Opinion
96-CV-1783 (JBS).
December 7, 1998
Edward J. Kloss, Jr., Esquire, Burlington, New Jersey, Attorney for Plaintiff.
Faith S. Hochberg, United States Attorney, By: John C. Jeannopoulos Special Assistant United States Attorney, United States Attorney's Office, Newark, New Jersey, Attorney for Defendant.
OPINION
This Matter comes before this court pursuant to section 205(g) of the Social Security Act ("Act"), as amended, 42 U.S.C. § 405(g), to review the final decision of the Commissioner of the Social Security Administration ("Commissioner"), denying plaintiff's claim for Disability Insurance benefits under Title II and Supplemental Security Income ("SSI") benefits under Title XVI of the Act. For the reasons stated below, this court will affirm the Commissioner's decision.
I. Background
A. Procedural History
Plaintiff, Iris Grover, applied for disability insurance benefits on January 12, 1993, alleging disability as of June 19, 1992, due to arthritis, pinched nerves, headaches, and depression anxiety. (R. 69-73.) This application was denied initially and upon reconsideration. (R. 93-95, 119-121.)
Plaintiff then requested a hearing, which was held on April 15, 1994, before Administrative Law Judge ("ALJ") Alan M. Neff. (R. 35-67, 124-125.) In his decision dated December 20, 1994, the ALJ found that plaintiff met the insured status requirements of the Act on June 19, 1992, the date plaintiff stated she became unable to work, and continued to meet them through the date of the decision. (R. 16.) The ALJ also found that plaintiff had not engaged in substantial gainful activity since June 19, 1992. (Id.) The plaintiff was found to have a severe impairment, but not an impairment or combination of impairments listed in or equal to one of those listed in 20 C.F.R. Part 404, Subpart P, Appendix 1, Regulation No. 4. (Id.) However, the ALJ found that plaintiff was capable of performing her past relevant work as a systems analyst and systems programmer because her impairment does not prevent her from meeting the exertional demands of those occupations. (R. 19-20.) Therefore, the ALJ concluded that the plaintiff is not entitled to a period of disability or disability insurance benefits. (R. 20.)
The ALJ's decision became the final decision of the Commissioner when the Appeals Council denied plaintiff's request for review on January 31, 1996. (R. 4-5.)
Plaintiff timely filed this action in the United States District Court on April 8, 1996, claiming that the Commissioner's finding that she is not entitled to disability insurance benefits was not based on substantial evidence. Specifically, plaintiff alleges that there was not substantial evidence supporting the ALJ's determinations that plaintiff's mental impairment was not severe and that plaintiff's testimony was not fully credible. (Pl. Br. at 1-10.)
B. Personal and Medical History
Ms. Grover was born on October 22, 1948. (R. 38.) She grew up on her parents' blueberry farm and spent most of her life working on the farm part-time. (R. 46.) In addition, plaintiff has worked in real estate, as a billing clerk for Sears, and made and sold crafts door to door. (R. 59-60.)
Ms. Grover received an Associate Degree in Data Processing from Burlington County College. (R. 44.) She began working in the computer field in 1980. (R. 47.) Since then, she has been employed by Burlington County College and the Department of Labor as a systems analyst and systems programmer. (R. 47-49.) She has also been employed by the Evaluation Research Corporation as a consultant for the government. (R. 48.) Ms. Grover last worked as a bakery clerk at a Foodtown in 1991. (R. 49.) She is currently single and lives alone. (R. 38-39.)
Plaintiff testified that she manages all of her household chores including vacuuming, cleaning, and shopping. (R. 40.) In December 1993, plaintiff and her boyfriend drove to Florida to visit her sister. (R. 40-41.) Plaintiff went on a second trip to Florida alone by airline just prior to her hearing before the ALJ. (R. 42.) Plaintiff also testified that she drives about half an hour to her brother's house once every two weeks. (R. 43.)
In 1987, plaintiff fell and sprained her neck, back, and leg. (R. 62.) Following the fall, plaintiff was treated by a chiropractor and an orthopedic surgeon. (R. 63.) She began physical therapy and was able to continue working. (Id.)
Plaintiff testified that after the fall, she began to suffer from pain and spasms when she sat at a desk. (Id.) She described the pain in her back as feeling like "someone's sticking a knife in it and turning it." (R. 64.)
On July 22, 1992, plaintiff was hospitalized for ten days as the result of a nervous breakdown and depression with psychosis. (R. 50.) She was treated by Dr. Ira Fox, who administered Thorazine, Cogentin, Dalmane, and Prozac. (R. 51, 179-80.) Following her discharge on August 3, 1992, plaintiff continued taking the prescribed medications and began seeing Sidney Moss, a private psychologist. (R. 51-52, 202-204.)
On September 23, 1993, plaintiff was treated by Dr. George Chatyrka for chronic arthritis of the neck. (R. 53, 188-190.) Dr. Chatyrka instructed plaintiff to start on traction for her radicular type symptoms and prescribed Darvocet, Relafen, Tagamet, and Prozac. (R. 54, 189.) Plaintiff also saw Dr. Casarina at the Mount Holly Family Practice when she was unable to afford to see Dr. Chatyrka. (R. 55.)
Plaintiff testified that Dr. Chatyrka informed her that there was nothing he was able to do for her pain other than prescribe medication. (R. 56.) As a result, Dr. Chatyrka referred plaintiff to Dr. Luis Cervantes, a neurosurgeon. (R. Id.) Dr. Cervantes informed plaintiff that surgery would not alleviate her symptoms, and instead recommended that she begin a physical therapy program. (R. 57.) Plaintiff was most recently seen by Dr. Barry Geller and Dr. Chandra Gupta. A complete summary of the medical findings follows.
1. MRI Study
Dr. James Koss, M.D. conducted an MRI of plaintiff's cervical spine on November 3, 1987. His conclusion of the study was a mild ventral impression on the thecal sac at C3-4 and C5-6 which appeared to be due to spurs. (R. 220.) He found no evidence of cord compression. (Id.)
2. Madison Orthopaedic Associates
Plaintiff was first seen by Madison Orthopaedic Associates on December 11, 1986, complaining of neck pain following a fall on November 19, 1986. (R. 221.) Plaintiff complained of neck pain with radiation into the upper extremities. (Id.) X-rays taken on November 24, 1986 were interpreted as showing degenerative changes in the cervical spine, with some mild hypertonic lipping in the intervertebral foramina. (Id.) Following examination, the clinical impression was musculo-ligamentous strain of the cervical spine and degenerative arthritis of the cervical spine. (Id.) The doctors recommended that plaintiff be prescribed a cervical collar, Indocin 75 mg. SR, and physical therapy to the neck and shoulders. (Id.)
Plaintiff continued with a number of follow up examinations through December 1, 1987. Examinations on December 29, 1986 and January 20, 1987 indicated that plaintiff was improving with the therapy and could continue with work. (R. 222.) On February 24, 1987, plaintiff complained of pain in both of her legs, in her lower back, both groins, and the lateral side of her knees. (R. 224.) Examination revealed that plaintiff was able to walk on toes and heels equally well with fairly good motion of the spine in all planes. (Id.) Plaintiff was instructed on leg exercises which she was able to perform at home. (Id.)
On March 26, 1987, plaintiff complained of recurrent cervical spine and neck pain, as well as pain in both arms, particularly into the fourth and fifth fingers. (Id.) Examination was normal, and she was prescribed Indocin. (Id.) On April 9, 1987, plaintiff indicated that the Indocin had helped somewhat with the pain. (R. 225.) It was recommended that she see Dr. Dwyer, a rheumatologist. (Id.)
On October 1, 1987, plaintiff reported that she had been in an automobile accident and complained of neck and shoulder pain. (Id.) Examination revealed tenderness over both scapuli, pain on motion of both arms, kyphosis of the dorsal spine, pain on motion of the neck, and tenderness over the sternum. (Id.) An X-ray of the cervical spine revealed no bony or joint abnormalities, except for some mild degenerative changes in the joints. (Id.) The clinical impression was musculo-ligamentous strain of the cervical and dorsal spine. (Id.) On October 8, 1987, plaintiff indicated that there has been improvement following physical therapy (R. 226.) Examination on October 22, 1987 revealed a small nodule to the right of the mid line in the occipital area which was barely palpable. (Id.) The doctors recommended that plaintiff receive a neurologic examination and, if the exam revealed no problem, that plaintiff should return to work and discontinue therapy. (Id.) The neurologic report was normal, and it was concluded that plaintiff did not have a surgical problem and may return to work anytime she feels able to do so. (R. 227.)
3. Dr. James Dwyer, D.O.
Plaintiff was seen by Dr. Dwyer for evaluation of musculoskeletal pain. (R. 256.) In his report dated November 17, 1988, Dr. Dwyer noted that the plaintiff had originally been seen in May 1987 with fibrositis symptoms. (Id.) Currently, plaintiff complained of significant discomfort in her neck, shoulder area, hands, as well as discomfort in her knees with "creaking". (Id.) An examination revealed some mild osteoarthritic changes in her hands and knees, but described the majority of her symptoms as soft tissue tenderness, most likely related to her fibrositis. (Id.) Dr. Dwyer noted that the plaintiff's use of Indocin had improved her neck symptoms; however, the symptoms would recur when the Indocin was stopped. (Id.) He recommended continuation of the Indocin with the addition of Parafon Forte 1 as a muscle relaxant. (Id.)
4. MRI Study
On April 29, 1989, Dr. Roberta Lynch, M.D. conducted an MRI on the plaintiff's temporomandibular joints. (R. 255.) Her conclusion was that plaintiff had a minimal early spur formation involving the anterior aspect of both mandibular condyles. (Id.) The temporomandibular joints were otherwise normal with the meniscus in good position. (Id.)
5. Bone Scan Examination
Dr. Kent Smith, M.D. conducted a bone scan examination on August 1, 1989. (R. 254) The examination revealed a tiny focal area of increased activity in the right side of the mid thoracic spine with no other focal defects. (Id.) Dr. Smith concluded that the tiny focal area may represent a degenerative spur or some other lesion. (Id.) Otherwise, no abnormalities were found in the rest of the skeleton. (Id.)
6. Rancocas Valley Hospital
Plaintiff was hospitalized at Rancocas Valley Hospital from July 22, 1992 through August 3, 1992. (R. 178-187.) A discharge report prepared by Dr. Ira Fox, M.D. indicates that the plaintiff was admitted to the hospital in a bizarre psychotic decompensated state with a history of having set fire to her bedroom a few days prior to her admission. (R. 179.) Her chief complaint was "I set the fire to get rid of the hate." (Id.)
Plaintiff's mental status upon admission was cooperative but very guarded. (Id.) Dr. Fox noted that plaintiff appeared to be in acute distress and had poor eye contact. (Id.) Her mood was depressed and her affect blunted. (Id.) Plaintiff was admitted following a review of suicidal and homicidal ideation and after she had admitted to setting the fire. (Id.)
The Hospital placed on suicide precautions and administered Thorazine, Cogentin, and Dalmane. (Id.) On July 28, 1992, she was started on Prozac. (Id.) Suicide precautions were discontinued on August 2, 1992 after the plaintiff had exhibited progressive improvement through milieu therapy and psycho chemotherapy and was no longer suicidal or homicidal in thought or ideation. (Id.) Upon discharge on August 3, 1992, plaintiff agreed to follow up as an outpatient and to continue taking her medications, including Prozac 20mg, Thorazine 50mg BID, and Cogentin 2mg BID. (R. 180.) Dr. Fox made a discharge diagnosis of depression with psychosis and concluded that plaintiff may return to work immediately. (R. 179, 180.)
7. Dr. Ira L. Fox, M.D.
Following her stay at Rancocas Hospital, plaintiff was seen by Dr. Fox on August 31, 1992, September 26, 1992, and October 27, 1992 for psychiatric evaluation. (R. 197.) In his report, he explained that plaintiff had been receiving treatment from Sidney Moss, a private psychologist, and that Mr. Moss was in a better position to answer any questions regarding plaintiff's mental health. (Id.)
8. Dr. George Chatyrka, M.D.
Plaintiff was seen by Dr. Chatyrka on September 23, 1992 complaining of arthritis of the neck. (R. 188.) Physical examination by Dr. Chatyrka revealed marked decrease in ranges of motion of the cervical area with plaintiff complaining of diffuse back pain in the dorsal area, neck pain, and pain in the lumbar and sacroiliac areas. (Id.) Dr. Chatyrka prescribed Prozac, Thorazine, Tagamet, Relafen, and Darvocet and instructed plaintiff to start on traction at home for her radicular type symptoms. (Id.)
Plaintiff was seen on a number of monthly follow up visits through April 1993. In October, 1992, plaintiff indicated that there had been improvement in her pain with the rest of the examination unremarkable and unchanged. (R. 188-89.) In November, plaintiff returned complaining of persistent pain in the neck and cervical area. (R. 189.) She was prescribed Elavil and continued on cervical traction. (Id.) Plaintiff continued to complain of pain during her December and January visits. (Id.) Dr. Chatyrka noted that there was a question as to whether, at this time, plaintiff suffered from hypochondriasis instead of true arthritis. (Id.)
Plaintiff was again evaluated on April 29, 1993 at which time she continued to complain of the same pain with examination revealing a decreased range of motion in the cervical area. (R. 212.) Dr. Chatyrka reviewed the results of an MRI performed on February 1, 1993, and he noted that plaintiff told him that there was nothing else that could be done for her and that she handles it the best she can. (R. 213.)
9. Dr. Luis A. Cervantes, M.D.
At the request of Dr. Chatyrka, plaintiff was seen by Dr. Cervantes on February 1, 1993. Upon examination, Dr. Cervantes found that plaintiff was not experiencing paravertebral muscle spasm or muscle tightness. (R. 194.) He further noted that there was no finding of muscle weakness or atrophy, with +2 biceps and tricep jerks, no sensory loss, no sciatic notch pain, and full range of motion of her cervical and lumbar spines. (Id.) Plaintiff had +2 deep tendon reflexes symmetrically and bilaterally, with bilateral plantar flexor responses. (Id.) He made no finding of any sensory loss. (Id.)
Dr. Cervantes reviewed an older MRI provided by the plaintiff and determined that it might show some spondylosis at C5-6. (Id.) A more recent cervical spine x-ray showed no instability and not much osteoarthritic changes. (Id.) He indicated that he could not tell plaintiff that she would improve with surgery and requested that she undergo another MRI of her cervical spine. (Id.)
10. MRI Study
Pursuant to Dr. Cervantes' request, plaintiff underwent an MRI of her cervical spine on February 1, 1993. Dr James Koss performed the MRI and concluded that the study revealed: (1) mild ventral impression on the thecal sac centrally at the C6-C7 and C3-C4 levels most likely due to mild ventral osteophytic ridges; (2) mild ventral impression on the thecal sac centrally and slightly more prominent to the left of the midline at the C4-C5 and C5-C6 most likely due to mild osteophytic ridges; and (3) no evidence of cord compression. (R. 192.)
11. Sidney Moss, ACSW
Plaintiff reported to Mr. Moss for psychotherapy beginning in August 1992 due to concern about her dangerous behavior. (R. 203.) Mr. Moss described plaintiff's mental status on her first visit as depressed, full of self blame, with low self esteem, and feelings of guilt over setting the fire in her house and her mother's death. (Id.) Following her most recent visit on March 1, 1993, Mr. Moss noted that Plaintiff's outlook was much improved, but was concerned about her physical health. (Id.) He further described her as somewhat depressed about her health. (Id.)
In describing plaintiff's current behavior, Mr. Moss noted that she had no problems with her usual daily activities; had regular interests; good ability to relate and socialize with other people; fine personal habits and hygiene; and excellent residual ability to comprehend, follow instructions, and adapt to work situations. (Id.) He noted that plaintiff had a very good response to psychotherapy, but required another year or so for help with her self image and coping with the loss of her mother. (r. 204.) Mr. Moss concluded that plaintiff is capable of making all occupational, personal, and social adjustments. (Id.)
12. Dr. Lewis S. Alban, Ph.D., Clinical Psychologist
Plaintiff reported to Dr. Alban on April 20, 1993 for a mental status examination. Upon examination, Dr. Alban noted that plaintiff's affect seemed to vary between normal, anxiety and depression. (R. 207.) Plaintiff was able to repeat seven, then five random digits in order without error. (Id.) She was able to count backwards from 100 by threes, making one error. (Id.) She identified the current President of the United States, the current governor of the State of New Jersey, the season, the month. the date, the year, the day of the week, the town where Dr. Alban's office was located, and Dr. Alban's name. (Id.)
Utilizing the DSM-III-R criteria, Dr. Alban reported the following clinical diagnosis: Axis I: 296.23, Major depression, single episode, severe, without psychotic features; Axis II: No diagnosis or condition; Axis III: By report, claimant has incapacitating arthritic pain; Axis IV: Code V; Axis V: GAF: Present 70. Past Year: 65. (R. 208.)
Dr. Alban concluded that plaintiff appeared to be able to manage funds in her own best interest. (Id.)
13. Memorial Hospital Physical Medicine and Rehabilitation Department
Plaintiff was enrolled in physical therapy three times a week for three weeks beginning January 14, 1994. (R. 230.) Her physical therapy consisted of a therapeutic exercise program concentrating on increasing her cervical mobility, postural education, a home exercise program, and a home TENS unit. R. 238-39.) It was noted in the evaluation and progress reports that plaintiff did not improve due to increased pain and soreness in the cervical area. (R.230.) It was explained that the increase in soreness and pain was a normal response to therapy. (Id.) However, plaintiff discharged herself from therapy on February 14, 1994. (Id.)
14. Dr. Barry Geller
Plaintiff presented to Dr. Geller on June 10, 1994 for a psychiatric evaluation which was requested by the Department of Disability Determinations. (R. 240.) During the mental status evaluation, Dr. Geller noted that plaintiff's affect was neutral and her speech was fluent, coherent, and logical. (Id.) Dr. Geller found that plaintiff was grossly oriented and exhibited no evidence of hallucinations, delusions, or looseness of association. (Id.) Plaintiff's memory was three out of three immediately and three out of three at six minutes and she was able to interpret proverbs abstractly. (R. 241-42.) Dr. Geller's impression following the evaluation was major depression, recurrent, in remission. (Id.) He concluded that plaintiff could manage her own funds. (Id.)
Dr. Geller also assessed the plaintiff's mental ability to perform work related activities. He rated as "unlimited/very good" plaintiff's abilities to maintain personal appearance and understand, remember, and carry out simple job instructions. (R. 244-45.) He rated as "good" plaintiff's abilities to follow work rules, relate to co-workers, deal with the public, use judgment, interact with supervisors, deal with work stress, function independently, behave in an emotionally stable manner, and relate predictably in social situations. (Id.) He rated as "fair" plaintiff's abilities to maintain attention/concentration and understand, remember, and carry out complex job instructions. (R. 244.)
15. Dr. Chandra Gupta
On June 18, 1994, Dr. Gupta conducted a disability evaluation which was requested by the Department of Disability Determinations. (R. 246.) Examination of plaintiff's neck revealed a myofascial area on deep palpation. (R. 248.) Dr Gupta described the area as tender in which a shooting pain goes up the right shoulder after deep palpation. (Id.) Plaintiff had full range of motion in the neck, and there was no evidence of deformity or tenderness in the spine, nor of any other paraspinal tenderness in the neck region. (Id.) Examination of both shoulders revealed normal range of motion without tenderness, swelling or deformity. (Id.) Emanation of the back revealed normal range of motion without any pain, tenderness, or lordosis in the lumbar area. (Id.)
Neurological examination revealed normal muscle tone and strength in most of the musculature of the extremities. (Id.) Plaintiff had muscular power 5/5 in all of the extremities. (Id.) Plaintiff's sensation of pinprick and deep touch were normal in all extremities and she was independent in ambulation and transfer. (Id.)
Dr. Gupta also assessed plaintiff's physical ability to perform work related activities. (R. 249.) She found that plaintiff's ability to lift and carry was limited to 10 15 pounds and her ability to crawl was limited to occasionally. (R. 249-50.) Dr. Gupta also found that plaintiff's ability to push/pull was limited due to pain in the neck region. (R. 250.)
II. Discussion
A. "Disability" Defined and Burdens of Proof
The Social Security Act defines "disability" for purposes of plaintiff's entitlement to benefits as 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 12 months." 42 U.S.C. § 1382c(a)(3)(A). Under this definition, a claimant qualifies as disabled "only if his physical or mental impairment or 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).
The Commissioner has promulgated regulations for determining disability applicable to Disability Insurance cases. See 20 C.F.R. § 404.1501-404.1599. Under these regulations, substantial gainful activity is defined as "work that (a) involves doing significant and productive physical or mental duties; and (b) is done (or intended) for pay or profit." 20 C.F.R. § 404.1510. Importantly, this definition presupposes a regular, continuing, and sustained ability to perform such work. Kangas v. Bowen, 823 F.2d 775, 778 (3d Cir. 1987).
The Commissioner has promulgated regulations that determine disability by application of a five-step sequential analysis codified in 20 C.F.R. § 404.1520. The Commissioner evaluates each case according to a five-step process until a finding of "disabled" or "not disabled" is obtained. 20 C.F.R. § 404.1520(a). This five-step process is summarized as follows:
1. If the claimant currently is engaged in substantial gainful employment, he will be found "not disabled."
2. If the claimant does not suffer from a "severe impairment," he will be found "not disabled."
3. If the severe impairment meets or equals a listed impairment in 20 C.F.R. Part 404, Subpart P, Appendix 1 and has lasted or is expected to last for a continuous period of at least twelve months, the claimant will be found "disabled."
4. If the claimant can still perform work he has done in the past ("past relevant work") despite the severe impairment, he will be found "not disabled."
5. Finally, the Commissioner will consider the claimant's ability to perform work ("residual functional capacity"), age, education and past work experience to determine whether or not he is capable of performing other work which exists in the national economy. If he is incapable, a finding of disability will be entered. On the other hand, if the claimant can perform other work, he will be found not to be disabled.20 C.F.R. § 404.1520(b)-(f).
This analysis involves a shifting burden of proof. Wallace v. Secretary of Health Human Servs., 722 F.2d 1150, 1153 (3d Cir. 1983). In the first four steps of the analysis, the burden is on the claimant to prove every element of her claim by a preponderance of the evidence. In the final step, however, the Commissioner bears the burden of proving that work is available for the petitioner: "Once a claimant has proved that he is unable to perform his former job, the burden shifts to the Commissioner to prove that there is some other kind of substantial gainful employment he is able to perform." Kangas, 823 F.2d at 777. See Olsen v. Schweiker, 703 F.2d 751, 753 (3d Cir. 1983).
B. Standard of Review
A reviewing court must uphold the Commissioner's factual decisions if they are supported by "substantial evidence." 42 U.S.C. § 405(g), 1383(c)(3); Williams v. Sullivan, 970 F.2d 1178, 1182 (3d Cir. 1992),cert. denied, 507 U.S. 924 (1993); Brown v. Bowen, 845 F.2d 1211, 1213 (3d Cir. 1988); Doak v. Heckler, 790 F.2d 26, 28 (3d Cir. 1986); Newhouse v. Heckler, 753 F.2d 283, 285 (3d Cir. 1985). "Substantial evidence" means more than "a mere scintilla." Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). "It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. The inquiry is not whether the reviewing court would have made the same determination, but, rather, whether the Commissioner's conclusion was reasonable. See Brown, 845 F.2d at 1213. Thus, substantial evidence may be slightly less than a preponderance. See Hanusiewicz v. Bowen, 678 F. Supp. 474, 476 (D.N.J. 1988).
The reviewing court, however, does have a duty to review the evidence in its totality. See Daring v. Heckler, 727 F.2d 64, 70 (3d Cir. 1984). In order to do so, "a court must `take into account whatever in the record fairly detracts from its weight.'" Schonewolf v. Callahan, 972 F. Supp. 277, 284 (D.N.J. 1997) (quoting Willbanks v. Secretary of Health Human Servs., 847 F.2d 301, 303 (6th Cir. 1988) (quoting Universal Camera Corp. v. NLRB, 340 U.S. 474, 488 (1951)). The Commissioner has a corresponding duty to facilitate the court's review: "[w]here the [Commissioner] is faced with conflicting evidence, he must adequately explain in the record his reasons for rejecting or discrediting competent evidence." Ogden v. Bowen, 677 F. Supp. 273, 278 (M.D.Pa. 1987) (citing Brewster v. Heckler, 786 F.2d 581 (3d Cir. 1986)). As the Third Circuit has held, access to the Commissioner's reasoning is indeed essential to a meaningful court review:
Unless the [Commissioner] has analyzed all evidence and has sufficiently explained the weight he has given to obviously probative exhibits, to say that his decision is supported by substantial evidence approaches an abdication of the court's duty to scrutinize the record as a whole to determine whether the conclusions reached are rational.Gober v. Matthews, 574 F.2d 772, 776 (3d Cir. 1978). Nevertheless, the district court is not "empowered to weigh the evidence or substitute its conclusions for those of the fact-finder." Williams, 970 F.2d at 1182.
Some types of evidence will not be "substantial." For example,
[a] single piece of evidence will not satisfy the substantiality test if the [Commissioner] ignores, or fails to resolve, a conflict created by countervailing evidence. Nor is evidence substantial if it is overwhelmed by other evidence particularly certain types of evidence (e.g. that offered by treating physicians) or if it really constitutes not evidence but mere conclusion.Wallace, 722 F.2d at 1153 (citing Kent v. Schweiker, 710 F.2d 110, 114 (3d Cir. 1983)).
The Third Circuit has long held that "[a] court considering a claim for disability benefits must give greater weight to the findings of a treating physician." Mason v. Shalala, 994 F.2d 1058, 1067 (3d Cir. 1993). See Kane v. Heckler, 776 F.2d 1130, 1135 (3d Cir. 1985). This is particularly true "`when the opinion reflects an expert judgment based on a continuing observation of the patient's condition over a prolonged period of time.'" Rocco v. Heckler, 826 F.2d 1348, 1350 (3d Cir. 1987) (quoting Podedworny v. Harris, 745 F.2d 210, 217 (3d Cir. 1984)).
The Third Circuit has also held that the ALJ cannot reject a treating physician's testimony in the absence of contradictory medical evidence.See Jones v. Sullivan, 954 F.2d 125, 128-29 (3d Cir. 1991); Frankenfield v. Bowen, 861 F.2d 405, 408 (3d Cir. 1988); Rossi v. Califano, 602 F.2d 55, 58 (3d Cir. 1979). However, an ALJ can reject the opinion of a treating physician if he or she explains on the record the reasons for doing so.See Allen v. Bowen, 881 F.2d 37, 41 (3d Cir. 1989); Brewster, 786 F.2d at 585. Moreover, apart from the substantial evidence inquiry, a reviewing court is entitled to satisfy itself that the Commissioner arrived at her decision by application of the proper legal standards. Friedberg v. Schweiker, 721 F.2d 445, 447 (3d Cir. 1983); Curtin v. Harris, 508 F. Supp. 791, 793 (D.N.J. 1981).
III. Analysis
In this case, the plaintiff requested benefits based on both physical and mental impairments. The ALJ found that plaintiff's mental impairment was not severe, and that her musculoskeletal impairment doesn't prevent her from performing her past relevant work as a systems analyst and as a systems programmer. Plaintiff argues that the Commissioner's final decision denying her SSI and Disability insurance benefits was not supported by substantial evidence. Specifically, plaintiff argues that the ALJ erred in two instances. First, plaintiff argues that there was not substantial evidence supporting the ALJ's decision that the plaintiff's mental impairment is not severe. (Pl. Br. 1-8.) Here, plaintiff contends that the ALJ misinterpreted and improperly discounted certain portions of Dr. Geller's report on plaintiff's mental status. (Id.) Second, plaintiff argues that there was not substantial evidence to support the ALJ's finding that the plaintiff's testimony regarding her complaints of pain was not fully credible. (Pl. Br. 8-10.)
For the following reasons, this court disagrees with Ms. Grover's contentions and finds that the ALJ's determination was based on substantial evidence. The court will therefore affirm the Commissioner's decision.
A. Whether the ALJ's Determination that Plaintiff did not have a Severe Mental Impairment is Supported by Substantial Evidence
Plaintiff alleges that there was not substantial evidence establishing that the plaintiff's mental impairment is not severe. (Pl. Br. 1-8.) Plaintiff contends that Dr. Geller's rating of certain work related abilities as "fair" may provide evidence that plaintiff currently suffers from a severe mental impairment. (Id. 2-3.) Plaintiff asserts that the ALJ discounted these findings without reason and instead made speculative inferences from the report that Dr. Geller rated the plaintiff's overall mental capacity as "good". (Id. at 3.)
Although an ALJ cannot substitute his or her own judgment for that of a doctor, an ALJ is not bound to accept a medical opinion regarding a claimant's disability without weighing it against the other evidence of record. Kent v. Schweiker, 710 F.2d 110, 115 n. 5 (3d Cir. 1983). When evaluating the existence of a mental impairment, the impairment "alone cannot be considered disabling without a showing of severe functional loss, that is, and inability to engage in substantial gainful activity."Hall v. Schweiker, 567 F. Supp. 213, 217 (E.D.Pa. 1983). Further, although the ALJ will consider medical opinions to determine whether a claimant is "disabled", the ALJ has the final responsibility to determine the claimant's residual functional capacity to perform past relevant work. 20 C.F.R. § 404.1527(e)(2) and 416.927(e)(2) (1995).
Plaintiff appears to argue that Dr. Geller's report alone is sufficient evidence to support a finding of a severe mental impairment without consideration of the remaining record. However, the ALJ is under no obligation to adopt the findings of one report before weighing the evidence in the record as a whole. See Kent v. Schweiker, at 115 n. 5. In this case, the ALJ reviewed the entire record and concluded that the claimant
does not have a severe mental impairment. She does not have ongoing evidence of psychosis. While she carries a diagnosis of major depression, the medical findings establish that she does not have more than minimal limitations in her ability to perform basic mental work-related activities. The claimant testified that she had a nervous breakdown in July 1992 and has seen a psychologist since then, but she did not testify as to ongoing symptoms or limitations. Consideration of the record as a whole establishes that she does not have a `severe' mental impairment.
(R. 17.) There is substantial evidence in the record supporting the ALJ's conclusion.
Dr Geller's own report indicates that the plaintiff had an episode of major depression which is now in remission. (R. 242.) He reported that during her mental evaluation, plaintiff was grossly oriented, her affect was neutral, and there was no evidence of hallucinations, delusions or looseness of association. (R. 241.) Plaintiff's memory was three out of three immediately and three out of three after six minutes. (Id.) She was able to calculate how many quarters were in $3.75, and she could make change from a dollar. (Id.) She was also able to interpret proverbs abstractly. (Id.) Based on these findings and the remaining medical evidence in the record, the ALJ was not required to adopt Dr. Geller's assessments of limitations in plaintiff's concentration, reliability, and ability to handle complex job instructions.
The ALJ's decision not to rely on Dr. Geller's limitations assessments is bolstered by the findings of Dr. Ira Fox. Dr. Fox evaluated plaintiff during her stay in the Rancocas Hospital from July 22, 1992 through August 3, 1992 for an episode of depression. (R. 179.) Dr. Fox concluded that plaintiff displayed improvement throughout the hospital stay and benefitted greatly from the therapy she had received. (Id.) Following the therapy, Dr. Fox concluded that plaintiff may return to work on August 4, 1992. (R. 180.)
The ALJ also relied on the findings of Dr. Lewis Alban, a clinical psychologist. Dr. Alban concluded that plaintiff's affect varied between normal, anxiety, and depression. (R. 207.) He further determined that she was oriented to time, place and person; her behavior was not compulsive; and she had no phobias. (R. 208.) Although Dr. Alban did find evidence of depression, there was no evidence of major thought disorder. (Id.) Plaintiff was able to repeat seven random digits in order without error and was able to count backwards from 100 by threes. (R. 207.) She exhibited a basic command of knowledge by identifying the current President of the United States, current governor of New Jersey, the season, month, date, year, day of the week, the town in which Dr. Alban is located, and Dr. Alban's name. (Id.) Dr. Alban determined that plaintiff had a global assessment functioning score of seventy. (R. 208.)
In the Diagnostic and Statistical Manual of Mental Disorders , 32 (4th ed. 1994), a score of 70 on the Global Assessment of Functioning Scale indicates that the party may exhibit some mild symptoms (e.g. depressed mood and mild insomnia) or some difficulty in social, occupational or school functioning, but generally functions pretty well, and has some meaningful interpersonal relationships.
Furthermore, the ALJ considered the findings of Sidney Moss, a private practice psychologist, who treated plaintiff from August 1992 through March, 1993. (R. 203.) In his final assessment of plaintiff, Mr. Moss concluded that her usual daily activities are "normal" and she has "no problem" with her ability to shop, work around the house, attend house of worship, and use public transportation. (Id.) He found that plaintiff has "good" ability to relate and socialize with other people and that her residual ability to comprehend, follow instructions, and adapt to work situations are "excellent." (Id.) Mr. Moss concluded that plaintiff is capable of making all occupational, personal, and social adjustments. (R. 204.)
There is substantial evidence in the record to support the ALJ's determination that plaintiff failed to sustain the burden of proof that she was entitled to Social Security benefits. Although Dr. Geller has performed the most recent evaluation of plaintiff, there is no evidence offered to establish that plaintiff has experienced any changes in her life which would affect or worsen her symptoms of depression. Dr. Geller's evaluation is, at most, one factor weighing in favor of plaintiff's claim. However, the ALJ relied on a number of additional factors, including consistent medical reports which indicate that plaintiff does not currently suffer from severe mental impairments. The court must uphold the decision of the ALJ unless it is not supported by substantial evidence. Sullivan 970 F.2d at 1182. Here, the evidence in the record reviewed as a whole supports the ALJ's decision and this court cannot say that it lacked substantial evidence.
Since the ALJ determined that plaintiff's mental impairment was not severe, he was not required to determine how the impairment may affect her ability to perform past relevant work. 20 C.F.R. § 404.1520(c),(e), 416.920(c),(e). Nonetheless, as part of his analysis of plaintiff's mental impairment, the ALJ also found that she was capable of performing her past relevant work. This finding appears to be supported by substantial evidence.
B. Whether Substantial Evidence Supports the ALJ's Finding that Plaintiff's Subjective Complaints of Pain were not Fully Credible
Plaintiff alleges that there was not substantial evidence to support the ALJ's determination that her testimony as to the frequency and severity of her pain was not credible. (Pl. Br. 8.) When evaluating the existence of a disability, subjective complaints of pain "do not in themselves constitute disability." Green v. Schweiker, 749 F.2d 1066, 1070 (3d Cir. 1984). They must be accompanied by medical signs and laboratory findings which show that the claimant has a medical impairment which could reasonably be expected to produce the pain or other symptoms alleged. See Bittel v. Richardson, 441 F.2d 1193, 1195 (3d Cir. 1971). In the present case, the ALJ indeed found that the medical evidence established that plaintiff had a severe musculoskeletal impairment. (R. 16.)
But the inquiry does not end here. Even if a medically determinable impairment exists which can reasonably be expected to produce pain, the intensity and persistence of symptoms must also be evaluated in order to determine how they might limit a claimant's ability to work. See 20 C.F.R. § 404.1529(c)(1) 1995). And when a claimant's subjective complaints of pain indicate a greater severity of impairment than the objective medical evidence supports, the ALJ can give weight to factors such as physician's reports and claimant's daily activities. See 20 C.F.R. § 404.1529(c)(3) (1995).
In this case, the ALJ found that the plaintiff's subjective allegations as to the frequency and severity of her pain and limitations are not supported by the medical record. (R. 18.) The ALJ made an initial finding that the plaintiff has retained the residual functional capacity to perform her past relevant work as a systems analyst and as a systems programmer since such work does not require exertion beyond lifting more than 10 to 15 pounds. (R. 17.) The ALJ indicated that this type of work is described a "sedentary" by the Dictionary of Occupational Titles. (Id.)
The definition of sedentary work as
promulgated by the Social Security Administration Sinvolves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.20 C.F.R. § 404.1567(a) (1995).
In making his determination, the ALJ relied in large part on the findings of Dr. Chandra Gupta. Dr. Gupta examined the plaintiff on June 18, 1994. (R. 246.) An examination of the neck did reveal a myofascial area on deep palpation. (R. 248.) However, there was no muscle tenderness, and plaintiff had full range of motion in the neck, shoulders and back. (Id.) Plaintiff presented no evidence of muscle atrophy, exhibited normal muscle tone and strength, and displayed full muscular power in all extremities. (Id.) Dr. Gupta also assessed the plaintiff's residual functional capacity and found that plaintiff is able to lift a maximum of 10-15 pounds as well as stand, walk, and sit without limitation. (R. 249-50.) The plaintiff is also able to climb, balance, stoop, crouch, kneel, and occasionally crawl. (R. 250.) Further, Dr. Gupta concluded that plaintiff's abilities to reach, bend, feel, see, hear, speak, and handle and perform fine manipulation are unaffected by her musculoskeletal impairment. (Id.)
The ALJ noted that Dr. Gupta's assessment of plaintiff's abilities is fully supported by the remaining medical evidence in the record. (R. 17.) An MRI performed on February 1, 1993 revealed mild ventral impression on the thecal sac centrally at the C6-C7 and C3-C4 levels due to mild osteophytic ridges. (R. 192.) There was no evidence of spinal cord compression. (Id.) Dr. George Chatyrka examined the plaintiff on February 2, 1993 and reported that there was a decrease in plaintiff's range of motion of the cervical area. (R. 188.) However, Dr. Chatyrka noted that he had difficulty ascertaining whether the plaintiff's complaints of pain were real pain or pain from a more psychosomatic nature. (R. 189.) Furthermore, Dr. Gupta's June 30, 1994 evaluation revealed that plaintiff's motion was full. (R.248.) Dr. Luis Cervantes examined the plaintiff on February 5, 1993 and found that plaintiff did not exhibit any paravertebral muscle spasm or muscle tightness. (R. 194.) Further, Dr. Cervantes found that plaintiff had no muscle weakness or atrophy, no sensory loss, and full range of motion of her cervical and lumbar spines. (Id.)
During plaintiff's testimony, she complained of pain in the neck and back which results in severe headaches. (R. 62.) She testified that she could not sit for longer than a couple of hours before experiencing sharp pains in her back and that she could not stand or walk for prolonged periods of time or bend to lift items. (R. 62, 64.) Plaintiff further testified that she could not continue her recommended therapy because it caused intense pain which she could not "handle." (R. 62.) However, despite plaintiff's complaints, the ALJ recognized that since the alleged onset of disability, the plaintiff has not had active ongoing treatment. (R. 18.) Moreover, plaintiff was actually discharged from physical therapy after her initial evaluation due to non-compliance. (R. 229, 233-34.)
The ALJ further determined that plaintiff's description of her daily activities contradict her allegations of debilitating pain. (R. 19.) Plaintiff testified that she drives her own van to go shopping "once or twice a week." (R. 39.) She testified that she goes out to dinner as well as cleans and vacuums her home. (R. 39-40.) Plaintiff traveled to Florida by car in 1993 and by plane in 1994. (R.40.) She also drives half an hour every two weeks to visit her brother. (R. 43.) The ALJ took this testimony as evidence that the plaintiff is not incapacitated by pain but, rather, is able to perform numerous exertional activities. (R. 19.)
This court declines to substitute its own determination of credibility for that of the ALJ, given that the ALJ had the opportunity to observe the plaintiff first-hand. See Wier v. Heckler, 734 F.2d 955, 962 (3d Cir. 1984) (recognizing that great deference is given to the ALJ's discretion "`to evaluate the credibility of a claimant and to arrive at an independent judgment, in light of medical findings and other evidence, regarding the true extent of the pain alleged by the claimant.'" Brown v. Schweiker, 562 F. Supp. 284, 287 (E.D.Pa. 1983) (quoting Bolton v. Secretary of Health Human Services, 504 F. Supp. 288, 291 (E.D.N.Y. 1980)).
There is substantial evidence in the record that indicates that the plaintiff's testimony of debilitating pain was not credible. Even the plaintiff, in her brief, concedes that her "testimony concerning her activities of daily living may not demonstrate that she is incapacitated by pain." (Pl. Br. 9.) To be found disabled requires "more than mere inability to work without pain;" the pain must be "so severe, by itself or in conjunction with other impairments, as to preclude any substantial gainful employment." Dumas v. Schweiker, 712 F.2d 1545, 1552 (3d Cir. 1983). The ALJ did acknowledge that plaintiff may not be able to perform heavier lifting, however this limitation would not prevent her from performing her past relevant work as a systems analyst and a systems programmer. (R. 19.) Based on the objective medical findings in the record and plaintiff's own testimony, this court cannot say that the ALJ's assessment of plaintiff's credibility was not supported by substantial evidence.
IV. Conclusion
For the reasons discussed above, this court finds that the Commissioner's determination that Mrs. Grover is not disabled is supported by substantial evidence. This court affirms the Commissioner's final decision denying plaintiff's claim for a period of Social Security Disability and Disability Insurance Benefits.
The accompanying order is entered.
O R D E R
This matter having come before the court upon plaintiff Iris Grover's application to review the final decision of the Commissioner Of the Social Security Administration denying plaintiff's application for Supplemental Security Income under Title XVI and Disability Insurance benefits under Title II of the Social Security Act; and this court having considered the entire record and all submissions on behalf of the parties; and for the reasons stated in the Opinion of today's date; and for good cause shown;
It is this 7th day of December, 1998, hereby ORDERED that the plaintiff's appeal be, and hereby is DENIED and the final decision of the Commissioner be, and hereby is, AFFIRMED.