Opinion
Civil Action No. 07-30083-KPN.
August 1, 2008
This matter is before the court pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3) which provide for judicial review of a final decision by the defendant, Commissioner of the Social Security Administration (the "Commissioner"), regarding an individual's entitlement to Social Security Disability Insurance ("SSDI") and Supplemental Security Income ("SSI") benefits. Confesor Navedo ("Plaintiff") claims that the Commissioner's decision denying him such benefits — memorialized in a July 24, 2006 decision by an administrative law judge — is not supported by substantial evidence and is predicated on errors of law. Plaintiff has sought to reverse or remand the decision, and the Commissioner, in turn, has moved to affirm.
With the parties' consent, the matter has been reassigned to the undersigned pursuant to 28 U.S.C. § 636(c) for all purposes, including entry of judgment. For the reasons set forth below, the Commissioner's motion to affirm will be allowed and Plaintiff's motion to reverse or remand will be denied.
I. STANDARD OF REVIEW
A court may not disturb the Commissioner's decision if it is grounded in substantial evidence. See 42 U.S.C. §§ 405(g) and 1383(c)(3). Substantial evidence is such relevant evidence as a reasonable mind accepts as adequate to support a conclusion. Rodriguez v. Sec'y of Health Human Servs., 647 F.2d 218, 222 (1st Cir. 1981). The Supreme Court has defined substantial evidence as "more than a mere scintilla." Richardson v. Perales, 402 U.S. 389, 401 (1971). Thus, even if the administrative record could support multiple conclusions, a court must uphold the Commissioner's findings "if a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support his conclusion." Irlanda Ortiz v. Sec'y of Health Human Servs., 955 F.2d 765, 769 (1st Cir. 1991) (citation and internal quotation marks omitted).
The resolution of conflicts in evidence and the determination of credibility are for the Commissioner, not for doctors or the courts. Rodriguez, 647 F.2d at 222; Evangelista v. Sec'y of Health Human Servs., 826 F.2d 136, 141 (1st Cir. 1987). A denial of benefits, however, will not be upheld if there has been an error of law in the evaluation of a particular claim. See Manso-Pizarro v. Sec'y of Health Human Servs., 76 F.3d 15, 16 (1st Cir. 1996). In the end, the court maintains the power, in appropriate circumstances, "to enter . . . a judgment affirming, modifying, or reversing the [Commissioner's] decision" or to "remand the cause for a rehearing." 42 U.S.C. § 405(g).
II. BACKGROUND
The court notes that most of the facts are taken from the Commissioner's undisputed recitation, Plaintiff having provided little by way of background. Where feasible, the court has cited the Administrative Record, even though some of the documents are difficult to decipher.
Plaintiff, born on August 29, 1956, was educated through the second grade in Puerto Rico. (Administrative Record ("A.R.") at 364.) He is unable to speak English and unable as well to read or write English or Spanish. (A.R. at 365.) He resides in Springfield, Massachusetts, and bases his claim of disability on "heart condition; bypass surgery." (A.R. at 75.)
A. EMPLOYMENT AND MEDICAL HISTORY
Plaintiff last worked as a parking attendant in March of 2003 when he entered the hospital with chest pain. (A.R. at 373.) He has not returned to work since bypass surgery on or about March 19, 2003. (A.R. at 75-76, 136.)
1. Employment Background
Plaintiff has worked in four capacities since 1998, the first year in which he reported employment. (A.R. at 86-93.) As a parking attendant from March of 2001 until March of 2003, Plaintiff directed drivers into parking spaces. (A.R. at 367). Previously, he worked assembling calendars (from September to November of 2002), placing cans and bottles on a conveyor belt to be recycled (from August of 1998 to June of 1999), and as a dishwasher (from March of 1990 to November of 1996). (A.R. at 86, 368-72.)
2. Medical Background
Despite indications that Plaintiff's bypass surgery in March of 2003 was successful and that he no longer suffers from chest pain (see A.R. at 137, 235, 243, 247), several symptoms lingered. On October 21, 2003, and again on February 10, 2004, Plaintiff visited the emergency room for pain. (A.R. at 256, 260.) And throughout this time period, Plaintiff received care at the High Street Health Clinic where his complaints included pain, dizziness, blurred vision and hypertension. (Def. Mem. in Support of Motion for Order Affirming Decision of Comm'r ("Def. Br.") at 2; A.R. at 231-54; Pl. Br. in Supp. of Compl. to Review and Set Aside Decision under the Social Sec. Act ("Pl. Br.") at 1.)
Several other ailments mentioned either in the medical record or Plaintiff's brief appear only marginally related to his heart condition. For example, in either June or September of 2004, Plaintiff was apparently diagnosed with diabetes mellitus (Def. Br. at 2; A.R. at 20; Pl. Br. at 1), although there appear to be no further facts with respect to this condition. In addition, Plaintiff's once complained of "stiffness" and was referred to physical therapy. (A.R. at 309.) Also, in December of 2005, Plaintiff was prescribed a device for shortness of breath and sleep apnea; a January 2006 report indicates that Plaintiff's ability to breathe had thereafter improved. (See A.R. at 310-12.) Finally, Plaintiff alleges in his brief that he suffers from anxiety, schizophrenia and paranoid ideation, (see Pl. Br. at 2), but those purported limitations were never part of his disability claim.
Plaintiff had several medical providers for his heart condition between 2003 and 2006. (See A.R. at 231-309.) From 2003 to sometime in 2005, Plaintiff's primary care provider was Dr. Antone Cruz. Thereafter, Plaintiff claims, it was Dr. Mustapha Karanouh.
At least one of Plaintiff's medical providers, as well as several agency doctors, have assessed Plaintiff to determine his work limitations. On June 7, 2005, Dr. Daniel Dress evaluated Plaintiff for the Massachusetts Rehabilitation Commission Disability Determination Services ("DDS"). He found that Plaintiff was "post coronary bypass without active angina at the present time," that he suffered from "[b]ack pain [and] [p]ossible obstructive sleep apnea," and that he "may have limitations as to heavy lifting." (A.R. at 274-276.)
The record also includes Physical Residual Functional Capacity Assessments by a Dr. Astarjian and a Dr. Narayan, one on January 27, 2005, and another on June 15, 2005. (A.R. at 266-73, 276-84.) Although it is unclear which assessment pertains to which doctor, both concluded that Plaintiff can occasionally lift or carry twenty pounds, frequently lift or carry ten pounds, sit for about six hours in an eight-hour workday, and had unlimited ability to push or pull. One of the doctors found that Plaintiff had no postural limitations, while the other determined that he could frequently balance and kneel but only occasionally climb ladders, ropes and scaffolds, stoop, crouch, or crawl. Both doctors, however, found that Plaintiff had no manipulative, visual, communicative or environmental limitations, e.g., to temperature extremes, noise or dust. (A.R. at 266-73, 278-84.)
Meanwhile, on June 8, 2006, Dr. Karanouh also assessed Plaintiff's work-related limitations in a report. Dr. Karanouh stated that Plaintiff can frequently carry less than ten pounds, can stand or walk less than two hours in an eight-hour workday, must periodically alternate between sitting and standing to relieve pain or discomfort, can frequently kneel and climb ramps, stairs, ladders, ropes and scaffolds, can never balance, crouch, crawl or stoop, has unlimited manipulative functions, can occasionally reach, handle, finger and feel, has limited hearing, and has no environmental limitations. (A.R. at 334-39.)
B. PROCEDURAL BACKGROUND
Plaintiff applied for SSDI and SSI benefits on August 25, 2004, claiming an onset of his disability on July 14, 2004. His application was denied on February 2, 2005, and again upon reconsideration on July 20, 2005. Plaintiff thereafter requested a hearing, which occurred on May 11, 2006.
At the hearing, the administrative law judge ("ALJ") posed a hypothetical question to a vocational expert that echoed Plaintiff's work history and assumed the limitations described by Drs. Astarjian, Narayan and Dress. In response, the vocational expert testified that such an individual could perform his past relevant work as a calendar assembler or recycling sorter. On July 24, 2006, the ALJ, evidently persuaded by such testimony, issued a decision denying benefits to Plaintiff, which decision the Appeals Council thereafter declined to review. Plaintiff then filed the instant case.
III. DISCUSSION
An individual is entitled to SSDI benefits if, among other things, he has an insured status and, prior to the expiration of that status, was under a disability. See 42 U.S.C. § 423(a)(1)(A) and (D). An individual is entitled to SSI benefits, on the other hand, he is both disabled and needy. See 42 U.S.C. §§ 1381a and 1382c(a)(3). Neither Plaintiff's financial need nor his insured status are challenged. The question on both fronts, therefore, is whether he suffers from a disability.
A. DISABILITY STANDARD AND THE ALJ'S DECISION
An individual is considered disabled under the Social Security Act ("the Act") if he is unable to participate 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. § 1382c(a)(3)(A). A claimant is considered disabled under the Act:
only if his physical or mental impairments are of such severity that he 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 the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work.42 U.S.C. § 1382c(a)(3)(B). See Barnhart v. Thomas, 540 U.S. 20, 23 (2003).
In determining disability, the Commissioner follows the five-step protocol described by the First Circuit as follows:
First, is the claimant currently employed? If he is, the claimant is automatically considered not disabled.
Second, does the claimant have a severe impairment? A "severe impairment" means an impairment "which significantly limits the claimants physical or mental capacity to perform basic work-related functions." If he does not have an impairment of at least this degree of severity, he is automatically considered not disabled.
Third, does the claimant have an impairment equivalent to a specific list of impairments contained in the regulations' Appendix 1? If the claimant has an impairment of so serious a degree of severity, the claimant is automatically found disabled.
. . . .
Fourth, . . . . does the claimant's impairment prevent him from performing work of the sort he has done in the past? If not, he is not disabled. If so, the agency asks the fifth question.
Fifth, does the claimant's impairment prevent him from performing other work of the sort found in the economy? If so, he is disabled; if not, he is not disabled.Goodermote v. Sec'y of Health Human Servs., 690 F.2d 5, 6-7 (1st Cir. 1982).
In the instant case, the ALJ found that Plaintiff had not engaged in substantial gainful activity since the alleged onset of his disability (question one) and that he had an impairment or combination of impairments considered "severe," although not severe enough to be listed in Appendix 1 (questions two and three). Regarding question four, the ALJ first found that Plaintiff has the residual functional capacity to "frequently lift ten pounds, occasionally lift twenty pounds and sit, stand and walk six hours during an eight-hour workday," that Plaintiff "would need to avoid concentrated exposure to dust, fumes, strong odors and temperature extremes" and that Plaintiff "would be limited to no more than simple, rote tasks." (A.R. at 20-21). Accordingly, without reaching question five, the ALJ found that Plaintiff was capable of performing his past relevant work as a calendar assembler and recycling sorter and, hence, was not disabled. (A.R. at 23.)
B. ANALYSIS OF PLAINTIFF'S CHALLENGE TO THE ALJ'S DECISION
Plaintiff argues that the ALJ, when determining that Plaintiff's heart condition was not disabling, improperly placed more weight on the opinions of non-examining physicians than on the opinion of Dr. Karanouh, who Plaintiff describes as his treating physician. Plaintiff also argues that the ALJ inappropriately discounted Dr. Karanouh's opinion because it was solicited by Plaintiff's counsel. While, in the court's opinion, Plaintiff's second argument has some weight, neither argument in the end warrants reversal or remand.
The court notes that, while Plaintiff variously refers in his brief to some mental limitations, these were not part of his disability claim. Accordingly, the court has not considered such purported limitations.
1. Weight Assigned to Various Sources
Although Plaintiff is correct that the opinions of treating sources such as Dr. Karanouh are generally given more weight than non-treating sources, no categorical rule requires an administrative law judge to defer to such sources. See 20 C.F.R. § 404.1527(d)(2)-(4) (2008) (noting that a treating source's opinion will be given "controlling weight" only 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"). In fact, the First Circuit has continually held that an administrative law judge has wide latitude to consider other medical opinions. See Arroyo v. Sec'y of Health Human Servs., 932 F.2d 82, 89 (1st Cir. 1991) ("The law in this circuit does not require ALJs to give greater weight to the opinions of treating physicians."); Tremblay v. Sec'y of Health Human Servs., 676 F.2d 11, 13 (1st Cir. 1982) (declining to adopt a "per se rule" that treating physicians' opinions should be given greater weight than those of consulting physicians).
To be sure, the purpose of giving more weight to a treating physician's opinion when otherwise appropriate is that "these sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of your medical impairment(s) and may also bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as consultative examinations or brief hospitalizations." 20 C.F.R. § 404.1527(d)(2) (2008). In the instant case, however, Plaintiff's medical records suggest that his relationship with Dr. Karanouh, upon which he now relies, was not significantly different than his relationship with Dr. Dress, who performed a consultative examination, or, given the facts, hardly different than the role of the non-examining physicians, Drs. Astarjian and Narayan, who reviewed the same records as Dr. Karanouh. Dr. Karanouh saw Plaintiff only three times, i.e., on August 22, 2005, October 17, 2005, and January 30, 2006, and during two of these visits, merely supervised other residents, i.e., Dr. Michael Picchioni and a Dr. Rosenblum, and signed off on their medical reports. (A.R. at 286-91.)
More to the point, however, an administrative law judge "need not give controlling weight to a treating physician where that physician's opinion conflicts with other medical evidence in the record, lacks support, or shows inconsistencies." Wright v. Barnhart, 389 F. Supp. 2d 13, 21-22 (D. Mass. 2005). Here, the ALJ cited ample discrepancies between Dr. Karanouh's opinion and other record evidence and also found "not entirely credible" Plaintiff's claims of the "intensity, persistence and limiting effects of [his] symptoms," claims upon which Dr. Karanouh's opinion was based (A.R. at 22.) The ALJ's conclusions, in the court's view, are supported by substantial evidence.
The court begins with the ALJ's credibility determination. It is well established that a court must generally defer to credibility assessments made by an administrative law judge. See Frustaglia v. Sec'y of Health Human Servs., 829 F.2d 192, 195 (1st Cir. 1987); Brown v. Sec'y of Health Human Servs., 740 F. Supp. 28, 36 (D. Mass. 1990). Moreover, as the First Circuit has long acknowledged, an administrative law judge is not required to take a claimant's subjective allegations at face value. See Bianchi v. Sec'y of Health Human Servs., 764 F.2d 44, 45 (1st Cir. 1985) (citation omitted). Still, a court must review an administrative law judge's determination to ensure that he made specific findings to the "relevant evidence" when deciding to disbelieve a claimant. See Da Rosa v. Sec'y of Health Human Servs., 803 F.2d 24, 26 (1st Cir. 1986). See also Social Security Ruling (SSR) 96-7p, Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual's Statements, 61 Fed. Regs. 34, 483, 34, 485-86 (1996) (requiring that "[w]hen evaluating the credibility of an individual's statements, the adjudicator must . . . give specific reasons for the weight given to the individual's statements" and "the reasons for the credibility finding must be grounded in the evidence and articulated in the determination or decision").
Here, the ALJ's analysis of Plaintiff's testimony — which formed the basis for discounting Plaintiff's credibility — was quite specific. (A.R. at 22.) For example, Plaintiff's testimony to the contrary, the ALJ referenced numerous statements in the record which indicated that Plaintiff's heart condition had stabilized to the point of causing him little to no discomfort. (See, e.g., A.R. at 22 (wherein the ALJ noted that "[i]n July 2003, [Plaintiff] was assessed as doing `remarkably well,'" that "[i]n January 2004 [Plaintiff] had no shortness of breath or diaphoresis" and that "in March 2004, his cardiac examination was entirely normal without syncope, chest pain or shortness of breath").) The ALJ also noted that on June 16, 2005, Plaintiff's coronary artery disease was described as "stable with normal echocardiogram, and blood pressure reading at that time was 117/63." ( Id.) Finally, the ALJ — Plaintiff's subsequent testimony again to the contrary — pointed out that Plaintiff himself maintained during his consultative examination with Dr. Dress that he had no chest pain. (A.R. at 22, 274.)
Plaintiff, for his part, quarrels with none of these findings. He merely cites evidence of other purported pains. (See Pl. Br. at 4.) Unfortunately for Plaintiff's cause, however, such assertions are immaterial because his claim of disability was based only on his heart condition. As a result, the ALJ's credibility assessment fully complied with the law: he gave specific reasons for the weight accorded Plaintiff's statements and the bases for his credibility determination were grounded in the evidence before him and articulated in his decision.
As for Plaintiff's challenge to what he describes as the ALJ's improper rejection of Dr. Karanouh opinion, the court finds that the ALJ fully considered that opinion and found it wanting. Specifically, the ALJ questioned Dr. Karanouh's assessment that Plaintiff was limited to sedentary work and noted a lack of objective evidence in the record establishing any such limitation. (A.R. at 22.) The ALJ also determined that there were "no musculoskeletal impairments established by any objective evidence, and the problems reasonably to be expected from [Plaintiff's] heart condition [did] not warrant such drastic limitations." ( Id.) The ALJ's analysis was hardly a "clear illustration" of his substituting his lay opinion for a medical opinion, Plaintiff's argument to the contrary. (See Pl. Br. at 4.) The ALJ was simply describing a record which contained neither objective medical evidence of Plaintiff's alleged inability to stand or walk nor any evidence connecting such alleged inability to his heart condition. Accordingly, the ALJ relied on the factually supported counter-opinions of Drs. Astarjian and Narayan (and, indeed, Dr. Dress) and concluded that Plaintiff had the residual functional capacity to return to at least two of his previous jobs.
In sum, the ALJ had substantial evidence upon which to conclude that Plaintiff's subjective claims lacked credibility and that Dr. Karanouh's opinion "conflict[ed] with other medical evidence in the record, lack[ed] support, or show[ed] inconsistencies." Wright, 389 F. Supp. 2d at 21-22. Having so found, the ALJ could appropriately defer to the state agency consultants' opinions. See Lizotte v. Sec'y of Health Human Servs., 654 F.2d 127, 130 (1st Cir. 1981) ("[I]t is clear that it is within the Secretary's province to accord greater weight to the report of a medical expert commissioned by the Secretary.") (citing Richardson, 402 U.S. at 399).
2. Solicitation
As described, the ALJ's determination that Plaintiff is capable of performing past relevant work — Dr. Karanouh's report to the contrary — was based on substantial evidence and not predicated on errors of law. Granted, as Plaintiff notes, the ALJ also suggested that Dr. Karanouh's opinion might not be fully credible because it was solicited by Plaintiff's attorney. In this court's view, that suggestion, were it to stand alone, would be cause for error. See Brooks v. Barnhart, 339 F. Supp. 2d 183, 189 (D. Mass. 2004) (noting that it was "not proper" for the administrative law judge (the same one here) "to reject the opinion of a treating physician simply because it was solicited by a claimant's attorney"). Accord Arroyo v. Barnhart, 295 F. Supp. 2d 214, 220-21 (D. Mass. 2003). Indeed, the First Circuit has criticized administrative law judges who assign treating physicians' reports little weight merely because they are solicited by claimants' lawyers. See Gonzalez Perez v. Sec'y of Health Human Servs., 812 F.2d 747, 749 (1st Cir. 1987). According to the First Circuit, "[s]omething more substantive than just the timing and impetus of medical reports obtained after a claim is filed must support an ALJ's decision to discredit them." Id.
To be sure, the ALJ offered some Ninth Circuit support for the approach he took. See Burkhart v. Bowen, 856 F.2d 1335, 1339 (9th Cir. 1988). But, as the AlJ should be aware, the Ninth Circuit has since clarified its decision in Burkhart and held "that, in the absence of other evidence to undermine the credibility of a medical report, the purpose for which the report was obtained does not provide a legitimate basis for rejecting it." Reddick v. Chater, 157 F.3d 715, 726 (9th Cir. 1998).
Here, however, the ALJ's reference to Plaintiff's counsel's solicitation of the opinion of Dr. Karanoub does not justify reversal or remand. See also Brooks, 339 F. Supp. 2d at 189 (deeming rejection of doctor's opinion on "solicitation" grounds to be immaterial). As described, the ALJ, solicitation concerns aside, properly found that Dr. Karanouh's opinion conflicted with other medical evidence of record, lacked support, and showed inconsistencies. Moreover, for all the reasons described, the ALJ, in the court's opinion, had independent grounds upon which to discount Plaintiff's credibility. That being so, the ALJ, in the court's opinion, had substantial evidence upon which to base his decision denying Plaintiff both SSDI and SSI benefits.
IV. CONCLUSION
For the reasons stated, the Commissioner's motion to affirm is ALLOWED and Plaintiff's motion to reverse or remand the ALJ's decision is DENIED.
IT IS SO ORDERED.