Opinion
Civil Action No. 97-4699 (NHP)
August 2, 1999
James Langton, Esq., LANGTON ALTER, Rahway, N.J., Attorneys for Plaintiff.
Anthony J. La Bruna, Jr., Assistant U.S. Attorney, FAITH S. HOCHBERG, UNITED STATES ATTORNEY, Newark, N.J., Attorneys for Defendant.
THE ORIGINAL OF THIS LETTER OPINION IS ON FILE WITH THE CLERK OF THE COURT
Dear Counsel:
Plaintiff Concepcion Guerra brings this action pursuant to §§ 205(g) and 1631(c) of the Social Security Act, 42 U.S.C. § 405(g) and 1383(c)(3). She seeks review of the Commissioner of Social Security's denial of her claim for disability insurance benefits and supplemental security income ("SSI"). For the reasons stated herein, the Commissioner's decision is AFFIRMED.
STATEMENT OF FACTS
On April 24, 1989, Plaintiff filed for Social Security disability benefits alleging a disability due to an inflammation in the nerve root, spondylitic at the C6-7 level and high blood pressure. Plaintiff complained of pain in her neck, shoulder and arm. (Tr. 51-54, 96-103). The application for benefits was denied both initially and on reconsideration. (Tr. 78-82, 85-86).Upon request, a hearing took place before Administrative Law Judge ("ALJ") Gregui Mercado on July 8, 1996. ALJ Mercado rendered a decision on Sept. 19, 1996, determining that Plaintiff was not entitled to disability insurance benefits. (Tr. 14-25, 27-50). The appeals council denied Plaintiff's request for review, making the decision final. (Tr. 5-6). An appeal to this Court ensued.
At the July 8, 1996 hearing, Plaintiff testified that she was born on Dec. 8, 1944. She is married with three children and she completed the third grade in Cuba. Plaintiff testified that she can read and write in Spanish, but cannot understand English at all. (Tr. 34). She has a driver's license, but does not drive.
Plaintiff's last employment was in October, 1993, as an embroiderer, a job she had performed for 18 years. Her job was performed while sitting. (Tr. 34, 36). According to Plaintiff's testimony, she worked with fabric 15 yards long and five feet wide and was required to push and pull the fabric to get it into the sewing machine. The heaviest she had to lift was seven pounds. (Tr. 35).
Plaintiff testified that she ceased working because of severe pain in her back. She stated that due to a fall, she damaged a disc in her back and cannot bend her head because of the pain. (Tr. 36). Plaintiff claimed that she is only able to stand for an hour or sit for 15 minutes before the pain increases. (Tr. 37). She said she can walk two or three blocks and that she can bend, but must do so very slowly. (Tr. 38).
Plaintiff stated that her back gets swollen when she rotates her hands in a circular motion and that she cannot lift her arm for long periods of time. According to her testimony, she also has a problem rotating her neck. (Tr. 38-40). Plaintiff stated that she participated in some physical therapy, but it only helped a little. (Tr. 40).
Plaintiff testified that she is being treated by a psychologist who prescribed medication to relax her and help her sleep. She then stated that she cannot sleep without the medication. (Tr. 41-42). Plaintiff also claimed that she is frustrated with her back condition and that she sometimes loses control because of it. She testified that she was hospitalized for six days due to a severe attack of gastritis and every day suffers from nausea, vomiting and diarrhea. (Tr. 45). Plaintiff claims to spend her time at home where she preforms very few duties, leaving the housework to her husband or daughter. Plaintiff is capable of performing her personal needs, but her daughter fixes her hair. (Tr. 46-47).
Plaintiff testified that she has no hobbies, though she will sometimes go shopping with her husband. She only drives when there is an emergency. (Tr. 48).
On Sept. 19, 1996, Judge Mercado issued a decision that the Plaintiff was not disabled because she retained the residual functional capacity to perform her past duties as an embroiderer. This appeal followed.
DISCUSSION
In order to be eligible for benefits under the Social Security Act, the Plaintiff must meet all relevant requirements of the statute.
First, the Plaintiff must meet the insured status requirements described in 42 U.S.C. § 423(c) for disability benefits, in addition to the income and resource limitations set forth in 42 U.S.C. § 1382(a) and (b) to receive SSI benefits
The Plaintiff must also show that he or she is not currently engaged in gainful activity. See 42 U.S.C. § 423(d)(1)(A) and § 1382(c)(a)(3)(A). Finally, the claimant must be disabled as defined in 42 U.S.C. § 423(c)(2)(B)(d) and § 1382(c)(3)(B):
An individual is determined to be under a disability 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 kinds of substantial gainful work which exists in the national economy. . . .42 U.S.C.A. §§ 423(c)(2)(B)(a) and 1382(c)(3)(B).
The Plaintiff meets the insured status requirements and has not engaged in substantial gainful employment since February 28, 1994. Therefore, the question for the Administrative Law Judge to resolve was whether the Plaintiff was "disabled" within the meaning of the statute.
In making this determination, the ALJ must consider five factors in order:
1. One who is working and engaging in substantial gainful activity will not be deemed "disabled," regardless of the medical evidence. 20 C.F.R. § 404.1520(b).
2. An individual with no "severe impairment" is not disabled. 20 C.F.R. § 404.1520(c).
3. If Plaintiff is not working and has a "severe impairment" that meets the twelve-month duration requirement and that impairment "meets or equals" a listed impairment in Appendix 1, Subpart P, Regulation No. 4, the Plaintiff is deemed "disabled" regardless of other vocational factors. 20 C.F.R. § 404.1520(d).
4. Plaintiff is not disabled if she is capable of performing work that she has in the past. 20 C.F.R. § 404.1520(e).
5. If the impairment is so severe that past work cannot be performed, the ALJ must consider factors such as age, education, past work experience and residual functional capacity to determine if claimant is capable of performing any work at all. 20 C.F.R. § 404.1520(f).
Therefore, in order to receive the requested benefits, the Plaintiff must have an impairment so severe that it creates functional limitations which will not allow her to perform any job which exists in the national economy.
In this case, the ALJ considered the above-listed factors and ruled that the claimant was not disabled within the confines of § 1614(a)(3)(A) of the Social Security Act. In making this determination, Judge Mercado made the following findings:
1. The claimant met the disability insured status requirements of the Act on February 28, 1993, the date the claimant stated she became unable to work, and met them through December of 1994.
2. The claimant has not engaged in substantial gainful activity since February 28, 1994.
3. The medical evidence establishes that the claimant has right C6 chronic radiculopathy and posterior spondylitic ridging at C5-C6 with a depressive reaction, and gastritis, but that she does not have an impairment or combination of impairments listed in, or medically equal to one listed in Appendix 1, Subpart P, Regulations No. 4.
4. The claimant's subjective complaints are not fully credible considering the objective medical evidence, the conservative treatment of the claimant, and the claimant's testimony at the hearing.
5. The claimant has the residual functional capacity to perform light work.
6. The claimant's past relevant work experience as a sewing machine operator did not require the performance of work-related activities precluded by her residual functional capacity. ( 20 C.F.R. § 404.1565 and 416.965).
7. The claimant's impairment does not prevent the claimant from performing her past relevant work.
8. The claimant was not under a "disability" as defined in the Social Security Act, at any time through the date of the decision.( 20 C.F.R. § 404.1565 and 416.965).
In opposition to the ALJ's decision, the Plaintiff argues that the decision was not based on substantial evidence. More specifically, the Plaintiff asserts two issues for appeal: (1) that the ALJ failed to explain sufficiently his ultimate conclusion that the Plaintiff can perform her past relevant work; and (2) that the ALJ failed to evaluate the Plaintiff's subjective complaints of pain.
Title 42 U.S.C. § 405(g), which is made applicable to SSI cases by 42 U.S.C. § 1383(c)(3), permits this Court to review the factual findings of the Commissioner of Social Security to determine whether the record contains substantial evidence to support such findings.
This Court is not permitted to conduct a de novo review. See Cotter v. Harris, 642 F.2d 700, 704 (3rd Cir. 1981). Rather, this Court is bound by the Commissioner's conclusions so long as they are supported by "substantial evidence" from the record viewed in its entirety. See Early v. Heckler 743 F.2d 1002, 1007 (3rd Cir. 1984).
In reaching its findings, the ALJ may draw inferences from the evidence and when there is more than one possible interpretation of the evidence, this Court must accept the ALJ's conclusion. See Sample v. Schweiker 694 F.2d 639, 642 (9th Cir. 1982). Even if the record, viewed as a whole, may support a conclusion contrary to the ALJ's conclusion, this Court is required to uphold the decision so long as "substantial evidence" exists. See Social Security Act, § 205(g) as amended 42 U.S.C. § 405(g).
The Supreme Court has defined "substantial evidence" in this context as, "such that might be relevant as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S.(1938)). "Substantial evidence does not mean a large or considerable amount." See Pierce v. Underwood, 487 U.S. 552, 565 (1988). "It means more than a mere scintilla, but may be less than a preponderance." Woody v. Secretary of HHS, 859 F.2d 1156, 1159 (3rd. Cir. 1988).
Claimant's first point asserts that the ALJ's decision was not supported by substantial evidence because he did not sufficiently explain his conclusion that the Plaintiff can perform her past work. This Court does not agree.
The ALJ is not required to be so thorough as to set forth and analyze every minute piece of conflicting evidence. All he needs to do is bring the essential considerations to the forefront with sufficient specificity so that the reviewing court can determine whether substantial evidence exists. See Cotter, 642 F.2d at 705 (3rd Cir. 1981) (citing Baerga v. Richardson, 500 F.2d 309, 312 (3rd Cir. 1974), cert. denied, 470 U.S. 931 (1975)).
In his decision, the ALJ discusses the Plaintiff's injuries from their alleged inception in October 1992, through the time this claim was filed. He examined all medical opinions, treatment regimens and diagnostic evidence from every treating physician. (Tr. 18-20). He analyzed all the relevant evidence in the record, even if he did not systematically dismiss the rare instances where the evidence pointed to a contrary conclusion.
The evidence supports the ALJ's conclusion that the Plaintiff was able to perform her past relevant work. None of the Plaintiff's impairments prevented her from sitting for three hours, standing for three hours, walking for three hours or adhering to the demands of her job. It was the Plaintiff's burden to prove otherwise.
On February 15, 1995, a non-examining state agency physician performed a residual functional capacity assessment of the Plaintiff's ability to perform physical activities (Tr. 62-68). After reviewing the medical evidence and considering the Plaintiff's complaints of pain, the reviewing doctor came to a conclusion that the Plaintiff's physical abilities exceeded even what the ALJ had determined.
The doctor found that Plaintiff could occasionally lift 50 pounds, frequently lift 25 pounds, stand or walk for six hours, and sit for six hours. (Tr. 62). The doctor found that the Plaintiff was capable of performing medium work activities. See 20 C.F.R. § 404.1567(c).
After a complete evaluation of the evidence on record, the ALJ made the determination that the Plaintiff was capable of performing her past work. For this appeal, the Plaintiff fails to point to any specific evidence that she felt the ALJ disregarded to her detriment. That said, the ALJ's conclusion that the Plaintiff is capable of performing past relevant work is reasonable and should be affirmed by this Court.
The Plaintiff's second assertion is that the ALJ improperly evaluated her subjective complaints of pain. Congress has established the type of evidence necessary to prove the existence of a disabling impairment by defining "impairment" as one that "results from anatomical, physiological or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." 42 U.S.C. § 432 (d)(3) and 1382c (a)(3)(c). The Plaintiff has the burden of showing that she is entitled to disability benefits. See 42 U.S.C. § 432(d)(5)(a) and 1382c (a)(3)(c). The Plaintiff must, therefore, point to medical evidence to demonstrate a condition which could reasonably produce the alleged symptoms. See 20 C.F.R. § 404.1529; see also Williams v. Sullivan, 970 F.2d 1178, 1186 (3rd Cir. 1992), cert. denied, 507 U.S. 924 (1993).
Subjective symptoms cannot be the only foundation upon which the Plaintiff claims disability. The ALJ has the discretion to evaluate the credibility of the Plaintiff's complaints of pain and to render an independent judgment based upon the medical evidence. See Van Horn v. Schweiker, 717 F.2d 871, 873 (3rd Cir. 1983). If supported by substantial evidence, this Court must defer to the ALJ's findings. See id.
Even if the medical record provides evidence which may reasonably be expected to produce the alleged pain, the inquiry does not end there. The ALJ then evaluates the intensity and persistence of the symptoms to determine the extent to which her capacity to work is diminished. See 20 C.F.R. § 404.1529 (c)(2) and 416.929(c)(2). If the claimant has alleged symptoms which are of greater severity than the objective evidence would indicate, the ALJ considers other factors such as daily activities, treatment of pain, medications, aggravating factors and other factors such as functional limitations the pain may cause.
In this case, the ALJ found that the Plaintiff's complaints were not credible. Plaintiff's testimony regarding the severity of her symptoms is inconsistent with the results of the medical tests.
In addition, Plaintiff's history of medical treatment does not indicate an ongoing disability. She was first treated at St. Mary's Hospital in January, 1991. (Tr. 123-34). Her next notable injury was on Nov. 1, 1992, when she received emergency room treatment after a fall down her stairs. (Tr. 136-140). On that occasion, the results of the x-rays did not show significant damage. Spine films showed no spondylolisthesis, fracture or bone lesion. (Tr. 139). There was no significant evidence of degenerative change or osteoarthritis. Id. The x-ray of the lumbar spine was equally nondescript. Plaintiff has normal bone density, no fracture or spondylolisthesis and no indication of degenerative damage. Id.
Remarkably, the Plaintiff did not have another medical visit until January 1994, 14 months after her fall and 11 months after the alleged onset of her injury. This treatment was for epigastric pain at Palisades General Hospital. (Tr. 141-44, 148-49). The examination by Dr. Gilberto Gastell revealed nothing significant. Plaintiff's abdominal exam revealed no guarding, no organomegaly, no masses and no "great" tenderness. (Tr. 143). Cervical examination showed no jugular distentions, hepatojugular reflux, bruits, thyromegaly or lymphadenopathy. (Tr. 143).
Plaintiff had full range of motion of her upper and lower extremities. A test for blood clotting in her legs was negative. Blood tests were negative. (Tr. 141). An axial tomography scan of the abdomen and pelvis was negative. A gastrointestinal series and small bowel series were also negative. Id. Because of all the negative tests, Dr. Gastrell could not even determine the cause of the Plaintiff's complaints. There was no medical evidence to suggest that the Plaintiff's discomfort was real or severe. (Tr. 142).
Plaintiff's first treatment for back and neck pain following her fall occurred in October 1994, 20 months after her alleged disability onset date. (Tr. 151). Dr. Oswaldo Salgado's report from that examination indicates that the Plaintiff had fallen on her back in March, 1993. This is the only mention in the record of this fall. The Plaintiff, however, is not able to allege that this fall precipitated her disability, because she claims an onset date one month earlier in February, 1993.
Dr. Salgado's examination indicated a 20 degree limitation in cervical rotation which equates to a four percent impairment of the total person according to the American Medical Association's Guides to Evaluation of Permanent Impairments 122 (4th ed. 1994). Plaintiff also had a 30 degree lateral flexion limitation which equals only a one percent impairment of the total person. (Tr. 120). The remainder of the exam revealed no other abnormalities. Lab tests revealed no disabling spinal conditions. (Tr. 151-152). Although a cervical MRI revealed positive findings at C5-C6, there was no spinal cord involvement. (Tr. 152). No spinal cord abnormalities were ever detected. (Tr. 152).
Plaintiff was also examined by Dr. Frank P. Cammisa in May, 1995. She was able to walk with a normal gait and heel-to-toe walk without a problem. (Tr. 157). She had no difficulty with balance and her range of motion was full. (Tr. 157). Her major joints showed a normal, full and painless range of motion. (Tr. 158).
It is true that the Plaintiff can point to some positive diagnostic findings like a "mild" degenerative change of the lumbar spine and "slight" ridging at C4-C5. Id. However, these minor findings cannot be described as disabling.
"It is not inconsistent to find that a claimant has some pain and discomfort and yet is not so severely impaired as to meet the stringent test for disability imposed by the Social Security Act." Dumas v. Schweiker, 712 F.2d 1545, 1662 (2nd Cir. 1983); Manzo v. Sullivan, 784 F. Supp. 1157, 1158 (D.N.J. 1991).
In addition, the record indicates that the Plaintiff's impairments did not prevent her from engaging in postural activities like climbing, balancing, stooping, kneeling, crouching or crawling. (Tr. 63).
In his discussion of the credibility of the Plaintiff's complaints, the ALJ points to these medical findings and the inconsistencies between them and the Plaintiff's assertions. Plaintiff alleges a disability onset date of February 23, 1993, yet the record shows no evidence of treatment at this time. (Tr. 51). The record shows an injury in November, 1992, with negative results. (Tr. 139). Then, the next medical treatment was 11 months later for a different problem. Plaintiff did not see another doctor for her allegedly disabling back pain until 20 months after she claims she became disabled. The confusion surrounding the onset of the disability, the lack of initial treatment and the lapse in time before subsequent treatment justifies the ALJ's rejection of the Plaintiff's testimony.
Furthermore, the record indicates that Dr. Cammisa recommended medication and rehabilitation to alleviate some of the Plaintiff's symptoms. (Tr. 158). There is nothing in the evidence to suggest that the Plaintiff followed through on the treatment. Dr. Cammisa's recommendations came in May 1995, but as of the time of the ALJ hearing in July 1996, the Plaintiff had no further orthopedic evaluations, physical therapy or further medication. When the Plaintiff did subject herself to treatment, it was very conservative: a diet change, over-the-counter medicine, hot compresses, etc. (Tr. 141, 151).
Therefore, the ALJ's evaluation that the Plaintiff's claims were not credible is clearly supported by substantial evidence in the record and he properly exercised his discretion in making this determination. The ALJ's decision thus was based on substantial evidence in the record which indicates that the Plaintiff had the functional capacity to perform her past work, precluding eligibility for disability and SSI benefits.
CONCLUSION
Accordingly, for the foregoing reasons and on the basis of the record as a whole, this Court finds that the Commissioner's determination that the Plaintiff is not entitled to disability insurance benefits under the Social Security Act should be and hereby is AFFIRMED.
An appropriate Order accompanies this Letter Opinion.