Opinion
Civil Action No. 01-5798.
May 5, 2004
MEMORANDUM AND ORDER
Plaintiff Debra Metz has appealed the final decision of the Commissioner of Social Security ("the Commissioner") denying her claim for disability insurance benefits ("DIB") under Title II of the Social Security Act ("the Act"), 42 U.S.C. § 401-433. Metz and the Commissioner have both moved for summary judgment. These cross-motions for summary judgment were referred to a magistrate judge, who submitted a report and recommendation that I grant the Commissioner's motion for summary judgment, and deny Metz's motion. Magistrate Judge's Report and Recommendation at 2.
Metz has filed objections to the magistrate judge's Report and Recommendation, Pl.'s Objections to the Mag. Judge's Rep. and Rec. [hereinafter Objections], in which she argues that the magistrate judge erred in adopting the Commissioner's findings because such findings are not supported by substantial evidence. Metz contends that the Administrative Law Judge ("ALJ") failed to analyze all of the evidence in the record and failed to provide an adequate explanation for disregarding significant findings that support Metz's disability claim opposition at 1 et seq. Metz also argues that the magistrate judge did not properly weigh and evaluate the opinion of Dr. Spinosa, Metz's primary care physician. Opposition at 4 et seq. Finally, Metz contends that the magistrate judge erred in upholding the ALJ's assessment of Metz's credibility. Opposition at 7 et seq.
The Commissioner has not filed a separate objection or opposition to the objections of Metz. For the following reasons, the court will adopt the magistrate judge's Report and Recommendation.
BACKGROUND
I. Procedural History
On April 7, 2000, plaintiff filed an application for DIB, alleging disability since October 9, 1999, the date that she last worked. R. 7. The Social Security Administration denied plaintiff's claim, but plaintiff requested a hearing before an administrative law judge. R. 62-65.
A hearing was held on June 5, 2001, before Administrative Law Judge Diane C. Moskal, who issued her decision on September 24, 2001. R. 7-14, 22. The ALJ found that Metz was not disabled within the meaning of the Act and that she could return to work. Id. The ALJ's decision became the Commissioner's final decision. R. 4-5.
Metz filed this action on November 19, 2001. After considerable preliminary skirmishing between the parties, the matter was reassigned to me, cross-motions for summary judgment were filed, and I referred it to a magistrate judge for a Report and Recommendation.
II. Factual History
Plaintiff claims that she has been unable to work since October 9, 1999 — when she worked for J.C. Penny as a sales clerk in the drapery department — due to herniated discs and spondylosis of her cervical spine. R. 24-25, 71, 84. Plaintiff has a history of low back and cervical pain for which she began seeking treatment in 1993. R. 85, 113, 206, 237. Sometime between May and July of 1999, after nearly falling from a ladder, plaintiff complained of "spontaneous" onset discomfort in her neck, left shoulder and left arm. R. 138, 166, 225. The pain apparently persisted for several months, and upon her primary physician's recommendation that she stop working at least temporarily, plaintiff did not return to work after October 9, 1999. R. 161, 165-166. After conservative treatment, consisting of physical therapy and steroid injections, plaintiff's pain on her left side was quickly resolved. R. 139, 203. On October 10, 1999, the day after plaintiff stopped working, Dr. Wilson, who had administered plaintiff's first steroid injection, noted that plaintiff's cervical rotation had improved. R. 136-137. After her third injection, plaintiff reported that the pain on her left side was completely alleviated in late November 1999, just over a month after she stopped working. R. 42, 201, 203. At that time, however, plaintiff also reported that she now felt pain on her right side. Id.
Between August 1986 and October 1999, plaintiff held various jobs, including work as a receptionist/greeter, a commissioned salesclerk, and assistant manager. R. 24-25, 85. Dennis Mohn, a vocational expert testified at the administrative hearing that plaintiff's former job as a receptionist/greeter involved doing semi-skilled sedentary tasks, while her former job as a sales clerk entailed doing light duties, and her job as a retail sales manager entailed skilled work at the medium exertional level because of the stocking. R. 52, 54.
Plaintiff was born on April 26, 1952 and was nearly forty-eight years old at the time of her initial application for disability insurance benefits, filed April 7, 2000. R. 22. At the time the ALJ issued her final decision on September 24, 2001, Metz was nearing her fiftieth birthday. Id.
Metz has completed high school.
On March 14, 1997, Metz's primary physician diagnosed Metz with a "probable" herniated disc of the lumbar spine that was causing shooting pain down the right leg with tingling. R. 111-112, 185.
A March 27, 1997 MRI of her lumbar spine suggested she had a herniated disc at the L1-L2 and L5-S1 levels. R. 111-112. The MRI revealed a large, right-sided herniated nucleus pulposus at L5-S1 causing "high-grade compromise of the right neural foramen and some degree of impingement upon the right anterolateral aspect of the dural sac." R. 112. The MRI also revealed a midline disc herniation and protrusion at L1-2 and L4-5. Id.
On May 14, 1997, another study indicated that plaintiff had degenerative disc disease and osteoarthritis between her shoulders, and plaintiff was diagnosed with lumbosacral radiculopathy and prescribed conservative treatment, including a course of epidural steroid injections and physical therapy. R. 114, 115, 117, 207.
In September 1997, plaintiff underwent an electromyogram (EMG) and nerve conduction study (NCS) of her upper extremities, after she complained of worsening numbness and discomfort in her hands. R. 118-121. The EMG/NCS results suggested she had carpal tunnel syndrome that was worse on her left side. R. 120.
In December 1998, Dr. Guarino performed carpal tunnel release surgery on plaintiff's left wrist. R. 284. Dr. Guarino instructed plaintiff that she could return to work in January 1999. Dr. Guarino told her that when she returned to work, she was limited to doing light duty tasks for the first two weeks, and after that time said she could return to "full duty" work with "no restrictions." R. 289. Consistent with Dr. Guarino's opinion, plaintiff continued working as a salesclerk after her carpal tunnel release surgery. R. 85.
According to Metz, the symptoms that Metz described in May 1997 — "aching and burning pain in her upper back between the shoulders which radiated into her head and left shoulder" (R. 113) — and those she later reported in November 16, 1998 — "mid scapular pain" with radicular discomfort in the left and sometimes the right arm depending on different movements — were "essentially the same symptoms" that eventually led Metz to leave work in October 1999. R. 113-116, 168, 170.
Dr. Wilson reported that plaintiff stated it was approximately eight weeks prior to plaintiff's September 17, 1999 visit that Metz experienced the "spontaneous occurrence" of pain, which would mean that the pain occurred in mid-July. R. 138. Metz reported to Dr. Salotto that this incident occurred sometime in May 1999. R. 204. Dr. Spinosa ordered an MRI of Metz's cervical spine when Metz complained of worsening pain between her shoulders as early as June 18, 1999. It is unclear from the record whether this pain occurred initially at the time she almost fell from a ladder.
Metz described her right side pain as a burning between her shoulders, radiating into her right shoulder and down that arm. R. 26, 39. Her symptoms in her right hand and wrist were alleviated by carpal tunnel surgery on May 12, 2000, but she still complained of pain in her right elbow. R. 43-44. At the hearing on June 5, 2001, Metz testified that she had difficulty opening water bottles and that she still dropped things. Id. She reported daily low back pain that increased when she was active. R. 40. She also reported that she could stand no longer than five minutes when preparing meals, and when she was feeling good, she could only dust ten to fifteen minutes before burning pain started in her shoulder and down the right side. R. 38-39. She also stated that she must lie down "every hour or so" to take the pressure off her cervical and lumbar spine to relieve the pain in her back. R. 48. Plaintiff has never received vocational rehabilitation to help her get back to work, although she has received physical therapy and other medical treatments. R. 90. Her medical treatment is outlined in detail below.
Plaintiff sought treatment and/or evaluation from Wendy Rush-Spinosa, M.D., a family practitioner (R. 159-198, 292-297); Edward Guarino, M.D., a plastic and reconstructive surgeon (R. 281-291, 307-309); Thomas DiBenedetto, M.D., an orthopedic specialist (R. 117); Ronald Salotto, M.D., a neurosurgeon (R. 199-207); Zev Elias, M.D., a neurosurgeon (R. 250); Comprehensive Pain Centers (R. 113-116); Lehigh Valley Hospital (R. 122-129, 134-140); Sacred Heart Hospital (R. 143-153, 307-309); Good Shepherd Rehabilitation Hospital (R. 208-228, 251-270, 298-306); Neurosurgical Services, Inc. (R. 154-157); Lehigh Neurology (R. 317-324); Helwig Diabetes Center (R. 141-142); Diabetes Healthways (R. 271-272); and Allentown Associates in Psychiatry and Psychology (R. 310-316). In order to assist plaintiff in the development of her claim, the state agency also referred her to Adam Cox, Ph.D., for a psychological evaluation in June 2000. R. 237.
When Metz complained to her primary care physician, Wendy Rush-Spinosa, M.D., of worsening pain between her shoulders on June 18, 1999, Dr. Spinosa ordered an MRI of Metz's cervical spine. R. 168. The MRI, dated August 6, 1999, revealed that Metz had "multilevel disc abnormalities of the cervical spine from C4-5 through C7-T1 [and m]oderate to large size broad-based central and left-sided posterior disc herniation at C4-5 causing anterior cord compression." R. 130-131 (notes of Dr. Todd Siegal). Based on these findings, Dr. Spinosa referred Metz to Dr. Arnold G. Salotto, a neurosurgeon whom Metz had seen in April 1997 for low back pain. R. 206.
Dr. Salotto examined Metz on September 3, 1999 and found that the "left sided moderately large herniation" revealed in the August 1999 MRI was the source of Metz's symptomatology. R. 204. Dr. Salotto noted that Metz "appears to have radicular type symptoms most consistent with the C4-5 herniation on the left side." R. 204. He recommended conservative treatment. Id. Dr. Salotto advised that Metz attend physical therapy and referred her to Robert E. Wilson, D.O., a pain specialist, for epidural steroid injections. Id. at 205.
Plaintiff saw Dr. Wilson for a pain management evaluation on September 17, 1999. R. 138-140. Dr. Wilson noted that Metz's cervical rotation to the right was only 50% with pain. Id. Dr. Wilson concurred with Dr. Salotto and recommended that plaintiff begin a course of physical therapy and epidural steroid injections. R. 139. Dr. Wilson administered the first epidural steroid injection and scheduled a follow-up appointment for a second injection two weeks later. R. 139-140.
Meanwhile, plaintiff's primary care physician, Dr. Wendy Rush-Spinosa, noted on October 7, 1999, that Metz "hurt her back with shoulder radiating to left side . . . sharp stabbing pain — worse walking upstairs." R. 166. Dr. Spinosa prescribed pain relievers (Darvocet, Vicoden), and a muscle relaxant (Robaxin). She also recommended that Metz stop working at least temporarily, which Metz did after October 9, 1999. R. 161, 165-166.
On October 10, 1999, Dr. Wilson noted that plaintiff's cervical rotation to the right had improved and was now at 80% with pain and administered a second injection. R. 136-137.
On October 15, 1999, plaintiff underwent an MRI scan of her thoracic spine, in order to investigate her complaints of back discomfort, which Joel Swartz, M.D., described as "[a]typical back pain." R. 132. Dr. Swartz found that Metz's thoracic cord was normal but that there was "premature mid thoracic disc degeneration with loss of disc signal and disc height and small focal disc herniations present at three contiguous mid thoracic intervertebral disc spaces." Id. Dr. Swartz found "no evidence of thoracic cord compression, expansion or internal signal aberration at any level." Id.
Plaintiff began physical therapy in November 1999 at Good Shepard Rehabilitation Hospital upon Dr. Spinosa's recommendation. During her initial physical therapy evaluation, on November 2, 1999, Metz stated that she was having difficulty with household chores like vacuuming, loading and unloading the dishwasher, doing laundry, and mopping the floor. R. 226. Metz also described radiating symptoms in both upper extremities, worse on the right side. R. 209, 225-228. On November 11, 1999, Dr. Wilson administered a third epidural steroid injection to plaintiff's cervical spine. R. 134-135.
After plaintiff completed her treatment course of three epidural steroid injections and while continuing with physical therapy, she returned to Dr. Salotto on November 22, 1999. R. 203. Plaintiff told Dr. Salotto she had experienced "complete resolution of her left arm pain." Id. However, she also noted "newer right shoulder and upper arm pain down to her elbow . . . [which] occurs intermittently but is somewhat annoying to her." Id. Dr. Salotto advised plaintiff to continue with physical therapy and scheduled a reevaluation appointment in six to seven weeks. Id. Dr. Salotto noted that if the symptoms continued in the right arm after that time, he would like to repeat the MRI to see if any changes had occurred. Id.
On January 11, 2000, Dr. Salotto saw plaintiff for a follow-up visit. R. 202. He noted that plaintiff "has had some benefit from physical therapy" and that her exam "shows normal strength" and that "[h]er gait is normal." Id. He also noted that "[s]he does have some decrease in pinprick sensation in an ulnar distribution bilaterally." Id. Dr. Salotto ordered a repeat MRI scan, the results of which suggested that Metz had "multiple levels of disc protrusion and spondylosis." R. 201. On March 7, 2000, upon reviewing the results of the MRI, Dr. Salotto decided to order a cervical myelogram Id. During this visit, Dr. Salotto also noted that plaintiff "has not had any recurrent left arm symptomatology." Id. Plaintiff reported that "she continues to have problems with neck, right shoulder and arm pain"; that "the right arm pain and tingling is limiting to her normal activities"; and that she "has some weakness into the right hand such as when she is attempting to open a lid from a bottle." Id. Dr. Salotto noted that the numbness plaintiff reported in the ulnar aspect of her hand and forearm is consistent with a C8 dermatome. Id.
On March 13, 2000, Dr. Salotto saw plaintiff again after she underwent a myelogram and a post-myelogram CT scan of her cervical spine. R. 143-153, 200. The myelogram revealed "no gross abnormalities." R. 150. Jeffrey S. Blinder, M.D., who read the report, and Roy Fertakos, M.D., who verified the reading, found that "[t]he only remarkable finding is a prominent posterior osteophyte with disc herniation at C4-C5"; however, the report also noted that "this is towards the left side which is opposite from the side of patient's symptoms." R. 149. Similar to her August 1999 MRI scan, the only "abnormality" on plaintiff's post-myelogram CT scan was a "prominent spur [or posterior osteophyte] and [C4-C5] disc herniation compressing the left side of the ventral aspect of the cord." R. 149. Dr. Salotto agreed with Drs. Blinder and Fertakos, noting also that there were "some milder changes seen to other levels" but that he "could not detect any evidence of nerve root compression on the right side to account for [the plaintiff's] symptomatology," especially her more distal symptoms. R. 200. Dr. Salotto referred Metz for an EMG nerve conduction study (NCS) on her right arm so that he could compare this to prior studies to determine if there were new changes, particularly involving the ulnar nerve. R. 200.
Drs. Blinder and Fertakos did note that the study was somewhat compromised by "dilutional effect" caused by plaintiff's obesity. R. 150.
On March 21, 2000, plaintiff underwent an EMG/NCS of her right upper extremity, which revealed "no evidence of an acute radiculopathy" stemming from a disc herniation, but reported that she had "[m]edian nerve entrapment neuropathy at the wrist consistent with carpal tunnel syndrome." R. 155. Douglas C. Nathanson, M.D., who reported the results of the EMG study noted that there was no evidence of any ulnar entrapment neuropathy "despite patient's symptoms of parethesias in the hypothenar eminence and fifth finger." R. 155-157.
In December 1998, plaintiff had had surgery for carpal tunnel release on the left wrist. Supra note 3. She mentioned to Dr. Salotto on April 10, 2000 that she was scheduled to have Edward Guarino, M.D., release the right carpal tunnel in the near future. R. 199. Following the EMG/NCS, Metz saw Dr. Guarino for evaluation of possible right carpal tunnel surgery. Dr. Guarino described her recent EMG as "strongly positive" for right carpal tunnel syndrome. R. 283. Dr. Guarino recommended and performed a release for Metz's right carpal tunnel on May 12, 2000. R. 281.
At plaintiff's follow-up visit on April 10, 2000, Dr. Salotto noted the EMG study "showed changes consistent with carpal tunnel syndrome on the right." R. 199. Dr. Salotto indicated that plaintiff showed normal strength in both upper and lower extremities and that "[h]er symptoms appear to be proximal to the right shoulder, scapular and upper arm area." Id. Dr. Salotto also reviewed her cervical myelogram again and confirmed that there did "not appear to be any nerve compression on the right side consistent with her symptoms." Id. Dr. Salotto did not recommend surgery or schedule another follow-up but noted that he would be glad to see the plaintiff for "follow-up if necessary in the future." Id.
Meanwhile, plaintiff had been showing signs of improvement with therapy with Good Shepard Rehabilitation Hospital, but once she began to experience an increase in symptoms (apparently connected with reaching when removing laundry from a washing machine), she requested that therapy be placed on hold pending a follow-up with her physician, which was scheduled for March 7, 2000. R. 215. Plaintiff's last physical therapy session was on February 9, 2000. Id. She was discharged from therapy on March 20, 2000 because she had not contacted the department after her doctor's appointment scheduled for March 7. Id.
It is unclear from the record which appointment Metz was referring to.
On April 18, 2000, before the carpal tunnel surgery on her right hand, plaintiff returned to the Good Shepard Rehabilitation Hospital upon Dr. Salotto's recommendation for an additional four- to six-week course of physical therapy in order to treat her complaint of increasing right upper extremity symptoms. R. 209-211. Plaintiff continued in the physical therapy program until Jill Speer, a physical therapist, discharged her from the program in September 26, 2000. R. 251-270. At her most recent physical therapy assessment prior to the discharge, on August 29, 2000, plaintiff reported "decreased pain and paresthesia in her right upper extremity," as well as "increased ability to perform activities at home such as loading and unloading dishes and folding wash." R. 251. Plaintiff also reported intermittent radiation of pain and paresthesia to the right fourth and fifth digits. Id. Speer reported that her patient's progress had plateaued and noted that "all short and long-term goals set upon initial evaluation have been achieved with the exception of increasing cervical range of motion to 75% of normal and returning to premorbid level of function." R. 252. Speer reported that functionally "patient is independent with ADL's" (activities of daily living). Id.
In addition, Dr. Spinosa referred plaintiff for an x-ray of her right shoulder in July 17, 2000. R. 277. The x-ray was normal. Id.
On September 15, 2000, following her right carpal tunnel surgery, plaintiff visited Dr. Elias (at Dr. Salotto's former practice) for another neurosurgical evaluation of her neck and right shoulder discomfort as well as diffuse paresthesia involving her upper right extremity. R. 250. Plaintiff was not taking any medication for discomfort at the time. Id. She complained of pain in the neck and right shoulder and with certain postures of her head, and diffuse paresthesia into her right upper extremity. Id.
Dr. Elias reported that her motor testing of the upper extremities was 5/5 throughout, that sensory was intact to pinprick, and that she had no discomfort with abduction of her right shoulder. Id. Dr. Elias reiterated Dr. Salotto's prior comments that there were no findings on plaintiff's diagnostic studies to readily explain her right-sided symptoms. Id. Consequently, Dr. Elias made no formal arrangements for a follow-up exam and recommended that she undergo a formal rehabilitation medicine evaluation to determine whether therapy would be beneficial. Id.
Dr. Spinosa continued to prescribe medication (pain relievers, muscle relaxants and anti-inflammatories) for Metz's neck and upper extremity symptoms as late as February 7, 2001. R. 159-198, 273-280.
During this time, plaintiff also had breast reduction surgery. In February 2001, plaintiff returned to see Dr. Guarino in order to make arrangements for breast reduction surgery. R. 286. Dr. Guarino performed the procedure on April 24, 2001. R. 307.
On April 15, 2001, Dr. Spinosa completed a "Physical Residual Functional Capacity Questionnaire" (hereinafter "Questionnaire") on plaintiff's behalf. R. 292-297. Dr. Spinosa concluded in the Questionnaire that plaintiff was limited to doing less than the full range of sedentary work. Id. In particular, Dr. Spinosa checked off boxes and circled numbers to indicate that plaintiff was limited to work that involved occasionally lifting and carrying less than ten pounds; entailed sitting no more than forty-five minutes at one time and standing no more than fifteen minutes at one time; required sitting, standing or walking no more than two hours total in an eight-hour workday; allowed her to shift her position at will between sitting, standing or walking; and permitted one to two unscheduled breaks hourly. R. 294-295. Dr. Spinosa also checked off a box estimating that plaintiff would be absent from work about four times a month because of her medical impairments or treatment. R. 296.
The Commissioner notes that there appear to be two different handwriting styles on the Questionnaire such that it is unclear whether Dr. Spinosa completed the entire Questionnaire herself. The contention is irrelevant to my review of the ALJ's decision.
On July 25, 2001, upon Dr. Spinosa's referral, plaintiff saw Jay Varrato, D.O., for a neurological evaluation of her complaints of chronic right arm pain and discomfort for the last three years. R. 322-324. Plaintiff also complained that she had experienced low back pain with radiation into the right buttock and leg, which "has been chronic over years and not significantly changed." R. 322. Dr. Varrato reviewed plaintiff's multiple MRI scans before the evaluation, which gave the impression of "[m]ild cervical spondylosis." R. 322-324. On examination, plaintiff reported multiple tender points about her cervical spine, shoulders, and low back region. R. 323. Her formal motor testing was normal, and there was no atrophy noted in her proximal and distal muscles. Id. She exhibited "mild" median sensory loss in her right hand to pinprick sensation, but otherwise her sensory exam was normal. Id. Her reflexes were intact, and her gait testing was normal. Id.
Dr. Varrato concluded that plaintiff's exam was "most consistent with musculoskeletal or fibromyalgia type pain." R. 324. Dr. Varrato ordered an EMG/NCS in order to determine whether she had radiculopathy. Id. Dr. Varrato recommended continued conservative management of plaintiff's condition, including continued exercise and weight loss. Id.
Plaintiff underwent the EMG/NCS the next month on August 14, 2001. R. 317-321. While plaintiff's August 6, 1999 MRI had indicated she had a herniated disc at the C4-C5 level, her EMG/NCS revealed no evidence of radiculopathy at that level. R. 317. The report revealed "likely" superimposed radiculopathy at the C8 level. R. 130-131. The EMG/NCS also showed that Metz had "mild to moderate ulnar entrapment neuropathy at her right elbow which is primarily demyelinating with some evidence of distal axon loss and signs of mild chronic bilateral median entrapment neuropathy at the wrist or carpal tunnel syndrome." R. 317.
Summarizing plaintiff's various conditions, she reported to Dr. Salotto in March 2000 that she had not had discomfort in her left shoulder or arm since January 2000. R. 201, 203. She also testified at the hearing on June 5, 2001 that she did not experience as much pain in her right hand and wrist since her May 2000 right carpal tunnel release surgery. R. 44. Plaintiff never required inpatient hospitalization. R. 87-88, 104. The only neuro-orthopedic surgery she required was for her carpal tunnel syndrome. R. 26, 199, 250, 281, 284. She did not participate in physical therapy after August 2000, when Speer discharged her from her most recent physical therapy program. R. 251-252. She did not require chiropractic manipulation. R. 138. She did not need to wear a brace or use an assistive device, like a cane. R. 23, 204. She was not involved in a work hardening program. R. 111-157, 159-228, 250-324. No doctor opined that she was unable to work, except for the responses to the Questionnaire completed by Dr. Spinosa.
Metz testifies that she remembered last going to physical therapy in October 2000, but the report clearly states that she was discharged in September 2000, and that her last assessment was on August 29, 2000. R. 29-30, 251.
Aside from a dry mouth, plaintiff's medical records reflect that she had no side effects from the medications she took. R. 314. In addition to her neuro-orthopedic complaints, plaintiff had diabetes, but her condition was controlled without complication. R. 48, 141, 292. Her high blood pressure was controlled through diet. R. 273. Plaintiff also had a history of bladder incontinence to a partial degree and still had some intermittent incontinence on a daily basis to a small degree. R. 204.
Plaintiff reported that she had received psychological treatment for anxiety and depression related to her divorce "off and on since 1983," which she reported had been beneficial to her. R. 35, 237, 310. In March 2001, Metz began treatment with Allentown Associates in Psychiatry for her depression, which had worsened in the six months before she sought treatment. R. 310-316. Her treating psychiatrist gave Metz an initial Global Assessment of Functioning (GAF) score of 50, which denotes serious symptoms or impairment. R. 311. Metz reported that her mood was improved and "much better" with treatment and that her medication was helpful. R. 312-313, 314, 316. Her psychotherapy notes indicated that her energy was "OK" and she had no disorder of her thought process. R. 312-313.
STANDARD OF REVIEW
I review de novo the parts of the magistrate judge's report and recommendation to which Metz objects. 28 U.S.C. § 636(b)(1)(C). I have the option to accept, reject or modify, in whole or in part, the magistrate judge's findings or recommendations. Id.
"Our review of the Commissioner's final decision is limited to determining whether that decision is supported by substantial evidence." Hartranft v. Apfel, 181 F.3d 358, 360 (3d. Cir. 1999) (citing 42 U.S.C.A. § 405(g) and Monsour Medical Ctr. v. Heckler, 806 F.2d 1185, 1190 (3d. Cir. 1986)). "[S]ubstantial evidence is more than a mere scintilla." Universal Camera Corp. v. NLRB, 340 U.S. 474, 477 (1951), quoted in Monsour, 806 F.2d at 1190. It "does not mean a large or considerable amount of evidence, but rather `such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'" Pierce v. Underwood, 487 U.S. 552, 565 (1988) (citation omitted). In making this determination, the court must "`consider the evidentiary record as a whole, not just the evidence that is consistent with the agency's finding.'" Monsour, 806 F.2d at 1190 (citations omitted). Importantly, "this test is deferential." Id. at 1191. Accordingly, the court "will not set the Commissioner's decision aside if it is supported by substantial evidence, even if [it] would have decided the factual inquiry differently." Hartranft, 181 F.3d at 360.
DISCUSSION
The Act "defines `disability' in terms of the effect a physical or mental impairment has on a person's ability to function in the workplace." Heckler v. Campbell, 461 U.S. 458, 459-60 (1983). It provides disability insurance benefits and supplemental security income only to those claimants who "are unable `to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment.'" Id. at 460 (quoting 42 U.S.C. § 423(d)(1)(A)). When evaluating a claim for disability benefits, the Commissioner applies a five-step sequential analysis. 20 C.F.R. § 404.1520 (2003); Sykes v. Apfel, 228 F.3d 259, 262-63 (3d Cir. 2000). Specifically, the Commissioner must consider, in this order, whether the claimant: (1) worked during the alleged period of disability; (2) has a severe impairment; (3) has an impairment that meets or equals the requirements of a listed impairment; (4) has an impairment that prevents her from returning to her past relevant work; and (5) whether she can perform any other work in the national economy. Id. The claimant bears the burden of proof as to steps one, two, and four of this analysis, but the burden of proof as to the fifth step is borne by the government. Sykes, 228 F.3d at 265. And, as the court explained in Sykes, "[b]ecause step three involves a conclusive presumption based on the listings, no one bears that burden of proof." Sykes, 228 F.3d at 263 n. 2 (citing Bowen v. Yuckert, 482 U.S. 137, 146-47 n. 5 (1987)).
Specifically, the inquiry proceeds in the following manner. If the first inquiry, whether claimant worked during the time of her alleged disability, is answered in the affirmative, then the evaluation is finished and claimant is unqualified for benefits. Conversely, if the first inquiry is answered in the negative, the Commissioner considers the second. If the answer to the second inquiry is negative, then the claimant is ineligible for disability benefits. However, if this second inquiry is answered in the affirmative, the Commissioner inquires whether the impairment meets the criteria of a listed impairment. If the Commissioner concludes that it does, then a presumption arises that the claimant is disabled and lacks the capacity to work. If she concludes to the contrary, she assesses the fourth inquiry, whether the claimant has the capacity to return to her past work despite her severe impairment(s). If the answer is affirmative, then plaintiff is not disabled under the Act. If the Commissioner concludes that the claimant lacks such capacity, then she proceeds to the final step, under which claimant is considered disabled under the Act only if it is answered in the negative. Sykes, 228 F.3d at 262-63.
I. Did the ALJ analyze all the evidence in the record and provide an adequate explanation for disregarding significant findings which allegedly support Metz's disability claim?
Metz argues that the ALJ failed to consider all of the evidence before making a determination about Metz's residual functional capacity (RFC). Objections at 1. Metz contends that the ALJ rejected evidence that supported her claim for disability and failed to provide reasons for discounting that evidence. Id. Metz argues that the ALJ failed to address the "most significant medical findings which support Metz's disability claim." Opposition at 7. Specifically, Metz points to the MRI of August 6, 1999 (part A), the EMG of March 21, 2000 (part B), the EMG of August 14, 2001 (part C) and the accompanying doctors' reports. Opposition at 3.
Residual functional capacity (RFC) describes the range of work activities the claimant can perform despite her impairments. Metz's subjective complaints are to be evaluated under the criteria established by 20 C.F.R. § 404.1529. Those criteria include: 1) the nature, location, onset, duration, frequency, radiation, and intensity of any pain; 2) precipitating and aggravating factors (e.g. movement, activity, environmental conditions); 3) type, dosage, effectiveness, and adverse side effects of any pain medication; 4) treatment, other than medication, for relief of pain; 5) measures other than treatment (e.g. sleeping on a board, standing for 15 minutes every hour, etc.); 6) functional restrictions; and 7) the claimant's daily activities.
A. MRI of August 6, 1999 and the reports of Drs. Salotto and Spinosa
The August 1999 MRI and the reports of Drs. Salotto and Spinosa concern Metz's left-sided symptomatology and therefore were properly discounted by the ALJ. Metz argues that the ALJ failed to point out that, according to the report of Dr. Siegel, Metz's MRI of August 6, 1999 revealed "moderate to large size broad-based central and left-sided posterior disc herniation at C4-5 causing anterior cord compression." Opposition at 2 (citing R. 10, 131). Metz argues that these disc abnormalities were present at a time when Metz was complaining of upper back pain and progressive problems with neck and left arm pain. Id. (citing R. 168, 204). Metz also contends that the ALJ failed to account for the findings of Dr. Salotto, who reported to Dr. Spinosa that Metz appeared "to have radicular type symptoms most consistent with the C4-5 herniation on the left side." Id. (citing R. 204). Metz argues that these objective medical findings explain her symptoms but that the ALJ discounted these findings without providing an explanation for doing so.
Her complaints were recorded in the reports of Drs. Salotto and Spinosa on June 18, 1999 and September 3, 1999 respectively. R. 168, 204.
Contrary to Metz's assertions, however, the ALJ did consider the cervical herniation diagnosed by the MRI of August 6, 1999. R. 10. The ALJ specifically noted in her opinion that cervical herniation was diagnosed by the MRI of August 6, 1999, and that a course of epidurals was completed on November 11, 1999. Id. Yet, the ALJ explained that the results of these tests account for Metz's left-side symptomatology, which Metz herself admits was completely resolved after physical therapy and the three steroid injections administered by Dr. Wilson. R. 10, 42, 201, 203. This series of steroid injections completely alleviated the pain on Metz's left side. R. 10. On November 22, 1999, just over a month after the date she claimed disability, plaintiff told Dr. Salotto that she had experienced "complete resolution of her left arm pain." R. 203. On March 7, 2000, she reiterated to Dr. Smith that she had not had any "recurrent left arm symptomatology." R. 201. Additionally, the ALJ pointed to a cervical spine CT of March 10, 2000, which noted that "the only remarkable finding is a prominent posterior osteophyte with disc herniation at C4-C5" but noted that it was toward the left side "which is opposite from the side of the patient's symptoms." R. 10. At that time, Metz's complaint related only to her right side. The ALJ also noted that the cervical myelogram of the same date "failed to detect any gross abnormalities" that would explain Metz's complained-of right-side symptomatology. Id.
Thus, the ALJ made clear that even if the MRI and Dr. Salotto's findings show that Metz had a herniated disc on her left side, her left-sided symptoms lasted little over a month after the date upon which she claims disability and, therefore, do not explain why Metz could still be disabled. The ALJ specifically noted in her opinion that Dr. Salotto reported that Metz had "complete resolution of her left arm pain" when he saw her on November 22, 1999. R. 10. Metz's reliance on the August 1999 MRI and Dr. Salotto's report is misplaced because Metz herself has reported that the pain on her left side had resolved by November of 1999.
I find that the ALJ properly considered the MRI of August 6, 1999 and the reports of Drs. Salotto and Spinosa, and that she made clear that her reason for discounting this evidence was that Metz reported complete resolution of her left side pain shortly thereafter.
B. EMG of March 21, 2000 and Dr. Nathanson's report
Next Metz contends that the ALJ ignored Dr. Nathanson's EMG/nerve conduction report conducted March 21, 2000. Dr. Nathanson reported that "[w]idespread polyphasic potentials in paraspinal muscles suggests a more chronic type of neuropathic pattern which would be consistent with widespread degenerative osteoarthritis with foramenal encroachment." Opposition at 3 (citing R. 155) (emphasis supplied by Metz). Metz argues that this neurodiagnostic study reveals evidence of distal axon loss: the "study also includes abnormal findings in the right upper extremity which are described to be `of a significant degree in severity with some evidence of axonal [nerve cell] injury.'" Id. Metz argues that the ALJ ignored this evidence as well as evidence of distal axon loss reported after Metz's EMG of August 14, 2001 (discussed below, part C) and its correlation to similar, abnormal diagnostic test results more than a year earlier. Opposition at 3 (citing R. 317). Metz notes that in November 1999, Dr. Salotto could not find a right-sided nerve compression on the cervical myelogram to account for Metz's more distal symptoms; however, he did state that her proximal symptomatology, involving the right shoulder, scapular and upper arm area "appear to be coming from her cervical spine." R. 199, 200 (emphasis added by Metz). Metz argues that in light of the August 1999 MRI and the March 2000 EMG, this proximal symptomatology undermines the ALJ's assertion that "there were no findings to readily explain Metz's right-sided symptoms." Opposition at 3.
The MRI of August 6, 1999 revealed "multilevel degenerative cervical disease with C4-5 causing anterior cord compression."
The EMG of March 21, 2000 revealed a "chronic type of neuropathic pattern . . . consistent with widespread degenerative osteoarthritis."
It was not the ALJ, but Dr. Elias who (based on Dr. Salotto's notes) concluded that there were no such findings. R. 10 (referring to R. 250).
Contrary to Metz's assertions, it is clear from her opinion that the ALJ considered Dr. Nathanson's report as part of her analysis. R. 10. The ALJ found that the "examination by Dr. Nathanson on March 21, 2000 again demonstrated generally normal motor, sensory and neurological findings." Id. (referring to R. 154). She also noted that the "EMG/NCS found no evidence of ulnar entrapment, neuropathy or acute radiculopathy." Id. (referring to R. 155). The ALJ noted in particular that Dr. Salotto reported on April 10, 2000 that Metz's symptoms were consistent with carpal tunnel syndrome on the right side. Id. (referring to R. 199). The results from an earlier EMG/NCS suggested Metz had carpal tunnel syndrome that was worse on her left side, and she had surgery for her left wrist. R. 120. Metz's March 2000 EMG suggested carpal tunnel, after which Dr. Salotto referred Metz to Dr. Guarino for right carpal tunnel release surgery. R. 10. Dr. Guarino concurred that surgery would be appropriate and performed the surgery on May 12, 2000. Thus, I find that the ALJ appropriately reviewed Dr. Nathanson's report as well as the findings of other doctors.
Dr. Nathanson did find median nerve entrapment at the wrist consistent with carpal tunnel syndrome on the right; however, Metz had carpal tunnel surgery on her right wrist on May 12, 2000. R. 10.
The ALJ noted in particular that Dr. Salotto reported on April 10, 2000 that Metz's symptoms were consistent with carpal tunnel syndrome on the right side. Id. (referring to R. 199). The results from an earlier EMG/NCS suggested Metz had carpal tunnel syndrome that was worse on her left side, and she had surgery for her left wrist. R. 120. Metz's March 2000 EMG suggested carpal tunnel, after which Dr. Salotto referred Metz to Dr. Guarino for right carpal tunnel release surgery. R. 10. Dr. Guarino concurred that surgery would be appropriate.
Even if the evidence Metz claims the ALJ ignored could have lead the ALJ to the conclusion that Metz was disabled, I may "not set the Commissioner's decision aside if it is supported by substantial evidence." Hartranft, 181 F.3d at 360. As outlined above, the ALJ repeatedly cited to objective medical findings in the record to support her conclusions. Thus, I find that the ALJ relied on substantial evidence in order to reach her conclusions and that she did consider evidence of the March 21, 2000 EMG. Therefore, Metz's objection is misplaced. C. EMG of August 14, 2001
Metz points to parts of the record that might show she is disabled. Opposition 3-4. However, Metz is incorrect in so far as she argues that these records were not considered at all by the ALJ. It is clear from her decision that the ALJ examined the record in full.
As for Metz's contention that the ALJ must indicate why the evidence is rejected, Metz has not shown that the ALJ has failed consider the evidence she points to in the record before making her residual functional capacity determination. Metz points to specific excerpts from doctor reports and claims that significant evidence was ignored; however, taken out of context, as Metz presents them, these findings detract from the general conclusions and impressions presented by the doctors. There is no indication here that significant medical findings were "not credited or simply ignored." Cotter v. Harris, 642 F.2d 700, 705-707 (3d Cir. 1981). Each of the doctor reports that Metz claims were ignored was clearly considered.
Moreover, the Third Circuit has made clear that "when the medical testimony or conclusions are conflicting, the ALJ is not only entitled but required to choose between them." Id. The court also noted that "[w]e cannot expect that this choice by the ALJ, in the exercise of his or her statutory responsibility, will be accompanied by a medical or scientific analysis which would be far beyond the capability of a non-scientist." Id. Thus, the ALJ is required to focus on the medical conclusions and recommendations of the physicians, and weigh each of these, rather than to parse language and findings of each individual report in an effort to conduct an independent medical or scientific analysis.
According to this principle, the ALJ need only explain why she discounted Dr. Spinosa's Questionnaire. I find that the ALJ did properly consider this evidence and amply explained her reasons for rejecting the report of Dr. Spinosa. See infra Section II.
Finally, Metz argues that the EMG of August 14, 2001 establishes an ulnar entrapment neuropathy of the right elbow "which is primarily demyelinating with some evidence of distal axon loss as well as a likely `superimposed C8 radiculopathy.'" Opposition at 4 (citing R. 317). Metz argues, contrary to the Commissioner's contentions, that these findings correlate with earlier test results. Id. Metz notes that Dr. Salotto had previously described numbness in the ulnar aspect of Metz's right hand and forearm as "consistent with C-8 dermatome." Id. (citing R. 201). Metz also avers that the ALJ never considered her likely cervical radiculopathy or its potential impact on her ability to perform sustained sedentary or light work. Id.
Again, Metz contends that the ALJ essentially ignored, or failed to properly consider, medical evidence that she claims clearly establishes the existence of neurological and manipulative impairments which impose additional restrictions on Metz's RFC [residual functional capacity]. Pl.'s Motion for Summ. Judg. at 14; Opposition at 2. I do not agree.
The ALJ considered the full record, and it is abundantly clear from her opinion that she based her conclusions on substantial evidence therein. R. 10. The ALJ discusses the results of this EMG, mentioning that "the impression was of mild to moderate ulnar entrapment at the right elbow, a possible C8 radiculopathy, and mild chronic bilateral median entrapment neuropathy at the wrist or carpal tunnel syndrome." R. 11.
Although the ALJ did not specifically refer to every piece of evidence that Metz mentions in support of her claim, it is apparent that she did consider the reports that Metz points to in support of her disability claim. Third Circuit has made clear that the ALJ must make a choice between conclusions when medical testimonies are conflicting, and in articulating a choice, it is not expected that the ALJ will conduct a medical or scientific analysis. Cotter v. Harris, 642 F.2d 700, 705-707 (3d Cir. 1981). It is clear from reviewing the record and the ALJ's opinion that she focused on the conclusions presented in each of the doctors' reports. In making a residual functional capacity assessment, the ALJ concluded that Metz's medical record indicates that the claimant has been subject to mild to moderate musculoskeletal impairments with the necessity for occasional physical therapy and renewal of prescriptions as appropriate. R. 11. Of course, the ALJ's decision does not recount every finding or opinion contained in each medical record; to do so would be prohibitively tedious. Importantly, though, it does contain a summary of the doctors' findings regarding Metz's alleged disabilities. In sum, the ALJ appropriately evaluated and weighed the numerous opinions and findings contained in Metz's medical records such that I find that the ALJ based her decision on substantial evidence.
While the evidence Metz claims the ALJ ignored perhaps could have lead the ALJ to the conclusion that Metz was disabled, this is not the appropriate standard for reversal of the ALJ's decision. As the Third Circuit has made clear, a court should "not set the Commissioner's decision aside if it is supported by substantial evidence, even if [it] would have decided the factual inquiry differently." Hartranft, 181 F.3d at 360. Because I find that the ALJ based her decision on substantial evidence in the record, I will affirm the final decision of the Commissioner.
II. Did the ALJ err in weighing the opinion of Dr. Spinosa?
Next Metz argues that the ALJ did not properly weigh and evaluate the opinion of Dr. Spinosa, Metz's primary care physician. The ALJ found that Dr. Spinosa's residual functional capacity assessment, which reported "extreme limitations," was not supported by the evidence of record. R. 9 (misnumbered R. 8). Consequently, she did not accord persuasive weight to Dr. Spinosa's assessment of Metz's RFC.
Dr. Spinosa's assessment was in the form of a multiple-choice-type questionnaire, completed on April 15, 2001. R. 292-297. Dr. Spinosa checked off a series of boxes to characterize Metz's functional limitations. Based on this completed questionnaire, the vocational expert at Metz's hearing testified that Metz is capable of a vocational level at "less than sedentary part-time" work. R. 53.
The ALJ noted that according to the record, Metz claimed that her chronic musculoskeletal complaints worsened from the time of her initial treatment with Dr. Spinosa in 1996 until claimant was forced to stop working in November 1999. 10-12. Yet, the ALJ found that "[t]he only physician supporting her claim for disability is her family physician, Dr. Spinosa, who sees claimant at intermittent intervals and who has referred claimant to neurologists and other specialists whose reports, like those of Dr. Salotto and Dr. Varrato are generally not consistent with the extreme complaints made by the claimant." R. 11. Additionally, the ALJ found that the record supports the conclusion that claimant exaggerates the degree of her physical and mental limitations, and that her allegations are not objectively demonstrable by evidence in the record. R. 12.
The ALJ noted that Metz's treatment has been largely conservative and that she has been told by specialists that the objective findings call for nothing more than conservative treatment, including physical therapy, weight loss, and exercise. R. 12. I find that the ALJ has provided substantial evidence from the record to support this conclusion. After evaluating the August 1999 MRI, Dr. Salotto recommended conservative treatment when he advised Metz to attend physical therapy and referred her to Robert E. Wilson, D.O., a pain specialist, for epidural steroid injections. R. 205. Dr. Wilson concurred with Dr. Salotto and also recommended conservative treatment. R. 139. After examining Metz, Dr. Elias did not schedule a follow-up examination; instead, he recommended that plaintiff undergo a formal rehabilitation medicine evaluation to determine whether therapy would be beneficial. R. 250. In July of 2001, Dr. Varrato recommended continued conservative treatment management of plaintiff's condition, including exercise and weight loss. R. 322-324. Even Dr. Spinosa recommended that plaintiff stop working only temporarily and advised that she participate in physical therapy and continue with medication. R. 209-211.
Yet, Metz contends that the Questionnaire, completed by Dr. Spinosa on April 15, 2001, should be given considerable, if not controlling weight, because her findings are well-supported by medical evidence and are not contradicted by any substantial medical evidence. See 20 C.F.R. § 404.1527(d); Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000); Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir. 1999). As the ALJ pointed out, however, Dr. Spinosa's findings as they are reported in the Questionnaire are not well supported by objective medical evidence and are in fact contradicted by substantial medical evidence. Furthermore, the ALJ is "entitled to place greater reliance on the doctor's full medical opinion than his cursory answers to . . . interrogatories." Plummer, 186 F.3d at 430.
After thorough consideration of the entire medical record, the ALJ concluded that the evidence did not support Dr. Spinosa's determination that plaintiff could not work. Specifically, the ALJ noted that "many of Dr. Spinosa's updated treatment notes consist simply of calling in renewals of plaintiff's prescriptions, with no indication that plaintiff was seen or examined." R. 11. The opinions of several physicians also contradict the contents of the Questionnaire. Most notably, Dr. Salotto agreed with Drs. Blinder and Fertakos that there was no evidence of nerve root compression on the right side to account for plaintiff's right-side symptoms. An EMG also revealed no evidence of acute radiculopathy but suggested carpal tunnel instead. Dr. Nathanson concurred that there was no evidence of ulnar entrapment neuropathy despite plaintiff's symptoms. R. 155-157. Dr. Salotto later reviewed these studies and confirmed his earlier assessment. R. 199. Significantly, he did not recommend surgery and did not schedule a follow-up appointment. Id. Metz's physical therapist, Speer, reported on August 29, 2000, that Metz was independent with ADLs (activities of daily living). R. 252. On September 15, 2000, following her right carpal tunnel surgery, plaintiff visited Dr. Elias (at Dr. Salotto's former practice) for another neurosurgical evaluation of her neck and right shoulder discomfort as well as diffuse paresthesia involving her upper right extremity. R. 250. At that time, Dr. Elias reported that her motor testing of the upper extremities was 5/5 throughout, that sensory was intact to pinprick, and that she had no discomfort with abduction of her right shoulder. Id. Dr. Elias reiterated Dr. Salotto's prior comments that there were no findings on plaintiff's diagnostic studies to readily explain her right-sided symptoms. Id. Consequently, Dr. Elias made no formal arrangements for a follow-up exam and recommended that she undergo a formal rehabilitation medicine evaluation to determine whether therapy would be beneficial. Id.
Metz argues that the ALJ relied inappropriately on the statements of physicians who never performed a functional assessment of Metz's work-related activities or even expressed an opinion about her capacity for employment. Opposition at 5. While it is true that Dr. Spinosa's Questionnaire provided a functional assessment, this report is inconsistent with the findings of the other physicians. It is also contradicted by substantial evidence in the record that demonstrates that Metz is capable of light work. The ALJ provides a detailed account of Metz's ability to complete light duty daily activities. R. 12 (citing Metz's own testimony). Dr. Spinosa's account is also contradicted by the report of Metz's physical therapist who noted that Metz is capable of completing activities of daily living. R. 251-270.
The ALJ reports that Metz testified that she could work only for sixty to ninety minutes at a time and that she needs to lie down frequently. However, she also testified to getting up at 4 a.m. to make breakfast for her husband She testified that she cooks meals as long as she can sit down and take breaks. She also reads magazines, watches cable television, loads the dishwasher, sorts laundry, and goes grocery shopping with her husband, although she reports she must support herself on the shopping cart. She also talks on the telephone and cares for her two dogs. Metz is able to drive to her doctor appointments. She also went walking at the mall with her husband the night before her hearing to relax. R. 12.
Metz also argues that the ALJ incorrectly concluded that Metz failed to receive medical treatment for a period of six months from June 20, 2000 to January 9, 2001. Opposition at 6. Metz concedes there was no treatment by Dr. Spinosa during this period but suggests that this fact carries little weight because there was not much else that Dr. Spinosa could do, other than to provide medication, because Dr. Salotto had already advised against surgery and physical therapy had not alleviated Metz's symptoms. Opposition at 7 (citing R. 158-198, 273-280). Metz argues that this evidence refutes the ALJ's conclusion that Metz's medical problems were "mild to moderate musculoskeletal impairments." Id.
On the contrary, the lack of medical treatment for a six month period supports the ALJ's conclusion of only "mild to moderate musculoskeletal impairments." Moreover, the record also reveals, contrary to Metz's contentions, that the physical therapy Metz received from April 18, 2000 until September 26, 2000 did alleviate her symptoms. Thus, I find that the ALJ supported her opinion with substantial evidence, and I will overrule Metz's objection.
According to the record, Metz made improvements through physical therapy. With physical therapy she completely resolved her left-arm pain. R. 203. Dr. Salotto advised she continue with the therapy and suggested therapy for her right side because she seemed to be making progress. R. 203, 215, 209-211. According to Speer, plaintiff reported "decreased pain and parethesia in her upper right extremity and increased ability to perform activities at home such as loading the dishwasher and folding laundry. R. 251. Speer also noted that Metz was independent with activities of daily living. R. 252.
III. The ALJ's assessment of Metz's credibility
Finally, Metz argues that ALJ improperly discredited her testimony and that the magistrate judge erred in upholding the ALJ's assessment of Metz's credibility. Opposition at 7. More specifically, Metz argues that "conservative treatment" and her daily activities are not "appropriate grounds for impugning Metz's testimony where it has been supported by competent medical evidence." Opposition at 8. Metz claims that the ALJ and magistrate judge ignored the fact that Metz consistently described her symptoms over many years, took multiple types of medication, and underwent both physical therapy (she claims twice unsuccessfully) as well as a series of epidural steroid injections, which are all relevant under 20 C.F.R. § 404.1529(c)(1) and SSR 96-7p. Id.
These injections resolved the pain Metz was feeling on her left side. R. 203.
Metz also contends that the ALJ's description of her daily activities is inaccurate. Id. Metz avers that she must lie down every hour or so during the day for pain relief and on a good day she can dust ten to fifteen minutes before burning pain starts in her shoulder and down the right side. Id. at 8 n. 8 (citing R. 31, 38-39). She stands no longer than five minutes in preparing food for meals and always shops with her husband while holding onto the cart. Id. Metz maintains that the ALJ has not properly gauged how Metz might endure in "competitive employment" on a regular and continuing basis. Id. at 9.
Credibility determinations are reserved for the ALJ, but the ALJ must also provide reasoning for discrediting testimony. Van Horn v. Schweiker, 717 F.2d 871, 873 (3d Cir. 1983). I find that the ALJ conducted a proper and thorough review of the intensity and persistence of Metz's symptoms as required by the Social Security regulations, considering both the objective medical evidence and Metz's subjective testimony. See 20 C.F.R. § 404.1529 (explaining how the SSA evaluates symptoms and delineating what evidence it considers). Moreover, contrary to Metz's assertion, the ALJ did not wholly discredit her complaints. R. 27. Rather, the ALJ only discounted Metz's testimony to the extent it was inconsistent with the objective medical evidence. See Hartranft, 181 F.3d at 362.
The ALJ noted that Metz drives when necessary. R. 12. She also noted that even though Metz reported her pain at hearing as a 7-8/10, Metz remained notably cheerful and chatty throughout the hearing. Id. Metz also testified that she went to the mall walking with her husband the night before the hearing to relax. Id. And while Metz complained of severe, chronic neck and arm pain, she nodded her head freely and frequently and moved her arms and hands often as she testified without visible limits of motion. Id. Objections at 10. Metz further testified that she could only work for sixty to ninety minutes at a time and that she needs to lie down frequently. R. 12. However, Metz testified that she gets up at four o'clock in the mornings to make breakfast for her husband Id. The ALJ noted that this seemed an inappropriate chore given her allegations. Id. The ALJ also considered in her decision the fact that Metz loads the dishwasher, sorts laundry, goes grocery shopping with her husband, reads and watches television, talks on the telephone and cares for her two dogs. Id. Based on this evidence and observations, the ALJ concluded that Metz exaggerated the degree of her physical and mental limitations and found her testimony unreliable.
Because I have dismissed Metz's argument that the ALJ failed to properly consider, discuss and weigh relevant medical evidence, I similarly must dismiss Metz's argument that the ALJ improperly discounted Metz's credibility. The ALJ provided substantial evidence in support of her finding that some of Metz's subjective complaints are inconsistent with objective medical evidence, and therefore cannot be accepted in full.
CONCLUSION
Contrary to Metz's assertions, the magistrate judge did not err in approving the Commissioner's findings. After reviewing the record and the ALJ opinion, I conclude that the ALJ relied on substantial evidence in the record to support her decision that Metz "exaggerates the degree of her physical and mental limitations" and that she has only been "subject to chronic, mild to moderate musculoskeletal impairments with the necessity for occasional physical therapy and renewal of prescriptions." I also find that the ALJ analyzed all of the evidence in the record and provided an adequate explanation for her findings as well as her decision to accord less weight to the opinion of Dr. Spinosa and to discredit the testimony of Metz in part. Thus, I will adopt the magistrate judge's recommendation that Metz's motion for summary judgment be denied and that the Commissioner's motion for summary judgment be granted.
An appropriate order follows.
ORDER
And now this ____ day of May 2004, upon consideration of the parties' cross-motions for summary judgment, and after careful review of the Report and Recommendation of the United States Magistrate Judge and the plaintiff's objections thereto, it is hereby ORDERED that:1. Plaintiff's objections are OVERRULED;
2. The Report and Recommendation is APPROVED and ADOPTED;
3. The motion of plaintiff Debra Metz for summary judgment is DENIED; and
4. The motion of defendant Jo Anne B. Barnhart, Commissioner of Social Security, for summary judgment is GRANTED.
5. Judgment is entered affirming the decision of the Commissioner.