyzed and discredited the plaintiff's hearing testimony about how his fatigue and other impairments have circumscribed his activities. The medical record, on the one hand, is replete with doctors' notes indicating that they encouraged the plaintiff to engage in vigorous physical activity to lose weight, control his blood pressure, and promote overall fitness. The plaintiff's hearing testimony, however, clearly demonstrated that the plaintiff had not followed his doctors' advice but had instead selflimited his physical activities to one small household chore a day, a half-hour walk with his dog, and occasionally visiting with friends or fishing. The doctors' advice is thus at odds with the plaintiff's testimony about his functional limitations. The plaintiff has no medical condition precluding vigorous physical activity.
Moreover, none of the plaintiff's physicians stated that he was unable to work. Dr. Oei and Dr. Knosp did state that the plaintiff should not work in a hazardous environment because of the risk of bleeding from injuries, and Dr. Knosp stated that the plaintiff should not work in extremely cold or hot environments because of an increased risk of nosebleeds. No other physicians placed any restrictions on the plaintiff's ability to go to school or to work, and certainly none stated that the plaintiff was unable to work. Under these circumstances, the ALJ properly applied the principles of Polaski v. Heckler, 739 F.2d 1320 (8th Cir. 1984), in discounting the plaintiff's testimony about the severity of his impairments. The ALJ acknowledged and examined each Polaski factor before concluding that he could not credit the plaintiff's subjective complaints, based on inconsistencies with the record as a whole. See Lowe v. Apfel, 226 F.2d 969, 972 (8th Cir. 2000).
As mentioned above, the plaintiff also contends that the ALJ's hypothetical improperly reflected the plaintiff's residual functional capacity. An ALJ determines residual functional capacity based on all the evidence in the record, not merely on medical evidence. 20 C.F.R. § 416.945-46. In addition to medical evidence, the ALJ must consider the observations of treating physicians and others, as well as the claimant's own description of the impairment. McKinney v. Apfel, 228 F.3d 860, 863 (8th Cir. 2000) ( citing Anderson v. Shalala, 51 F.3d 777, 779 (8th Cir. 1995)). The determination of residual functional capacity, however, is, at base, a medical question. Nevland v. Apfel, 204 F.3d 853, 858 (8th Cir. 2000).
The ALJ determined that the plaintiff should not work in hazardous environments or in extreme heat or cold; limited the amount the plaintiff could carry and lift; restricted the plaintiff from working at heights; and found that the plaintiff should not work around crowds. This determination of the plaintiff's residual functional capacity relied on the medical recommendations of Dr. Oei, the plaintiff's treating physician, as well as the opinions of Dr. Knosp, a consultative physician — who actually imposed greater restrictions than had Dr. Oei. The ALJ's residual functional capacity assessment was thus based on medical evidence about the plaintiff's illness and his risk of bleeding. As discussed above, the ALJ was entitled to discount the plaintiff's allegation of disabling fatigue because it was inconsistent with the medical evidence in the record. Thus, the hypothetical question posed to the vocational expert was sufficient because it both contained the impairments reflected by substantial evidence in the record and accepted as true by the ALJ, and "capture[d] the concrete consequences of the [plaintiff's] deficiencies." Hunt v. Massanari, 250 F.3d 622, 625 (8th Cir. 2001).
Accordingly, the court finds that the decision of the ALJ is supported by substantial evidence in the record as a whole. The decision of the Commissioner is therefore affirmed.
IT IS ORDERED
1. The plaintiff's complaint, Filing No. 1, is dismissed with costs and disbursements.
2. By separate order, judgment will be entered for the defendant in accordance with section 205(g) of the Social Security Act, 42 U.S.C. § 405(g), affirming the decision of the ALJ in this matter.