Opinion
Cause No. IP 00-252-CH/G
March 28, 2001
ENTRY ON JUDICIAL REVIEW
Plaintiff Christine Gray seeks judicial review of the Commissioner of Social Security's denial of her application for disability insurance benefits under Title II of the Social Security Act. An administrative law judge ("ALJ") found that Mrs. Gray suffered from severe physical impairments that prevented her from performing her past relevant work. However, the ALJ ultimately concluded that Mrs. Gray was not disabled under the Act because she was capable of performing jobs that exist in significant numbers in the national economy. The Appeals Council denied review of the ALJ's decision, making his determination the final decision of the Commissioner. Mrs. Gray challenges that decision on several grounds, but as explained below, this court affirms the Commissioner's decision. This was a relatively complex case, and the ALJ gave it close attention. His decision is supported by substantial evidence.
William A. Halter replaced Kenneth S. Apfel as Commissioner of Social Security in January 2001. Pursuant to Fed.R.Civ.P. 25(d), Mr. Halter has been substituted for Mr. Apfel as the defendant in this matter.
Background
Mrs. Gray was born on November 22, 1957, and was 40 years old at the time the ALJ made his decision denying her disability benefits. R. 51. Mrs. Gray has a bachelor's degree in communications and has past work experience as a customer service representative, a cashier, a title clerk, and a waitress. However, Mrs. Gray has not worked since approximately April 1994. R. 53-54.
Mrs. Gray applied for disability insurance benefits on February 9, 1995. R. 89. Her application identified several impairments: bilateral carpal tunnel syndrome, cubital tunnel syndrome, cervical disc disease, bilateral foot impairments, and asthma, among other impairments. Mrs. Gray also has a history of depression.
Mrs. Gray's initial claim for benefits was denied on May 17, 1995. R. 90. At Mrs. Gray's request, a hearing was held before an ALJ on July 8, 1997. The ALJ found that Mrs. Gray did in fact suffer from severe physical impairments but that her mental impairments were not severe. The ALJ concluded that Mrs. Gray's pain complaints were not credible and that, among other things, her ability to perform activities of daily living demonstrated her ability to function independently and to manage her own affairs. The ALJ determined that Mrs. Gray retained the residual functional capacity to perform a wide range of sedentary work. R. 28. Relying on the testimony of a vocational expert, the ALJ determined that Mrs. Gray could still perform a significant number of jobs that exist in the national economy. R. 35. The Appeals Council denied Mrs. Gray's request for review on December 13, 1999. Mrs. Gray now seeks judicial review of the Commissioner's decision.
Disability and the Standard of Review
To be eligible for disability insurance benefits, Mrs. Gray must establish that she was disabled within the meaning of the Social Security Act. The Act defines "disabled" as an inability to engage in substantial gainful activity by reason of a medically determinable impairment that can be expected to cause death or to last for at least twelve continuous months. 42 U.S.C. § 423 (d)(1)(A). Mrs. Gray was not disabled unless her impairments were of such severity that she was unable to perform work she had done previously and if, based on her age, education, and work experience, she could not engage in any other kind of substantial work existing in the national economy. 42 U.S.C. § 423(d)(2)(A).
This is a stringent standard. Mrs. Gray would not necessarily be entitled to receive benefits even if she had substantial impairments. The Act does not contemplate degrees of disability or allow for an award based on partial disability. Stephens v. Heckler, 766 F.2d 284, 285 (7th Cir. 1985). These benefits are made available by taxes, including taxes paid by many people for whom working is difficult and painful as a result of serious physical and/or mental impairments. Under this statutory standard, these benefits are available only as a matter of nearly last resort.
In evaluating Mrs. Gray's case, the ALJ followed the five step sequential analysis set forth in 20 C.F.R. § 404.1520. The steps are as follows:
(1) Is the claimant engaging in substantial gainful activity? If so, he or she is not disabled.
(2) If not, does the claimant have an impairment or combination of impairments that are severe? If not, he or she is not disabled.
(3) If so, does the impairment(s) meet or equal a listed impairment in the appendix to the regulations? If so, the claimant is disabled.
(4) If not, can the claimant do his or her past relevant work? If so, he or she is not disabled.
(5) If not, can the claimant perform other work given his or her residual functional capacity, age, education, and experience? If so, then he or she is not disabled.
The burden of persuasion is on the claimant for the first four steps, and on the Commisioner at step five if the analysis gets that far. Young v. Secretary of Health and Human Services, 957 F.2d 386, 389 (7th Cir. 1992).
The ALJ found that Mrs. Gray satisfied step one because she had not engaged in substantial gainful activity since April 11, 1994. Although Mrs. Gray had attempted to return to work since April 1994, the ALJ concluded that these brief attempts were unsuccessful work attempts. R. 21.
At step two, the ALJ found that Mrs. Gray suffered from several severe physical impairments: asthma, residuals from bilateral cubital and carpal tunnel syndrome, bilateral foot calluses, and cervical degenerative disc disease. R. 25. However, the ALJ also found that Mrs. Gray's depression did not constitute a severe mental impairment. At step three, the ALJ found that none of Mrs. Gray's impairments, either singly or in combination, met or equaled any of the listed automatically disabling impairments. R. 27.
At step four, the ALJ concluded that Mrs. Gray could not perform her past relevant work.
However, the ALJ evaluated the extent of the limitations caused by Mrs. Gray's impairments and concluded that she remained capable of performing certain types of work. The ALJ restricted Mrs. Gray to performing only sedentary work not requiring rapid, repetitive turning of the neck, extensive reaching, or more than occasional climbing, balancing, stooping, kneeling, crouching, or crawling. She was also restricted from performing frequent pushing or pulling, and she was precluded from using vibrating tools, power gripping, and engaging in sustained fine manipulation. R. 36.
At step five, the ALJ found that Mrs. Gray could perform work as an information clerk or surveillance system monitor and that a significant number of these jobs existed in the national economy. Based on this finding, the ALJ concluded that Mrs. Gray was not disabled within the meaning of the Social Security Act. R. 35.
Mrs. Gray attacks the Commissioner's decision on several grounds. If the Commissioner's findings of fact are supported by substantial evidence, the findings must be upheld by a reviewing court. 42 U.S.C. § 405(g); Maggard v. Apfel, 167 F.3d 376, 379 (7th Cir. 1999). Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Cass v. Shalala, 8 F.3d 552, 555 (7th Cir. 1993), quoting Richardson v. Perales, 402 U.S. 389, 401 (1971). If substantial evidence in the record supports the Commissioner's ( or here the ALJ's) findings, the court must affirm the decision unless the Commissioner committed an error of law. Nelson v. Apfel, 131 F.3d 1228, 1234 (7th Cir. 1997).
The courts ordinarily do not attempt to determine whether the plaintiff was actually disabled. See Books v. Chater, 91 F.3d 972, 977 (7th Cir. 1996). The Commissioner or his designate, the ALJ, is responsible for weighing the evidence, resolving material conflicts, making independent findings of fact, and deciding the case accordingly. See Richardson, 402 U.S. at 399-400; Delgado v. Bowen, 782 F.2d 79, 82 (7th Cir. 1986). The court may not decide facts anew, reweigh the evidence, or substitute its judgment for that of the ALJ. Nelson, 131 F.3d at 1234.
The court must not, however, simply rubber-stamp the decision without critically reviewing the evidence as a whole. Howell v. Sullivan, 950 F.2d 343, 347 (7th Cir. 1991). In considering the record as a whole, the court must look at all the relevant evidence, not only the evidence that supports the Commissioner's conclusion. Nelson, 131 F.3d at 1237; accord, Lauer v. Apfel, 169 F.3d 489, 494 (7th Cir. 1999) (ALJ "must consider all of the evidence and discuss significant evidence contrary to her ruling"). The court must therefore consider "whatever in the record fairly detracts from [the] weight" of the Commissioner's determination. Bauzo v. Bowen, 803 F.2d 917, 923 (7th Cir. 1986). Ultimately, however, where "conflicting evidence allows reasonable minds to differ," the court must defer to the Commissioner's resolution of that conflict. Binion v. Chater, 108 F.3d 780, 782 (7th Cir. 1997).
Discussion
On judicial review, Mrs. Gray argues that the ALJ erred in several respects at step four and step five of the sequential analysis. Mrs. Gray contends that the ALJ failed to properly consider evidence of some of her physical limitations in determining her residual functional capacity. In addition, Mrs. Gray contends that the ALJ mischaracterized pertinent facts in the record. Mrs. Gray also challenges the ALJ's finding that she could perform jobs that exist in significant numbers in the national economy.
I. Residual Functional Capacity
Mrs. Gray contends that the ALJ erred in determining her residual functional capacity because he failed to evaluate properly or to articulate sufficiently his evaluation of her chronic pain syndrome and her pain-related insomnia. Mrs. Gray contends that the ALJ should have given more weight to the limiting effects of these impairments, or at least should have given a better explanation for discounting these impairments.
Residual functional capacity is an assessment of what a claimant can still do despite her limitations. 20 C.F.R. § 404.1545(a). This assessment does not equal a determination of disability. Instead, it helps to evaluate the types of work that might be available to a claimant with particular limitations. 20 C.F.R. § 404.1545(a). The final responsibility for deciding a claimant's residual functional capacity rests with the ALJ. 20 C.F.R. § 404.1527(e)(2). The ALJ determines residual functional capacity by considering all relevant medical and non-medical evidence, which includes descriptions and observations (by the claimant and third parties, including physicians) of the claimant's limitations, such as pain, which go beyond symptoms, as well as medical reports and statements as to what a claimant can still do. 20 C.F.R. § 404.1545(a); Social Security Ruling ("SSR") 96-8p, printed in 61 Fed. Reg. 34474, 34475 (1996) (residual functional capacity is an administrative assessment of claimant's limitations that may affect his capacity to perform work-related physical and mental activities); see also Diaz v. Charter, 55 F.3d 300, n. 2 (7th Cir. 1995) (the assessment of the residual functional analysis is not a medical judgment; it depends on medical and non-medical evidence).
Social Security Rulings are "interpretive rules intended to offer guidance to agency adjudicators. . . . While they do not have the force of law [of] properly promulgated notice and comment regulations, the agency makes SSRs `binding on all components of the Social Security Administration.'" Lauer v. Apfel, 169 F.3d 489, 492 (7th Cir. 1999) (citation omitted), quoting 20 C.F.R. § 402.35(b)(1).
A. Evaluation of Pain-Related Symptoms
Mrs. Gray argues that remand is required because, when assessing her impairments for purposes of determining her residual functional capacity, the ALJ failed to consider sufficiently chronic pain syndrome and pain-related insomnia. Mrs. Gray also alleges that the ALJ mischaracterized facts in the record regarding these issues. Although the ALJ did not refer specifically to chronic pain syndrome or pain-related insomnia, his opinion demonstrates that he properly considered Mrs. Gray's pain and the effects of that pain.
An ALJ is not required to provide an in-depth analysis of every piece of evidence the claimant provides. Diaz, 55 F.3d at 307-08; Zblewski v. Schweiker, 732 F.2d 75, 79 (7th Cir. 1984) The question is whether the reasons given by the trier of fact build an accurate and logical bridge between the evidence and the result. Shramek v. Apfel, 226 F.3d 809, 811 (7th Cir. 2000). The ALJ is required to account for "all medical evidence that is credible, supported by clinical findings, and relevant to the question at hand." Nelson, 131 F.3d at 1237. The ALJ must offer a minimal articulation of his or her assessment of such medical evidence to show that the ALJ considered the evidence the law requires him to consider. Stephens, 766 F.2d at 288; cf. Bates v. Apfel, 69 F. Supp.2d 1143 (N.D.Iowa 1999) (remanding case where ALJ failed to discuss chronic pain syndrome and failed to take into account claimant's pain).
"An ALJ's failure to consider an entire line of evidence falls below the minimal level of articulation required." Diaz, 55 F.3d at 307, citing Herron v. Shalala, 19 F.3d 329, 333 (7th Cir. 1994). The minimal articulation standard is met when the court can "track the ALJ's reasoning and be assured that the ALJ considered the important evidence." Diaz, 55 F.3d at 308, quoting Green v. Shalala, 51 F.3d 96, 101 (7th Cir. 1995). Cf. Rohan v. Chater, 98 F.3d 966, 971 (7th Cir. 1996) (minimal articulation standard not met where court was unable to discern how the ALJ arrived at his findings apart from substituting his own judgment for medical evidence). Finally, a court reviewing the ALJ's opinion should give it "a commonsensical reading rather than nitpicking at it." Shramek, 226 F.3d at 811, quoting Johnson v. Apfel, 189 F.3d 561, 564 (7th Cir. 1999). Remand is appropriate only when the ALJ's decision is "in a word, unreasoned." Groves v. Apfel, 148 F.3d 809, 811 (7th Cir. 1998).
The ALJ's decision satisfies the minimal articulation standard with respect to Mrs. Gray's evidence of disabling pain, including CPS and pain-related insomnia. The court can track the ALJ's reasoning with respect to that evidence. First, the ALJ considered Mrs. Gray's pain and other limitations when imposing the restrictions on the type of work she could perform. The ALJ considered the medical opinion of Dr. Lorber who found that Mrs. Gray, due to her neck pain and upper extremity problems, should avoid jobs requiring power gripping or frequent use of the hands, such as pushing, pulling, or fine manipulation. R. 295. The ALJ obviously took this information into consideration when he limited Mrs. Gray to work that did not involve this type of use of the hands. R. 36. One of Mrs. Gray's treating physicians, Dr. Combs, also found that Mrs. Gray could return to work for only four to six hours per day due to her upper extremity problems. R. 435. The ALJ also considered this opinion when limiting the work Mrs. Gray could perform. R. 36. After considering each of Mrs. Gray's physical impairments in turn, the ALJ made specific reference to the limitations suggested by each examining physician. R. 21-25. Although the ALJ concluded that Mrs. Gray could still perform a limited range of sedentary work, he placed a significant amount of restrictions on the type of work Mrs. Gray could perform. R. 34. It is reasonable to infer that these limits were established, at least in part, based on Mrs. Gray's pain.
The ALJ also considered Mrs. Gray's pain during his evaluation at step two of his analysis, where the ALJ determined that Mrs. Gray suffered from severe impairments. The ALJ first noted Mrs. Gray's subjective complaints of abnormal sensation in her arms. R. 21. He also referred to Mrs. Gray's self-treatment of pain with ice packs and Ibuprofen. R. 21. The ALJ noted Mrs. Gray's 1994 complaints of paresthesias of her left arm. R. 22. The ALJ's reference to Dr. Comb's reduction of his percentage estimate of Mrs. Gray's permanent partial impairment is further evidence that the ALJ considered Mrs. Gray's pain. The ALJ noted that Dr. Combs based his assessment primarily on Mrs. Gray's pain and weakness. R. 22. The ALJ also considered the pain and discomfort associated with Mrs. Gray's feet problems. R. 23. The ALJ noted the tenderness, discomfort, and pain in Mrs. Gray's neck that began after a 1996 car accident. R. 24. The ALJ also pointed out that Mrs. Gray had pain when she turned her neck to either side. R. 24.
In addition to the ALJ's specific references to Mrs. Gray's pain, the ALJ's opinion as a whole reveals that he sufficiently considered Mrs. Gray's pain and its limiting effects. After considering all of Mrs. Gray's claims of physical impairments as a whole, the ALJ concluded that her impairments were in fact severe and could produce symptoms that were severe. R. 25.
Mrs. Gray also contends that she suffers from insomnia and that sleep deprivation is one of her most serious debilitating symptoms. Mrs. Gray argues that the ALJ failed to give sufficient weight to this impairment and also failed to provide an explanation for discounting the impact of this impairment on her ability to function.
The standards for evaluating the ALJ's treatment of Mrs. Gray's sleeping problems are the same as the standards applied above regarding her pain. Although the ALJ did not refer to Mrs. Gray's sleeping problems as "pain-related insomnia," it is clear from the record that the ALJ considered evidence of her sleep problems.
The ALJ referred to Mrs. Gray's sleeping problems during his evaluation of her subjective complaints. R. 29. On multiple occasions, the ALJ specifically referred to Mrs. Gray's asserted need to take naps during the day. R. 29. The ALJ also expressly noted Mrs. Gray's testimony that she was unable to sleep at night due to her pain. R. 29. The ALJ considered Mrs. Gray's testimony that her emotional problems were related to a lack of sleep. R. 30. The ALJ also considered testimony that a lack of sleep affected Mrs. Gray's concentration. R. 30.
The record demonstrates that the ALJ considered Mrs. Gray's sleep problems. Although the ALJ did not emphasize this problem as Mrs. Gray might have wished, he was not required to provide a thorough explanation of every piece of evidence. Moreover, the insomnia was essentially a symptom of Mrs. Gray's other impairments, not a separate impairment. The ALJ was not required to analyze and assess insomnia independently as a possibly disabling impairment.
The ALJ's decision satisfies the minimum articulation standard with respect to chronic pain syndrome and pain-related insomnia. The available medical evidence and Mrs. Gray's own testimony regarding her ability to function support the ALJ's determination that Mrs. Gray was not suffering from disabling pain and that her pain-related insomnia was not a disabling impairment. Substantial evidence means "such evidence as a reasonable mind might accept as adequate to support a conclusion." Luna v. Shalala, 22 F.3d 687, 689 (7th Cir. 1994), quoting Richardson v. Perales, 402 U.S. 389, 401 (1971). There is substantial evidence from which a reasonable mind might conclude that Mrs. Gray's pain and sleep problems were not as severe as she contends. The ALJ met the minimum articulation standard with respect to each of these alleged impairments, and there is a logical bridge between the ALJ's reasoning and his decision on these issues.
B. ALJ's Treatment of the Facts
Mrs. Gray also claims that the ALJ mischaracterized and improperly disregarded certain facts. These alleged mischaracterizations primarily relate to evidence on Mrs. Gray's pain and her ability to do work.
Mrs. Gray contends that the ALJ failed to consider the significance of her foot pain. The analysis applicable to this claim is the same as that applied to Mrs. Gray's chronic pain syndrome and pain-related insomnia. The ALJ was not required to provide an in-depth analysis of every piece of evidence. He need only provide a minimal articulation of his assessment of the relevant evidence. See Stephens, 766 F.2d at 288; Diaz, 55 F.3d at 307-08. The ALJ satisfied the minimum articulation standard in regards to Mrs. Gray's foot pain. The ALJ specifically referred to Mrs. Gray's various foot conditions at step two of the sequential analysis. R. 23. The ALJ also considered Mrs. Gray's foot problems during his assessment of her residual functional capacity. The ALJ made specific references to Mrs. Gray's foot impairments and acknowledged that she had considered a foot amputation. R. 29. The ALJ also considered Mrs. Gray's feet when assessing her subjective pain complaints. He noted Mrs. Gray's ability to walk without assistance and her need to have her calluses trimmed. R. 31-32. The ALJ gave sufficient consideration to Mrs. Gray's foot problems and has provided a sufficient bridge between the evidence he considered and the result.
Mrs. Gray also argues that the ALJ erroneously referred to her bilateral surgeries as "successful." Certain pieces of evidence may be subject to conflicting interpretations, but where "conflicting evidence allows reasonable minds to differ," the court must defer to the Commissioner's resolution of that conflict. Binion, 108 F.3d at 782. If the record as a whole contains substantial evidence to support the ALJ's factual determination, that decision must be affirmed unless there has been an error of law. Waite v. Bowen, 819 F.2d 1356, 1360 (7th Cir. 1987). However, when the ALJ's decisions on matters of fact are unreliable because of serious mistakes, the reviewing court must reverse unless it is satisfied that no reasonable trier of fact could have come to a different conclusion. Sarchet v. Chater, 78 F.3d 305, 309 (7th Cir. 1996).
The ALJ's comment that Mrs. Gray "underwent successful bilateral surgeries" was reasonable, not a serious mistake. The record indicates that Mrs. Gray's carpal and cubital tunnel syndrome had improved after her surgeries. R. 177, 196, 408. Although there may be varying degrees of success associated with any medical procedure, it is not unreasonable to say that a surgery is successful when there are improvements in a person's condition after surgery. Reasonable minds could differ as to the interpretation of the results of Mrs. Gray's surgeries. The ALJ's comment does not warrant a remand.
Mrs. Gray also alleges that the ALJ ignored evidence of her inability to work for more than a specified number of hours and that he improperly evaluated her need to pace herself when working. However, the ALJ acknowledged Mrs. Gray's ability to work only for certain amounts of time when considering her functional limitations and when imposing limitations on the work she could perform. R. 32, 34. The ALJ also considered Mrs. Gray's need to pace herself during his analysis of her mental impairment and at the step three analysis. R. 25, 27.
Although Mrs. Gray may disagree with the manner in which the ALJ assessed these issues, his factual conclusions regarding her time limits on working and her need to pace herself are supported by substantial evidence. Where reasonable minds could differ on a factual issue, this court must defer to the ALJ. This court will not disturb the ALJ's factual findings.
II. Subjective Complaints of Pain
The ALJ also considered Mrs. Gray's subjective complaints of pain in great detail. R. 28-34. The ALJ ultimately found that these complaints were not credible. Mrs. Gray contends that the ALJ's analysis of her subjective pain complaints was erroneous.
Section 404.1529 of the Social Security regulations and SSR 96-7p set forth a detailed process for the ALJ's evaluation of symptoms, including complaints of disabling pain. The ALJ must "evaluate the intensity, persistence, and limiting effects of the individual's symptoms to determine the extent to which the symptoms limit the individual's ability to do basic work activities." SSR 96-7p, 61 Fed. Reg. 34483, 34485; 20 C.F.R. § 404.1529(a). "The ALJ may not disregard subjective complaints merely because they are not fully supported by objective medical evidence." Knight v. Chater, 55 F.3d 309, 314 (7th Cir. 1995); accord, Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000); Luna, 22 F.3d at 691; SSR 96-7p, 61 Fed. Reg. at 34484. Thus, a full evaluation of the intensity, persistence, and limiting effects of the individual's symptoms requires an analysis that reaches beyond the objective medical evidence.
Section 404.1529(c) and SSR 96-7p identify seven examples of the type of evidence the ALJ must consider when assessing the credibility of an individual's statements:
(1) The person's daily activities;
(2) The location, duration, frequency, and intensity of the person's pain or other symptoms;
(3) Factors that precipitate and aggravate the symptoms;
(4) The type, dosage, effectiveness, and side effects of any medication the person takes or has taken to alleviate pain or other symptoms;
(5) Treatment, other than medication, the person receives or has received for relief of pain or other symptoms;
(6) Any measures other than treatment the person uses or has used to relieve pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 20 minutes every hour, or sleeping on a board);
(7) Any other factors concerning the person's functional limitations and restrictions due to pain or other symptoms.
The ALJ need not mechanically recite findings on each factor, but the ALJ must give specific reasons for the weight given to the individual's statements. SSR 96-7p, 61 Fed. Reg. at 34485.
"Because hearing officers are in the best position to see and hear the witnesses and assess their forthrightness, [reviewing courts] afford their credibility determination special deference." Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000). An ALJ's credibility finding will not be disturbed unless it is "patently wrong in view of the cold record." Imani v. Heckler, 797 F.2d 508, 512 (7th Cir. 1986). Here, the court will not disturb the ALJ's credibility finding because it is supported by substantial evidence and is not patently wrong.
The extensive analysis of Mrs. Gray's pain complaints shows the ALJ's awareness of her pain and provides an explanation for discounting the effects of such pain. The ALJ performed his analysis in accord with the Social Security Regulations regarding subjective pain complaints.
At the outset of this analysis, the ALJ specifically addressed Mrs. Gray's subjective complaints pertaining to her arms, feet, and neck. R. 29. The ALJ referred to Mrs. Gray's testimony regarding her complaints of pain. Her testimony on this subject included complaints regarding pain in her neck which increased by use, pain in her thumbs, pain when making a fist, her inability to sleep because of pain, foot pain, and trouble breathing. During this testimony, Mrs. Gray also indicated her physical limitations due to each of the types of pain. See R. 30.
The ALJ applied the factors listed in SSR 96-7p to assess the credibility of Mrs. Gray's complaints. The first factor he addressed was the nature, frequency, severity, and other matters descriptive of Mrs. Gray's symptoms. R. 31. The ALJ considered such things as Mrs. Gray's carpal tunnel syndrome and found it to be very mild. The ALJ also noted that her foot pain was severe only when she was on her feet too long. He also noted that there was not sufficient evidence of severe asthma and that Mrs. Gray was a heavy smoker. His conclusion on this factor was that the evidence failed to establish credible symptoms of the frequency, severity, or duration that would preclude Mrs. Gray from performing a wide range of sedentary work. R. 31.
The ALJ also addressed precipitating and aggravating factors. The ALJ found that Mrs. Gray had increased pain when turning her neck and took this into account in his assessment of her residual functional capacity. R. 31. The ALJ also determined that Mrs. Gray could not operate vibrating tools because such work could reasonably cause pain. R. 31. The ALJ also addressed Mrs. Gray's testimony that her pain occurred with activity such as cleaning or child care or housework. R. 31. Although the ALJ agreed with the complaint, he stated that those activities required more effort with her arms than the activities that he limited her to performing at work. R. 32. Therefore, each of the alleged aggravating factors was properly accounted for by the ALJ's limitations.
The next factor addressed was the medications taken by Mrs. Gray and their side effects. The ALJ noted that Mrs. Gray took a lot of aspirin but did not take prescription analgesics. She also claimed no side effects to any medication. The ALJ noted that the medication she was taking for depression, the foot orthotics, and the cervical collar were helpful to Mrs. Gray. R. 32.
The ALJ next considered Mrs. Gray's functional limitations. In doing so, the ALJ considered the medical opinions of her treating sources. Here, the ALJ found that his limits on the amount of time Mrs. Gray could spend doing certain tasks without exacerbating her symptoms were more restrictive than those allowed by Dr. Combs, one of Mrs. Gray's treating physicians. R. 32. The ALJ also considered the medical opinions of, Dr. Miller, another treating physician who included several substantial recommended restrictions on Mrs. Gray's activities. However, the ALJ properly discounted these assessments as inconsistent with the criteria for evaluating medical opinions under 20 C.F.R. § 404.1527(d). R. 33.
The last and probably most significant factor considered by the ALJ when assessing Mrs. Gray's subjective pain complaints was her activities of daily living. The ALJ first referred to his earlier discussion of Mrs. Gray's daily activities where he noted: she held a driver's license and operated a vehicle approximately five days per week by driving to schools, stores, and doctors' offices; she enjoyed reading and listening to music and continued to socialize; she did housework and prepared meals; she cared for her personal needs, she took care of the children and got them ready for and took them to school; she helped her children with their homework; she maintained her own household and managed her own funds. The ALJ noted evidence indicating that Mrs. Gray enjoyed being a full-time wife and mother and that she found her days full and satisfying. R. 26-27. The ALJ ultimately concluded that these activities showed that Mrs. Gray may have had difficulties with her condition, but that she was still capable of functioning independently and managing her own affairs. He again noted her household activities and day-to-day lifestyle.
The ALJ found that the pain Mrs. Gray experienced with these types of activities was consistent with his assessment of her residual functional capacity because they involve more intensive use of her hands than he found her capable of performing. In other words, the ALJ's residual functional capacity assessment actually limited Mrs. Gray to performing activities that are less strenuous than the activities she already performed.
Contrary to Mrs. Gray's assertion, the ALJ properly evaluated her subjective complaints of pain under the applicable rules. The ALJ's decision demonstrates that he considered the relevant evidence but ultimately rejected Mrs. Gray's allegations of disabling pain as not credible. This credibility finding was not patently wrong and will not be disturbed.
III. Jobs in the National Economy
At step five of the disability analysis, the ALJ concluded that Mrs. Gray could perform a significant number of jobs in the national economy. R. 35. Mrs. Gray contends the ALJ erred by considering the State of Indiana as the relevant region rather than the counties surrounding her home in Fishers, Indiana. She also asserts that there was not a sufficient number of jobs in the relevant region and that the determination of jobs in "other regions" was inaccurate.
The ALJ consulted a vocational expert who testified that a person with Mrs. Gray's residual functional capacity and transferable skills could perform such jobs as an information clerk and surveillance system monitor. R. 35. The vocational expert testified that the "relevant region" for a person such as Mrs. Gray who lived in Fishers, Indiana, would be Hamilton, Hendricks, Marion, Hancock, Morgan, Johnson, and Shelby Counties. R. 77. However, when the vocational expert was asked whether there were certain jobs that a person with Mrs. Gray's limitations could perform, the vocational expert first answered that there existed approximately 2,655 information clerk jobs in Indiana and 112 surveillance monitor jobs in Indiana. After the vocational expert gave the Indiana numbers, he stated that "in the region" there existed 362 information clerk jobs and 35 surveillance monitor jobs. R. 80.
The ALJ's reliance on the state-wide job numbers was not erroneous. The issue is not necessarily what the "proper region" is but whether Mrs. Gray could perform work that existed in the national economy in significant numbers. See 42 U.S.C. § 423 (d)(2)(A); 20 C.F.R. § 404.1566(b). Work exists in the national economy when it exists in significant numbers either in the region where the claimant lives or in several other regions. 20 C.F.R. § 404.1565(a). Based on these rules, it would be sufficient if there were a significant number of jobs in the region where Mrs. Gray lived.
The regulations state that the jobs available in the claimant's region need not be located in the immediate area where the claimant lives. 20 C.F.R. § 404.1566(a)(1). The relevant jobs do not need to be immediately accessible to the claimant in order to be available in the national economy. Otherwise, any claimant who chose to live far away from any area of concentrated population could be found "disabled" more readily than those in bigger cities. The relevant region is not always the area immediately surrounding the claimant's home.
Although the Seventh Circuit has not laid down a bright-line rule specifically defining the exact region to be considered, Mrs. Gray's home state of Indiana is not an inappropriate region. In Backenger v. Sullivan, the court found that the proper region was the entire state of Wisconsin. No. 91-C-340-S, 1991 WL 329567, at *6 (W.D.Wis. Nov. 25, 1991). In that case, Judge Shabaz also held that "region" refers to region of the country and not the region of the state where the claimant resides. Backenger, 1991 WL 329567 at *6. The existence of at least 7,876 jobs in Wisconsin met the requirement that significant numbers of jobs must exist in the region where the individual lives. Backenger, 1991 WL 329567 at *6. The rule of 42 U.S.C. § 423(d)(2)(A) is applied in the context of determining jobs in the national economy. Therefore, it is reasonable to find that "region" can be interpreted in terms of region of the country.
Since the State of Indiana is an appropriate region, 2,767 jobs in that region were sufficient to constitute a significant number of jobs in the national economy. In Lee v. Sullivan, the Seventh Circuit held that 1,400 jobs were a significant number of jobs under the Act. 988 F.2d 789, 794 (7th Cir. 1993). The court noted that cases from several sister circuits had held that anywhere from 174 to 1,350 jobs were a significant number of jobs at step five. See Lee, 988 F.2d at 794, citing Hall v. Bowen, 837 F.2d 272, 275 (6th Cir. 1988) (1,350 positions were significant number of jobs); Barker v. Secretary of Health Human Services, 882 F.2d 1474, 1479 (9th Cir. 1989) (1,266 positions were a significant number of jobs); Trimiar v. Sullivan, 966 F.2d 1326, 1330-32 (10th Cir. 1992) (850-1,000 potential jobs were a significant number). See also Jenkins v. Bowen, 861 F.2d 1083, 1087 (8th Cir. 1988) (500 jobs were significant number); Allen v. Bowen, 816 F.2d 600, 602 (11th Cir. 1987) (174 positions were significant number); Nix v. Sullivan, 744 F. Supp. 855, 863 (N.D.Ill. 1990) (675 jobs were significant number), aff'd, 936 F.2d 575 (7th Cir. 1991). The ALJ's step five findings were supported by substantial evidence.
Conclusion
There is substantial evidence in the record to support the ALJ's finding that Mrs. Gray retained the residual functional capacity to perform a limited range of sedentary work. There is also substantial evidence to support the ALJ's finding that a significant number of jobs exist in the national economy that Mrs. Gray could perform. For the foregoing reasons, the court AFFIRMS the decision of the Commissioner. Final judgment will be entered.